1. Seminal Vesicle Adherent to Rectal Wall Following Neoadjuvant Chemoradiotherapy: A Potential False-Positive Diagnostic Pitfall.
- Author
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Liaquat S, Idowu MO, and Hatfield BS
- Subjects
- Adenocarcinoma pathology, Adenocarcinoma therapy, Biopsy, Chemoradiotherapy, Adjuvant methods, Colonoscopy, Diagnosis, Differential, Diagnostic Errors prevention & control, Humans, Male, Margins of Excision, Middle Aged, Neoadjuvant Therapy methods, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local therapy, Neoplasm Staging, Neoplasm, Residual, Proctectomy, Rectal Neoplasms pathology, Rectal Neoplasms therapy, Rectum diagnostic imaging, Rectum pathology, Rectum surgery, Seminal Vesicles surgery, Tissue Adhesions pathology, Adenocarcinoma diagnosis, Neoplasm Recurrence, Local diagnosis, Rectal Neoplasms diagnosis, Seminal Vesicles pathology, Tissue Adhesions diagnosis
- Abstract
The standard of care for stage T3 and stage T4 rectal adenocarcinomas involves neoadjuvant chemoradiotherapy followed by either low anterior resection or abdominopelvic resection. The presence of residual adenocarcinoma or positive surgical margins provides useful prognostic information and can influence ongoing adjuvant therapy. Although uncommon, mimics of treated adenocarcinoma may be present in the surgical specimen. A high index of suspicion is critical in avoiding potential false-positive pitfalls, and the exclusion of mimics of treated adenocarcinoma is paramount to accurate diagnosis and treatment. Seminal vesicle epithelium has long been a challenge in differentiating prostatic adenocarcinoma from benign epithelium. However, the role of incidental seminal vesiculectomy in rectal resections due to fibrous adhesion to the rectal wall secondary to chemoradiation has not been studied. As the seminal vesicle epithelium can show markedly atypical nuclei with radiation-type effect at baseline, the potential risk of misinterpretation as residual adenocarcinoma is high. In this article, we present 2 case reports of rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy followed by transabdominal resection (low anterior resection or abdominopelvic resection) with incidental seminal vesiculectomies mimicking either residual adenocarcinoma or residual adenocarcinoma at a margin of resection.
- Published
- 2020
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