At presentation, the patient had an indwelling Foley catheter that was draining brown, cloudy urine. Laboratory test results indicated mild anemia (hemoglobin level, 10.1 g/dL) and normal transaminase levels (aspartate aminotransferase/alanine aminotransferase, 27/23 U/L) but an elevated bilirubin level of 9.2 mg/dL and an α1-fetoprotein level of 280 ng/mL. (To convert hemoglobin to grams per liter, multiply by 10; aspartate aminotransferase and alanine aminotransferase to microkatals per liter, multiply by 0.0167; bilirubin to micromoles per liter, multiply by 17.104; and α1-fetoprotein to micrograms per liter, multiply by 1.) We obtained another computed tomographic image, which demonstrated a large necrotic pelvic mass measuring 8.7 × 7.3 cm and extending to the sigmoid colon with associated wall thickening (Figure 1). The mass communicated with the prostate and the urinary bladder (Figure 2). Although there were no focal lesions in the liver allograft, we noted radiographic evidence of portal hypertension, including prominent venous collaterals in the left side of the upper abdomen.