Gastroenterology clinical image challenge: A 77-year-old woman with a history breast cancer status post lumpectomy one year ago presented to the emergency room with new-onset hematochezia, severe rectal pain and tenesmus. She described worsening constipation and abdominal discomfort over the last year. She often had to strain with minimal output. The patient had a good appetite and denied weight loss, nausea or vomiting. A computed tomography scan of the abdomen and pelvis showed an 8.5-cm, circular, target-like mass with multiple layers of calcifications in the distal rectum (Figures A [coronal view], B [sagittal view], C [axial view]). A digital examination showed a firm, smooth mass in the distal rectum with minimal bleeding and small clots.
What is the diagnosis and how should it be managed?
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