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100310
1
We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck.
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100310
2
The medical history was unremarkable and no comorbidities existed.
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100310
3
There was no history of radiation exposure.
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100310
4
Clinical examination revealed a multinodular goiter.
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100310
5
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
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100310
6
There was no evidence of lung lesions.
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100310
7
The patient underwent a surgical exploration.
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100310
8
There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea.
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100310
9
The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma.
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100310
10
A total thyroidectomy was realized.
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100310
11
Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles.
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100310
12
Tumor cells are atypical with strange nuclei.
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100310
13
Chromatin is distributed inhomogeneously.
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100310
14
The cytoplasmic membrane is irregular and thick.
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100310
15
The nucleolus is very large.
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100310
16
The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule.
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100310
17
The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present.
[ [ "high", "rate" ], [ "19 mitosis/10 high power field", "rate" ] ]
100310
18
The neoplasia showed invasion of the peri-glandular fat tissue.
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100310
19
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed.
[]
100310
20
The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers.
[ [ "negative", "markers" ], [ "negative", "pancytokeratin" ] ]
100310
21
On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
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100310
22
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
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100339
1
A 21-year-old male was referred to the gastroenterology clinic for incidental findings of severe chronic pancreatitis on cross-sectional imaging but no associated symptoms of pancreatitis.
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100339
2
He had presented to the emergency department for abdominal pain consistent with prior episodes of renal colic.
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100339
3
Computed tomography scan confirmed the presence of renal calculi that passed with conservative management.
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100339
4
An incidental finding on the imaging showed marked pancreatic atrophy with multiple sub-centimeter calcifications consistent with severe chronic pancreatitis.
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100339
5
Remarkably, he did not report having any symptoms associated with pancreatic insufficiency including epigastric pain, vomiting, steatorrhea and weight loss.
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100339
6
He denied having any prior episodes of acute pancreatitis and had no history of alcohol use.
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100339
7
His laboratory tests were all within normal range, including complete blood count, liver function tests, amylase and lipase.
[ [ "normal range", "tests" ], [ "normal range", "tests" ], [ "normal range", "count" ], [ "normal range", "lipase" ], [ "normal range", "amylase" ] ]
100339
8
His family history was significant as his father had an isolated episode of pancreatitis which required abdominal surgery.
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100339
9
Magnetic resonance cholangiopancreatography (MRCP) showed severe parenchymal atrophy and pancreatic ductal stones with ductal dilation to 9mm.
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100339
10
Due to his young age and atypical presentation, he was referred for genetic testing and counselling.
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100339
11
He underwent genetic testing for various genes known to cause hereditary pancreatitis: CASR, CFTR, CTRC, PRSS1, SPINK1.
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100339
12
He tested positive for homozygous variant of SPINK1 (N34S) mutation.
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100339
13
Reflex testing of at-risk relatives confirmed that both of his parents were heterozygous carriers of the same SPINK1 (N34S) mutation and a review of their extended pedigree revealed that they were distant cousins.
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100339
14
Given his asymptomatic clinical course, he remains under close follow-up without requiring any specific treatment for pancreatic insufficiency.
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100339
15
Due to the severity of pancreatitis noted on imaging and long expected lifespan, he was counselled about the increased risk of pancreatic malignancy and is undergoing regular cross-sectional imaging for the detection and prevention of cancer.
[]
100345
1
A 20-year-old right-handed female factory worker with no medical history is consulting in the emergency ward with an open trauma of the left hand resulting from an occupational accident.
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100345
2
Her hand was crushed under a heavy object.
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100345
3
Physical examination found an important swelling and obvious distortion at the dorsum of the hand associated with wounds of the ulnar and radial edges of the left hand.
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100345
4
The neurovascular examination was normal; in particular no sensitive deficit in the median nerve area was noted.
[ [ "normal", "examination" ] ]
100345
5
Plain radiographs with front and lateral views showed a dislocation of the three lesser fingers associated with fractures of the hamatum and the second metacarpal.
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100345
6
The three lesser metacarpals and the distal fragment of the hamatum were medially displaced.
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100345
7
The patient was immediately brought to the operating theatre.
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100345
8
The treatment consisted of a reduction and stabilisation using a multiple carpo-metacarpal and cross inter-metacarpal pinning.
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100345
9
The wound was cleaned up trimmed and sutured.
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100345
10
The had and the wrist were immobilized with a splint for six weeks.
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100345
11
The patient had an intense and regular rehabilitation program.
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100345
12
At one year follow-up, the outcome is good: the patient is painless with good bone consolidation in right position, strictly normal range of motion (metacarpophalangeal 90°, proximal interphalagienne 100° and distal interphalageal 90°) and a 80% grip strength compared to the right side.
[ [ "90°", "metacarpophalangeal" ], [ "100°", "interphalagienne" ], [ "90°", "interphalageal" ], [ "80%", "strength" ] ]
100385
1
A 45 year old female with history of sickle cell disease presented with abdominal pain.
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100385
2
A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen.
[ [ "2.9cm x 2.0cm x 2.1cm", "measuring" ] ]
100385
3
She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive.
[ [ "positive", "test" ] ]
100385
4
The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass.
[]
100385
5
The lesion increased minimally in size.
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100385
6
Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum.
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100385
7
A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
[]
100385
8
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million.
[ [ "300,000", "count" ], [ "1.3 million", "count" ] ]
100385
9
She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound.
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100385
10
Her platelet count normalized to 334,000.
[ [ "334,000", "count" ] ]
100385
11
On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma.
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100385
12
There was no splenic tissue in the specimen.
[]
100385
13
It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
[]
100385
14
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules.
[]
100385
15
The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
[ [ "within normal limits", "count" ] ]
100415
1
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration.
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100415
2
There was no vomiting or weight loss.
[]
100415
3
Bowel movements were normal.
[]
100415
4
Clinical examination at the time was unrevealing.
[ [ "unrevealing", "examination" ] ]
100415
5
An abdominal ultrasound examination was reported as normal.
[ [ "normal", "examination" ] ]
100415
6
The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
[]
100415
7
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis.
[ [ "6cm", "diameter" ] ]
100415
8
She was prepared for exploratory laparotomy.
[]
100415
9
The pancreas was explored through the gastrocolic omentum.
[]
100415
10
The body and tail of the pancreas including the tumour were resected.
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100415
11
The spleen was also removed.
[]
100415
12
The end of the pancreas was suture ligated.
[]
100415
13
Her post-operative recovery was uneventful.
[]
100415
14
Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across.
[ [ "60mm x 50mm across", "tumour" ] ]
100415
15
Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli.
[]
100415
16
Areas of necrosis were present with hemorrhage.
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100415
17
A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete.
[]
100415
18
No capsular of vascular invasion was seen.
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100415
19
Immuno-peroxidase staining was positive for chromogranin A.
[ [ "positive", "staining" ], [ "positive", "chromogranin" ] ]
100415
20
Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf.
[ [ "strongly positive", "Synaptophysin" ], [ "negative", "CD10" ], [ "less than 2% positive", "Ki-67" ], [ "2-20 per 10 hpf", "count" ] ]
100415
21
The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas.
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100415
22
The final staging of the completely excised tumour was T3 N0 M0.
[ [ "T3 N0 M0", "staging" ] ]
100415
23
Following discharge, she was followed up regularly and remains symptom free.
[]
100415
24
A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
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100432
1
A 64-year-old woman was admitted to our institution with palpable lump in her left breast.
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100432
2
Patient had not any previous medical and family story of cancer and denied any use of alcohol and cigarettes.
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100432
3
She took oral contraception for 5 years.
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100432
4
Her menarche was at age 12.
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100432
5
Physical examination revealed a 3 cm tumor located on the left breast adhere to deep plans.
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100432
6
There was no retraction of the nipple, skin ulceration or inflammatory changes.
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100432
7
The right breast exam was negative and there was no clinical evidence of axillary lymph node involvement.
[ [ "negative", "exam" ] ]
100432
8
Mammography revealed a 2.6 cm round hyperdense mass with irregular and speculated margins in the subareolar area with associated microcalcifications within the mass.
[]
100432
9
The mass was categorized as Breast Imaging Reporting and Data System category 5.
[ [ "5", "category" ] ]
100432
10
Fine needle aspiration and a core biopsy of the lesion were performed and the diagnostic was tubular carcinoma of the breast.
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100432
11
The patient underwent left lumpectomy with axillary node dissection.
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100432
12
The macroscopic (gross) examination of specimens revealed the presence of a nodule measuring 1.5 cm in its largest diameter.
[ [ "1.5 cm", "measuring" ], [ "1.5 cm", "diameter" ] ]
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