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We present a case of a 32 - year-old woman with a history of gradual enlargement of the anterior neck . | [
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"text": "enlargement of the anterior neck",
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The medical history was unremarkable and no comorbidities existed . | [] |
There was no history of radiation exposure . | [] |
Clinical examination revealed a multinodular goiter . | [
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"text": "multinodular goiter",
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Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch . | [
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"text": "thyroid nodule",
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] |
There was no evidence of lung lesions . | [
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"text": "lung lesions",
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The patient underwent a surgical exploration . | [] |
There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea . | [
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"text": "lobe nodule",
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The intraoperative consultation pathology diagnosis was : undifferentiated carcinoma . | [
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"text": "undifferentiated carcinoma",
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A total thyroidectomy was realized . | [] |
Histological examination showed a proliferation of elongated spindle-shaped cells , arranged in interweaving fascicles of varying sizes , intersected at right angles . | [
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"text": "proliferation of elongated spindle-shaped cells",
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Tumor cells are atypical with strange nuclei . | [
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"text": "Tumor cells",
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Chromatin is distributed inhomogeneously . | [] |
The cytoplasmic membrane is irregular and thick . | [] |
The nucleolus is very large . | [] |
The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule . | [
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"text": "tumor",
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The mitotic rate was extremely high ( 19 mitosis / 10 high power field ) , and atypical mitotic figures were also present . | [] |
The neoplasia showed invasion of the peri-glandular fat tissue . | [
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"text": "neoplasia",
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Immuno-histochemical staining of the slides with caldesmon , desmin , PanCK , CK 5 -6 , CK 7 , myogenin , epithelial membrane antigen ( EMA ) , CEA , thyroid transcription factor ( TTF- 1 ) , pancytokeratin , smooth muscle actin ( SMA ) , MelanA , S 100 protein , CD 45 , CD 3 , CD 30 , CD 20 , CD 15 , CD 34 , ALK , calcitonin and KI 67 protein was performed . | [] |
The tumour was strongly positive for caldesmon , SMA , desmin , and negative for pancytokeratin and other epithelial , lymphoid and melanocytic markers . | [
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On the basis of the clinical , radiographic , histopathological and immunohistochemical features , the final diagnosis was primary thyroid leiomyosarcoma , FNCLCC grade 3 . | [
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"text": "thyroid leiomyosarcoma",
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In multidisciplinary tumour board , it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin . | [] |
Here we report a case of aggressive metastatic cholangiocarcinoma ( MCC ) in 72 - year-old man , sequentially treated with two targeted chemotherapies . | [
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"text": "metastatic cholangiocarcinoma",
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Initially disease quickly progressed during best clinical practice care ( gemcitabine in combination with cisplatin or capecitabine ) , which was accompanied by significant decrease of life quality . | [] |
Monotherapy with TKI sorafenib was prescribed to the patient , which resulted in stabilization of tumor growth and elimination of pain . | [
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"text": "pain",
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The choice of the inhibitor was made based on high-throughput screening of gene expression in the patient ' s tumor biopsy , utilized by Oncobox platform to build a personalized rating of potentially effective target therapies . | [] |
However , time to progression after start of sorafenib administration did not exceed 6 months and the regimen was changed to monotherapy with Pazopanib , another TKI predicted to be effective for this patient according to the same molecular test . | [] |
It resulted in disease progression according to RECIST with simultaneous elimination of sorafenib side effects such as rash and hand-foot syndrome . | [
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"text": "hand-foot syndrome",
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After 2 years from the diagnosis of MCC the patient was alive and physically active , which is substantially longer than median survival for standard therapy . | [
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"text": "MCC",
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A 36 year old female farmer gravida 5 para 4 at 27 weeks gestation presented to our facility . | [] |
Her main complaint was a 3 month history of epigastric abdominal pain , which was gradual in onset , dull and persistent . | [
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"text": "epigastric abdominal pain",
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Pain had gradually worsened over the months with no known relieving or aggravating factors but with intermittent radiation to the chest . | [] |
There was a history of significant weight loss but no associated early satiety , jaundice , fever , itch or spontaneous bleeding . | [] |
No history of blood transfusion and patient was on her routine hematinic from the antenatal clinic ( ANC ) . | [] |
She is not a known diabetic , Hypertensive and has no known chronic illness . | [
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"text": "Hypertensive",
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Patient did not know her Hepatitis status . | [] |
Denied to taking any alcohol or smoking . | [] |
There were no cardiorespiratory nor urogenital symptoms . | [] |
She did not store grains at home and had no known contact with chemicals or ionizing radiation . | [] |
Clinical signs on examination included wasting , mild pallor , a tinge of jaundice but well hydrated , afebrile and no palpable lymphnodes . | [] |
She had palmer erythema but no clubbing and parotid enlargement . | [] |
Respiratory , cardiovascular and neurological examinations were unremarkable . | [] |
Abdomen was grossly distended with distorted contour in the upper half and visibly distended anterior abdominal wall veins draining away from the umbilicus . | [] |
Liver was enlarged 12 cm below the costal margin with a span of 17 cm . | [] |
The liver was hard , nodular with irregular edge , mild tendernes and had a bruit on auscultation . | [] |
The spleen was not palpable but with demonstrable mild ascites and bipedal eodema up to the mid shin . | [] |
Symphysio fundal height was 26 cm , with longitudinal lie and breech presentation . | [] |
Fetal heart rate was 134 bpm and regular . | [] |
Rectal and vaginal examination were unremarkable . | [] |
Initial diagnosis of hepatocellular Carcinoma in pregnancy was made . | [] |
Laboratory assesment revealed HB- 10 . 3 g / dl , WBC 10200 cells / dl ; Neutrophils 59 . 3 % , lymphocytes 26 . 1 % , Monocytes 10 . 1 % and Eosinophils 2 . 7 % . | [] |
Platelets 350000 / ul . | [] |
Normal bilirubin but GGT and AST were raised ( 4 times upper limit ) . | [] |
Total protein and albumin were low , 44 g / L and 29 g / L respectively with INR- 1 . 3 . HBsAg was positive , HBeAg negative with HBV DNA level of 126869 IU / ml \ ( Viral load ) . | [] |
VDRL positive but TPHA not done . | [] |
Alphafeto protein ( AFP ) > 50000 KU / L . | [] |
She tested negative to HIV and HCV . | [] |
Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lessions . | [] |
The liver measured 17 . 2 cm and there was mild ascites . | [] |
Pelvic scan revealed a 27 week , 3 day old fetus , with active fetal movements . | [] |
A revised diagnosis of hepatocellular carcinoma on a cirrhotic liver with decompensation in pregnancy was made . | [
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"text": "hepatocellular carcinoma on a cirrhotic liver",
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She was managed with analgesia , furosemide , spironolactone and lamivudine added for prevention of mother to child trasmission of the hepatitis B infection . | [] |
The plan was to allow pregnancy to continue to at least 32 completed weeks to improve the chance of neonatal survival . | [] |
However because of the progressive unbearable abdominal pain , pregnancy was terminated at 30 weeks 3 days by successful induction of labour . | [
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"text": "abdominal pain",
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The outcome was a fresh stillbirth weight 1 . 2 kg . | [] |
Pain was markedly reduced post delivery and was discharged home after 5 days . | [] |
She was booked for a follow up visit at the gastrointestinal clinic . | [] |
She was seen at the clinic at 2 weeks and four weeks post discharge but was lost to follow up afterwards . | [] |
We report the case of a male patient , 79 years old , diabetic for 10 years on metformin , hypertensive for 5 years on amilodipine ; occasional alcoholic weaned 4 years ago . | [] |
He was initially admitted for mental confusion with sudden onset dysarthria dating back 48 hours before . | [
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"text": "dysarthria",
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Initial assessment found Glasgow score ( GCS ) of 12 / 15 ( eye opening at 5 , verbal response at 2 , motor response at 5 ) , symmetrical and reactive pupils , without feeling-motor deficit , normal osteotendinous reflexes , slightly polypneic at 24 cycles / min , pulsed oxygen saturation ( SpO 2 ) at 97 % in ambient air , he was tachycardic at 115 bpm and hypertensive at 160 / 95 mmHg , his capillary blood glucose at 2 . 24 g / L , and glycosuria on the urine dipstick test without ketonuria . | [
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"text": "hypertensive",
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The patient was apyretic . | [] |
Arterial gas testing showed normal corrected anion gap metabolic acidosis , with hypokalaemia at 3 mmol / L and normal lactatemia at 0 . 43 mmol / L . | [
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"text": "hypokalaemia",
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Diagnosis of diabetes decompensation was made despite absence of ketone bodies on urine dipstick test . | [] |
After conditioning , the patient was put on a hydration regimen with hypokalaemia correction and insulin therapy , and then referred to intensive care for additional management in face of non-improvement in his neurological condition . | [] |
A brain scan was performed objectifying multiple parietal ischemic foci , chest scanner showed a thickening of the septal and foci of bronchial dilation without sign of pneumopathy linked to COVID- 19 infection ; abdominal ultrasound did not show any abnormalities . | [] |
An electrocardiogram was performed showing no electrical signs of hypokalaemia or repolarization disturbances , transthoracic echocardiography was normal , as was ultrasound of supraortic trunks . | [
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Laboratory workup showed an elevated C-reactive protein ( CRP ) of 45 . 5 with negative procalcitonin ( 0 . 04 ng / ml ) , white blood cells at 12 , 500 ( PNN at 9280 and normal lymphocytes at 2140 ) , no thrombocytopenia , normal ferritinemia , fibrinogen levels elevated to 5 . 37 and negative D-dimers . | [
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"text": "thrombocytopenia",
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Natremia , magnesemia , corrected serum calcium , phosphoremia and thyroid assessment was normal . | [] |
SARS-CoV- 2 reverse transcription polymerase chain reaction ( RT-PCR ) by nasopharyngeal swab was negative , COVID- 19 serology ( IgM and IgG ) was also negative . | [] |
Faced with concept of ischemic lesions on a brain scan , anticoagulation at a prophylactic dose , antiplatelet aggregation with aspirin and statins were initiated as well as an antibiotic therapy at a meningeal dose with ceftriaxone pending results of the lumbar puncture which subsequently showed a clear liquid with a high proteinorachia at 0 . 58 g / l ( normal between 0 . 15 and 0 . 45 ) , a normal glycorachia / blood sugar ratio at 0 . 58 ( normal at 0 . 5 ) ; with a culture showing less than 3 elements , sterile after 24 hours . | [] |
Cerebral Magnetic resonance angiography performed on day 2 of admission showed signs in favor of vascular leukopathy , with some calcifications in basal ganglia and cortical atrophy . | [
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"text": "calcifications in basal ganglia",
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"text": "cortical atrophy",
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Electroencephalogram showed signs of epilepsy , which prompted us to retain the diagnosis of nonketotic hyperglycemia-related epileptic seizures . | [
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"text": "epileptic seizures",
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Anticonvulsant treatment was started with sodium valproate . | [] |
The Patient worsened neurologically despite correction of his metabolic acidosis , he was intubated on day 3 of his admission ( day 5 of symptoms onset ) . | [] |
A cerebral computerized tomography ( CT ) scan was performed without showing any progressive lesions . | [
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"text": "lesions",
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Faced with installation of lymphopenia ( HIV serologies 1 and 2 negative ) with increased CRP , a multiplex RT-PCR in protected distal bronchial sample as well as in Cerebrospinal fluid ( CSF ) were performed , the first was positive to SARS-CoV- 2 . | [] |
Reverse transcription polymerase chain reaction of SARS-CoV- 2 in CSF was positive but with a cycle threshold ( CT ) of 38 . 6 . | [] |
The diagnosis of SARS-CoV- 2 encephalopathy was retained . | [
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"text": "SARS-CoV- 2 encephalopathy",
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The patient is still in intensive care . | [] |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week ’ s duration . | [
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"text": "epigastric pain",
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There was no vomiting or weight loss . | [
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"text": "vomiting",
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},
{
"offsets": [
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"text": "weight loss",
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] |
Bowel movements were normal . | [] |
Clinical examination at the time was unrevealing . | [] |
An abdominal ultrasound examination was reported as normal . | [] |
The patient ’ s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution . | [] |
The CT scan showed a large tumour ( 6 cm in largest diameter ) in the body and tail of pancreas with no evidence of metastasis . | [
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"text": "metastasis",
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She was prepared for exploratory laparotomy . | [] |
The pancreas was explored through the gastrocolic omentum . | [] |
The body and tail of the pancreas including the tumour were resected . | [
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"text": "tumour",
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Subsets and Splits