1/5. Solitary metastatic carcinoma of the spleen.A care is reported in which an isolated metastatic lesion of the spleen was discovered one year after a modified radical mastectomy for carcinoma of the breast, and seven years following total hysterectomy and bilateral salpingo-oophorectomy for carcinoma of the left ovary. splenectomy was followed by significant clinical improvement of the patient who remains alive and well four years after operation. Regular physical and roentgen examinations have revealed no evidence of recurrent disease. The factors relating to the occurrence of solitary splenic metastasis are discussed briefly. This case is apparently the fifth reported in the literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Ectopic production of antidiuretic hormone (adh), adrenocorticotrophic hormone (ACTH) and beta-melanocyte stimulating hormone (beta-msh) by an oat cell carcinoma of the lung.A 61 year old woman presented with profound hyponatremia and markedly low serum osmolality. urine osmolality was greater than the serum osmolality, an abnormality that was corrected by water restriction, suggesting inappropriate ADH secretion. Although there were no physical signs of Cushing's syndrome, her serum potassium level was low and markedly elevated levels of plasma and urine corticosteroids were not altered by the administration of large amounts of dexamethasone, suggesting the ectopic ACTH-MSH syndrome. plasma levels of immunoreactive ACTH and beta-msh were elevated. At autopsy, a metastastic oat cell carcinoma of the lung, not detected antemortem by chest roentgenograms and bronchoscopy, was found. Immunoreactive ADH, ACTH and beta-msh were detected in the primary tumor and in metastases to the liver. beta-msh was also detected in the spleen, in which metastases were observed. This is the first documented case of the simultaneous production of ADH, ACTH and beta-msh by neoplastic tissue associated with clinical manifestations of the syndrome of inappropriate ADH secretion and the ectopic ACTH-MSH syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Functional asplenia and portal hypertension in a patient with primary splenic hemangiosarcoma.A 60-year-old man with primary splenic hemangiosarcoma (PSH) presented with weakness, weight loss, abdominal pain, and anemia. physical examination revealed hepatomegaly, ascites, and firm, huge splenomegaly. ultrasonography showed many nodular structures characterized by hypoechogenic and hyperechogenic areas. The patient also had portal hypertension, which was confirmed by physical findings and by measurement of portal vein pressure during operation. A liver-spleen scan using Tc-99m sulfur colloid and Tc-99m labeled heat denatured erythrocytes failed to demonstrate any splenic uptake, a reliable feature of functional asplenia. Although on a total body scan with Ga-67 citrate there was no splenic uptake, there was gallium uptake in the liver, where the presence of the metastatic lesion was histopathologically verified and confirmed by operation. There was also uptake in the middle zones of the lungs. Ga-67 citrate imaging appears to be helpful in the diagnosis of metastasis of PSH, and PSH can rarely cause portal hypertension.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. Spontaneous rupture of splenic hamartoma.hamartoma of the spleen is a rare benign tumor. Only one spontaneously ruptured splenic hamartoma has been reported that presented with an acute surgical abdomen. A second case of a ruptured hamartoma of the spleen is illustrated; however, this case is unique in that it presented as a nonsurgical abdomen. This case stresses the importance of serial physical examinations of the patient and appropriate diagnostic studies in correctly determining the diagnosis when preliminary findings are inconclusive. Surgeons should include splenic hamartomas in the differential diagnoses of splenic defects seen on radiologic studies or splenic masses palpated during abdominal exploration.- - - - - - - - - - ranking = 21.320154113411keywords = physical examination, physical (Clic here for more details about this article) |
5/5. CD5 negative diffuse mantle cell lymphoma with splenomegaly and bone marrow involvement.We report the case of a 78-year-old man in whom routine physical examination revealed cervical adenopathy and splenomegaly. Peripheral blood showed a normal white blood cell count with an absolute lymphocytosis, which included a population with slightly indented nuclei. Lymph node biopsy showed morphology compatible with mantle cell lymphoma. bone marrow biopsy showed replacement by a lymphoid proliferation composed of lymphocytes with features similar to those found in the peripheral blood. Immunophenotypic analysis of both peripheral blood and lymph node showed positivity for CD19, CD20 and CD22, with lambda light chain restriction. Tests for CD5 and CD10 were negative. cytogenetic analysis and polymerase chain reaction studies confirmed the presence of t(11,14) supporting a diagnosis of mantle cell lymphoma. This unusual case of CD5-negative mantle cell lymphoma exemplifies the importance of combined molecular, cytogenetic, and morphologic evaluation when confronted with a lymphoma having an atypical phenotype.- - - - - - - - - - ranking = 21.320154113411keywords = physical examination, physical (Clic here for more details about this article) |