COLORECTAL CARCINOMA AMDT 0417-2024.pptx

colorectal CA MDT

1. Colorectal Cancer Multidisciplinary Team Conference April 17, 2024 Frece Angelo A. Rosalia, MD Radiology Resident

2. Case 1

3. Patient Profile V. C. 60/M Chief complaint: Hematochezia

4. Baseline Chest, Whole abdomen CECT (03/26/2024) Axial arterial phase Findings : Hypodense rectal wall thickening with associated luminal narrowing and minimal perirectal fat stranding, about 4.0 cm from the anal verge, and spanning 4cm in length Coronal arterial phase 4.0 cm FAV Sagittal arterial phase Luminal narrowing 4.0 cm in length

5. Baseline Chest, Whole abdomen CECT (03/26/2024) Axial arterial phase Findings : Hypodense rectal wall thickening with associated luminal narrowing and minimal perirectal fat stranding, 4.0 cm FAV, spanning 4cm Coronal arterial phase 4.0 cm FAV Sagittal arterial phase 4.0 cm in length Perirectal Fat Stranding

6. Baseline Chest, Whole abdomen CECT (03/26/2024) Axial portal venous phase SUBCENTIMETER HEPATIC CYSTS (Coiunaud segments III, VII) ( (too small to characterize) Other findings Axial portal venous phase Right kidney SUBCENTIMETER NON-ENHANCING RIGHT RENAL CORTICAL CYSTS Left kidney

7. Baseline Chest, Whole abdomen CECT (03/26/2024) ATHEROSCLEROTIC VASCULAR DSE No pulmonary mass or lesions Other findings THORACOLUMBAR SPONDYLOSIS No osseous lesions Sagittal bone window Coronal plain lung window

8. Baseline Chest, Whole abdomen CECT (03/26/2024) Axial venous phase NO LYMPHADENOPATHIES Inguinal nodal station Pelvic nodal station Para-aortic nodal station

9. Baseline Chest, Whole abdomen CECT (03/26/2024) Axial venous phase NO LYMPHADENOPATHIES Inguinal nodal station Pelvic nodal station Para-aortic nodal station

10. Impression: CHEST UNREMARKABLE CHEST CT ABDOMEN BIOPSY-PROVEN RECTAL ADENOCARCINOMA. NO METASTATIC PROCESS ARE APPRECIATED FEW CYSTIC HEPATIC FOCI, TOO SMALL TO CHARACTERIZE RENAL CORTICAL CYSTS, RIGHT (BOSNIAK 1) COLONIC DIVERTICULUM, ASCENDING COLON ATHEROSCLEROTIC VASCULAR DISEASE PROSTATIC CONCRETIONS MILD THORACIC DEXTROSCOLIOSIS AND SPONDYLOSIS

11. Case 2

12. Patient Profile M. E. 64/F Chief complaint: Hematochezia

13. Baseline Chest, Whole abdomen CECT (12/27/2023) Axial arterial phase Mesorectal Fat Stranding Sagittal arterial phase Findings : Nodular thickening with homogenous enhancement at the right posterolateral wall of the lower rectal segment, measuring 3.5 x 3.6 x 1.9 cm (LWT) . Fat stranding is noted in the mesorectum on the right.

14. Baseline Chest, Whole abdomen CECT (12/27/2023) Axial arterial phase Findings : Nodular thickening with homogenous enhancement at the right posterolateral wall of the lower rectal segment, measuring 3.5 x 3.6 x 1.9 cm (LWT) . Fat stranding is noted in the mesorectum on the right. Mesorectal Fat Stranding 3.5 x 3.6 x 1.9 cm (LWT) Sagittal arterial phase

15. Baseline Chest, Whole abdomen CECT (12/27/2023) Findings : Multiple hyperdense foci within the gallbladder with the largest measuring 0.7 cm . No bile duct dilatations noted. Axial soft tissue plain Coronal soft tissue plain Multiple hyperdense gallbladder foci

16. Baseline Chest, Whole abdomen CECT (12/27/2023) Findings : Reticular and ground-glass opacities in the right upper lobe and (not shown) bibasal segments Axial Plain, lung window Coronal plain, lung window Reticular and ground-glass opacities

17. Baseline Chest, Whole abdomen CECT (12/27/2023) Coronal arterial phase, level of aortic arch Axial arterial phase, level of aortic arch Findings : A 0.5 cm luminal filling defect is noted at the aortic arch, with intimal wall calcifications of the coronary arteries and thoracic aorta

18. Baseline Chest, Whole abdomen CECT (12/27/2023) Coronal arterial phase, level of aortic arch Axial arterial phase, level of aortic arch Findings : A 0.5 cm luminal filling defect is noted at the aortic arch, with intimal wall calcifications of the coronary arteries and thoracic aorta

19. Baseline Chest, Whole abdomen CECT (12/27/2023) SPONDYLOSIS DEFORMANS, C/T/L Sagittal plain, bone window Axial plain, bone window Enostosis, T1 vertebra

20. Baseline Chest, Whole abdomen CECT (12/27/2023) Axial venous phase NO LYMPHADENOPATHIES Inguinal nodal station Pelvic nodal station Para-aortic nodal station

21. Baseline Chest, Whole abdomen CECT (12/27/2023) Axial venous phase NO LYMPHADENOPATHIES Inguinal nodal station Pelvic nodal station Para-aortic nodal station

22. Impression: CHEST, WHOLE ABDOMEN CECT INTERSTITIAL AND ALVEOLAR PNEUMONIC INFILTRATES, BILATERAL CORONARY AND AORTIC ATHEROSCLEROSIS THROMBUS FORMATION, AORTIC ARCH CERVICOTHORACOLUMBAR SPONDYLOSIS RECTAL MASS WITH EXTENSION INTO THE MESORECTAL FAT CHOLECYSTOLITHIASIS

23. Case 3

24. Patient Profile D. S. 62/M Chief complaint: LUQ pain, decreasing stool caliber and weight loss

25. Baseline Chest, Whole abdomen CECT (04/04/2024) Axial arterial phase Findings : A polypoid filling defect in the proximal descending colon, approximately 3.4 cm from the splenic flexure, measuring 1.6 x 0.7 cm (LT) Coronal arterial phase 3.4 cm from splenic flexure Sagittal arterial phase Proximal descending colon Polypoid filling defect 1.6 x 0.7 cm

26. Baseline Chest, Whole abdomen CECT (04/04/2024) Axial arterial phase Findings : Two subcentimeter polypoid filling defects in the sigmoid colon. The sigmoid colon also appears redundant Coronal arterial phase Sagittal arterial phase Sigmoid colon Subcentimeter polypoid filling defects

27. Baseline Chest, Whole abdomen CECT (04/04/2024) NEGATIVE PULMONARY FINDINGS No pulmonary mass or lesions Other findings THORACOLUMBAR SPONDYLOSIS DEFORMANS No osseous lesions Sagittal bone window Coronal plain lung window CORONARY & AORTIC ATHEROSCLEROSIS

28. Baseline Chest, Whole abdomen CECT (04/04/2024) Axial arterial phase RIM-CALCIFIED LYMPH NODE (?), RIGHT ANTERO-LATERAL PELVIC SPACE 1.6 x 0.7 cm (LT) Other findings The peritoneum, omentum, and the rest of the mesenteric spaces are clear

29. Impression: CHEST, WHOLE ABDOMEN NEGATIVE PULMONARY, PLEURAL AND MEDIASTINAL CT CONSIDER LEFT-VENTRICULAR CARDIOMEGALY CORONARY AND AORTOILIAC ATHEROSCLEROSIS COLONIC POLYPS, SIGMOID AND PROXIMAL DESCENDING SEGMENTS CALCIFIED NODULE, ANTEROLATERAL PELVIC SPACE – CALCIFIED LYMPH NODE? THORACOLUMBAR SPONDYLOSIS

30. THANK YOU