Lateral Pelvic Sidewall Nodes
- Author(s)
- Kelly, ME; Heriot, AG;
- Journal Title
- Diseases of the Colon and Rectum
- Publication Type
- Case report
- Abstract
- A 68-year-old woman presented with rectal bleeding, urgency, and tenesmus. A digital rectal examination confirmed a craggy mass infiltrating into the sphincter complex. Follow-up colonoscopy noted a low-rectal tumor (3 cm from the dentate), and histopathology confirmed a moderately differentiated adenocarcinoma. Subsequent staging with MRI confirmed a 5-cm circumferential low-rectal neoplasm with extramural vascular invasion and threatened circumferential resection margin. The neoplasm abutted the posterior vaginal wall and was invading the internal sphincter complex. Four enlarged mesorectal nodes (>7 mm) and several enlarged right pelvic sidewall nodes (largest at 17 mm) were also observed. There was no evidence of distant disease. The patient underwent long-course neoadjuvant chemoradiotherapy. Restaging showed a good treatment response with some regression and no involvement/encroachment of the vagina. All the mesorectal nodes had reduced in size (~4 mm), and all but one of the right pelvic sidewall nodes had also decreased in size. However, 1 pelvic sidewall node (obturator fossa) still remained at 10 mm. After the tumor board discussion, a decision to proceed to abdominoperineal resection with right sidewall clearance was made. Final histopathology confirmed a moderately differentiated adenocarcinoma with no mesorectal nodal involvement (19 nodes sampled), and 1 of 7 sidewall nodes had evidence of metastatic adenocarcinoma.
- Publisher
- Wolters Kluwer
- Keywords
- Female; Humans; Aged; Lymph Nodes/pathology; *Rectal Neoplasms/surgery/pathology; Rectum/surgery; Pelvis/pathology; *Adenocarcinoma/surgery/pathology; Neoplasm Staging; Neoadjuvant Therapy
- Department(s)
- Surgical Oncology
- PubMed ID
- 36728599
- Publisher's Version
- https://doi.org/10.1097/DCR.0000000000002706
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2023-05-30 07:27:53
Last Modified: 2023-05-30 07:28:52