1/36. Malignant phyllodes tumor in the right breast and invasive lobular carcinoma within fibroadenoma in the other: case report.CONTEXT: The malignant variety of the phyllodes tumor is rare. The occurrence of invasive lobular carcinoma within fibroadenoma is rare as well. DESIGN: Case report. CASE REPORT: A 58-year-old black female patient was referred to the Mastology unit of the Department of gynecology, Federal University of Sao Paulo / Escola Paulista de Medicina, in February 1990, presenting an ulcerated tumor in the right breast with fast growth over the preceding six months. She was a virgin, with meno-pause at the age of 45 years and had not undergone hormone replacement treatment. The physical examination showed, in her right breast, an ulcerated tumor of 20 x 30 cm which was not adher-ent to the muscle level, multilobular and with fibroelastic consistency. The axillary lymph nodes were not palpable. The left breast showed a 2 x 3 cm painless, movable nodule, with well-defined edges, and fibroelastic consistency. We performed left-breast mammography, which showed several nodules with well-defined edges, the largest being 2 x 3 cm and exhibiting rough calcification and grouped microcalcifications within it. The patient underwent a frozen biopsy that showed a malignant variant of the phyllodes tumor in the right breast and fibroadenoma in the left one. After that, we performed a total mastectomy in the right breast and an excision biopsy in the left one. paraffin study confirmed the frozen biopsy result from the right breast, yet we observed that in the interior of the fibroadenoma that was removed on the left, there was a focal area of invasive lobular carcinoma measuring 0.4 cm. The patient then underwent a modi-fied radical mastectomy with total axillary lymphadenectomy. None of the 21 dissected lymph nodes showed evidence of metastasis. In the follow-up, the patient evolved asymptomatically and with normal physical and laboratory examination results up to July 1997.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/36. Segmental neurofibromatosis in association with nevus sebaceus of Jadassohn.We describe an unusual case involving the simultaneous occurrence of segmental neurofibromatosis (Type V NF) in a patient with a large nevus sebaceus of Jadassohn in the same physical distribution. Causative mechanisms of development of these 2 genetic disorders have not been definitively linked. Factors producing these diseases probably involve similar tissues at the same point in development because both have been reported in association with central nervous system anomalies and have been classified among the neurocutaneous syndromes. This is a case of a nevus sebaceus occurring in association with and in the same physical distribution as segmental NF. These disorders most likely represent a spectrum of disease within the phakomatoses.- - - - - - - - - - ranking = 0.13131033349182keywords = physical (Clic here for more details about this article) |
3/36. Coexistence of an endocrine tumour in a serous cystadenoma (microcystic adenoma) of the pancreas, an unusual association.A pancreatic endocrine tumour arising within a serous cystadenoma is reported. A 49 year old woman was admitted with a history of epigastric pain, nausea, vomiting, and weight loss of two months duration. She had been diabetic for 12 years. An epigastric mass was palpated in the physical examination, and computed tomography revealed a multiloculated cystic lesion in the pancreas. Pathological examination of the pancreatic tumour revealed the coexistence of a serous cystadenoma and an endocrine tumour. The endocrine tumour, which was located inside the serous cystadenoma, was 1 cm in diameter. The first case of a serous cystadenoma of the pancreas containing a pancreatic endocrine tumour was reported in the literature recently. This paper reports another incidentally found pancreatic endocrine tumour arising within a serous cystadenoma.- - - - - - - - - - ranking = 0.93434483325409keywords = physical examination, physical (Clic here for more details about this article) |
4/36. neurilemmoma arising in the brachial plexus in association with breast cancer: report of case.A 48-year-old woman without von Recklinghausen's disease presented to our department for investigation of a left breast lump and a lump in the left axilla. A presumptive diagnosis of left breast cancer with axillary lymph node involvement was made based on the findings of physical examination and needle biopsy of the left breast lump. However, on exploration we discovered that the axillary lump was a neurogenic tumor arising in the brachial plexus. Enucleation of the neurogenic tumor, which was subsequently histologically confirmed as neurilemmoma, as well as a modified radical mastectomy, was performed. Postoperatively, the patient experienced slight numbness in her left second and third fingers, but this symptom improved within 5 months. When last seen 21 months after her operation, there were no signs of recurrence of either the breast cancer or the neurilemmoma.- - - - - - - - - - ranking = 0.93434483325409keywords = physical examination, physical (Clic here for more details about this article) |
5/36. Non-invasive lobular carcinoma within a fibroadenoma, a preoperatively diagnosed case.breast cancer within a fibroadenoma is rare and usually diagnosed postoperatively from pathological specimens. This paper reports a 54-year-old female with non-invasive carcinoma within a fibroadenoma, diagnosed preoperatively. She underwent a medical examination and mastopathy was suspected. On physical examination a mass 2 cm in diameter was palpated in the left breast. ultrasonography showed a mass with smooth margins and uniform internal echoes, but cytology showed malignancy. mammography showed a round mass with distinct margins and no calcification. As fibroadenoma, diagnosed by ultrasonography and mammography, and breast cancer, diagnosed by cytology, were not consistent results several core biopsies were performed. Needle biopsy showed proliferation of atypical epithelial cells; breast cancer within a fibroadenoma was diagnosed. MRI showed a circular mass with distinct, smooth margins and in a dynamic study, the mass showed irregular staining and the presence of early staining. Left lumpectomy and dissection of the left axillary lymph nodes was performed. Histological examination showed non-invasive lobular carcinoma occurring within a fibroadenoma.- - - - - - - - - - ranking = 0.93434483325409keywords = physical examination, physical (Clic here for more details about this article) |
6/36. Typical and atypical Carney's triad presenting with malignant hypertension and papilledema.This report encourages clinicians to consider a diagnosis of Carney's triad in patients with multifocal gastric stromal sarcoma, extraadrenal paraganglioma (predominantly mediastinal), or pulmonary chondroma. The authors conducted a retrospective 20-year survey at the Hospital for Sick Children and identified two children with Carney's triad. One child, presenting atypically with papilledema and fundal hemorrhages from malignant hypertension and benign intracranial hypertension from chronic iron-deficiency anemia, is the second patient ever to date be described with the complete Carney's triad of neoplasms at diagnosis. Another child presented more typically with gastric stromal sarcoma and pulmonary chondroma without paraganglioma. Carney's triad is a rare differential diagnosis for "idiopathic" hypertension or iron-deficiency anemia from chronic gastrointestinal bleeding. If missed, patients with Carney's triad may have the debilitating physical and mental consequences of chronic iron deficiency and may die of untreated prolonged hypertension and metastatic leiomyosarcoma.- - - - - - - - - - ranking = 0.065655166745911keywords = physical (Clic here for more details about this article) |
7/36. Bilateral elastofibroma dorsi: proper positioning for an accurate diagnosis.Elastofibroma dorsi is a rare, slow-growing, ill-defined soft tissue tumor of the chest wall, most commonly located beneath the rhomboid major and latissimus dorsi muscles. It is usually unilateral, and bilateral involvement occurs in only 10% of patients. We report herein a case of a 56-year-old woman with bilateral elastofibroma dorsi. The patient was found to have bilateral involvement of the tumor following a physical examination with proper positioning. An elastofibroma should be considered in the differential diagnosis of tumors deeply located at the periscapular area. Meticulous physical examination may reveal a nonpalpable coexisting tumor with deep subscapular location and help the accurate diagnosis of bilateral elastofibroma dorsi, hence preventing a secondary operation.- - - - - - - - - - ranking = 1.8686896665082keywords = physical examination, physical (Clic here for more details about this article) |
8/36. Mycobacterium infection directly observed in a surgical outpatient centre.BACKGROUND: This study aims to check the presence and the role of the mycobacterium tuberculosis infection, in an Ambulatory and Day Surgery Out-Patient Centre. methods: Two periods of activity in this Centre are evaluated corresponding separately to the years 1989-1993 and 1994-1998 and the total number of patients, coming for examination, ambulatory or day surgery, hospitalization, postoperative follow-up, is considered, in order to identify the number of cases and the clinical signs of this disease. All cases were examined by the same team and the checks were completed, in the selected cases in which it was advisable, with radiological, bacteriological, bioptical, radiometrical exams and with the Elisa test (after informed consent). RESULTS: In the first period 1989-1993, 21,220 patients were examined and no case of tubercular infection was observed. In 1994-1998, 24,347 patients were examined and 4 cases of tubercular infection detected, which represent 0.016% of the patients attending the service. The clinical cases are as follows. Case 1: right sub-mammary lump, diameter 7 x 5 cm, smooth, oval, firm. Case 2: right breast swelling, diameter 5 cm, not sore, with deep attachments. The mammography and ultrasound scan indicate: the opacity is compatible with mali moris breast lesion. Case 3: coloured, immigrant, who presents back swelling, diameter 8 cm, with fluctuation. CT of the chest indicates opacity near left latissimus dorsi muscle, diameter 10 cm, without bronchopleural connections. Case 4: bleeding neoplastic ulcer of the wrist. At physical exam a right subclavear amphoric breath sound is noticed, corresponding at chest X-ray to an opacity including cavitation. In the 4 cases no lymph node in the regional effusion areas is detected. In the 4 cases surgical therapy is integrated with antituberculous chemotherapy till 6 months after operation. CONCLUSIONS: mycobacterium tuberculosis infection has been increasing in the second group of years considered, as it is observed in European industrialized countries and north america. This increase corresponds to 0.016% in 24,374 patients examined in the period 1994-98. This infection must not be connected with the classic sites and traditional primary and post-primary symptons, but must be considered and identified in a surgical hospital out-patient centre, in unusual sites, sometimes masquerading as a false positive carcinoma, in patients with predisposition, because of old age, race, immunodepression (also if hiv negatives), resistance to treatment, previous tuberculous infection. In the cases identified deep diagnostic definition, the surgical treatment and a prolonged antituberculous chemotherapy are necessary.- - - - - - - - - - ranking = 0.065655166745911keywords = physical (Clic here for more details about this article) |
9/36. Spontaneous regression of subcutaneous metastasis of cutaneous melanoma.A case is presented of a 44-year-old Caucasian man who was operated on in October of 1988 for a cutaneous melanoma in his trunk and who in the space of 1 year manifested a single subcutaneous nodule compatible with a metastasis of melanoma by fine-needle aspiration biopsy. No other abnormal findings were revealed by physical and instrumental examinations. During the subsequent hospitalization, we witnessed (in conjunction with the occurrence of painful symptoms in the hands of an inflammatory nature) the total, progressive, spontaneous regression of the metastasis, which was confirmed by the clinic and the tests. After 15 months of follow-up, the patient has not shown any further signs of illness.- - - - - - - - - - ranking = 0.065655166745911keywords = physical (Clic here for more details about this article) |
10/36. Metastatic thyroid cancer as an incidental finding during neck dissection: significance and management.Occult thyroid cancer is an occasional incidental finding during surgery for other indications and is usually considered of minor clinical significance; however, the appropriate approach for incidentally found metastatic thyroid cancer is less clear especially when it occurs in the context of another malignancy that has more aggressive potential. Among 2,855 patients treated for squamous cancer of the tongue at The University of texas M. D. Anderson Cancer Center, eight patients had coexisting differentiated thyroid cancer metastatic to cervical lymph nodes which was found incidentally during regional lymph node dissection. The eight patients included three women and five men with a median age of 47 years (range, 32-62 years); tumors were of the papillary variety in four patients and follicular in the other four. In one patient, no gross or microscopic primary tumor could be identified after thyroidectomy; in another patient, no gross tumor was evident, but whole organ section revealed an area of fibrosis consistent with a primary lesion. Two patients had primary lesions less than 1 cm in maximal diameter. In four patients who had no surgery, physical exam and radiologic evaluation failed to show any intrathyroidal lesions. Clinically relevant thyroid cancer did not develop in any of those patients during the duration of documented follow-up (1-15 years). Three patients died of progressive tongue cancer, one patient of unrelated pulmonary disease, and four patients remain alive without evidence of disease for 1 to 15 years of available follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.065655166745911keywords = physical (Clic here for more details about this article) |
| | Next -> |