44b - Answer: 87-year-old male presents with prostate cancer, rectal cancer
HISTORY:
This 87-year-old male presents with prostate cancer, rectal cancer. Presurgical assessment.
PRIMARY FINDING:
PI-RADS 5.
FINDINGS:
The prostate measures 4.4 x 2.0 x 4.3cm for an estimated volume of 27.1cc.
Peripheral zone: Decreased signal intensity throughout the peripheral zone of the prostate. No diffusion-restricting lesion within the peripheral zone.
Central Gland: CZ/TZ hypertrophy and bladder wall thickening compatible with chronic outlet obstruction accentuated by incomplete distension. A 1.6 x 1.4cm T2 hypointense teardrop-shaped lesion in the left prostate base, left CZ, with corresponding weekly positive DCE, involves the left seminal vesicle.
Both seminal vesicles are desiccated.
Impingement upon the left neurovascular bundle by the lesion that protrudes posterosuperiorly from the left CZ near the midline. The right neurovascular bundle is normal.
The space of Retzius is normal.
No lymphadenopathy or bone lesion.
Mild symphysis pubis and SI joint arthrosis.
Bilateral femoroacetabular arthropathy.
Diffuse circumferential rectal soft tissue thickening. No invasion of the muscularis layer into the mesorectal fat.
Mild muscle atrophy.
CONCLUSION:
1. Left paramedian CZ prostate lesion measuring 1.6 x 1.4cm with involvement of the left seminal vesicle, PI-RADS 5. T3b. No sign of lymphadenopathy or bone lesion.
2. Diffusely thickened mucosa of the rectum without sign of full-thickness invasion of the mesorectal fascia or into the mesorectal fat.
3. No sign of lymphadenopathy or bone lesion.
4. Degenerative arthropathy and osteopenia.
Case Challenge: Prostate MRI Cases
Case Challenge
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Content reviewed: October 25, 2021