A 58-Year-Old Man Is Being Evaluated for Constipation and Weight

question 41

Multiple Choice

A 58-year-old man is being evaluated for constipation and weight loss over the last several months.  During the past 2 weeks, he has had several episodes of rectal bleeding.  The patient has never had a screening colonoscopy.  Examination shows a soft and nontender abdomen without masses or organomegaly.  Digital rectal examination reveals a firm palpable mass in the rectal vault.  Flexible rectosigmoidoscopy shows a large ulcerative mass in the middle third of the rectum extending to the rectosigmoid junction.  He undergoes surgical resection of the rectosigmoid colon.  Frozen section analysis reveals clear margins of the colon specimen with metastases in the pararectal lymph nodes.  Which of the following lymph node groups should be sampled in this patient for further assessment of metastatic disease?

• A)Celiac
• B)Internal iliac
• C)Left colic
• D)Right colic
• E)Superficial inguinal
• F)Superior mesenteric
• G)Supraclavicular

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