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Gardner's Syndrome

Double Trouble

Step 1: View clinicals

A 17 year old girl presents with a rapidly enlarging, painless lump in the right loin for two weeks. She also gives a history of intermittent passage of fresh blood per rectum for a few months. This was attributed to hemorrhoids and was not investigated further. Her medical and family histories are unremarkable. A full blood count, urea and electrolytes and liver profile are found to be normal.

Step 2: Order all relevant investigations

CT Abdomen & Pelvis

A large, well demarcated soft tissue mass arising from the right latissimus dorsi muscle is noted. No other abnormalities are seen.

Colonoscopy & biopsy

Colonoscopy reveals numerous polyps < 5 mm in size carpeting the entire colon and rectum. Multiple polyps are biopsied. Histology shows them to be tubular adenomas with varying degrees of dysplastic transformation.

Upper GI endoscopy

No abnormalities are noted.

Incision biopsy

An incision biopsy will be arranged next week.

Step 3: Select appropriate management

Complete excision of lump
Screen relatives

Score: ★★☆