A 53-year-old woman was referred by her oncologist for a diagnostic colonoscopy. The patient gave a history of abdominal pain three months ago. The patient underwent complete investigations. Computed tomography of the abdomen revealed a small hepatic focal lesion with minimal ascites. PET/CT showed a bony osteolytic lesion besides the focal hepatic lesion in the lumbar vertebrae and increased metabolic activity in the right colon. The patient underwent a colonoscopy that revealed a protruding mass at the right colon 15 min from the beginning of the procedure. The trial for taking biopsies failed; the axis of the forceps is away from the mass. Any trial for repositioning leads to displacement of the scope and the forceps away from the mass (introduction and withdrawal, suction of air, flushing with water, changing the patient position, etc.). After that, it took about 16 min to reach the mass again and take biopsies, but with difficulties, and only two biopsies were taken blindly and with suction. To reach just before the mass, only 40 cm from the scope was used, but to reach the mass, a long loop was made, and the scope was used up to the end of the insertion tube.
QUESTIONS:
1- Do you have any cases like the above?
2- what are suggestions for biopsies from this mass?
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