Fig. 1.

Within the lower rectum, there is an intraluminal polyp with an anterior peduncle (asterisk, A-C). Disease is seen to involve the muscularis propria, but does not breach the mesorectum (arrow, B). This was staged T2 N0. Eight months after a local resection and chemoradiotherapy with a Papillon boost low signal fibrosis is seen at the previous tumor site (arrows, D, E). There is no residual intermediate signal tumor remaining. Some tethering to the seminal vesicles is seen with indrawing of the anterior mesorectal margin giving a “black spider” appearance. A scar with contact bleeding, but no evidence of recurrence, was seen on endoscopy (F). At 1-year post-treatment (arrows, G, H), the scar matures, becomes less spiculate, more conglomerate, and remains black with no evidence of residual tumor. Endoscopy revealed no evidence of recurrence (I)