Bleeding Abdominal Mass in a Patient With Genetic Cutaneous Disorder

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A 72-year-oldman presented to the hospital after sustaining a fall, with prior generalized weakness and fatigue.Hehadbeenhaving recurrent gastrointestinal bleeding andmelena during the past year. He reported a 6.75-kgweight loss during the past fewmonths but did not have abdominal pain, nausea, vomiting, fevers, or chills. His surgical history was notable for a coronary artery bypass graft 9months earlier and γ-knife resection of an acoustic neuroma 10 years ago. Physical examination revealed a soft, nontender abdomen without obvious palpable masses. Inspection of the patient’s skin demonstrated multiple fleshy, soft cutaneous nodules (Figure 1A). The patient’s laboratory testing was only notable for anemia with a hemoglobin level of 10.4 g/dL (reference range, 12-16 g/dL). A prior extensive examination, including upper and lower endoscopy, upper gastrointestinal series with small-bowel follow-through, and capsule endoscopy did not reveal a diagnosis. A computed tomography image of the abdomen and pelvis is shown in Figure 1B. A B