Female 45 years old Reason: Rectal cancer please assess and evaluate extent of disease prior to start of therapy. Please follow protocol IRB # 14-0288. Additional history per electronic medical record: patient underwent colonoscopy which showed a 6mm sessile polyp in the rectum as well as a 60% circumferential friable, nodular, ulcerated mass about 3 cm from the anal verge. Biopsies confirmed moderately differentiated adenocarcinoma which was microsatellite stable. The other polyp was tubular adenoma. EUS showed a fungating mass beginning at the anal verge and extending 4 cm cephalad with probable invasion into sphincter muscle. This was uT3N0. Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: Uterine fibroids. Normal variant nabothian cysts. The ovaries appear within normal limits.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Several subcentimeter lymph nodes are present within the perirectal space, at least one of which on the left abuts the mesorectal fascia (series 4, image 24).Lymph nodes outside the mesorectal fascia: Several subcentimeter internal iliac and pelvic sidewall lymph nodes the largest of which is on the left and measures 6 mm in short axis (series 4, image 17).BOWEL, MESENTERY: Rectal Tumor:Size: 1.3 cm AP x 2.7 cm TR x 5.0 cm CC (series 4, images 36 and 37; series 3, image 22)Tumor appearance on T2-weighted images: Iso to hyperTumor location: Involving the lower rectum as described below.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 2.1 cm.Circumference of the rectum involved: Near circumferential.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): There is possible focal invasion of the perineum/vagina anteriorly less than 5 mm.MRI T-stage: T3a - Tumor invades < 0.5cm into perirectal fat or extramural. Please refer to key images.Tumor Distance to Mesorectal Fascia: The tumor is located in the low rectum and abuts the external sphincter, right greater than left.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.
Findings compatible with rectal cancer involving the lower rectum with suspected focal extraserosal invasion, please see details above.