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Image Challenge_06082020
June 8, 2020

Image challenge: an unusual cause of abdominal palpable mass

What caused a 5-cm mass to appear and obstruct the lumen of the colon in a 76-year-old patient with pencil-thin stool?
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Gastroenterology clinical image challenge: A 76-year-old woman presented to the emergency department with a palpable mass and tenderness in the right lower quadrant of the abdomen for 10 days. The pain was dull, constant, nonradiating, nonmigrating and associated with loss of appetite. She also had change in bowel habits and pencil-thin stool recently. Her past medical history included hypertension and type 2 diabetes mellitus. There was no history of fever, blood in stools or weight loss.

On physical examination, her vital signs were normal. A tender 7-cm mass without rebound tenderness or guarding was located on the right lower quadrant of her abdominal wall. The remainder of the physical examination was unremarkable. Laboratory studies showed leukocytosis with a shift to the left (a white blood cell count of 17,540 cells/mL with 88.1% segmented neutrophils), normocytic normochromic anemia (hemoglobin, 9.9 g/dL), elevated levels of carcinoembryonic antigen (524.5 ng/mL) and carbohydrate antigen 125 (45.8 U/mL). A contrast-enhanced computed tomography scan of the abdomen showed a 9-cm heterogeneous enhanced mass involving the ascending colon and cecum, marked pericolic peripheral fat stranding, pericolic lymph nodes and mesenteric lymphadenopathy The patient underwent a colonoscopy, which revealed a 5-cm protruding mass, ulcerated mucosa with friability and obstructing the lumen of the colon in the ascending colon (figure).

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology.

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