Presentation
Preoperative evaluation of uterine leiomyomas. No rectal bleeding or secretory diarrhea.
Patient Data
The MRI sequences demonstrate a polypoid pedunculated soft mass within the rectum measuring 7.5 x 6.5 x 5 cm, with the distal edge 8 cm from the anal verge. It shows intermediate signal intensity on T1WI, and T2WI with heterogeneous enhancement following IV contrast, with a shaggy nodular margin and a "cauliflower" appearance. The villi are well visualized with surrounding fluid. The pedicle is attached to the posterior rectal wall, well visualized on axial and coronal sequences. The muscularis propria seems to be involved at the base of the pedicle at 7 o'clock with no evidence of extramural extension. No perirectal lymphadenopathy is seen.
The uterus is diffusely enlarged with multiple leiomyomas of various size, mainly of intramural location.
Case Discussion
Colorectal adenomas or polyps are commonly located in the rectum and considered as the least common of all colorectal polyps. They are considered to be a precursor to malignancy. The malignant transformation increases with the presence of villous components, as well as cellular dysplasia and overall size.
Due to the risk of malignant transformation, villous adenomas should be excised.