Female 79 years old Reason: staging for rectal cancer History: none Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy. The vaginal cuff is unremarkable. BLADDER: The urinary bladder is partially distended with normal thickness and no focal abnormality.LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: 1.0 x 0.9 cm enlarged round lymph node within the pericolonic fat adjacent to the left anterolateral aspect at the level of the upper-rectal mass (series 4/20). The mesorectal fascia is not clearly defined at this level. More superolaterally is a 5 mm lymph node (series 4/16).Otherwise punctate sub-5 mm lymph nodes are noted adjacent to the mid and lower rectum.Lymph nodes outside the mesorectal fascia: Scattered non pathologically enlarged pelvic lymph nodes. BOWEL, MESENTERY: Rectal Tumor:Size: 4.1 x 1.8 x 3.6 cm (series 4/25 and series 5/29)Tumor appearance on T2-weighted images: Intermediate T2-weighted signal hyperintensity.Tumor location: Middle to upper third. No evidence of proximal colonic dilatation/obstruction. (For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): Approximately 10 cm.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Approximately 7 cm.Circumference of the rectum involved: The lesion appears to involve the majority of the wall circumference. Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): The mass lesion is approximately 1.3 cm from the left anterolateral presumed mesorectal fascia. The mural wall is ill-defined at the left lateral aspect of the lesion with subtle soft-tissue spiculations. There is minimal peri-rectal fluid. MRI T-stage: T3b - Tumor invades 0.5cm to 1cm into perirectal fat or extramural.Tumor Distance to Mesorectal Fascia: Approximately 1.3 cm from the right anterolateral mesorectal fascia (series 4/25). BONES, SOFT TISSUES: In the dorsal mesorectal fat there is ill-defined tubular structures (series 5/29) which may represent extramural vascular invasion. OTHER: No significant abnormality noted.
Mid to upper rectal tumor with adjacent peri-rectal lymphadenopathy and extramural tumor extension as described above. Findings suggestive of extramural vascular invasion.