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| EN100022 |
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| EN100022 |
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| EN100022 |
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| EN100022 |
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| EN100022 |
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| EN100022 |
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] | A 60 year-old man presented to an outside institution for septic shock with hematesis. He had a medical history of diabetes mellitus, hypertension and he was amputated right leg (trans-femoral amputation) for diabetic arteriopathy six months before admission complicated by venous thrombosis. Home medications included daily pioglitazone, atenolol, furosemide and anticoagulant with poor compliance. Initial examination revealed a patient in state of septic shock, respiratory rate 28 cycles per min, his pulse was regular with an apical rate of 120 beats/min, temperature 39° C, blood pressure 70/40 mmHg, he had necrotic and suppurative amputation stump with peripheral pulse abolished. Patient was given immediately oxygen, fluids, antibiotics, and drugs to increase blood pressure. Six hours later, the patient presented a single episode of hematemesis. There was no associated melena or abdominal pain. He had no history of alcohol use, liver disease, varices, peptic ulcer disease, abdominal aortic surgery, nonsteroidal anti inflammatory drug use, gastroparesis, or previous GI bleeding. Physical examination was unremarkable. Pertinent laboratory studies included a hemoglobin level of 10 g/dL, platelet count was normal, blood urea of 1,2 g/l (0,18-0,45 g/L), and a creatinine level of 68 mg/L (7-13 mg/L). After hemodynamic stabilization, an oesophageo-gastro-duodenoscopy was performed which showed: The upper third of the esophagus was circumferentially congestive, but the middle and lower third showed circumferential black pigmentation: the mucosa was black and covered by an exudate of the same color associated with diffuse bleeding. Gastric mucosa was strictly normal in direct vision and in retrovision, the bulb and duodenum were normal. Biopsie specimens were showed necrotic debris, mucosal submucosal necrosis with a local inflammatory response. The treatment of this condition was based continuous high dose omeprazole (8 mg / h) after bolus of 80mg and total parenteral nutrition. The patient experienced no further hematemesis or melena. Due to the severity of the necrosis, and with deterioration of his condition and persistent sepsis he died later in the same day.
| EN100022 |
Due to the severity of the necrosis, and with deterioration of his condition and persistent sepsis he died later in the same day. | [
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] | A 60 year-old man presented to an outside institution for septic shock with hematesis. He had a medical history of diabetes mellitus, hypertension and he was amputated right leg (trans-femoral amputation) for diabetic arteriopathy six months before admission complicated by venous thrombosis. Home medications included daily pioglitazone, atenolol, furosemide and anticoagulant with poor compliance. Initial examination revealed a patient in state of septic shock, respiratory rate 28 cycles per min, his pulse was regular with an apical rate of 120 beats/min, temperature 39° C, blood pressure 70/40 mmHg, he had necrotic and suppurative amputation stump with peripheral pulse abolished. Patient was given immediately oxygen, fluids, antibiotics, and drugs to increase blood pressure. Six hours later, the patient presented a single episode of hematemesis. There was no associated melena or abdominal pain. He had no history of alcohol use, liver disease, varices, peptic ulcer disease, abdominal aortic surgery, nonsteroidal anti inflammatory drug use, gastroparesis, or previous GI bleeding. Physical examination was unremarkable. Pertinent laboratory studies included a hemoglobin level of 10 g/dL, platelet count was normal, blood urea of 1,2 g/l (0,18-0,45 g/L), and a creatinine level of 68 mg/L (7-13 mg/L). After hemodynamic stabilization, an oesophageo-gastro-duodenoscopy was performed which showed: The upper third of the esophagus was circumferentially congestive, but the middle and lower third showed circumferential black pigmentation: the mucosa was black and covered by an exudate of the same color associated with diffuse bleeding. Gastric mucosa was strictly normal in direct vision and in retrovision, the bulb and duodenum were normal. Biopsie specimens were showed necrotic debris, mucosal submucosal necrosis with a local inflammatory response. The treatment of this condition was based continuous high dose omeprazole (8 mg / h) after bolus of 80mg and total parenteral nutrition. The patient experienced no further hematemesis or melena. Due to the severity of the necrosis, and with deterioration of his condition and persistent sepsis he died later in the same day.
| EN100022 |
A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. | [
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"text": "6 times",
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. | [
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"text": "25th gestational weeks",
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
At birth the girl was small for gestational age. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
Both pregnancies ended successfully. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight. | [
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] | A 35-year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times. The patient was treated with injections of Sandostatin LAR® (octreotide) during the first four pregnancies. Her first pregnancy in 1999 was unknown until approximately 25th gestational weeks with fatal intrauterine growth retardation. The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia. During the fourth pregnancy, in which the fetus also had the mutation, serial ultrasound examinations showed a small fetus with appropriate growth. At birth the girl was small for gestational age. She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated. One day old, her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis. After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth. In the following two pregnancies Sandostatin LAR® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring. Both pregnancies ended successfully. One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight.
| EN105832 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. | [
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] | Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
| EN104655 |
Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. | [
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] | Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
| EN104655 |
Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. | [
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] | Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
| EN104655 |
She was treated with intravenous immunoglobulin resulting in a remarkable recovery. | [
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] | Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
| EN104655 |
Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected. | [
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] | Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
| EN104655 |
A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
CT scan indicated benign ovarian cystic tumors. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
The patient underwent laparoendoscopic single-site (LESS) surgery. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Clinical diagnosis was suggestive of left paratubal cyst. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
The patient underwent hysterectomy and BSO. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Frozen sections were prepared from surgery specimens and confirmed a benign cyst. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
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A final diagnosis of paratubal borderline serous tumor was confirmed. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. | [
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
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The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
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Pelvic ECT, TVS and tumor markers were checked every three months. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis. | [
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] | A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst. Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously. Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital. The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS). However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago. The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle. She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy. Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges. Uterine cervical cytology at the time of admission was normal. TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections. The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus. Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites. CT scan indicated benign ovarian cystic tumors.
The patient underwent laparoendoscopic single-site (LESS) surgery. On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube. The left fallopian tube was grossly unremarkable and the left ovary was atrophied. The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside. Clinical diagnosis was suggestive of left paratubal cyst. The patient underwent hysterectomy and BSO. Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy. Frozen sections were prepared from surgery specimens and confirmed a benign cyst. After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst. The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor. A final diagnosis of paratubal borderline serous tumor was confirmed. The patient was discharged from the hospital on postoperative day 3. CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery. Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery. The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up. Pelvic ECT, TVS and tumor markers were checked every three months. The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.
| EN100427 |
A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. | [
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] | A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
| EN103266 |
MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. | [
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] | A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
| EN103266 |
The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus. | [
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] | A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.
| EN103266 |
A 24-year-old African-American man presented to our Emergency Department with a one-week history of fever, dyspnea, cough, and abdominal pain. | [
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| EN107559 |
A computed tomography scan of his chest and abdomen revealed bilateral lower lobe pneumonia and two retained Jackson-Pratt drains in the right upper quadrant. | [
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| EN107559 |
He was taken to the operating room for drain removal, a right hemicolectomy, debridement of a duodenal injury, a Roux-en-y duodenojejunostomy, and an end ileostomy. | [
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| EN107559 |
He subsequently became increasing hypoxemic in the intensive care unit and a bronchoperitoneal fistula was diagnosed. | [
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| EN107559 |
He required high-frequency oscillatory ventilation followed by lung isolation, and was successfully resuscitated using these techniques. | [
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| EN107559 |
A 29-year-old man was admitted to our hospital with an unidentified fever. | [
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| EN101114 |
He was diagnosed with malignant lymphoma (extra-nodal NK/T cell lymphoma nasal type), and chemotherapy was administered. | [
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| EN101114 |
After chemotherapy, nodular lung shadows along with new brain, cervical, and myocardial abscesses appeared, despite anti-bacterial/fungal therapy. | [
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] | A 29-year-old man was admitted to our hospital with an unidentified fever. He was diagnosed with malignant lymphoma (extra-nodal NK/T cell lymphoma nasal type), and chemotherapy was administered. After chemotherapy, nodular lung shadows along with new brain, cervical, and myocardial abscesses appeared, despite anti-bacterial/fungal therapy. Gene analysis of the cervical abscess biopsy revealed the presence of Aspergillus fumigatus species, and the transesophageal echocardiogram showed a mobile mural vegetation in the left ventricle (22 × 8 mm). He underwent surgical resection of this mural vegetation. His postoperative course was uneventful. He remains healthy at 28 months after surgery with continued oral antifungal therapy.
| EN101114 |
Gene analysis of the cervical abscess biopsy revealed the presence of Aspergillus fumigatus species, and the transesophageal echocardiogram showed a mobile mural vegetation in the left ventricle (22 × 8 mm). | [
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] | A 29-year-old man was admitted to our hospital with an unidentified fever. He was diagnosed with malignant lymphoma (extra-nodal NK/T cell lymphoma nasal type), and chemotherapy was administered. After chemotherapy, nodular lung shadows along with new brain, cervical, and myocardial abscesses appeared, despite anti-bacterial/fungal therapy. Gene analysis of the cervical abscess biopsy revealed the presence of Aspergillus fumigatus species, and the transesophageal echocardiogram showed a mobile mural vegetation in the left ventricle (22 × 8 mm). He underwent surgical resection of this mural vegetation. His postoperative course was uneventful. He remains healthy at 28 months after surgery with continued oral antifungal therapy.
| EN101114 |
He underwent surgical resection of this mural vegetation. | [
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| EN101114 |
His postoperative course was uneventful. | [
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| EN101114 |
He remains healthy at 28 months after surgery with continued oral antifungal therapy. | [
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] | A 29-year-old man was admitted to our hospital with an unidentified fever. He was diagnosed with malignant lymphoma (extra-nodal NK/T cell lymphoma nasal type), and chemotherapy was administered. After chemotherapy, nodular lung shadows along with new brain, cervical, and myocardial abscesses appeared, despite anti-bacterial/fungal therapy. Gene analysis of the cervical abscess biopsy revealed the presence of Aspergillus fumigatus species, and the transesophageal echocardiogram showed a mobile mural vegetation in the left ventricle (22 × 8 mm). He underwent surgical resection of this mural vegetation. His postoperative course was uneventful. He remains healthy at 28 months after surgery with continued oral antifungal therapy.
| EN101114 |
A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. | [
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| EN100593 |
No headache, blurred vision or spontaneous bleeding were mentioned. | [
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| EN100593 |
She was not a known diabetic or hypertensive and has no history of blood transfusion. | [
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| EN100593 |
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| EN100593 |
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| EN100593 |
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| EN100593 |
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| EN100593 |
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| EN100593 |
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| EN100593 |
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
Her alphafeto-protein (AFP) was higher (2232 ng/mL). | [
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
HBsAg was positive. | [
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| EN100593 |
She tested negative to human immunodeficiency viruses (HIV) and HCV. | [
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. | [
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. | [
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. | [
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. | [
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| EN100593 |
The plan was to have the mother's health improved to securely induce the labour. | [
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| EN100593 |
Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. | [
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. | [
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after. | [
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] | A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss. No headache, blurred vision or spontaneous bleeding were mentioned. She was not a known diabetic or hypertensive and has no history of blood transfusion. Clinical signs on examination included mild pallor and cholestatic jaundice. Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C. Respiratory, cardiovascular and neurological examinations were unremarkable. The abdomen was grossly distended with visible collateral veins. Liver was enlarged, hard, nodular with a painful irregular edge. The spleen was not palpable. There was bipedal edema up to the mid shin. Fetal heart rate was 140 bpm and regular. Laboratory examination showed leukocytosis, anemia and normal platelet counts. Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L. Her alphafeto-protein (AFP) was higher (2232 ng/mL). HBsAg was positive. She tested negative to human immunodeficiency viruses (HIV) and HCV. Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions. Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks. The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made. She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection. The plan was to have the mother's health improved to securely induce the labour. Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure. Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia. Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.
| EN100593 |
A 37-year-old Arabian woman presented with 12 months of progressive Cushing's syndrome-like symptoms. | [
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] | A 37-year-old Arabian woman presented with 12 months of progressive Cushing's syndrome-like symptoms. Biochemical evaluation confirmed adrenocorticotropic hormone -dependent Cushing's syndrome. However, the anatomical site of her excess adrenocorticotropic hormone secretion was not clearly delineated by further investigations. Magnetic resonance imaging of our patient's pituitary gland failed to demonstrate the presence of an adenoma. Spiral computed tomography of her chest only revealed the presence of a non-specific 7 mm lesion in her left inferobasal lung segment. Functional imaging, including a positron emission tomography scan using 18-fluorodeoxyglucose and gallium-68-DOTA-D-Phe1-Tyr3-octreotide, also failed to show increased metabolic activity in the lung lesion or in her pituitary gland. Our patient was commenced on medical treatment with ketoconazole and metyrapone to control the clinical features associated with her excess cortisol secretion. Despite initial normalization of her urinary free cortisol excretion rate, levels began to rise eight months after commencement of medical treatment. Repeated imaging of her pituitary gland, chest and pelvis again failed to clearly localize a source of her excess adrenocorticotropic hormone secretion. The bronchial nodule was stable in size on serial imaging and repeatedly reported as having a nonspecific appearance of a small granuloma or lymph node. We re-explored the treatment options and endorsed our patient's favored choice of resection of the bronchial nodule, especially given that her symptoms of cortisol excess were difficult to control and refractory. Subsequently, our patient had the bronchial nodule resected. The histological appearance of the lesion was consistent with that of a carcinoid tumor and immunohistochemical analysis revealed that the tumor stained strongly positive for adrenocorticotropic hormone. Furthermore, removal of the lung lesion resulted in a normalization of our patient's 24-hour urinary free cortisol excretion rate and resolution of her symptoms and signs of hypercortisolemia.
| EN107405 |
Biochemical evaluation confirmed adrenocorticotropic hormone -dependent Cushing's syndrome. | [
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] | A 37-year-old Arabian woman presented with 12 months of progressive Cushing's syndrome-like symptoms. Biochemical evaluation confirmed adrenocorticotropic hormone -dependent Cushing's syndrome. However, the anatomical site of her excess adrenocorticotropic hormone secretion was not clearly delineated by further investigations. Magnetic resonance imaging of our patient's pituitary gland failed to demonstrate the presence of an adenoma. Spiral computed tomography of her chest only revealed the presence of a non-specific 7 mm lesion in her left inferobasal lung segment. Functional imaging, including a positron emission tomography scan using 18-fluorodeoxyglucose and gallium-68-DOTA-D-Phe1-Tyr3-octreotide, also failed to show increased metabolic activity in the lung lesion or in her pituitary gland. Our patient was commenced on medical treatment with ketoconazole and metyrapone to control the clinical features associated with her excess cortisol secretion. Despite initial normalization of her urinary free cortisol excretion rate, levels began to rise eight months after commencement of medical treatment. Repeated imaging of her pituitary gland, chest and pelvis again failed to clearly localize a source of her excess adrenocorticotropic hormone secretion. The bronchial nodule was stable in size on serial imaging and repeatedly reported as having a nonspecific appearance of a small granuloma or lymph node. We re-explored the treatment options and endorsed our patient's favored choice of resection of the bronchial nodule, especially given that her symptoms of cortisol excess were difficult to control and refractory. Subsequently, our patient had the bronchial nodule resected. The histological appearance of the lesion was consistent with that of a carcinoid tumor and immunohistochemical analysis revealed that the tumor stained strongly positive for adrenocorticotropic hormone. Furthermore, removal of the lung lesion resulted in a normalization of our patient's 24-hour urinary free cortisol excretion rate and resolution of her symptoms and signs of hypercortisolemia.
| EN107405 |
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] | A 37-year-old Arabian woman presented with 12 months of progressive Cushing's syndrome-like symptoms. Biochemical evaluation confirmed adrenocorticotropic hormone -dependent Cushing's syndrome. However, the anatomical site of her excess adrenocorticotropic hormone secretion was not clearly delineated by further investigations. Magnetic resonance imaging of our patient's pituitary gland failed to demonstrate the presence of an adenoma. Spiral computed tomography of her chest only revealed the presence of a non-specific 7 mm lesion in her left inferobasal lung segment. Functional imaging, including a positron emission tomography scan using 18-fluorodeoxyglucose and gallium-68-DOTA-D-Phe1-Tyr3-octreotide, also failed to show increased metabolic activity in the lung lesion or in her pituitary gland. Our patient was commenced on medical treatment with ketoconazole and metyrapone to control the clinical features associated with her excess cortisol secretion. Despite initial normalization of her urinary free cortisol excretion rate, levels began to rise eight months after commencement of medical treatment. Repeated imaging of her pituitary gland, chest and pelvis again failed to clearly localize a source of her excess adrenocorticotropic hormone secretion. The bronchial nodule was stable in size on serial imaging and repeatedly reported as having a nonspecific appearance of a small granuloma or lymph node. We re-explored the treatment options and endorsed our patient's favored choice of resection of the bronchial nodule, especially given that her symptoms of cortisol excess were difficult to control and refractory. Subsequently, our patient had the bronchial nodule resected. The histological appearance of the lesion was consistent with that of a carcinoid tumor and immunohistochemical analysis revealed that the tumor stained strongly positive for adrenocorticotropic hormone. Furthermore, removal of the lung lesion resulted in a normalization of our patient's 24-hour urinary free cortisol excretion rate and resolution of her symptoms and signs of hypercortisolemia.
| EN107405 |
Subsets and Splits