Newly diagnosed rectal cancer-rectal cancer staging. Li Fraumeni p53 mutation, bilateral breast carcinoma. Recent TAH/BSO. Colonoscopy proven invasive moderately differentiated rectal adenocarcinoma and rectosigmoid polyp with adenocarcinoma. Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Multiple pathologic lymph nodes are present. The largest is at the 4:00 position measuring 1.6 x 1.3 cm approximately 2 mm from the left posterolateral mesorectal fascia (series 601/51).Lymph nodes outside the mesorectal fascia: There are non-specific mildly prominent left obturator and external iliac lymph nodes (series 601/57).Some pathologic morphology lymph nodes are noted superiorly in the presacral space. The largest measures 5 x 5 mm (series 601/69).BOWEL, MESENTERY: Rectal Tumor: Intermediate T2-weighted enhancing polypoid circumferential thickening of the mid to distal rectum. There is adjacent hypervascularity and suggestion of linear soft tissue extension (series 601/38), suspicious for extramural vascular invasion.Size: There is intermediate T2 weighted polypoid near circumferential thickening of the mid to distal rectum extending approximately 6.3 cm in craniocaudal dimension (series 801/33). The thickest region of wall thickening measures 2.1 cm (series 601/39).Tumor appearance on T2-weighted images: IntermediateTumor location: Middle-third to lower third of the rectum.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 1 to 2 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 0Circumference of the rectum involved: 100%Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): The tumor appears to invade the right aspect of the mid/superior vaginal cuff (series 601/43). At the lower vaginal cuff the rectovaginal fat plane is obscured, suspicious for tumoral invasion(series 601/32).There is soft tissue stranding extending beyond the expected serosal margin suspicious for perirectal fat invasion.MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: 8 mm (image 801/series 49).More proximally there is a short segment of the rectosigmoid which appears fixed/collapsed (series 601/63) throughout the exam and demonstrates circumferential hyperenhancement (series 1303/528) and restricted diffusion (series 902/456). This region appears to be discontinuous from the mid/distal rectal lesion. Diverticulosis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Polypoid circumferential lesion involving the mid to distal rectum with perirectal lymphadenopathy, mesorectal fat extension and suspicion of extramural vascular invasion. The mass invades the vaginal cuff as described above.2. Mesorectal lymphadenopathy. 3. Multiple additional prominent pelvic lymph nodes as described above. 4. Abnormal appearing short-segment of the rectosigmoid is discontinuous from the rectal lesion; this may correspond to the site of rectosigmoid adenocarcinoma biopsied during colonoscopy. 