Case Presentation:
A 19-year-old man came to the outpatient gastrointestinal clinic complaining of rectal bleeding and severe constipation. He had a history of constipation and tenesmus since childhood. His symptoms intensified and presented with rectal bleeding recently, so he came to the clinic. He didn’t have any past medical or past surgical history and didn’t use any medication. His family history of bowel disease and colorectal cancers were unremarkable. He had no complaint of recent weight loss or abdominal pain.
At First, general physical examinations were performed, and there were no abnormalities except pallor. Digital rectal examination was impossible to perform due to partial obstruction of the lumen of the rectum. His blood pressure was 115/75 mm Hg, his heart rate was 96 bpm, his body temperature was 36.6°C, his respiratory rate was 18, and his oxygen saturation was 97% without supplementation.
On his laboratory investigation, his white blood cell count was 7,600, his hemoglobin was 10.9 gm/dl, his hematocrit was 38.8%, his mean corpuscular volume was 65 FL, his ferritin was 6.3 ng/ml, his platelet count was 361,000 and his erythrocyte sedimentation rate (ESR) was 5 mm/h. There was evidence in favor of hypochromic microcytic anemia as a result of iron deficiency anemia. Coagulation profile and liver function tests were within normal ranges. Examinations of stool for parasites and cultures were negative. Occult blood of stool was positive repeatedly.
According to the colonoscopy indications in this patient such as positive occult blood of stool and iron deficiency anemia as a result of gastrointestinal blood loss, colonoscopy was performed and revealed one large semi-circumferential infiltrative fungoides mass lesion in the rectum at 5 cm of the anal verge. (Figure 1) The entire colon up to the cecum was observed to be normal. As the mass was suspected to be malignant, biopsy was taken.