Sigmoid colon cancer on musculoskeletal pelvic MRI

Case contributed by Dr Vikas Shah

Presentation

Previous diagnosis of polymyalgia rheumatica. Elevated inflammatory markers. Gluteal and back pain and tender sacroiliac joints.

Patient Data

Age: 60 years
Gender: Male
MRI

MRI pelvis for hip and SIJ assessment

No bone marrow edema. No SIJ pathology. Changes of bilateral peritrochanteric bursitis, worse on left side. Bilateral hamstring tendinopathy, worse on left side. Left paralabral cyst suggestive of acetabular labral tear.

1 year later, re-presents with rectal bleeding and flexible sigmoidoscopy shows sigmoid tumour.

MRI

MRI pelvis for sigmoid tumor assessment

This study shows a tumor of the distal sigmoid, entirely above the peritoneal reflection. The tumor breaches the muscularis propria and there are signs of extramural venous invasion. Several abnormal local nodes are seen. Staged as T3 N2 M0 V1 (no metastases on body CT).

Case Discussion

On retrospective review of the first MRI, the tumor in the sigmoid colon is visible, albeit smaller than seen on the second MRI. This highlights the importance of closely inspecting the organs outside the main area of interest on all imaging studies, and in particular CT and MRI. Biopsies confirmed moderately differentiated adenocarcinoma.

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Case information

rID: 54974
Published: 11th Aug 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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