2025 Volume 58 Issue 7 Pages 418-425
The patient was a 26-year-old male who presented with hematochezia during defecation. Lower gastrointestinal endoscopy identified a polyp in the rectosigmoid (RS) region, which was removed by endoscopic mucosal resection (EMR). Histopathological examination revealed a moderately differentiated tubular adenocarcinoma with submucosal and lymphovascular invasion. The patient was referred to our department for additional surgical intervention. Laparoscopic high anterior resection was performed. Histopathological examination of the resected intestine and dissected lymph nodes showed no residual malignancy. At 12 months postoperatively, a nodular lesion was detected anterior to the left common iliac artery on CT, with FDG uptake on FDG-PET/CT. The lesion was diagnosed as lymph node metastasis of rectal cancer, and surgical resection was performed. The tumor was resected from the left common iliac artery, but was found to involve the left hypogastric nerve, which could not be preserved. Thus, en bloc resection of the left hypogastric nerve was performed. Histopathological examination revealed proliferation of spindle-shaped cells with indistinct borders, with no malignant features, leading to diagnosis of a nodular fasciitis-like lesion. Postoperatively, the patient developed ejaculatory dysfunction. At 2 years and 6 months postoperatively, there has been no recurrence of rectal cancer or nodular fasciitis.
