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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 |
We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. | [
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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.
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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.
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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.
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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.
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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.
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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 |
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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 |
The neoplasia showed invasion of the peri-glandular fat tissue. | [
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] | We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter.
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue.
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
| EN100310 |
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. | [
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] | We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter.
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue.
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
| EN100310 |
The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. | [
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] | We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter.
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue.
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
| EN100310 |
On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3. | [
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] | We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter.
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue.
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
| EN100310 |
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin. | [
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] | We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter.
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue.
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
| EN100310 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. | [
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] | A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
| EN100700 |
Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. | [
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] | A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
| EN100700 |
She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). | [
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] | A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
| EN100700 |
Her neonatal period was unremarkable. | [
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] | A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
| EN100700 |
Clinical findings: on physical examination, she was colored and active. | [
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] | A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
| EN100700 |
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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 |
The patient was on parenteral nutrition until day seven postoperatively. | [
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] | A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
| EN100700 |
She was 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. | [
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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 |
For the future, the follow-up will be done on a three months basis for a year and then, twice yearly. | [
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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 |
Here we report a case of aggressive metastatic cholangiocarcinoma (MCC) in 72-year-old man, sequentially treated with two targeted chemotherapies. | [
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] | Here we report a case of aggressive metastatic cholangiocarcinoma (MCC) in 72-year-old man, sequentially treated with two targeted chemotherapies. Initially disease quickly progressed during best clinical practice care (gemcitabine in combination with cisplatin or capecitabine), which was accompanied by significant decrease of life quality. Monotherapy with TKI sorafenib was prescribed to the patient, which resulted in stabilization of tumor growth and elimination of pain. The choice of the inhibitor was made based on high-throughput screening of gene expression in the patient's tumor biopsy, utilized by Oncobox platform to build a personalized rating of potentially effective target therapies. However, time to progression after start of sorafenib administration did not exceed 6 months and the regimen was changed to monotherapy with Pazopanib, another TKI predicted to be effective for this patient according to the same molecular test. It resulted in disease progression according to RECIST with simultaneous elimination of sorafenib side effects such as rash and hand-foot syndrome. After 2 years from the diagnosis of MCC the patient was alive and physically active, which is substantially longer than median survival for standard therapy.
| EN103220 |
Initially disease quickly progressed during best clinical practice care (gemcitabine in combination with cisplatin or capecitabine), which was accompanied by significant decrease of life quality. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The mass took the front and the two sides of the neck. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The goiter measured 18 x 11 cm. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The mass was firm, painless, and mobile with the swallowing movements. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
Lymphadenopathy research was difficult and found no palpable lymph nodes. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The laboratory tests (T 3, T 4 and TSH) were normal. | [
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| EN100067 |
Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
It took heterogeneously the contrast and then evocate a large MNG. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
Endotracheal intubation was relatively easy by the laryngoscope. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The incision performed was a Kocher cervicotomy. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
There was a multinodular, hypervascularized goiter. | [
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| EN100067 |
Its lower end plunges behind the sternal manubrium. | [] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The larynx was deviated towards the right side. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The retrosternal part of the goiter was released using the finger by the same incision. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
The operation was finished by double aspiration drainage. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
In the first hours after surgery, the patient developed a large cervical hematoma. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. | [
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] | A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago. In the family history, her mother, sisters and cousins underwent a surgery for MNG. Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs. She never suffered from thyroid dysfunction. Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification. The mass took the front and the two sides of the neck. Its surface was embossed and covered by a thin normal skin. There were some veins of the collateral circulation limited to the neck. The goiter measured 18 x 11 cm. The mass was firm, painless, and mobile with the swallowing movements. Lymphadenopathy research was difficult and found no palpable lymph nodes. The laboratory tests (T 3, T 4 and TSH) were normal. Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea. Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum. It took heterogeneously the contrast and then evocate a large MNG. The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx. The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward. The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum. Endotracheal intubation was relatively easy by the laryngoscope. The incision performed was a Kocher cervicotomy. There was a multinodular, hypervascularized goiter. Its lower end plunges behind the sternal manubrium. The larynx was deviated towards the right side. The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy. The retrosternal part of the goiter was released using the finger by the same incision. Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage. One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle. The operation was finished by double aspiration drainage. In the first hours after surgery, the patient developed a large cervical hematoma. She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding. The operation was completed with a double suction drainage. In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine. After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped. Histological study concluded in multinodular colloid goiter. The patient was discharged from the hospital after 20 days in good health.
| EN100067 |
Subsets and Splits