1/6. Peripancreatic Castleman disease.CONTEXT: Castleman disease or giant lymph node hyperplasia is a rare disorder of the lymphoid tissue, usually occurring in the mediastinum. We report a case of localized peripancreatic plasma cell type Castleman disease, which is an unusual site. CASE REPORT: A 45-year-old woman with a history of mild epigastric pain radiating to the back for the previous year was admitted and her physical examination was normal. A raised erythrocyte sedimentation rate, c-reactive protein and hypergammaglobulinemia were found. Abdominal ultrasonography and magnetic resonance imaging demonstrated a homogeneously hypoechoic solid mass having a smooth-surface, 6 cm in diameter, located between the head of the pancreas, the lower margin of the antrum and the left lobe of the liver. The mass was totally excised surgically with repair of the pancreas capsule. Histopathological examination of the tumor showed plasma-cell type Castleman disease. CONCLUSION: Clinicians should be aware that Castleman disease may involve peripancreatic tissue which leads to difficulties in arriving at a differential diagnosis. Surgical excision is both a diagnostic and a curative method for management of the disease.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/6. Angio-immunoblastic lymphadenopathy terminating as Hodgkin's disease.The clinical course of a 33-year-old man with generalized lymphadenopathy bearing all physical, laboratory and histologic characteristics of "angio-immunoblastic lymphadenopathy with dysproteinemia" (AILD) is described. Therapy was without significant benefit and the patient died 22 months after initial diagnosis. At autopsy in addition to the characteristic cellular polymorphism of AILD, numerous Hodgkin's cells and Sternberg-Reed cells were identified in the lymph nodes and spleen. Pleomorphic cellular infiltrates containing an increased number of immunoblasts and some giant cells were found also in the portal spaces of the liver. The evolution of Hodgkin's disease (H.D.) from AILD suggests that the latter may have represented a reaction to the agent which causes H.D..- - - - - - - - - - ranking = 0.088324670131947keywords = physical (Clic here for more details about this article) |
3/6. The Shulman syndrome.The Shulman syndrome is a symptom complex recently described in the rheumatology literature that is characterized by eosinophilia, hypergammaglobulinemia, and a diffuse scleroderma-like process of the extremities. The onset of illness has been associated with a period of unusual physical exertion. The condition seems to respond to corticosteroid therapy for systemic effect.- - - - - - - - - - ranking = 0.088324670131947keywords = physical (Clic here for more details about this article) |
4/6. Interstitial pneumonia in angio-immunoblastic lymphadenopathy with dysproteinemia. A case report with special histopathologic studies.A patient presented with characteristic historical, physical, and laboratory findings of angio-immunoblastic lymphadenopathy with dysproteinemia. This newly described entity apparently represents a nonneoplastic proliferation of the B-lymphocyte system with immunoblastic transformation of many lymphocytes and excessive production of immunoglobulins. It is associated with fever, sweats, weight loss, skin rash, lymphadenopathy, splenomegaly, hepatomegaly, and characteristic histologic features of the involved lymph nodes. Noteworthy in the patient reported here are the extent and course of radiographically and clinically evident pulmonary involvement and the biopsy documentation of an interstitial pneumonia marked by histopathologic changes closely resembling those found in the lymph nodes, with immunohistologic demonstration of immunoglobulins in the alveolar walls.- - - - - - - - - - ranking = 0.088324670131947keywords = physical (Clic here for more details about this article) |
5/6. Perforation of the nasal wall and hyper-IgE syndrome.Hyper-IgE syndrome is basically characterized by recurrent infections, chronic eczematous lesions, specific IgE antibodies against staphylococcus aureus and markedly high serum IgE values. We present the case of an 11-year-boy with no relevant personal or family history, who came to our Department with highly pruriginous papulovesicular skin lesions of 3 years' duration. He presented marked obesity ( 4 SD) and micropapulovesicular lesions in the trunk and extension areas of the limbs. The rest of the physical exploration was normal. Complementary studies revealed peripheral eosinophilia, increase in globular sedimentation rate and IgE values of 20,000 IU/ml, a nonspecific reaction to skin tests, and a skin biopsy compatible with atopic dermatitis. Three months later, he presented eczematous lesions in the trunk and limbs, perforation of the nasal wall due to staphylococcal abscess (diagnosed by biopsy), bilateral maxillary sinusitis and IgE values of 59,238 IU/ml. The differential diagnoses are discussed, as well as new diagnostic-therapeutic possibilities.- - - - - - - - - - ranking = 0.088324670131947keywords = physical (Clic here for more details about this article) |
6/6. Severe, chronic anorexia and extensive leg ulcerations as presenting signs of primary sjogren's syndrome.We report the case of a 75-year-old woman with a 15-year history of inappetance resulting in weight loss of approximately 40 kg. On physical examination, the skin of the lower extremities was markedly hyperpigmented with a brown-greyish hue. In addition, the skin of the legs was infiltrated, erythematous, riddled with erosions and necrotic ulcers. Clinical and laboratory evaluation revealed sicca syndrome, a pronounced polyclonal hypergammaglobulinemia (60 g/l), high levels of antinuclear, anti-SSA and anti-SSB antibodies. Histological examination of involved skin demonstrated a leukocytoclastic vasculitis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |