Clinical Images
A Painless Abdominal Mass
Sarah Dhannoon, MD, Ali Alsaad, MD, Sayed K. Ali MD, FACP
September 23, 2016
A 64-year-old man with a history of hypertension and hyperlipidemia was referred to our institution for significant weight loss and anemia. He was in his normal state of health until 4 months prior to his presentation. Over this time, he noted a 40-pound unintentional weight loss with some mild constipation.
He was up to date on age-appropriate cancer screening, including a normal colonoscopy one year prior to his presentation. He denied any fevers, night sweats, nausea, vomiting, diarrhea, melena or bright red blood in his stool. He lived with his wife and denied any alcohol, tobacco or illicit drug use. His family history was pertinent for diabetes in both parents, but no history of cancer.
On physical exam his vital signs were normal. The patient was alert and oriented to person, place and time. Mild conjunctival pallor was noted otherwise the remainder of his exam was normal. His labs on presentation showed a hemoglobin of 10.2 mg/dL (baseline 13 mg/dL), mean corpuscular volume of 84 fl, ESR of 126 mm/hr and LDH of 104 U/L. A urinalysis showed microscopic hematuria with no white blood cell or casts. A renal function panel, including serum electrolytes, was within normal limits. A fecal occult blood test was negative. He underwent CT imaging with contrast, and axial slices of the abdomen are shown in Figures 1 and 2.
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References:
1. Trans-Atlantic Working Group. Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol.2015;22(1):256-63
2. Mullimax JE, Zager JS, Gonzalez RJ. Current Diagnosis and Management of Retroperitoneal Sarcoma. Cancer Control 2011;18(3):177-87
About the authors:
Sarah Dhannoon, MD is a 1st year resident in Internal Medicine at the University of Central Florida, College of Medicine, Orlando, Florida.
Ali Alsaad, MD is a 1st year resident in Internal Medicine at the Mayo Clinic, Jacksonville, Florida.
Sayed K. Ali MD, FACP is a faculty member in the department of Internal Medicine at the Orlando VA Medical Center, Orlando, Florida.