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Transrectal Sonography of Anal Sphincter Infiltration in Lower Rectal Carcinoma

Andrea G. Maier1, Soeren H. Kreuzer1, Friedrich Herbst2, Fritz Wrba3, Wolfgang Schima1, Martin A. Funovics1, Bela K. Teleky2 and Gerhard L. Lechner1

1 Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
2 Department of Surgery, University of Vienna, A-1090 Vienna, Austria.
3 Department of Clinical Pathology, University of Vienna, A-1090 Vienna, Austria.



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  		Fig. 1A. —Normal appearance of anal canal. Coronal diagram of anal canal and sphincter apparatus. Longitudinal line (1) shows level of transrectal sonogram.

 


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  		Fig. 1B. —Normal appearance of anal canal. Transrectal sonogram depicts mucosa (white arrow), internal sphincter (black arrow), and sling of puborectalis and deep external sphincter (arrowheads).

 


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  		Fig. 2A. —40-year-old man with lower rectal cancer (pT3, N1, G3) and superficial spreading into mucosa of anal canal. Transrectal sonogram shows hypoechoic lesion from 3-o'clock to 6-o'clock positions (arrowheads) limited to mucosa, representing tumor extension. Internal sphincter (black arrow) and external sphincter (white arrow) are not affected.

 


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  		Fig. 2B. —40-year-old man with lower rectal cancer (pT3, N1, G3) and superficial spreading into mucosa of anal canal. Corresponding photomicrograph of histopathologic slice shows tumor to be restricted to mucosa of anal canal (arrowhead). Internal sphincter (short arrow) and external sphincter (long arrow) are intact. Specimen was opened anteriorly by surgeon. (H and E, x15)

 


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  		Fig. 3A. —74-year-old man with lower rectal cancer (pT3, N0, G2) with extension into anal canal. Transrectal sonogram shows infiltration of mucosa and internal sphincter (arrowhead) from 11-o'clock to 2-o'clock positions. (black arrows). External sphincter (white arrow) is intact.

 


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  		Fig. 3B. —74-year-old man with lower rectal cancer (pT3, N0, G2) with extension into anal canal. Photomicrograph of histopathologic specimen shows tubular tumor structures infiltrating smooth muscle structure (arrows) of internal sphincter muscle. (H and E, x200)

 


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  		Fig. 4. —73-year-old woman with lower rectal cancer (pT3, N1, G3). Transrectal sonogram shows massive infiltration of internal sphincter (arrowhead), external sphincter (arrow), and all layers of anal canal between 11-o'clock and 2-o'clock positions (white arrows).

 

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