Rectal Mass in a Pregnant Patient: How Come?

A 23-year-old pregnant Native American woman was initially evaluated at the onset of labor with the additional complaint of severe constipation and the finding of iron deficiency anemia. Immediately following manual disimpaction of feces, her rectum prolapsed revealing a 4 cm 9 4 cm bleeding mass. Following a successful Cesarean section, colonoscopy later revealed a 10 cm circumferential, necrotic mass with histologic characteristics of a moderately differentiated, invasive adenocarcinoma with IHC staining characteristic of LS. She left without resolving this problem. Because LS is a common cause of hereditary CRC, screening for LS and MSI is now increasingly being advocated. Early identification of those affected can reduce mortality from colon and a number of other cancers, particularly in females. Awareness of the issue is particularly important in Native American communities where screening rates are low and death rates from CRC are high, particularly in the western USA and in Alaska.