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A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia.
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A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.
EN101783
Hormonal study and dynamic biochemical tests performed indicated ECS.
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A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.
EN101783
Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases.
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A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.
EN101783
Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis.
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A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.
EN101783
The patient underwent right parotidectomy, and histopathologic examination confirmed ACC.
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A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.
EN101783
Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide.
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A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.
EN101783
Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.
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A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.
EN101783
We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The medical history was unremarkable and no comorbidities existed.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
There was no history of radiation exposure.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
Clinical examination revealed a multinodular goiter.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
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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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
There was no evidence of lung lesions.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The patient underwent a surgical exploration.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
A total thyroidectomy was realized.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
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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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
Tumor cells are atypical with strange nuclei.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
Chromatin is distributed inhomogeneously.
[]
We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The cytoplasmic membrane is irregular and thick.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The nucleolus is very large.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The neoplasia showed invasion of the peri-glandular fat tissue.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
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.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
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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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
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We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter. 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. There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue. 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. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
EN100310
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US).
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Her neonatal period was unremarkable.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Clinical findings: on physical examination, she was colored and active.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg).
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Abdomen was soft on palpation and tympanic on percussion.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
The digital rectal examination was unremarkable.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid).
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Timeline: our patient experienced first symptoms since August 2019.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
The patient has been treated and discharged in August 2020 and pathology results were available 11 days later.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Diagnostic assessment: blood results were within normal range.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Abdominal X-ray showed distension of an intestinal loop in the left lumbar region.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Contrast enema was unremarkable.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
It measured ten cm in length and had prominent serosal vessels.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Adjacent mesentery was thickened.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
No further anatomic anomaly was identified.
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A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches.
[ { "id": "8428", "offsets": [ 2, 11 ], "role": "", "semantic_type_id": "", "text": "resection", "type": "EVENT" }, { "id": "8443", "offsets": [ 83, 94 ], "role": "", "semantic_type_id": "", "text": "anastomosis", "type": "EVENT" } ]
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria.
[ { "id": "8458", "offsets": [ 0, 9 ], "role": "", "semantic_type_id": "", "text": "Follow-up", "type": "EVENT" }, { "id": "8473", "offsets": [ 14, 22 ], "role": "", "semantic_type_id": "", "text": "outcomes", "type": "EVENT" }, { "id": "8488", "offsets": [ 36, 47 ], "role": "", "semantic_type_id": "", "text": "examination", "type": "EVENT" }, { "id": "8503", "offsets": [ 48, 56 ], "role": "", "semantic_type_id": "", "text": "revealed", "type": "EVENT" }, { "id": "8518", "offsets": [ 71, 83 ], "role": "", "semantic_type_id": "", "text": "infiltration", "type": "EVENT" }, { "id": "8807", "offsets": [ 59, 83 ], "role": "", "semantic_type_id": "C1262091", "text": "lymphocytic infiltration", "type": "CLINENTITY" }, { "id": "8915", "offsets": [ 102, 124 ], "role": "", "semantic_type_id": "", "text": "the muscularis propria", "type": "BODYPART" } ]
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+.
[ { "id": "8533", "offsets": [ 22, 34 ], "role": "", "semantic_type_id": "", "text": "infiltration", "type": "EVENT" }, { "id": "8814", "offsets": [ 10, 34 ], "role": "", "semantic_type_id": "C1262091", "text": "lymphocytic infiltration", "type": "CLINENTITY" }, { "id": "8921", "offsets": [ 61, 82 ], "role": "", "semantic_type_id": "", "text": "T lymphocytes CD3+/8+", "type": "BODYPART" }, { "id": "8927", "offsets": [ 97, 121 ], "role": "", "semantic_type_id": "", "text": "some B lymphocytes CD20+", "type": "BODYPART" } ]
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Locally diminished actin coloration indicated atrophy of smooth muscle fibers.
[ { "id": "8548", "offsets": [ 25, 35 ], "role": "", "semantic_type_id": "", "text": "coloration", "type": "EVENT" }, { "id": "8563", "offsets": [ 36, 45 ], "role": "", "semantic_type_id": "", "text": "indicated", "type": "EVENT" }, { "id": "8578", "offsets": [ 46, 53 ], "role": "", "semantic_type_id": "", "text": "atrophy", "type": "EVENT" }, { "id": "8821", "offsets": [ 46, 77 ], "role": "", "semantic_type_id": "C0333751", "text": "atrophy of smooth muscle fibers", "type": "CLINENTITY" }, { "id": "8933", "offsets": [ 57, 77 ], "role": "", "semantic_type_id": "", "text": "smooth muscle fibers", "type": "BODYPART" } ]
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration.
[ { "id": "8593", "offsets": [ 74, 80 ], "role": "", "semantic_type_id": "", "text": "intact", "type": "EVENT" }, { "id": "8828", "offsets": [ 129, 153 ], "role": "", "semantic_type_id": "C1262091", "text": "lymphocytic infiltration", "type": "CLINENTITY" }, { "id": "8939", "offsets": [ 0, 12 ], "role": "", "semantic_type_id": "", "text": "Nerve fibers", "type": "BODYPART" }, { "id": "8945", "offsets": [ 17, 31 ], "role": "", "semantic_type_id": "", "text": "ganglion cells", "type": "BODYPART" }, { "id": "8951", "offsets": [ 49, 68 ], "role": "", "semantic_type_id": "", "text": "submucosal plexuses", "type": "BODYPART" }, { "id": "8957", "offsets": [ 107, 121 ], "role": "", "semantic_type_id": "", "text": "NK CD56+ cells", "type": "BODYPART" } ]
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
No ectopic tissue was identified.
[ { "id": "8608", "offsets": [ 11, 17 ], "role": "", "semantic_type_id": "", "text": "tissue", "type": "EVENT" }, { "id": "8623", "offsets": [ 22, 32 ], "role": "", "semantic_type_id": "", "text": "identified", "type": "EVENT" } ]
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
The postoperative period was uneventful.
[ { "id": "8638", "offsets": [ 29, 39 ], "role": "", "semantic_type_id": "", "text": "uneventful", "type": "EVENT" }, { "id": "9170", "offsets": [ 4, 17 ], "role": "", "semantic_type_id": "", "text": "postoperative", "type": "TIMEX3" } ]
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
The patient was on parenteral nutrition until day seven postoperatively.
[ { "id": "8653", "offsets": [ 30, 39 ], "role": "", "semantic_type_id": "", "text": "nutrition", "type": "EVENT" }, { "id": "9054", "offsets": [ 0, 11 ], "role": "PATIENT", "semantic_type_id": "", "text": "The patient", "type": "ACTOR" }, { "id": "9179", "offsets": [ 46, 55 ], "role": "", "semantic_type_id": "", "text": "day seven", "type": "TIMEX3" }, { "id": "9188", "offsets": [ 56, 71 ], "role": "", "semantic_type_id": "", "text": "postoperatively", "type": "TIMEX3" } ]
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
EN100700
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