Presentation
Previous diagnosis of polymyalgia rheumatica. Elevated inflammatory markers. Gluteal and back pain and tender sacroiliac joints.
Patient Data
No bone marrow oedema. 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.
This study shows a tumour of the distal sigmoid, entirely above the peritoneal reflection. The tumour 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 tumour 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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