History of rectal cancer. Status post neoadjuvant radiation. Patient with rectal bleeding pain and urgency. Evaluate circumferential margin.Rectal bleeding in May 2015 and was found to have a rectal mass. Colonoscopy revealed rectal cancer reported to be 5 cm from the anal verge. He is s/p neoadjuvant chemoXRT.7.11.2015 Rectal biopsy: Infiltrating moderately differentiated adenocarcinoma. Overall image quality: AdequatePELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: There are scattered lymph node with the largest measuring 0.8 x 0.5 cm (series 4, image 47); the distance from this lymph node to the mesorectal fascia is approximately 7 mm. Additionally, there is concern for lymphovascular invasion on the right as noted on coronal series 6, image 23).Lymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor:Size: 2.8 x 2.1 x 1.0 cm (image 18/series 5; image 48, series 4)Tumor appearance on T2-weighted images: The aforementioned lesion is hypointense.Tumor location: Anterior rectal wall approximately 5 cm from the anal verge.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 5 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 7 cmCircumference of the rectum involved: Less than 25%Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): No evidence of invasion of the prostate or seminal vesicles.Tumor Distance to Mesorectal Fascia: 7 mm (series 4, image 47)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Finding findings concerning for rectal neoplasm with associated mesorectal lymph nodes and concern for lymphovascular invasion as detailed above.