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Rectal bleeding and abdominal mass
  1. Robin Spiller, Editor,
  2. L Chaptini,
  3. F Nammour,
  4. S Peikin
  1. Cooper University Hospital, Robert Wood Johnson Medical School, Camden, New Jersey, USA
  1. Correspondence to:
    Dr L Chaptini
    GI Department, 3rd Floor, Cooper University Hospital, Robert Wood Johnson Medical School, 401 Haddon Ave, Camden 08104, New Jersey, USA; chaptini-louis{at}

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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.

Figure 1

 Computed tomography scan of the abdomen.


A CT guided biopsy and pictures from the colon are shown in figs 2 and 3. What is the diagnosis?

Figure 2

 Histology slide of computed tomography guided biopsy of the tumour.

Figure 3

 Endoscopic pictures from the colon.

See page 40 for answer

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