case_images: PMC11236715_01
case_images: Timeline of patient clinical events.
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case_images: f1
case_images: (A) Colonoscopy revealed a rectal cauliflower-like neoplasm. (B) CT scans showed a tumor-like lesion in the rectum. (C) MRI suggested rectal cancer.
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case_images: f2
case_images: The rectal finger examination did not reveal a mass, but the retracted finger was stained with blood. The colonoscopy on June 11, 2021, suggested the presence of a rectal cauliflower-like neoplasm at 11 cm from the anal verge, with surface erosion and bleeding, invading most of the intestinal lumen so that it was narrowed, only allowing the colonoscope to barely pass through ( Figure 2A ). The lesion was surrounded by multiple small lymph nodes in the superior rectal artery ( Figure 2B ). T4aN1, circumferential resection margin (CRM) (+), extramural venous invasion (EMVI) (-), and enlarged lymph nodes behind the left seminal vesicle ( Figure 2C ).
case_images: (A) Rescan of enhanced CT found a large amount of fluid in the abdominal cavity. (B) PET-CT scans showed uneven thickening of the peritoneum, omentum, and mesentery.
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case_images: f3
case_images: The enhanced CT rescan on Feb 18, 2022, suggested the following: 1) a circular line-like high-density shadow in the upper middle section, which was considered as a postoperative change; 2) a large amount of fluid in the abdominal cavity, which was new with a slightly thickened peritoneum compared with the old film from June 13, 2021; and 3) an increase in the splenic volume (SV) ( Figure 3A ). Although metabolic activity was not increased significantly, metastasis could not be excluded ( Figure 3B ).
case_images: Enhanced CT examination suggested no ascites or recurrence.
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case_images: f4
case_images: The latest examination was conducted on September 22, 2022, which revealed that there was no ascites or recurrence in the enhanced CT examination ( Figure 4 ).