E3C-Native
Collection
E3C dataset in the 5 original languages (Basque, English, French, Italian, Spanish). Each dataset comes with a train-validation-test split
•
6 items
•
Updated
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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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| EN101783 |
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| EN101783 |
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| EN101783 |
Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. | [
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| EN101783 |
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| EN101783 |
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| 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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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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"text": "The cytoplasmic membrane",
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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 |
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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 |
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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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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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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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| 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 |
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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 |
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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 |
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| EN100700 |
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| 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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| EN100700 |
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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 |
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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 |
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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. | [
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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 |
Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. | [
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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 dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. | [
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"text": "some B lymphocytes CD20+",
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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 |
Locally diminished actin coloration indicated atrophy of smooth muscle fibers. | [
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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 |
Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. | [
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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 ectopic tissue 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 |
The postoperative period was uneventful. | [
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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 |
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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 |