Presentation
Change in bowel habit to looser stools. Flexible sigmoidoscopy identified stricturing sigmoid malignancy, biopsies confirm adenocarcinoma. Staging CT.
Patient Data
Abnormal thickening and narrowing of sigmoid colon over 5 cm. Multiple adjacent lymph nodes. Relative paucity of diverticula in this segment. Inferior surface lies close to roof of urinary bladder but there is a fat plane between them. No other colonic mass. No focal suspicious liver lesions. Findings in keeping with sigmoid colon adenocarcinoma staging T4a N2 M0.
HISTOLOGY REPORT
Clinical Details: Rectal tumor invading anteriorly into bladder - open anterior resection. Cuff of bladder excised with specimen.
Macroscopic: Length of colon/rectum = 180 mm, with stricture at 55 mm and a 70 mm cuff of bladder
Site of tumor = Circumferential tumor of the rectum
Maximum tumor diameter = 47mm
Distance to nearest longitudinal resection margin = 30mm
Tumor perforation present? = No
Tumor type = Adenocarcinoma
Differentiation = Poor, with areas of mucinous differentiation
Extent of spread = Peritoneal and serosal involvement
Distance beyond MP = 4mm
Serosal involvement = Yes
Involvement of adjacent organs = Tumor extends through mesorectum towards bladder, but does not involve bladder wall.
Maximum depth of venous invasion = Extramural
Lymphovascular invasion = Not identified
Perineural invasion = Not identified
No. of lymph nodes = 10
No. of involved nodes = 5
Non nodal tumor deposits (N1c) = Yes, multiple
Highest lymph node site and involvement = Apical node uninvolved
Background abnormalities = None
Margins:
Proximal - Clear
Distal - Clear (30mm)
CRM - Clear
Conclusion: Poorly differentiated adenocarcinoma of the rectum
TNM 8 Stage: pT4a, pN2a (5/10) V1, R0
Case Discussion
Colonic malignancies can vary in their appearance, with this being a classic appearance of a stricturing circumferential adenocarcinoma of the sigmoid colon. There is serosal infiltration (T4a) and multiple local abnormal nodes are identified.