Presentation
History of rectal bleeding. Lesion found on colonoscopy.
Patient Data
- tumor: polypoidal
- distance from anal verge 65mm
- extends craniocaudally 38mm
- distal edge lies at 29mm above puborectalis sling
- upper border lies at 16mm below peritoneal reflection
- Staging
- tumor edge: from 11 o'clock to 4 o'clock
- muscularis propria involved at the base of the polyp at 2 o'clock and confined to the muscle without extramural spread
- EMVI: absent
- peritoneal reflection: not involved
- adjacent pelvic organs (lev ani, prostate, vagina): not involved
Conclusion: T2 CRM clear EMVI neg N0 low rectal tumor.
This patient had also staging CT, where the rectal polypoid lesion can be seen. No metastatic disease.
Case Discussion
Rectal tumor biopsies have been performed at colonoscopy:
Macroscopy: Multiple pieces of pale tan tissue, 1-3mm.
Microscopy: The pieces show colonic mucosa with a crowded and complex tubulovillous architecture. There is extensive epithelial cell mucin depletion, nuclear crowding and hyperchromasia. In one of the fragments, there is more extensive nuclear stratification with frequent mitotic figures, indicative of high-grade dysplasia. This piece contains an acute inflammatory cell infiltrate. There is no desmoplastic stromal reaction to indicate invasive malignancy.
Conclusion: "rectal tumor" biopsy: Tubulovillous adenoma with focal high-grade dysplasia. No invasive malignancy identified.
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