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A 23 year old woman with no significant past medical history presented with rectal bleeding and left lower quadrant abdominal pain. Surgical history included cholecystectomy, caesarean section, and tubal ligation within the past five years. Her father died of colon cancer when he was 44 years old. Physical examination revealed a large abdominal mass located in the supraumbilical region near a previous surgical scar. The mass was hard and moderately tender to palpation. On rectal examination, no masses were palpable and her stools tested positive for occult blood. The remainder of her examination was unremarkable. On admission, laboratory studies revealed a microcytic anaemia. A computed tomography (CT) scan of the abdomen showed multiple large abdominal peritoneal and retroperitoneal masses (fig 1). These masses appeared to be centred on the mesentery.
A CT guided biopsy and pictures from the colon are shown in figs 2 and 3. What is the diagnosis?
See page 40 for answer
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