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Rectal adenocarcinoma - metastatic

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

Investigation of PR bleed with coloscopy showing a rectal lesion. Biopsy has been performed. Further imaging staging.

Patient Data

Age: 45 years
Gender: Male

MRI Rectum

mri

PRIMARY TUMOR:
Distance to the anal verge: 12 cm
Distance to the top of sphincter complex/anorectal junction: 10 cm
Relationship to anterior peritoneal reflection: Above
Craniocaudal length: 6 cm
Circumferential location (o’clock position): circumferential
Morphology: Annular   
Mucinous: No  
MR‐T category:  T3c   (tumor penetrates >5‐15 mm beyond muscularis propria) 
EMVI: Yes
CRM: N/A: (tumor at peritonealized portion of the rectum)
LYMPH NODES: Mesorectal/superior rectal lymph nodes and/or tumor deposits:  N2b (short axis <5 mm AND all 3 morphologic criteria*)
Superior most suspicious lymph node/deposit is located: peritoneal
Extra mesorectal lymph nodes: M1: common iliac and retroperitoneal
IMPRESSION:
Stage: T3c N2b
Suspicious extra mesorectal lymph nodes: Yes

MRI Liver

mri

Extensive liver metastatic disease with lesions involving all the liver segments. 

Macroscopy: Rectal biopsy - Multiple fragments of friable tan tissue <1-3 mm.​

Microscopy: The sections show fragments of ulcerated, moderately differentiated adenocarcinoma. The tumor is composed of complex cribriform structures and irregular glands of irregular glands and complex cribriform structures lined by severely dysplastic epithelium and set within the desmoplastic stroma. 

Conclusion: Moderately differentiated adenocarcinoma.

Case Discussion

Adenocarcinoma involving the upper rectum and with nodal and extensive liver metastatic disease. Disease staging T3c N2b M1c - stage IV. 

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