Presentation
Presented with straining during urination and defecation. Hypercalcemia noted on serum biochemistry.
Patient Data
There is a mass in the left anal sac that is well-circumscribed, heterogeneously contrast enhancing with a small cavitary region in its dorsolateral margin. The sublumbar lymph nodes are severely enlarged and heterogeneously contrast enhancing, causing marked ventral deviation of the colon, bladder, aorta and caudal vena cava as well as the vessel branches following trifurcation. The caudal vena cava is poorly differentiated from the lymph nodes in this region. The mass created by these severely enlarged nodes measures 10cm in length and extends to the level of the pubis. The lumbosacral disc space is markedly irregular and there is marked dorsal herniation of the intervertebral disc. There is moderate ventral spondylosis deformans.
Case Discussion
The enlarged sublumbar lymph nodes suggest metastasis from a pelvic neoplasia on the radiographs. The lymphatics of the pelvis drain to the medial iliac and internal iliac lymph nodes. On physical examination, a mass was found in the anal sac. Both the lymph nodes and anal sac mass contained adenocarcinoma on fine needle aspirate and cytopathology. The CT examination confirmed these findings.
The size of the lymph nodes caused both fecal and urinary obstruction. The lymph nodes are in the retroperitoneal space and displace the colon ventrally.
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