1/21. adrenal insufficiency caused by primary aggressive non-Hodgkin's lymphoma of bilateral adrenal glands: report of a case and literature review.A 64-year-old woman was hospitalized because of poor general condition, gastrointestinal upset, unexplained fever, electrolyte imbalances, and an incidental finding of bilateral huge adrenal masses on computerized tomography (CT) of the abdomen. Non-Hodgkin's lymphoma (NHL) of B-cell origin was proven by ultrasound-guided aspiration biopsy of the left adrenal gland. Meanwhile, primary adrenal insufficiency was confirmed by her low serum cortisol level, high ACTH level, and inadequate adrenal response to the rapid ACTH stimulation test. The diagnosis of primary adrenal NHL was supported by detailed physical examinations, bone marrow examination, and such imaging studies as CT scan and sonography. She received three courses of chemotherapy with cyclophosphamide, vincristine, and prednisolone and there was an initial transient response, but she died of sepsis and progression of NHL three and a half months later.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/21. Intracardiac lymphoma in a child: successful treatment with chemotherapy alone.A 5-year-old female child with history of non-Hodgkin's lymphoma presented with cough and palpitation. On physical examination a cardiac tumor plop was heard. Paroxysmal supraventricular tachycardia was noted on the electrocardiogram. Transthoracic echocardiogram revealed multiple large tumor masses within the right and the left atrium. The right atrial tumor was flopping back and forth at the tricuspid valve orifice. The tumor resolved completely with chemotherapy without any surgical intervention.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/21. cardiac tamponade: an unusual clinical presentation.pericardial effusion with cardiac tamponade is an unusual presentation of lymphoma, although cardiac involvement is often a late finding in widespread malignancy. Clinical identification can be difficult ante-mortem. New cardiac symptoms or classic findings of cardiac tamponade should prompt aggressive investigation. We present a case of B-cell lymphoma that initially presented as pericardial effusion with tamponade and discuss the characteristic physical findings and radiographic data that assist in diagnosis.- - - - - - - - - - ranking = 0.050681900870467keywords = physical (Clic here for more details about this article) |
4/21. Microvasculitic paraproteinaemic polyneuropathy and B-cell lymphoma.Microvasculitis may play a greater part in the pathogenesis of paraproteinaemic neuropathies than is generally recognised, producing tissue destruction by convergent immune and physical mechanisms. We present a patient with a clinical syndrome of mononeuritis multiplex and a circulating IgM lambda paraprotein, in whom bone marrow aspiration revealed a lymphoplasmacytoid lymphoma. Microvasculitic changes were present in the first nerve biopsy, and the second showed extensive destruction of neural architecture and deposition of IgM-related material. A 2-stage pathogenic cascade is postulated and explored with a review of the relevant literature.- - - - - - - - - - ranking = 0.050681900870467keywords = physical (Clic here for more details about this article) |
5/21. Midline malignant B-cell lymphoma with leukemic transformation.This article presents a case of lethal midline granuloma on the palate of a 44-year-old woman, which had been identified histologically as B-cell lymphoma with leukemic transformation in the terminal stages. At the first visit, physical and laboratory examinations showed no remarkable findings except for a necrotizing ulcer of the palate, and the biopsy specimens only showed massive inflammatory cell infiltration and necrosis of the granulation tissue. There was a short-term resolution after treatment with cyclophosphamide and prednisolone, but the disease reactivated and the necrotic ulcerative lesion progressively advanced into the nasal cavity. Specimens from the third biopsy exhibited histologic features that were consistent with malignant lymphoma of the diffuse, mixed B-cell type. Chemotherapy with the regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone was adopted but was interrupted after a short time because of bone marrow suppression. Subsequently, large numbers of enlarged abnormal lymphocytes with a few vacuoles in the cytoplasm appeared in the circulating blood, indicating leukemic transformation of the midline lymphoma. The patient died on the seventh day after the initiation of chemotherapy. In the presentation of this case, the authors mention clinically important matters regarding midline lethal lymphoma and briefly discuss the pathophysiology and pathogenesis.- - - - - - - - - - ranking = 0.050681900870467keywords = physical (Clic here for more details about this article) |
6/21. Primary B cell lymphoma of the penis: successful treatment with organ preservation.Malignant lymphoma uncommonly manifests in the genitourinary tract. Primary penile lymphoma is extremely rare. A 77-year-old male presented with primary malignant B-cell lymphoma of the penis with the chief complaint of a painless and itching nodule on the penile glans for more than 2 months. The pathologic examination with immunohistochemical stain of penile biopsy revealed malignant B cell lymphoma, mixed cellular type. The physical examination and the computed tomography scan of chest, abdomen, and pelvis showed no evidence of superficial, thoracic, abdominal, or pelvic lymphadenopathy. This case was treated with local excision and systemic chemotherapy with good cosmetic and functional results. There was absence of recurrence 16 months after therapy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/21. Long-lasting fever of unknown origin preceding the diagnosis of intravascular lymphomatosis: a further case stimulates some remarks.Neurological and skin involvements usually dominate the clinical presentation of intravascular lymphomatosis (IL), while fever is the most frequent general sign. However, an onset only characterized by fever of unknown origin (FUO) has been rarely reported. We would like to describe a further case of IL, which presented a long-lasting FUO before the diagnosis. At admission, physical examination detected hepatosplenomegaly without lymph nodes enlargement or dermatological or neurological abnormalities. Significant laboratory data included severe anemia, leukopenia, thrombocytopenia, and increased serum LDH. Moreover, a chest CT evidenced bilateral multiple pulmonary infiltrates and pleural effusion. After the development of proteinuria, a diagnosis of large B-cell intravascular lymphoma was made with a renal biopsy 10 months after the onset of the clinical manifestations. So far, more than 100 cases of IL have been reported and the diagnosis often turned out to be difficult, as clinical signs did not point to a lymphoproliferative disorder. This report confirms that FUO is not only frequently associated with IL but that it even marks the real onset of the disease. We are then tempted to conclude that undiagnosed fever is not so rare in IL and if we call it FUO, it is only because diagnosis is necessarily elusive and hence time-consuming.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/21. Primary hepatic non-Hodgkin's lymphomas: case report and review of the literature.A 31-yr-old man presented with a 1-wk history of fever, chills, weakness, headaches, and a significant 20-lb weight loss over the preceding 2 months. His past medical history was relevant for liver amebiasis during childhood. Two days before admission, the patient noticed jaundice. He denied abdominal pain or other GI symptoms, and there was no history of alcohol intake, medications, or illicit drugs. His physical examination revealed generalized jaundice, hepatosplenomegaly, and bilateral leg edema. Neurologically, the patient was agitated, with periods of disorientation, and he had bilateral flapping. His blood tests revealed pancytopenia, renal failure, liver failure, and coagulopathy. Because the patient had a fever, hepatosplenomegaly, and pancytopenia, a further workup also included a bone marrow and liver biopsy. No conclusive diagnosis could be made from the above tests, and the patient died 5 days after admission. Postmortem evaluation, including flow cytometry and gene rearrangement in the tissue obtained from the liver, revealed large B cell lymphoma. This case illustrates an unusual presentation of hepatic non-Hodgkin's lymphoma. Current information regarding this entity is scant, mainly owing to its rarity. We present a review of the literature, including the incidence, presentation, treatment, and prognosis of primary hepatic lymphoma.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/21. Bilateral adrenal non-Hodgkin lymphoma type B.The adrenal localization of a primary non-Hodgkin lymphoma (NHL) is rare. We report a case of a 66-yr-old woman who had severe asthenia, diffuse skin hitching and abdominal pain. The physical examination revealed poor general conditions, irritability, pallor, dehydration and diffuse skin scratching lesions. The abdomen was painful at left hypochondrium and the Giordano's maneuvre was positive on both sides. A peripheral blood smear showed the presence of big rare lymphocytes with dyshomogeneous chromatin and granulated and hyperbasophil cytoplasm. She underwent abdominal ultrasonography which showed the presence of a hypoechogenic ovoidal mass (major diameter 8.4 cm) within the splenorenal left region. The presence of the suprarenal mass was confirmed by computed tomography (CT) scan which showed an enlarged left adrenal gland (8.1 x 6.2 cm) of solid structure. The right adrenal gland was also enlarged and of round shape (4.5 cm). CT scan-guided fine needle aspiration biopsy was then carried out on the left adrenal mass. It revealed the presence of NHL type B with large cells and modest T-lymphocyte reactive component. The patient was treated with three cycles of cyclophosphamide, adriamycin, vincristine and prednisolone. At the end of the third cycle, there was a transient clinical improvement and the hitching disappeared, but the patient worsened rapidly and she died few weeks later.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/21. Neurofibromatosis type 1 associated with central nervous system lymphoma.PURPOSE: To report the occurrence of central nervous system (CNS) lymphoma in a patients with neurofibromatosis type 1 (NF1). DESIGN: Interventional case report. methods: A 47-year-old male with a parieto-occipital lobe lesion was referred for ocular evaluation. skin, brain, and vitreous biopsies were performed. RESULTS: The discovery of Lisch nodules of the iris prompted a physical examination that revealed cutaneous stigmata of NF1. biopsy of the CNS lesion revealed diffuse large B-cell lymphoma. biopsy of papules on the back and abdomen were compatible with neurofibroma. No malignant cells were found in the vitreous specimen. A clinical diagnosis of NF1 was made. CONCLUSION: This is the first report of CNS lymphoma in a patient with NF1. Additional reports may shed more light on the possible association between the two conditions.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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