Answer for BIR CoW 13 Jul 2025
Rectal carcinoma with intussusception
Findings
Evidence of irregular heterogeneous enhancing asymmetric circumferential wall thickening involving upper and mid rectum with telescoping of proximal sigmoid into the lesion. The lesion causing serosal breach but 12-1 o’clock position with adjacent mesorectal fat infiltration. Circumferential resection margin 4.1 mm Lower margin of the lesion located 8 cm from the anal verge. Fat plane maintained between the lesion and prostate seminal vesicles. Few (5-6) subcentimetric mesorectal lymph nodes Impression: Features suggestive of malignant growth involving upper and mid rectum with serosal breach at 12-1 o’clock position associated with nodal metastasis and intussusception of proximal sigmoid into the segment of growth – stage T3c N2 Mx
Discussion
Rectal cancer presenting with intussusception is a rare but clinically important scenario. Intussusception: Telescoping of a segment of the intestine into an adjacent distal segment. Rectal ca-related intussusception: Typically involves a lead point, usually a tumor in the rectum or distal sigmoid colon, causing the intussusception. Pathophysiology: A tumor (like rectal adenocarcinoma) acts as a lead point, pulled forward by normal peristalsis. This causes the proximal bowel to telescope into the distal bowel. In the rectum, this may present as rectorectal or sigmorectal intussusception. Imaging features CT Scan: “Target sign” or “sausage-shaped” mass in axial views. Identification of bowel-within-bowel configuration with eccentric mass as lead point. May associated with obstruction, wall thickening, lymphadenopathy. MRI (especially for rectal cancer staging): May demonstrate mass and layers of invaginated rectum/sigmoid with lead point. Useful in planning surgical resection. Clinical presentation Often nonspecific and intermittent. Symptoms: - Rectal bleeding - Abdominal pain - Tenesmus - Obstructive symptoms - Palpable mass per rectum in some cases Management: Surgery is the mainstay. In adults, reduction is controversial due to risk of tumor dissemination. Oncologic resection is preferred: low anterior resection or abdominoperineal resection depending on tumor location. Preoperative biopsy and staging (MRI pelvis, CT chest/abdomen/pelvis). Neoadjuvant chemoradiotherapy may be indicated depending on stage.
Findings
Evidence of irregular heterogeneous enhancing asymmetric circumferential wall thickening involving upper and mid rectum with telescoping of proximal sigmoid into the lesion. The lesion causing serosal breach but 12-1 o’clock position with adjacent mesorectal fat infiltration. Circumferential resection margin 4.1 mm Lower margin of the lesion located 8 cm from the anal verge. Fat plane maintained between the lesion and prostate seminal vesicles. Few (5-6) subcentimetric mesorectal lymph nodes Impression: Features suggestive of malignant growth involving upper and mid rectum with serosal breach at 12-1 o’clock position associated with nodal metastasis and intussusception of proximal sigmoid into the segment of growth – stage T3c N2 Mx
Discussion
Rectal cancer presenting with intussusception is a rare but clinically important scenario. Intussusception: Telescoping of a segment of the intestine into an adjacent distal segment. Rectal ca-related intussusception: Typically involves a lead point, usually a tumor in the rectum or distal sigmoid colon, causing the intussusception. Pathophysiology: A tumor (like rectal adenocarcinoma) acts as a lead point, pulled forward by normal peristalsis. This causes the proximal bowel to telescope into the distal bowel. In the rectum, this may present as rectorectal or sigmorectal intussusception. Imaging features CT Scan: “Target sign” or “sausage-shaped” mass in axial views. Identification of bowel-within-bowel configuration with eccentric mass as lead point. May associated with obstruction, wall thickening, lymphadenopathy. MRI (especially for rectal cancer staging): May demonstrate mass and layers of invaginated rectum/sigmoid with lead point. Useful in planning surgical resection. Clinical presentation Often nonspecific and intermittent. Symptoms: - Rectal bleeding - Abdominal pain - Tenesmus - Obstructive symptoms - Palpable mass per rectum in some cases Management: Surgery is the mainstay. In adults, reduction is controversial due to risk of tumor dissemination. Oncologic resection is preferred: low anterior resection or abdominoperineal resection depending on tumor location. Preoperative biopsy and staging (MRI pelvis, CT chest/abdomen/pelvis). Neoadjuvant chemoradiotherapy may be indicated depending on stage.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!