PMC3617976_01
Barium enema revealed two lesions in the upper rectum (a). One was an elevated lesion on the oral side (arrows) and the other was an ulcerated lesion on the anal side of the upper rectum (arrowheads). Computed tomography revealed a rectal mass (b) and multiple hepatic metastases (c).
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F1
Barium enema indicated two lesions in the upper and lower rectum (fig. 1a). One was an elevated lesion with ulceration in the upper rectum (fig. 1a, arrows), while the other was an ulcerated lesion in the lower rectum (fig. 1a, arrowheads). Computed tomography revealed a rectal mass (fig. 1b) and multiple hepatic metastases (fig. 1c).
The surgical specimen revealed an elevated lesion with ulceration on the oral side of the upper rectum (arrows) and an ulcerated lesion on the anal side of the upper rectum (arrowheads).
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F2
The resected specimen had an elevated lesion with ulceration in the upper rectum (fig. 2, arrows) and an ulcerated lesion in the lower rectum (fig. 2, arrowheads).
Histopathological examination with hematoxylin and eosin staining revealed NEC in the oral lesion from the upper rectum (a, x200) and moderately differentiated tubular adenocarcinoma from the anal lesion on the upper rectum (b, x200). Immunohistochemical analyses indicated that many NEC cells were positive for synaptophysin (c, x200) and chromogranin A (d, x200).
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F3
Histopathological examination with hematoxylin and eosin staining revealed NEC in the upper rectum (fig. 3a) and moderately differentiated tubular adenocarcinoma in the lower rectum (fig. 3b), and also showed that these two lesions were completely separated from each other. Immunohistochemical analyses indicated that many NEC cells were positive for synaptophysin (fig. 3c) and chromogranin A (fig. 3d), and all of the lymph nodes were metastasized from NEC.