• 55 year old female
  • Patient was reffered to us for the favor of evaluation of suspected rectal mass seen on other imaging modalities
  • Colonoscopy showed a large submucosal lesion in the rectum about 4 cm from the anal verge
  • Rectal EUS –  A large hypoechoic 4 cms x 3 cms mixed echoic variegated lesion in the perirectal region, There was no evidence of hypoechoic nodes in the perirectal  region.
  • EUS guided FNA was then performed from the suspected lesion
  • Cytology report confirmed it to be a Rectal Benign Gastro intestinal stromal tumor

 

EXPERT COMMENTS:-

  • Endosonography of the rectal submucosal lesions help to assess tumor characteristics, obtain tumor histology and plan therapeutic option1
  • Features suggestive of Malignancy : 1
  1. Size greater than 4 cm
  2. Irregular outer margin
  3. Hypoechoic perirectal lymphnodes
  4. Echogenic foci
  5. Cystic spaces
  • EUS guided FNA and/or Tru Cut Biopsy are useful in the diagnostic evaluation and therapeutic plan in patients with rectal and perirectal lesion2

TAKE HOME MESSAGE:-

  • EUS and EUS guided FNA is a safe procedure for accurate diagnosis of the rectal submucosal region as well as evaluation of perirectal masses
  • Presence of perirectal malignant lymphomas and malignant GIST has been reported in literatures, which can be diagnosed on EUS-FNA
  • This helps to avoid unnecessary surgeries, having chance of anal sphincter-saving surgeries and timely administration of appropriate chemotherapy

REFERENCES:-

  1. Palazzo, L et al. Endosonographic features predictive of benign and malignant gastrointestinal stromal tumors. Gut 46:88-92, 2000
  2. Boo SJ et al. EUS guided fine needle aspiration and trucut needle biopsy for examination of rectal and perirectal lesions.Scand J Gastroentero.2011 Dec;46(12):1510-8
Colonoscopy showing Large rectal mass

Colonoscopy showing Large rectal mass

Endosonography showing the mass limited to the rectal wall

Endosonography showing the mass limited to the rectal wall

 

 

 

 

 

 

 

 

 

Colour Doppler showing  paucity of vascularity in the mass

Colour Doppler showing paucity of vascularity in the mass

EUS guided FNA of the rectal mass

EUS guided FNA of the rectal mass

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