Fungating Anal Mass: Extrapulmonary Small Cell Carcinoma Masquerading as a Hemorrhoid

Excerpt

An 81-year-old man was referred to the general surgery service from the emergency department for surgical evaluation of a single, enlarged, thrombosed hemorrhoid. His past medical history was significant for coronary artery disease, hypertension, iron deficiency anemia, prostate cancer treated with brachytherapy, and banding for hemorrhoids. A colonoscopy one-year prior to presentation was negative for pathology. He was found to have a fecal immunochemical test positive for occult blood. His hemoglobin and hematocrit on presentation were 12.3 g/dL and 37.7%, respectively. Physical examination in the surgery clinic revealed a fungating, hard, irregular mass at the right posterolateral position originating from the anal canal (Fig. 1). On digital rectal examination, the mass was found tracking into the anal canal and fixed to the pelvic sidewall. There was no palpable inguinofemoral lymphadenopathy. No other abnormalities were noted on physical exam.

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