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December 10, 2018

Image challenge: A mysterious calcified target lesion causing gastrointestinal bleeding

What caused a firm, smooth mass to appear in the distal rectum of a 77-year-old woman with a history breast cancer?

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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?


To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play.


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