55 y/o HIV positive man has a fungating mass growing out of his anus
which he can feel when he wipes himself after a bowel movement but is
not painful. For the past 6 months he’s noted blood on the tissue and
from time to time he has noted blood coating the outside of his stool.
He has lost weight and looks emaciated and ill.  On physical exam,
the mass is easily visible. It measures 3.5 cm in diameter, is fixed to
surrounding tissues and appears to grow out of the anal canal.  He
also has rock-hard, enlarged inguinal lymph nodes on both groins, some
of which as large as 2.5 cm in diameter.  Which of the following
is the most likely diagnosis?

A. Adenocarcinoma of the rectum

B. Condyloma acuminata of the anus

C. External hemorrhoids

D. Rectal prolapse

E. Squamous cancer of the anus


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