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A 67-year-old man was referred urgently by his primary care practitioner with rectal bleeding. The patient reported a single episode of dark red blood per rectum, without associated abdominal pain, change in bowel habit or weight loss. He had a background of a congenital bicuspid aortic valve, and prostate cancer treated with prior radiotherapy and ongoing hormonal therapy. He was on aspirin but no other anticoagulation. Physical examination of the abdomen and rectum was unremarkable. Haemoglobin was within the normal range (13.7 g/dL).
To further investigate the rectal bleeding, he underwent colonoscopy which demonstrated a 10 cm polypoid lesion with tip ulceration arising from the cecum in the region of the ileocaecal valve (figure 1). Biopsies were taken.
How would you further investigate and what is the most likely diagnosis?
Contributors URQ is the primary author and submitted the report. TPC was involved in reviewing and the final drafting of the manuscript. PJB was the endoscopist of the case and involved in reviewing and final drafting of the manuscript. Tara Walker, Consultant Histopathologist at Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, served as reporting and advising histopathologist of this case.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.