PMC5818929_01
(a) T1-weighted MRI of the pelvis demonstrates multiple lesions in the ilium with low T1 signal intensity (arrows), suggesting multiple bone metastases. (b) Abdominal contrast-enhanced CT scan reveals long segmental bowel thickening in the rectum (arrows).
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Magnetic resonance imaging (MRI) revealed low T1 signal intensity spreading diffusely in multiple vertebrae as well as the ilium, suggesting multiple bone metastases (Figure 1(a)). Computed tomography (CT) scan of the abdomen and pelvis with contrast revealed diffuse concentric thickening of the rectum with narrowing of the lumen and regional lymphadenopathy (Figure 1(b)).
(a) Colonoscopy identifies edematous stenotic lesion spreading over the entire circumference in the rectum at 10-18 cm from the anal verge. (b) Chromoendoscopy using indigo carmine was performed.
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There was edematous lesion spreading over the entire circumference of the rectum at 10-18 cm from the anal verge (Figures 2(a) and 2(b)).
(a) Miniprobe ultrasound shows diffuse thickening of the rectal wall without destruction of a 5-layer structure. (b-d) Endoscopic mucosal resection was performed with a conventional electrosurgical snare to remove the edematous thick mucosa, followed by boring biopsies from the resected area (arrow) to obtain deeper specimens.
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On another day, endoscopic ultrasound (EUS) was performed to assess the rectal lesion, which revealed diffuse thickening of the colonic lumen without destruction of the normal layer structure (Figure 3(a)). In brief, we removed overlying edematous epithelia using an electric snare without mucosal lift by injection and then carried out boring biopsies from the resected area (Figures 3(b)-3(d)).
Hematoxylin and eosin (a) and periodic acid-Schiff (b) staining demonstrate scattered SRCC cells (arrows) in the lamina propria mucosae with fibrous stromal reaction.
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Histological examination found irregularly scattered SRCC cells in the lamina propria mucosae (Figure 4), which confirmed rectal SRCC with multiple bone metastases (stage IVB).
(a and b) CT scanning with positron-emission tomography shows significant FDG uptake in the rectum (arrows) and extensive bone metastasis in the pelvis and vertebrae. (c) The self-expandable metal stent was placed endoscopically.
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CT scanning with positron-emission tomography (PET-CT) revealed extensive bone metastasis with significant uptake of FDG in the rectum (Figures 5(a) and 5(b)). Considering poor performance status and widespread metastasis, the patient underwent radiotherapy with a total dose of 50 Gy to reduce back pain and stent placement to release colon obstruction (Figure 5(c)).