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.