Recurrent bladder cancer presenting as rectal linitis plastica.

A 55-year-oldman presentedwith a 4-day history of rectal pain, urgency, and a feeling of heaviness. He had also noticed thinning of the caliber of his stool. His past history included stage II, T2–3, muscle invasive urothelial bladder carcinoma, diagnosed 10 months previously, for which he had received neoadjuvant chemotherapy before undergoing radical cystoprostatectomy, pelvic lymphadenectomy, and the creation of an ileal conduit. A few days prior to this presentation, evaluation by his urologist and oncologist had deemed him to be cancer-free. Rectal examination revealed marked rectal narrowing, rigidity, and tenderness to palpation. The results of a comprehensive panel of blood tests were normal. A computed tomography (CT) scan showed diffuse rectal wall thickening, with postoperative changes in the pelvis (●" Fig.1). Colonoscopy revealed a markedly narrowed, indurated, firm distal rectal wall, with changes extending from the anal verge to 8cm proximally (●" Fig.2). Rectal endoscopic ultrasound (EUS) showed a diffusely thickened rectal wall to 15mm circumferentially, with an irregular outer border (●" Fig.3). The architecture of the wall layers was discernible and the mucosa propria was the thickest layer, measuring 10mm. There was one round 5-mm hypoechoic lymph node adjacent to this area. Rectal tunnel biopsies were obtained. Hematoxylin and eosin (H&E) staining of the biopsy specimens revealed benign colonic mucosa with scattered fragments of submucosal tissue containing rare atypical cells and collections of crushed cells. Immunohistochemical staining demonstrated that the crushed cell population Fig.1 Computed tomography (CT) scan images showing diffuse rectal wall thickening on: a axial view; b coronal view.