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Depiction and Local Staging of Rectal Tumors: Comparison of Transrectal US before and after Water Instillation¹

¹ From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135–710, Korea. From the 2002 RSNA scientific assembly. Received January 9, 2003; revision requested March 20; final revision received August 7; accepted September 29. Address correspondence to H.K.L. (e-mail: hklim@smc.samsung.co.kr).

View larger version (160K): [in a new window]   Figure 1a. Transverse transrectal US images of small pT1 adenocarcinoma in a 52-year-old man. (a) Scan obtained before water instillation does not depict the mass. (b) Scan obtained after instillation of 50 mL of degassed water clearly shows a small hypoechoic mass (arrows), 1.2 cm in diameter, in the rectal wall between 10- and 11-o’clock positions. The tumor is confined to the mucosal and submucosal layers (pT1).

View larger version (168K): [in a new window]   Figure 1b. Transverse transrectal US images of small pT1 adenocarcinoma in a 52-year-old man. (a) Scan obtained before water instillation does not depict the mass. (b) Scan obtained after instillation of 50 mL of degassed water clearly shows a small hypoechoic mass (arrows), 1.2 cm in diameter, in the rectal wall between 10- and 11-o’clock positions. The tumor is confined to the mucosal and submucosal layers (pT1).

View larger version (197K): [in a new window]   Figure 2a. Images show pT2 adenocarcinoma in the midrectum in a 62-year-old man. (a) Transverse transrectal US scan obtained before water instillation shows a hypoechoic mass (arrows) with irregular margins in the rectal wall between 4- and 9-o’clock positions, which extends through the muscularis propria (uT3). (b) Transverse transrectal US scan obtained after water instillation shows a hypoechoic mass (arrowheads) that invades the muscularis propria and was interpreted as uT2, but the perirectal fat is clear. (c) Histologic slide of the resected specimen shows adenocarcinoma (arrows) invading the muscularis propria without infiltration of the perirectal fat (F) (pT2). (Hematoxylin-eosin stain; original magnification, x1.)

View larger version (198K): [in a new window]   Figure 2b. Images show pT2 adenocarcinoma in the midrectum in a 62-year-old man. (a) Transverse transrectal US scan obtained before water instillation shows a hypoechoic mass (arrows) with irregular margins in the rectal wall between 4- and 9-o’clock positions, which extends through the muscularis propria (uT3). (b) Transverse transrectal US scan obtained after water instillation shows a hypoechoic mass (arrowheads) that invades the muscularis propria and was interpreted as uT2, but the perirectal fat is clear. (c) Histologic slide of the resected specimen shows adenocarcinoma (arrows) invading the muscularis propria without infiltration of the perirectal fat (F) (pT2). (Hematoxylin-eosin stain; original magnification, x1.)

View larger version (122K): [in a new window]   Figure 2c. Images show pT2 adenocarcinoma in the midrectum in a 62-year-old man. (a) Transverse transrectal US scan obtained before water instillation shows a hypoechoic mass (arrows) with irregular margins in the rectal wall between 4- and 9-o’clock positions, which extends through the muscularis propria (uT3). (b) Transverse transrectal US scan obtained after water instillation shows a hypoechoic mass (arrowheads) that invades the muscularis propria and was interpreted as uT2, but the perirectal fat is clear. (c) Histologic slide of the resected specimen shows adenocarcinoma (arrows) invading the muscularis propria without infiltration of the perirectal fat (F) (pT2). (Hematoxylin-eosin stain; original magnification, x1.)

View larger version (205K): [in a new window]   Figure 3a. Transverse transrectal US images of villotubular adenoma in a 63-year-old woman. (a) Scan obtained before water instillation shows a mass (arrows) between 6- and 12-o’clock positions that was interpreted as cancer invading the muscularis propria (uT2). (b) On a scan obtained after water instillation, each layer (SM = submucosa, MP = muscularis propria, F = perirectal fat) is clearly identified. The mass was interpreted as uT1. Villotubular adenoma (not shown) confined to the mucosal layer was confirmed after surgery.

View larger version (198K): [in a new window]   Figure 3b. Transverse transrectal US images of villotubular adenoma in a 63-year-old woman. (a) Scan obtained before water instillation shows a mass (arrows) between 6- and 12-o’clock positions that was interpreted as cancer invading the muscularis propria (uT2). (b) On a scan obtained after water instillation, each layer (SM = submucosa, MP = muscularis propria, F = perirectal fat) is clearly identified. The mass was interpreted as uT1. Villotubular adenoma (not shown) confined to the mucosal layer was confirmed after surgery.

View larger version (198K): [in a new window]   Figure 4a. Images show pT2 adenocarcinoma in the midrectum in a 53-year-old woman. (a) On a transverse transrectal US scan before water instillation, a polypoid hypoechoic mass (arrows) between 9- and 11-o’clock positions is noted. The outer hypoechoic muscle layer (MP) appears intact (uT1). (b) On a transverse transrectal US scan after water instillation, it was also interpreted as a uT1 lesion (arrowheads). (c) Microscopic slide of the resected specimen reveals that the tumor cells (*) extend to the muscularis propria (arrows) (pT2). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (198K): [in a new window]   Figure 4b. Images show pT2 adenocarcinoma in the midrectum in a 53-year-old woman. (a) On a transverse transrectal US scan before water instillation, a polypoid hypoechoic mass (arrows) between 9- and 11-o’clock positions is noted. The outer hypoechoic muscle layer (MP) appears intact (uT1). (b) On a transverse transrectal US scan after water instillation, it was also interpreted as a uT1 lesion (arrowheads). (c) Microscopic slide of the resected specimen reveals that the tumor cells (*) extend to the muscularis propria (arrows) (pT2). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (166K): [in a new window]   Figure 4c. Images show pT2 adenocarcinoma in the midrectum in a 53-year-old woman. (a) On a transverse transrectal US scan before water instillation, a polypoid hypoechoic mass (arrows) between 9- and 11-o’clock positions is noted. The outer hypoechoic muscle layer (MP) appears intact (uT1). (b) On a transverse transrectal US scan after water instillation, it was also interpreted as a uT1 lesion (arrowheads). (c) Microscopic slide of the resected specimen reveals that the tumor cells (*) extend to the muscularis propria (arrows) (pT2). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (198K): [in a new window]   Figure 5a. Images show pT3 adenocarcinoma in the midrectum in a 53-year-old woman. (a) Transverse transrectal US scan before water instillation shows that the hypoechoic tumor with irregular borders (arrows) between 11- and 3-o’clock positions penetrates the perirectal fat (F) (uT3). (b) Transverse transrectal US scan after water instillation shows the tumor (arrowheads), which had been interpreted as penetrating into the perirectal fat (F) and staged as uT3. (c) Microscopic slide of the resected specimen reveals that the tumor cells (arrows) infiltrate the perirectal fat (F) (pT3). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (195K): [in a new window]   Figure 5b. Images show pT3 adenocarcinoma in the midrectum in a 53-year-old woman. (a) Transverse transrectal US scan before water instillation shows that the hypoechoic tumor with irregular borders (arrows) between 11- and 3-o’clock positions penetrates the perirectal fat (F) (uT3). (b) Transverse transrectal US scan after water instillation shows the tumor (arrowheads), which had been interpreted as penetrating into the perirectal fat (F) and staged as uT3. (c) Microscopic slide of the resected specimen reveals that the tumor cells (arrows) infiltrate the perirectal fat (F) (pT3). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (167K): [in a new window]   Figure 5c. Images show pT3 adenocarcinoma in the midrectum in a 53-year-old woman. (a) Transverse transrectal US scan before water instillation shows that the hypoechoic tumor with irregular borders (arrows) between 11- and 3-o’clock positions penetrates the perirectal fat (F) (uT3). (b) Transverse transrectal US scan after water instillation shows the tumor (arrowheads), which had been interpreted as penetrating into the perirectal fat (F) and staged as uT3. (c) Microscopic slide of the resected specimen reveals that the tumor cells (arrows) infiltrate the perirectal fat (F) (pT3). (Hematoxylin-eosin stain; original magnification, x40.)