Rectosigmoid tumor with metastases

Case contributed by Dr Wayland Wang

Presentation

Faecal loading. Worsening faecal incontinence and tenesmus.

Patient Data

Age: 89
Gender: Male

A soft tissue mass is noted at the rectosigmoid junction over a distance of approximately 40 mm, compatible with malignancy. A 28 x 26 mm nodule in the posterior left mesorectal fat is suspicious for tumor extent beyond the serosal surface of the colon.

A lymph node conglomerate is noted at the bifurcation of the right common iliac artery, measuring 31 x 21 mm. There are also enlarged para-aortic lymph nodes measuring up to 24 x 26 mm just inferior to the left renal artery.

Diffuse low-density liver lesions are noted measuring up to 20 mm, compatible with metastases. Small pulmonary nodule seen in the anterior right lower lobe measuring up to 5 mm. Remainder of the large bowel is unremarkable. Bilateral moderate hydronephrosis and hydroureter are noted without intraluminal obstructing lesion demonstrated. There is a grossly enlarged prostate gland (80 cc) with a median lobe that projects to the trigone of the bladder. Intrarenal calculi in the left kidney measuring up to 17 mm at the lower pole. Numerous simple cysts also noted in the kidneys measuring up to 28 mm at the upper pole of the right kidney. The spleen, pancreas, adrenals, stomach and small bowel are unremarkable.

Patchy sclerotic/permeative changes in the S1 vertebral body. Impression of linear lucencies through the S1 may be old fractures. Fractures seen through the sacral ala bilaterally and the left L5 transverse process. Degenerative changes at L4/5 and L5/S1.

Conclusion:

Soft tissue mass at the rectosigmoid junction extend beyond the serosal surface of the colon with associated lymph node disease to the para-aortic chain. Extensive hepatic metastases. Suspected pulmonary and S1 vertebral body metastases. Probable S1 pathological fracture. Prostatomegaly with associated hydroureter and hydronephrosis. Left kidney lower pole 17 mm intrarenal calculus. Fractures of the sacral ala and left L5 transverse process.

Case Discussion

This patient had a known history of rectal cancer. In order to complete the staging, MRI of the rectum should be performed to provide more accurate T and N staging information.

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Case information

rID: 51045
Published: 27th Mar 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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