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Fig. 8 | Insights into Imaging

Fig. 8

From: Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide

Fig. 8

“Near-complete” tumour response. An 83 year-old female presented with a low mrT2 (arrows in a, b) mrN1a (not shown) EMVI− CRM− rectal cancer. She underwent NAT and was re-staged on endoscopy as grade 1 due to the presence of a red scar (arrow in d), and on MR imaging as mrTRG2/3 given tumour bed was now a black scar with a single focus of intermediate signal intensity below endoluminal aspect, a bit displaced from the centre (arrow in e), that presented with high signal intensity at high b value DWI (arrow in f). Patient was considered a “near-complete” responder and was followed. At 2nd re-staging, an adenomatous mucosal abnormality was observed at the periphery of the scar (arrow in g) and patient was considered a grade 2 on endoscopy. On MR imaging, she was now an mrTRG3 due to the expansion of the intermediate signal focus (arrow in h), which was also more conspicuous on high b value DWI (arrow in i). Patient underwent abdomino-perineal excision and specimen was a ypT3 ypN0 ypEMVI-TRG3 R0. The endoluminal regrowth was apparent on the gross examination of the fresh specimen (arrow in j) and at histology was depicted as a focal persistent niche of tumour at the endoluminal aspect of the tumour bed (arrows in k and l) growing in depth. It reached the mesorectal fat which was focally invaded (not shown)

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