1/14. Atypical medullary carcinoma of the breast with cartilaginous metaplasia in a patient with a BRCA1 germline mutation.We examined a 34-year-old premenopausal woman who had noticed a left-breast lump a month previously. She had no past history of malignancies but had a family history of breast and ovarian cancers. Her mother had suffered from ovarian cancer when aged 47 years and had died of the disease at age 52. The younger two of the patient's four aunts had developed breast cancer when they were 37 and 48 years old. A physical examination showed an ill-defined mass, 1.5 cm in diameter, located in the upper outer quadrant of the patient's left breast. mammography revealed diffuse microcalcification in both breasts but ultrasonography revealed an irregular tumorous lesion only in the left breast. Aspiration breast cytology revealed adenocarcinoma of the left breast. Modified radical mastectomy of the left breast and excision of a biopsy specimen from the right breast were carried out simultaneously. Histopathologically the left-breast tumor was an atypical medullary carcinoma with cartilaginous metaplasia, of histological grade 3, and the right-breast specimen showed fibrocystic changes with atypical ductal hyperplasia. Estrogen receptors were positive, but progesterone receptor was not detected on the tumor cells, which were immunopositive for nuclear p53 although c-erbB-2 overexpression was not observed. A nonsense germline mutation of the BRCA1 gene (exon5) was detected. The patient has been well since the operation (10 months). These findings may provide useful information about the carcinogenesis and biological behavior of BRCA1-associated breast cancers.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/14. pheochromocytoma combined with pre-clinical Cushing's syndrome in the same adrenal gland.pheochromocytoma (PHEO) occasionally associates with pathological lesions of the adrenal cortex. In most of them, ectopic adrenocorticotropic hormone (ACTH) produced by PHEO resulted in bilateral adrenocortical hyperplasia. The coexistence of PHEO and pre-clinical Cushing's syndrome (PCS) of the same adrenal gland has rarely been reported. We report on a patient and discuss the peculiar diagnostic aspects of this entity. A 52-yr-old Turkish woman was hospitalized at Farabi Hospital for further examinations of a right adrenal mass that was incidentally discovered by abdominal ultrasonography during examinations for abdominal bloating and "gas" in other hospital. The patient had a history of palpitations, nervousness, sweating and heat intolerance. On admission, her blood pressure was 140/90 mmHg. A physical examination revealed no signs of an excessive production of adrenocortical steroids such as in CS. Tension Holter monitoring revealed paroximal hypertension attacks (183/105 mmHg). Urinary catecholamines were markedly increased. Her serum cortisol concentrations ranged from 5 to 17 microg/dl, whereas ACTH levels were undetectable. Cortisol was not suppressed on the overnight 1 mg oral dexamethasone suppression test (DST), 2-day low-dose dexamethasone suppression test (DST). Abdominal computed tomography and magnetic resonance imaging studies revealed a solid round tumor approximately 4 cm in diameter, located in the right adrenal gland. A 131 lodine-metaiodobenzylguanidine (131 I-MIBG) scan revealed uptake within tumor in the right adrenal gland. Right adrenalectomy was performed; the surgical specimen revealed PHEO and adrenocortical hyperplasia. To our knowledge, the present report is a rare case of PHEO combined with PCS in the same adrenal gland.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/14. vitamin a toxicity in a physical culturist patient: a case report and review of the literature.Excessive intake of vitamin a may produce acute or chronic toxicity. vitamin a can be consumed in foods, fortified products and supplements. We present a case of a young physical culturist man who was referred to our Unit because of chronic liver disease of unknown origin. The patient had a history of increased vitamin a intake from natural source with the addition of high dose of vitamin a supplements with the purpose of improving his muscular development. Our patient showed chronic liver disease with severe fibrosis, signs of portal hypertension and marked hyperplasia of Ito cells. In conclusion, chronic vitamin a toxicity may produce severe liver damage and should be recognized in the differential diagnosis of chronic liver diseases.- - - - - - - - - - ranking = 0.43113296960155keywords = physical (Clic here for more details about this article) |
4/14. Characterization of human papillomavirus type 13 from focal epithelial hyperplasia Heck lesions.focal epithelial hyperplasia Heck lesions of a Turkish patient were shown to contain papillomavirus-specific dna, which was molecularly cloned into bacteriophage lambda. It proved to be related to human papillomavirus (HPV) type 6 dna and HPV type 11 dna. Reassociation kinetics revealed a cross-hybridization of 4 and 3%, respectively. There was no cross-reactivity with HPV type 1, 2, 3, 4, 5, 8, or 10. This papillomavirus type will be referred to as HPV type 13. The dna was characterized by cleavage with several restriction enzymes, and the cleavage sites were physically mapped. Papules from two additional cases of Morbus Heck contained HPV type 13 dna as shown by Southern blot hybridization and by the characteristic cleavage patterns. This may indicate that HPV type 13 is more frequently associated with focal epithelial hyperplasia Heck than are other HPV types.- - - - - - - - - - ranking = 0.08622659392031keywords = physical (Clic here for more details about this article) |
5/14. Tonsillar hyperplasia in children. A cause of obstructive sleep apneas, CO2 retention, and retarded growth.Tonsillar hyperplasia causing obstructive sleep apneas in children is a well-defined clinical entity with nocturnal CO2 retention, retarded growth, and impaired physical and psychological status. Pulmonary hypertension, cor pulmonale, and ultimately, death may develop in a small number of these children. This syndrome may also develop in children with only moderately enlarged tonsils in association with neuromuscular hypothonia or anatomical defects. Anamnesis will readily detect the children at risk. The syndrome is cured completely by tonsillectomy. The CO2 retention disappears and length and weight growths are accelerated after surgery.- - - - - - - - - - ranking = 0.08622659392031keywords = physical (Clic here for more details about this article) |
6/14. A case of leprechaunism with severe hyperinsulinemia.This report describes an infant with physical features typical of leprechaunism, including a characteristic facies, hirsutism, and decreased subcutaneous tissue and muscle mass. Intermittent hypoglycemia and severe hyperinsulinemia were documented. The patient's insulin was normal in molecular size and biological activity, but its binding to the patient's cultured fibroblasts was profoundly decreased. insulin antibodies were not present. A literature review has been undertaken to clarify further the clinical, metabolic, and pathological characteristics of this condition.- - - - - - - - - - ranking = 0.08622659392031keywords = physical (Clic here for more details about this article) |
7/14. Pseudocarcinomatous hyperplasia of the larynx due to candida albicans.A female patient presented with hoarseness. Findings on physical examination showed whitish true vocal cords. Laryngeal biopsies were performed on two two occasions. On the first biopsy a histopathological diagnosis of candida albicans and acanthosis was controversial because the acanthosis resembled squamous cell carcinoma. On the second biopsy, several months later, the diagnosis of acanthosis was again controversial, but a diagnosis of pseudocarcinomatous hyperplasia was not determined until several months later. Finally, we can point out that pseudocarcinomatous hyperplasia can be associated with primary candidiasis and state that hoarseness, whitish true vocal cords, and pseudocarcinomatous hyperplasia can masquerade as squamous cell carcinoma of the larynx.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/14. focal nodular hyperplasia of the liver: a study of 21 pediatric cases.Twenty-one cases of focal nodular hyperplasia of the liver in pediatric patients are presented and compared with 40 cases previously reported. In this series, the lesion was usually asymptomatic (95%) and presented as a nontender mass noted on routine physical examination or was discovered incidentally at autopsy. There was a distinct female predominance (81%). Radiographic examination demonstrated a vascular space-occupying hepatic mass. The lesions were noted bilaterally or in the left lobe in 62% of cases. They were large, nonencapsulated, firm masses with central stellate areas subdividing the lesions into multiple lobules. Microscopically, septa contained eccentrically thickened vessels, small bile ducts, and an acute and/or chronic inflammatory infiltrate. hepatocytes resembled those of the normal liver but some contained increased glycogen and fat. The lesions had no malignant potential and, except in women taking oral contraceptives, could be treated conservatively.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/14. rupture and hemorrhage of hepatic focal nodular hyperplasia.Although adenoma and focal nodular hyperplasia (FNH) are both benign liver lesions, adenomas are associated with a risk of rupture and malignant degeneration. This had led to the general recommendation of resection of adenomas. However, FNH rarely ruptures or becomes malignant, and a nonoperative approach has been adopted by most hepatobiliary centers when the diagnosis of FNH can be made with reasonable certainty. There are only two previous reports of rupture of FNH in the English literature; we present a third case of FNH with spontaneous rupture and hemorrhage. An 18-year-old healthy Caucasian woman presented with sudden onset of severe RUQ pain. She had never been pregnant, nor used oral contraceptive agents, and had not sustained major trauma. Her abdominal exam revealed RUQ tenderness on palpation. Hepatic biochemical tests, CBC, and coagulation tests were normal. Her hematocrit of 44% fell to 31% over 48 hours. CT scan revealed right anterior lobe and left medial segment hypodense liver lesions (4-5 cm) as well as hemoperitoneum and angiography revealed hypervascular lesions. At laparotomy, two tan fibrous subcapsular masses were excised. pathology showed a central stellate scar in both lesions with several nodules surrounding the central scar on microscopic section, characteristic of FNH. There was evidence of hemorrhage in one lesion. Significant symptoms are an indication for resection of FNH lesions. However, most patients with FNH are asymptomatic and have a normal physical exam. The natural history of these lesions is enigmatic, and the indications for surgery are still evolving. This report emphasizes that a small risk of rupture clearly exists.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.08622659392031keywords = physical (Clic here for more details about this article) |
10/14. Focal liver lesions. Evaluation of solid neoplasms.A logical, stepwise approach to the diagnostic evaluation of solid focal liver lesions relies heavily on the fundamental clinical tools of history taking, physical examination, and identification of basic tumor markers. Imaging procedures alone or along with percutaneous, laparoscopic, or open biopsy techniques are then applied in order to obtain a specific diagnosis. The astute clinician must be concerned not only with an accurate diagnosis but also with therapeutic implications of the diagnosis balanced against the costs in terms of potential complications, survival time, resources, and patient inconvenience. A thorough understanding of the biologic behavior and natural history of the lesion helps assure a rational, cost-effective treatment strategy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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