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Case report-right iliac fossa mass in an HIV-positive woman. Cryptococcal meningitis.

A 35 year old woman was admitted to Queen Elizabeth Central Hospital (QECH) with fever, abdominal pain and vomiting for 3 days. A week earlier she had started antiretroviral therapy (ART) in a clinical trial in Blantyre, Malawi, after meeting all the requirements of the study. At the time of enrolment, her CD4 count was 19/µl, and viral load >400,000 copies/ml. She was started on a combination of amtricitabine (FTC), tenofivir (TDF) and atazanavir (ATV). 
 
At the present admission, she looked ill. Her axillary temperature was 38°C, blood pressure 110/70 mmHg, pulse rate 100/minute, weight 56Kg. The abdomen was tender to touch without any palpable enlarged organs. A full blood count showed a haemoglobin concentration of 9.8g/dl, other parameters being within normal limits. Blood biochemistry and liver function tests were normal. A blood sample for culture was taken which remained sterile after 7 days of incubation. The patient was started on empirical intravenous broad spectrum antibiotic (ceftriaxone 2g once a day) for possible sepsis. 
 
Two days later the patient remained ill and examination now revealed a right iliac fossa mass which was tender to touch. A bimanual pelvic examination suggested that the mass was arising from the pelvis. A gynecological review confirmed the findings. An ultrasound of the abdomen and pelvis identified a mass arising from the pelvis but was unable to define the organ of origin. Intravenous metronidazole was added to ceftriaxone. After ten days of antibiotic treatment, there was no clinical response. 
 
The gynecologists decided to take the patient for surgical exploration. During the procedure a mass was found affecting the ileocaecal junction and the whole of the ascending colon. The visual findings were suggestive of a carcinoma of the ascending colon with areas of perforation. A hemi-colectomy was done (see figure 1-gross specimen of the colon) 
 
 
 
Figure 1 
 
Part of the resected tumor 
 
 
 
The patient remained unwell and died two weeks later in hospital after repeated breakdown of the anastomosis site. A histology report came out two days after the patient died. 
 
What is the diagnosis?