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JAMA Surgery Clinical Challenge
November 2015

Giant Perianal Mass

Author Affiliations
  • 1Department of Surgery, Faculty of Medicine, University of Osijek, Osijek, Croatia
  • 2Department of Surgery, County Hospital Požega, Požega, Croatia
  • 3Department of Neurology, County Hospital Požega, Požega, Croatia
JAMA Surg. 2015;150(11):1089-1090. doi:10.1001/jamasurg.2015.0968

A 65-year-old man was admitted to our hospital with a painful anal mass and fecal incontinence. The anal lesion appeared 1 year earlier and grew slowly to the current size. The patient reported bleeding from the rectum after defecation and denied weight loss or fever. The patient noted no other symptoms.

His medical history included atopic dermatitis and pulmonary tuberculosis. There was no family history of gastrointestinal pathology. He had not undergone any previous abdominal surgery, except inguinal hernia repair. He claimed to be a heavy smoker. No history of sexually transmitted diseases was found. Physical examination revealed a 12 × 10-cm hard mass on the left side of the anus (Figure 1A). It was ulcerated, covered by purulent exudate, and very painful. The scrotum was mildly tender to palpation. Digital rectal examination and rectoscopy were not performed because of the pain and fecal incontinence. The abdomen was soft and nontender. Routine blood, liver, and renal function test results were normal, as were results for carcinoembryonic antigen and cancer antigen 19-9. Chest radiography showed no abnormalities. Computed tomographic scan of the pelvis showed a hypodense 12 × 7 × 3-cm mass extending to the anus, anal canal, and lower perirectal space (Figure 1B). Abdominal computed tomography showed no pathology.

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