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The bottom line: MRI and CT findings of unusual rectal and perirectal pathology

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Abstract

Although common nonspecific symptoms (i.e., rectal bleeding, pelvic pressure, and change in bowel habits) are associated with rectal cancer, occasionally these are related to a different underlying disease. Over the past few years, considerable progress has been made in imaging of the rectum. Specifically, new magnetic resonance techniques and capabilities provide impressive high-resolution assessment of the rectal wall and enable evaluation and characterization of the perirectal tissues. This paper reviews imaging findings of uncommon causes of rectal and perirectal pathology that may be clinically confounded with rectal cancer. Radiologists need to be aware of uncommon pathologies in this region in order to facilitate optimal management decisions.

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References

  1. Kenig J, Richter P (2013) Definition of the rectum and level of the peritoneal reflection—still a matter of debate? Wideochir Inne Tech Maloinwazyjne 8:183–186. https://doi.org/10.5114/wiitm.2011.34205

    PubMed  PubMed Central  Google Scholar 

  2. Iafrate F, Laghi A, Paolantonio P, et al. (2006) Preoperative staging of rectal cancer with MR imaging: correlation with surgical and histopathologic findings. Radiographics 26:701–714. https://doi.org/10.1148/rg.263055086

    Article  PubMed  Google Scholar 

  3. Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Anorectal gastrointestinal stromal tumors: CT and MR imaging features with clinical and pathologic correlation. AJR Am J Roentgenol 180:1607–1612. https://doi.org/10.2214/ajr.180.6.1801607

    Article  PubMed  Google Scholar 

  4. Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 23:283–304 (quiz 532). https://doi.org/10.1148/rg.232025146

    Article  PubMed  Google Scholar 

  5. Rouse HC, Godoy MC, Lee WK, et al. (2008) Imaging findings of unusual anorectal and perirectal pathology: a multi-modality approach. Clin Radiol 63:1350–1360. https://doi.org/10.1016/j.crad.2008.06.008

    Article  CAS  PubMed  Google Scholar 

  6. Kim H, Kim JH, Lim JS, et al. (2011) MRI findings of rectal submucosal tumors. Korean J Radiol 12:487–498. https://doi.org/10.3348/kjr.2011.12.4.487

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hong X, Choi H, Loyer EM, et al. (2006) Gastrointestinal stromal tumor: role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. Radiographics 26:481–495. https://doi.org/10.1148/rg.262055097

    Article  PubMed  Google Scholar 

  8. Franquemont DW (1995) Differentiation and risk assessment of gastrointestinal stromal tumors. Am J Clin Pathol 103:41–47

    Article  CAS  PubMed  Google Scholar 

  9. Fletcher CD, Berman JJ, Corless C, et al. (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465

    Article  PubMed  Google Scholar 

  10. Suster S (1996) Gastrointestinal stromal tumors. Semin Diagn Pathol 13:297–313

    CAS  PubMed  Google Scholar 

  11. Hain KS, Pickhardt PJ, Lubner MG, Menias CO, Bhalla S (2013) Presacral masses: multimodality imaging of a multidisciplinary space. Radiographics 33:1145–1167. https://doi.org/10.1148/rg.334115171

    Article  PubMed  Google Scholar 

  12. Jiang ZX, Zhang SJ, Peng WJ, Yu BH (2013) Rectal gastrointestinal stromal tumors: imaging features with clinical and pathological correlation. World J Gastroenterol 19:3108–3116. https://doi.org/10.3748/wjg.v19.i20.3108

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pickhardt PJ, Kim DH, Menias CO, et al. (2007) Evaluation of submucosal lesions of the large intestine: part 1. Neoplasms. Radiographics 27:1681–1692. https://doi.org/10.1148/rg.276075027

    Article  PubMed  Google Scholar 

  14. Jacob AG, Driscoll DJ, Shaughnessy WJ, et al. (1998) Klippel–Trenaunay syndrome: spectrum and management. Mayo Clin Proc 73:28–36. https://doi.org/10.1016/S0025-6196(11)63615-X

    Article  CAS  PubMed  Google Scholar 

  15. Cha SH, Romeo MA, Neutze JA (2005) Visceral manifestations of Klippel–Trenaunay syndrome. Radiographics 25:1694–1697. https://doi.org/10.1148/rg.256055042

    Article  PubMed  Google Scholar 

  16. Servelle M, Bastin R, Loygue J, et al. (1976) Hematuria and rectal bleeding in the child with Klippel and Trenaunay syndrome. Ann Surg 183:418–428

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Wilson CL, Song LM, Chua H, et al. (2001) Bleeding from cavernous angiomatosis of the rectum in Klippel–Trenaunay syndrome: report of three cases and literature review. Am J Gastroenterol 96:2783–2788. https://doi.org/10.1111/j.1572-0241.2001.04110.x

    CAS  PubMed  Google Scholar 

  18. Levy AD, Sobin LH (2007) From the archives of the AFIP: gastrointestinal carcinoids: imaging features with clinicopathologic comparison. Radiographics 27:237–257. https://doi.org/10.1148/rg.271065169

    Article  PubMed  Google Scholar 

  19. Wong WL, Johns TA, Herlihy WG, Martin HL (2004) Best cases from the AFIP: multicystic mesothelioma. Radiographics 24:247–250. https://doi.org/10.1148/rg.241035068

    Article  PubMed  Google Scholar 

  20. Onaitis MW, Kirshbom PM, Hayward TZ, et al. (2000) Gastrointestinal carcinoids: characterization by site of origin and hormone production. Ann Surg 232:549–556

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Jiang C, Gu L, Luo M, Xu Q, Zhou H (2015) Primary rectal lymphoma: a case report and literature review. Oncol Lett 10:43–44. https://doi.org/10.3892/ol.2015.3164

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ghai S, Pattison J, O’Malley ME, Khalili K, Stephens M (2007) Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics 27:1371–1388. https://doi.org/10.1148/rg.275065151

    Article  PubMed  Google Scholar 

  23. Toledano-Massiah S, Luciani A, Itti E, et al. (2015) Whole-body diffusion-weighted imaging in Hodgkin lymphoma and diffuse large B-cell lymphoma. Radiographics 35:747–764. https://doi.org/10.1148/rg.2015140145

    Article  PubMed  Google Scholar 

  24. van Schaik PM, Ernst MF, Meijer HA, Bosscha K (2008) Melanoma of the rectum: a rare entity. World J Gastroenterol 14:1633–1635

    Article  PubMed  PubMed Central  Google Scholar 

  25. Healy JC (2001) Detection of peritoneal metastases. Cancer Imaging 1:4–12. https://doi.org/10.1102/1470-7330.2001.002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Hoeffel CC, Azizi L, Mourra N, et al. (2006) MRI of rectal disorders. AJR Am J Roentgenol 187:W275–W284. https://doi.org/10.2214/AJR.05.0508

    Article  PubMed  Google Scholar 

  27. Montgomery E, Goldblum JR, Fisher C (2001) Myofibrosarcoma: a clinicopathologic study. Am J Surg Pathol 25:219–228

    Article  CAS  PubMed  Google Scholar 

  28. Inan N, Arslan AS, Akansel G, et al. (2007) Colitis cystica profunda: MRI appearance. Abdom Imaging 32:239–242. https://doi.org/10.1007/s00261-006-9048-5

    Article  PubMed  Google Scholar 

  29. Sunagawa H, Kinjyou T, Nagahama M, Nishimaki T, Nakayama T (2005) Enteritis cystica profunda presenting as ileoileal intussusception in a child: report of a case. Surg Today 35:164–167. https://doi.org/10.1007/s00595-004-2912-4

    Article  PubMed  Google Scholar 

  30. Hulsmans FJ, Tio TL, Reeders JW, Tytgat GN (1991) Transrectal US in the diagnosis of localized colitis cystica profunda. Radiology 181:201–203. https://doi.org/10.1148/radiology.181.1.1887033

    Article  CAS  PubMed  Google Scholar 

  31. Dahan H, Arrive L, Wendum D, et al. (2001) Retrorectal developmental cysts in adults: clinical and radiologic-histopathologic review, differential diagnosis, and treatment. Radiographics 21:575–584. https://doi.org/10.1148/radiographics.21.3.g01ma13575

    Article  CAS  PubMed  Google Scholar 

  32. Yang DM, Park CH, Jin W, et al. (2005) Tailgut cyst: MRI evaluation. AJR Am J Roentgenol 184:1519–1523. https://doi.org/10.2214/ajr.184.5.01841519

    Article  PubMed  Google Scholar 

  33. Kim MJ, Kim WH, Kim NK, et al. (1997) Tailgut cyst: multilocular cystic appearance on MRI. J Comput Assist Tomogr 21:731–732

    Article  CAS  PubMed  Google Scholar 

  34. Mesurolle B, Sayag E, Meingan P, et al. (1996) Retroperitoneal extramedullary hematopoiesis: sonographic, CT, and MR imaging appearance. AJR Am J Roentgenol 167:1139–1140. https://doi.org/10.2214/ajr.167.5.8911166

    Article  CAS  PubMed  Google Scholar 

  35. Sauer B, Buy X, Gangi A, Roy C (2007) Exceptional localization of extramedullary hematopoiesis: presacral and periureteral masses. Acta Radiol 48:246–248. https://doi.org/10.1080/02841850601128991

    Article  CAS  PubMed  Google Scholar 

  36. Del Frate C, Girometti R, Pittino M, et al. (2006) Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics 26:1705–1718. https://doi.org/10.1148/rg.266065048

    Article  PubMed  Google Scholar 

  37. Coutinho A Jr, Bittencourt LK, Pires CE, et al. (2011) MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics 31:549–567. https://doi.org/10.1148/rg.312105144

    Article  PubMed  Google Scholar 

  38. O’Neil JD, Ros PR, Storm BL, Buck JL, Wilkinson EJ (1989) Cystic mesothelioma of the peritoneum. Radiology 170:333–337. https://doi.org/10.1148/radiology.170.2.2643136

    Article  PubMed  Google Scholar 

  39. Koo PJ, Wills JS (2009) Case 146: benign multicystic mesothelioma. Radiology 251:944–946. https://doi.org/10.1148/radiol.2513071235

    Article  PubMed  Google Scholar 

  40. Jerbi M, Hidar S, Ziadi S, Khairi H (2006) Benign multicystic peritoneal mesothelioma. Int J Gynaecol Obstet 93:267–268. https://doi.org/10.1016/j.ijgo.2006.03.013

    Article  CAS  PubMed  Google Scholar 

  41. Diel J, Ortiz O, Losada RA, et al. (2001) The sacrum: pathologic spectrum, multimodality imaging, and subspecialty approach. Radiographics 21:83–104. https://doi.org/10.1148/radiographics.21.1.g01ja0883

    Article  CAS  PubMed  Google Scholar 

  42. Wells RG, Sty JR (1990) Imaging of sacrococcygeal germ cell tumors. Radiographics 10:701–713. https://doi.org/10.1148/radiographics.10.4.2165626

    Article  CAS  PubMed  Google Scholar 

  43. Farsad K, Kattapuram SV, Sacknoff R, Ono J, Nielsen GP (2009) Sacral chordoma. Radiographics 29:1525–1530. https://doi.org/10.1148/rg.295085215

    Article  PubMed  Google Scholar 

  44. Sciubba DM, Chi JH, Rhines LD, Gokaslan ZL (2008) Chordoma of the spinal column. Neurosurg Clin N Am 19:5–15. https://doi.org/10.1016/j.nec.2007.09.006

    Article  PubMed  Google Scholar 

  45. York JE, Kaczaraj A, Abi-Said D, et al. (1999) Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery 44:74–79 (discussion 79–80)

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Diagnostic Radiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA

    Stephanie Font, Candice Bolan & Melanie Caserta

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  1. Stephanie Font
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Correspondence to Candice Bolan.

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CME activity This article has been selected as the CME activity for the current month. Please visit https://ce.mayo.edu/node/56624 and follow the instructions to complete this CME activity.

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Font, S., Bolan, C. & Caserta, M. The bottom line: MRI and CT findings of unusual rectal and perirectal pathology. Abdom Radiol 43, 1101–1119 (2018). https://doi.org/10.1007/s00261-017-1385-z

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