RT Journal
A1 Zoccali M, Hart J, Fichera A
T1 IMage of the month—quiz caseimage of the month—diagnosis
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD January 1
VO 147
IS 1
SP 93
OP 93
DO 
UL http://dx.doi.org/
AB 
A 64-year-old man was referred to our institution after he was found to have a retrorectal mass on a computed tomographic scan he underwent for persistent rectal pain and discomfort. Family and medical history were unremarkable. No laboratory abnormalities or specific findings were noted on physical examination. At digital rectal examination, the mass was not palpable and the rectal mucosa was intact. The computed tomographic scan showed a 40-mm mass in the ischiorectal fossa adherent to the levator ani muscle and rectum, and while it was suspicious for invasive rectal carcinoma, the exophytic appearance was suggestive of a soft tissue neoplasm. The patient also underwent magnetic resonance imaging, which revealed an enhancing, 35-mm soft tissue mass in the right ischiorectal fossa adherent to the wall of the rectum with questionable involvement, extending through the right levator ani muscle, suspicious for a rectal carcinoma vs a soft tissue mass (Figure 1). Transrectal ultrasonography was performed and a 30-mm solid hypoechoic mass with a 4-mm calcification in the left lateral perirectal space 9 to 11 cm from the anal verge was noted without signs of rectal wall invasion. No lesions suspicious for locoregional invasion were identified. Fine-needle (22-gauge) aspiration was performed and the cytological analysis revealed the presence of neoplastic elements positive for AE1/AE3 and synaptophysin but not for chromogranin and p63.