RT Journal
A1 Umoh NJ, Khoo RH
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD December 1
VO 147
IS 12
SP 1149
OP 1149
DO 10.1001/archsurg.2011.2230a
UL http://dx.doi.org/10.1001/archsurg.2011.2230a
AB 
A 58-year-old woman with a history of ulcerative colitis and subsequent total proctocolectomy and end ileostomy 35 years prior presented with a 2-year history of peristomal polypoid lesions. The lesions were associated with occasional bleeding but no pain. She had no obstructive symptoms. Prior biopsies revealed acute and chronic inflammation. She was treated with cromolyn sodium, 2%, without significant regression. Because the lesions were increasing in size, she was referred to our clinic for further management. Examination revealed a friable, nontender polypoid mass surrounding the ileostomy (Figure 1). Repeated biopsies were performed. Her carcinoembryonic antigen level was 3.6 ng/mL (to convert to micrograms per liter, multiply by 1.0). Positron emission tomography and computed tomography revealed an intensely fluorodeoxyglucose-avid peristomal mass and right inguinal lymph node (Figure 2).