1/35. Pseudo sister mary joseph's nodule.The sister mary joseph's nodule is a significant finding in the physical examination. It is sometimes the only indication of an intra-abdominal metastatic malignancy. We report a patient who presented with an umbilical nodule that was discovered to be an omphalith. A review of the literature discusses the sister mary joseph's nodule and this unusual finding.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/35. A case of a primary ovarian leiomyosarcoma.A primary ovarian leiomyosarcoma is extremely rare. Moreover, there is no established treatment modality other than surgery, and the prognosis is extremely poor. We report a case of a primary ovarian leiomyosarcoma. The patient was a gravida 4, para 2, 73-year-old female. She first presented with chief complaints of constipation and a pelvic mass. A physical examination revealed a solid tumor in the pelvic cavity. Which was about the size of an infant's head and had an irregular shape. The patient was suspected of having a subserosal myoma of the uterus or an ovarian tumor, and she was subjected to a laparotomy. A solid tumor about the size of an infant's head was found in the left uterine adnexa, and an intraoperative rapid pathological diagnosis of an ovarian leiomyosarcoma was made. A total abdominal hysterectomy, a bilateral salpingo-oophorectomy, a pelvic lymphadenectomy, and an omentectomy were then performed. The final pathological diagnosis confirmed a left primary ovarian leiomyosarcoma. After a series of discussions with the patient's family about her therapeutic plan, we decided to let the patient be followed-up without adjuvant therapy. Forty-two months after the surgery, the patient accumulated massive amounts of pleural effusion and ascites, with extensive organ metastasis. She received terminal care and soon died.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/35. Solitary metastatic carcinoma of the spleen.A care is reported in which an isolated metastatic lesion of the spleen was discovered one year after a modified radical mastectomy for carcinoma of the breast, and seven years following total hysterectomy and bilateral salpingo-oophorectomy for carcinoma of the left ovary. splenectomy was followed by significant clinical improvement of the patient who remains alive and well four years after operation. Regular physical and roentgen examinations have revealed no evidence of recurrent disease. The factors relating to the occurrence of solitary splenic metastasis are discussed briefly. This case is apparently the fifth reported in the literature.- - - - - - - - - - ranking = 0.10280387788637keywords = physical (Clic here for more details about this article) |
4/35. Cases from the Osler Medical Service at Johns Hopkins University.A 73-year-old man who had been receiving chronic anticoagulation treatment with warfarin for multiple prior strokes presented to the hospital because of several weeks of pain in his right calf. He also complained of several months of anorexia and weight loss of 20 lbs. On physical examination, he was thin and showed signs of temporal wasting. There was minimal pitting edema in the right leg, with a positive Homans' sign. lower extremity Doppler ultrasound showed a popliteal thrombus. The morning after admission, he developed an acutely swollen, painful upper extremity and was found to have an occlusive clot in the left subclavian vein. Because these thrombi occurred in the setting of a therapeutic prothrombin time (international normalized ratio, 2.7) on warfarin, he was begun on treatment with intravenous heparin.What is the diagnosis?- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/35. Differences in the integration pattern and episomal forms of human papillomavirus type 16 dna found within an invasive cervical neoplasm and its metastasis.Human papillomavirus (HPV) type 16 dna was found in three separate neoplastic lesions within a female patient. The physical state of the viral dna in each lesion was determined by two-dimensional agarose gel electrophoresis. The primary cervical tumor contained large amounts of several distinct episomal forms as well as integrated HPV dna. Metastatic tumor tissue found in the vagina had greatly reduced levels of episomal dna and a viral dna integration pattern that was different from that of the primary tumor. The vulvar carcinoma in situ had what appears to be free and integrated forms of viral dna. The results show that although metastatic tissue retained HPV dna, further rearrangements of the integrated viral dna pattern found in the primary tumor may occur with a dramatic decrease of episomal forms during malignant progression.- - - - - - - - - - ranking = 0.10280387788637keywords = physical (Clic here for more details about this article) |
6/35. Near-lethal respiratory failure after recombinant human thyroid-stimulating hormone use in a patient with metastatic thyroid carcinoma.A patient with widely metastatic differentiated thyroid cancer who had been heavily pretreated with (131)I was given recombinant human thyroid stimulating hormone (rhTSH) prior to (131)I treatment. Clinical and physical data from both this case and the literature suggest that the recombinant hormone, not the (131)I, may have caused a significant portion of the tumor swelling, which in turn was the most likely cause of the patient's symptoms. The potential effect of (131)I-induced tumor swelling and direct radiation effect on the lung is also analyzed. We review the potential hazards associated with rhTSH in patients with metastasis and propose means of minimizing this risk.- - - - - - - - - - ranking = 0.10280387788637keywords = physical (Clic here for more details about this article) |
7/35. Hepatic lymphoma metastasis presenting with severe acute liver failure: a rare case.Hepatic lymphoma metastasis is rare, and should always be considered in the differential diagnosis of hepatic malignancy. A 52-year-old man presented with a four-day history of fever, fatigue, yellowish skin and nausea. His past medical history was unremarkable. There was no history of alcohol intake or medications. His physical examination revealed generalized jaundice and hepatomegaly. His blood tests showed liver failure and coagulopathy. Abdominal ultrasonography illustrated hepatomegaly. A further work-up included bone marrow and liver biopsy. The pathology report was B-cell lymphoma. He was treated with chemotherapy, and his laboratory findings during follow-up showed steady improvement. In conclusion, lymphoma metastasis to liver can be a cause of liver dysfunction. A high index of suspicion is required for the diagnosis. We emphasize the importance of obtaining tissue sample in all patients with suspicious lesion in any organ to avoid missing the rare but curable pathologies.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/35. Ovarian teratoma with diffused peritoneal reactions mimicking advanced ovarian malignancy.BACKGROUND: Benign cystic teratomas are one of the most common benign ovarian neoplasms. Although its rupture is rare, once occurred it can cause complications such as granulomatous peritonitis, mimicking metastatic ovarian malignancy. CASE: A 39-year-old woman, Para 0-0-0-0, presented to the hospital with rapid abdominal distention for 3 months. Her physical examination and ultrasonographic findings led to a diagnosis of advanced stage ovarian carcinoma. An exploratory laparotomy was performed and the operative impression was that of stage III ovarian carcinoma. Total hysterectomy with bilateral salpingo-oophorectomy and surgical staging were done. The postoperative pathology revealed a benign cystic teratoma of right ovary with chronic granulomatous peritonitis. She was well at discharge and at her 1-year follow-up. CONCLUSION: Although ruptured a benign cystic teratoma is rare, it can cause granulomatous peritonitis, the clinical findings of which mimic advanced stage ovarian carcinoma. This warrants physicians to be aware of and intraoperative frozen section should be used, its correct management will provide a good outcome with less complication.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/35. Clear cell hidradenoma: a mimic of metastatic clear cell tumors.Clear cell hidradenoma is a benign skin appendage tumor that may mimic conventional-type renal cell carcinoma. Histologically, clear cell hidradenoma contains small ductular lumens, focal apocrine and squamoid change, and a less prominent vascular pattern than renal cell carcinoma. Furthermore, immunohistochemical studies can aid in distinguishing the 2 tumors. Knowing the cytologic features of primary skin adnexal neoplasms helps distinguish them from cutaneous metastases, which are more commonly referred for fine-needle aspiration biopsy evaluation. Detailed clinical history, physical findings, and ancillary studies are essential for correct diagnosis and categorization of these tumors. We report the rare case of a patient with renal cell carcinoma who underwent excision of an axillary clear cell hidradenoma, which was clinically suggestive of cutaneous metastatic disease.- - - - - - - - - - ranking = 0.10280387788637keywords = physical (Clic here for more details about this article) |
10/35. Treatment of metastatic gestational choriocarcinoma with oral methotrexate in a combat environment.BACKGROUND: Gestational trophoblastic neoplasia (GTN) is a rare neoplastic complication of pregnancy. This disease can be successfully treated with parenteral intravenous or intramuscular chemotherapy. We present a case of metastatic gestational choriocarcinoma following a term pregnancy that was treated successfully with oral methotrexate therapy. CASE: A 25-year-old, G4 P4, native Afghani with a history of irregular menses since the birth of her son 6 months ago received a physical examination that was within normal limits. Pelvic examination revealed minimal blood in the vault and slight bleeding from a closed cervical os. The uterus was slightly enlarged, 5 weeks in size, and without any adnexal masses. Laboratory evaluation was significant for a positive urine and serum beta-HCG. Pelvic ultrasound examination revealed a 5-cm uterus with a 2-cm endometrial stripe. Chest radiograph revealed multiple bilateral ill-defined pulmonary nodules confirmed by computerized tomography. The patient underwent dilation and curettage productive of a moderate amount of tissue. The patient continued to have positive serum beta-HCGs and was given the presumptive diagnosis of FIGO stage III gestational choriocarcinoma. Because of the lack of intravenous chemotherapeutic agents, the patient was begun on methotrexate 0.40 mg/kg orally on days 1-5, with 9 days off. The patient completed one course of chemotherapy, followed by an interval total abdominal hysterectomy with bilateral salpingo-oophorectomy. The patient had a complete response to therapy and was treated with oral methotrexate for 2 courses after a negative serum beta-HCG. The patient tolerated the chemotherapy without any complication. CONCLUSION: methotrexate is routinely used in a parenteral intramuscular fashion for the treatment of gestational choriocarcinoma. physicians should be aware that, in very limited situations, oral methotrexate in combination with hysterectomy still could offer a patient successful treatment for stage III GTN.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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