A Rare Rendezvous with Carcinoma Sigmoid

We present here to you a 75-year-old man who presented with features of lower urinary tract symptoms such as increased frequency and incomplete sense of voiding for 3 months. He did not have any other comorbidities. Clinical examination of the abdomen was normal. On digital rectal examination, grade II fi rm gland and small fi rm nodules in both upper poles were noted. Initially ultrasound of the abdomen and pelvis was done, which showed no signi fi cant abnormality except for enlarged prostate gland. Contrast-enhanced computed tomography (CT) abdomen and pelvis was done that demonstrated (a) enhancing asymmetric wall thickening involving the proximal sigmoid colon with a nodal mass in the presacral region with a contiguous lytic lesion in the sacrum, (b) multiple perirectal nodes and perirectal fascial thickening, (c) enhancing fi lling defect noted in the inferior mesenteric vein by the nodal deposit — tumor thrombus involving the portal venous system ( ► Fig. 1 ), (d) enhancing fi lling defect noted in the right internal iliac vein and the inferior vena cava, with distension of the veins — tumor thrombus involving the systemic venous system ( ► Fig. 2 ), and (e) liver and lung metastasis. Conclud-ed as an aggressivelesion of neoplastic etiology involving the sigmoid colonwith apresacral nodal deposit, associatedwith transvenous spread