Customize your JAMA Network experience by selecting one or more topics from the list below.
S. ROZYCKI, MDGRACEMD
A 34-year-old woman was admitted with abdominal pain predominantly at the right side and rectal bleeding of several days' duration. She had been diagnosed as having Gardner syndrome 2 years before. Among the manifestations of this disease were multiple osteomas and polyposis coli, for which a subtotal colectomy and ileorectal anastomosis had been performed. Physical examination findings revealed fullness of the abdomen with a nonmobile mass measuring approximately 30 cm in diameter. No source for the rectal bleeding could be detected at rectoscopy. Ultrasonography showed a very large, solid intra-abdominal tumor, which was confirmed by computed tomographic scanning. The tumor, measuring 23 × 15 cm, extended onto the left liver lobe and could not be distinguished from the abdominal wall (Figure 1). To obtain histologic characteristics, the abdomen was opened through a left pararectal incision. Immediately, it became clear that there was tumor infiltration into the left rectus muscle. A large biopsy specimen of this tissue was taken, as well as incisional biopsy specimens of tumor infiltrating the mesentery (Figure 2). The tumor was considered unresectable because of diffuse large- and small-bowel mesenteric invasion. The patient is currently being treated with tamoxifen citrate, 40 mg/d, and was responding well at this report, 7 months after the operation.
What is your diagnosis?
A.Gastrointestinal stromal tumor B.Fibrosarcoma C.Desmoid tumor D.Ovarian carcinoma
Hemmer PH, Zeebregts CJ, van Baarlen J, Klaase JM. Image of the Month—Quiz Case. Arch Surg. 2004;139(2):223. doi:10.1001/archsurg.139.2.223
Coronavirus Resource Center
Create a personal account or sign in to: