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Special Feature
July 2010

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.




Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Surg. 2010;145(7):703. doi:10.1001/archsurg.2010.121-a

A 62-year-old man was sent to the emergency department by his primary care physician because of abdominal distention, anemia, fatigue, and worsening lower extremity edema. His medical history was remarkable only for coronary artery disease for which he had undergone a coronary artery bypass graft 2 years prior. The patient was not taking any antiplatelet or anticoagulation medications. A computed tomographic scan revealed a large abdominal mass measuring at least 25 cm × 20 cm × 20 cm (Figure 1). There was no discernable point of origin, but there was a clear fat plane separating the mass from the liver. Laboratory values were significant for a hemoglobin level of 4.9 g/dL (to convert to grams per liter, multiply by 10) and a creatinine level of 1.9 mg/dL (to convert to micromoles per liter, multiply by 88.4). There were normal values for urine and plasma 5-hydroxyindoleacetic acid, aldosterone, metanephrine, and cortisol, confirming a nonfunctional tumor.

Figure 1.
Image not available

Computed tomographic scan demonstrating a large abdominal mass of at least 25 cm × 20 cm × 20 cm.

What Is the Diagnosis?

A. Liposarcoma

B. Renal cell carcinoma

C. Lymphoma

D. Hematoma/abscess