I have an asymptomatic with incidental following findings in MRI. A well-defined thin-walled cystic lesion is seen in the left pararectal space, appearing heterogeneously hyperintense on T1 and hyperintense on T2W images, suggestive of the hemorrhagic cystic lesion. The core of the lesion also reveals diffusion restriction. Antero-medially there is also a T2 hypointense solid component. Its dimensions are approximately 6.6 cm SI x 6.3 cm RL x 6.4 cm AP in size. This lesion is in close relation to the left lateral wall of the rectum, with slight effaced fat planes. It is located infero-medially to the tip of the coccyx. Fat planes of the lesion with the piriformis muscle and the sciatic nerve are maintained. There was no evidence of extension into the gluteal region. Can you please tell me what should be the next course of action?
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Well, the description is not specific for a particular diagnosis. A radiologist is the best person to diagnose based on the findings on the MRI (magnetic reonance imaging).
Given the location in the rectum wall, there is a possibility of a gastrointestinal stromal tumor or leiomyosarcoma or a benign lesion like a diverticular abscess.
The best next step is sigmoidoscopy and biopsy. If EUS (endoscopic ultrasound) guided biopsy is possible in your hospital, then go for it. Otherwise, a radiologist can do an ultrasound-guided biopsy and confirm the diagnosis.
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