 Good morning, everyone. I'm Dr. Manisha, junior resident in the department of failure diagnosis from P. Janus, Northup. In presenting an unusual case of Casinoma rectum, rectal cancer constitutes 42% of the total colorectal cancer. Patient with rectal cancer commonly present with change in bowel habits, bleeding by rectum, occult breed, rectal mass, abdominal pain, and iron deficiency anemia. Due to distinctive anatomy and physiological features, there is increased risk of recurrence and local spread of rectal cancer. Prognostic determinants of rectal cancer are depth of invasion, number of lymph nodes involved, and circumference, circumferential resection margin involved. Preoperative imaging plays an important role in helping deciding the management of rectal cancer and the most adopted surgical technique. Imaging in rectal cancer is aimed at determining the stage of disease and diagnosis and thus deciding the appropriate management of the patient. Endoscopic USG can differentiate the layers of the ball ball and thus determining the depth of tumor invasion in early stages. USG can also be used to take FNA and biopsy in patients in early stage disease. However, in post-eartheral patients, due to changes like inflammation, necrosis, and fibroids changes, accuracy of endoscopic USG decreases. CT colonography. Abdominal CT can demonstrate regional extension of tumor as well as adenopathy and distinct metastases and thus is variable in planning surgery for rectal cancer. Interpretation of rectal heredity, such as obstruction, perforation, and fistula can also be visualized with CT scan. Use of CT is critical for identifying metastases, recurrences, evaluation, and ethnic-releasing relationships, documenting normal post-operative anatomy, and confirming the absence of new regions during and after therapy. The main disadvantages of CT are radiation exposure and difficulty in interpretation of pathology in presence of residual fecal matter fluid-understanded or contracted segments of end- or regional artifacts. Now we are discussing the case. A 59-year-old female patient presented 2-guining opidine. There was a cleaning of high discharge per vaginom and prognitis. On clinical examination, the patient's cervix was bulky, edematous, and there was a false felling discharge coming out of vagina. Ultrason findings. Minimal fluid collection with homogenous decos was noted in intermittent cavity. Cervix was bulky with fluid collection also in cervical canal. There was focal loss of fat plane of cervix with rectum and there was evidence of also rectal bone treatment. The CT findings exude sections of contrast and hermiticity of pelvis showing heterogeneous and hermitage of both rectum and cervix with the suspicious loss of fat planes between cervix and rectum. In societal sections, distal rectum and anal canal appear bulky and heterogeneous. With circumferential wall thickening approximately 11 mm, noted with suspicious loss of fat planes with upper vaginom. Cervix appears bulky with mild differential enhancement and fluid collection in cervical canal and also in the endometrial cavity fluid is noted. On MRI, T2 weighted images show circumferential thickening of rectal wall with involvement of austere wall of cervix and DLD. However, the lumen of the rectum appears patent. Few of lymph nodes with irregular margins and heterogeneous signal intensity are noted in mesorectal fat on right side. On societal section, T2 hyper intense irregular circumferential wall thickening noted approximately 2 cm from anal verge for a length of approximately 5.6 cm with loss of fat plane with cervix and upper vagina and DLD. Few round lymph nodes with heterogeneous signal intensity and irregular margins are noted in mesorectal fat which are suspicious. So, the local stage of CA rectum came out to be as T4 and 1. In this case, 59 year old female patient presented with the complaints of foul smelling vaginal discharge and vaginal pulitis on examination and ultrasound. Cervix and vaginal were bulky and edematous with foul smelling discharge by vaginal. On the basis of clinical history and examination, the case was told to be of cervical malignancy. However, cervical biopsy for malignancy came out negative. CCDMR findings revealed the findings suggestive of some malignant rectal pathology with involvement of adjacent cervix and vagina. On rectal histopathological examination, moderately differentiated adenocarcinoma was found. Collateral cancer is incredibly common representing the fourth reading cause of cancer mortality and second most common malignancy worldwide. Of all colorectal cancer, rectal cancer comprises over one third of cases with over 40% arising within 6 cm of anal verge. For primary tumor staging, performing rectal MRI is important for evaluation of tumor location and morphology. T-category, anal splinter format, involvement, CRM status, involvement of pelvic sidewall, EMY and N-category. It is crucial to describe the tumor location in corticodal length, circumferential plane SLS length, relationship to anterior pediatrics, and distance from inferior part of the tumor to anal verge. The information helps to determine the best surgical approach. Tumor located over 50 cm from anal verge are stateless, polon, cancer with their different staging and treatment protocols. Local staging has become very critical in patient's management due to increasing incorporation of neurogymotherapy, which is basically required for locally advanced CR rectum to downgrade the tumor stage and thus followed by surgery. In our case, the staging on MRI came out as T4N1M0 which constitutes high risk group. The recommended management protocol for this group is long term chemotherapy followed by surgery if possible. Usually rectal malignancy is present with bleeding per rectum, bowel obstruction, perforation, rectal mass. In complicated cases, patient may present with adverse formation, superficial collection, adjacent organ inflammatory changes like in our case like serviceitis, vaginitis. In such cases, patient history and clinical examination and imaging finding may sometimes mislead the diagnosis and thus, in such cases we need to do appropriate imaging modality, use appropriate imaging modality and stop adenolation examination is very crucial to reach the accurate diagnosis. Thank you everyone.