Photo Quiz: A 55-Year-Old-Man with Rectal Bleeding and a Rectal Mass

Abstract

A 55-year-old man with a history of tobacco use presented with a 5-day history of diarrhea and rectal bleeding. This was associated with intermittent low-grade fever and weight loss that he was not able to quantify. There was no family history of malignancy. He had traveled frequently within South East Asia, and his last travel had been 6 months prior to this presentation. Physical examination revealed a medium-built male who was hemodynamically stable, with a temperature of 38°C on presentation. His cardiovascular, respiratory, and abdominal examination was normal, with no organomegaly. Digital rectal examination showed a craggy irregular nonobstructing mass at the 11-to 1-o'clock position, 6 cm from the anal verge, without contact bleeding. His laboratory investigations revealed a white blood cell count of 11.5 ϫ 10 9 /liter (neutrophils, 63%; lymphocytes, 24.5%; eosinophils, 3%), normocytic normochromic anemia (12.5 g/dl), and a platelet count of 373 ϫ 10 9 /liter. C-reactive protein level was