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V/S BP 120/80 mmHg HR 84/min
ROS
melena/hematochezia (-/-) bowel habit change (-) bearing down sensation
PMHx.
hemorrhoidectomy, 14 YA
CT
submucosal mass lesion at the anterior portion of rectum
lymphadenopathy, 1.2 x 0.5 cm, the left mesentery at the kidney level
no mass lesion in the liver and other solid organs in the abdomen
ascites (-)
lung and bone : within normal limits
Colonoscopy
nodular elevated lesion at AV 12cm 4-5cm sized elevated lesion covering mucosa : normal at the margin hyperemic and nodular mucosa at the center hard in consistency
Impression)
#1. lymphoma #2. invasion of gynecologic malignancy #3. polyp
Differential diagnosis of rectal submucosal tumor
Non-neoplastic lesion Neoplastic lesion
Intramural origin Extramural origin
EndometriosisVascular lesionsCystic lesionsHematoma
Endometriosis
Onset : child bearing age Site : Rectosigmoid area (96%), appendix, ileumSymptom : asymptomatic localized tenderness, low back pain intermittent abdominal pain, consipation hematochezia (rare) - usually not related to menstrual cycleDiagnosis : Clinical suspicion – IBS Colonoscopy and biopsy CT : well enhancing mass
Differential diagnosis of rectal submucosal tumor
Non-neoplastic lesion Neoplastic lesion
Intramural origin Extramural origin
LipomaCarcinoid tumorHemangiomaGISTLymphomaOther primary tumors
Metastatic tumorDirect invasion of extracolonic tumor
Lymphoma
Primary lymphoma of intestine Stomach > small intestine > large intestine
Lymphoma of large intestine mostly non-Hodgkin B-cell lymphoma ileocecal area – rectosigmoid region
Symptom : non-specific bleeding, obstruction
Morphologic manifestation : fungating mass, infiltration, ulcer, SMT