case_images: PMC7262371_01
case_images: a: Magnetic resonance imaging showed a mass measuring 10 cm in maximum on the left side of the lower rectum. The tumor extended to the left side of the prostate and part of the left levator ani muscle. b: After 8 months preoperative chemotherapy with imatinib mesylate, it showed that marked shrinkage of tumor to 7.8 cm.
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case_images: Pelvic magnetic resonance imaging (MRI) showed a mass measuring 10 cm on the left side of the lower rectum (Fig. 1). In a CT scan 2 months later, the tumor diameter had shrunk to 9.5 cm and the contrast effects inside the tumor had disappeared (Fig. 1).
case_images: Intraoperative laparoscopic view.. a: Large tumor where is left side of the rectum from the view of Intraperitoneal (white line). Without damaging the pseudo-capsule, we dissected the tumor. b: Tumor extending to the left levator ani muscle from the view of Intraperitoneal (yellow line). A part of tumor was attached to it (blue arrow). c: The abdominal cavity and anal side was opened all around by anal-side approach. The white line points to the tumor.
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case_images: The patient indicated a strong desire to preserve the anus, and therefore, we chose laparoscopic ISR and temporary transverse colostomy (Fig. 2). Around the left side of the rectum, we dissected the tumor without damaging the pseudo-capsule (Fig. 2a). When the tumor location was confirmed by intraoperative rectal examination, we judged that it was difficult to dissect the rectum from the intraperitoneal with a enough anal margin (Fig. 2b), so got started anal-side approach under the microscope. The abdominal cavity and anal side was opened all around (Fig. 2c).
case_images: Pathological examinations.. a: The resected tumor was 70 x 50 mm in size with necrotic change. b: Histological examination (hematoxylin and eosin staining). Most of the tumor was disappeared by vitrification and fibrosis.
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case_images: In histopathological tissue, most of the tumor disappeared by vitrification and fibrosis (Fig. 3).