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We present a case of a 32 - year-old woman with a history of gradual enlargement of the anterior neck .
|
[
{
"entity_text": "enlargement of the anterior neck",
"type": "CLINENTITY"
}
] |
The medical history was unremarkable and no comorbidities existed .
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[] |
There was no history of radiation exposure .
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[] |
Clinical examination revealed a multinodular goiter .
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[
{
"entity_text": "multinodular goiter",
"type": "CLINENTITY"
}
] |
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch .
|
[
{
"entity_text": "thyroid nodule",
"type": "CLINENTITY"
}
] |
There was no evidence of lung lesions .
|
[
{
"entity_text": "lung lesions",
"type": "CLINENTITY"
}
] |
The patient underwent a surgical exploration .
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[] |
There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea .
|
[
{
"entity_text": "lobe nodule",
"type": "CLINENTITY"
}
] |
The intraoperative consultation pathology diagnosis was : undifferentiated carcinoma .
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[
{
"entity_text": "undifferentiated carcinoma",
"type": "CLINENTITY"
}
] |
A total thyroidectomy was realized .
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[] |
Histological examination showed a proliferation of elongated spindle-shaped cells , arranged in interweaving fascicles of varying sizes , intersected at right angles .
|
[
{
"entity_text": "proliferation of elongated spindle-shaped cells",
"type": "CLINENTITY"
}
] |
Tumor cells are atypical with strange nuclei .
|
[
{
"entity_text": "Tumor cells",
"type": "CLINENTITY"
}
] |
Chromatin is distributed inhomogeneously .
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[] |
The cytoplasmic membrane is irregular and thick .
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[] |
The nucleolus is very large .
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[] |
The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule .
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[
{
"entity_text": "tumor",
"type": "CLINENTITY"
}
] |
The mitotic rate was extremely high ( 19 mitosis / 10 high power field ) , and atypical mitotic figures were also present .
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[] |
The neoplasia showed invasion of the peri-glandular fat tissue .
|
[
{
"entity_text": "neoplasia",
"type": "CLINENTITY"
}
] |
Immuno-histochemical staining of the slides with caldesmon , desmin , PanCK , CK 5 -6 , CK 7 , myogenin , epithelial membrane antigen ( EMA ) , CEA , thyroid transcription factor ( TTF- 1 ) , pancytokeratin , smooth muscle actin ( SMA ) , MelanA , S 100 protein , CD 45 , CD 3 , CD 30 , CD 20 , CD 15 , CD 34 , ALK , calcitonin and KI 67 protein was performed .
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[] |
The tumour was strongly positive for caldesmon , SMA , desmin , and negative for pancytokeratin and other epithelial , lymphoid and melanocytic markers .
|
[
{
"entity_text": "tumour",
"type": "CLINENTITY"
}
] |
On the basis of the clinical , radiographic , histopathological and immunohistochemical features , the final diagnosis was primary thyroid leiomyosarcoma , FNCLCC grade 3 .
|
[
{
"entity_text": "thyroid leiomyosarcoma",
"type": "CLINENTITY"
}
] |
In multidisciplinary tumour board , it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin .
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[] |
Here we report a case of aggressive metastatic cholangiocarcinoma ( MCC ) in 72 - year-old man , sequentially treated with two targeted chemotherapies .
|
[
{
"entity_text": "metastatic cholangiocarcinoma",
"type": "CLINENTITY"
}
] |
Initially disease quickly progressed during best clinical practice care ( gemcitabine in combination with cisplatin or capecitabine ) , which was accompanied by significant decrease of life quality .
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[] |
Monotherapy with TKI sorafenib was prescribed to the patient , which resulted in stabilization of tumor growth and elimination of pain .
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[
{
"entity_text": "pain",
"type": "CLINENTITY"
}
] |
The choice of the inhibitor was made based on high-throughput screening of gene expression in the patient ' s tumor biopsy , utilized by Oncobox platform to build a personalized rating of potentially effective target therapies .
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[] |
However , time to progression after start of sorafenib administration did not exceed 6 months and the regimen was changed to monotherapy with Pazopanib , another TKI predicted to be effective for this patient according to the same molecular test .
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[] |
It resulted in disease progression according to RECIST with simultaneous elimination of sorafenib side effects such as rash and hand-foot syndrome .
|
[
{
"entity_text": "rash",
"type": "CLINENTITY"
},
{
"entity_text": "hand-foot syndrome",
"type": "CLINENTITY"
}
] |
After 2 years from the diagnosis of MCC the patient was alive and physically active , which is substantially longer than median survival for standard therapy .
|
[
{
"entity_text": "MCC",
"type": "CLINENTITY"
}
] |
A 36 year old female farmer gravida 5 para 4 at 27 weeks gestation presented to our facility .
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[] |
Her main complaint was a 3 month history of epigastric abdominal pain , which was gradual in onset , dull and persistent .
|
[
{
"entity_text": "epigastric abdominal pain",
"type": "CLINENTITY"
}
] |
Pain had gradually worsened over the months with no known relieving or aggravating factors but with intermittent radiation to the chest .
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[] |
There was a history of significant weight loss but no associated early satiety , jaundice , fever , itch or spontaneous bleeding .
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[] |
No history of blood transfusion and patient was on her routine hematinic from the antenatal clinic ( ANC ) .
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[] |
She is not a known diabetic , Hypertensive and has no known chronic illness .
|
[
{
"entity_text": "diabetic",
"type": "CLINENTITY"
},
{
"entity_text": "Hypertensive",
"type": "CLINENTITY"
}
] |
Patient did not know her Hepatitis status .
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[] |
Denied to taking any alcohol or smoking .
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[] |
There were no cardiorespiratory nor urogenital symptoms .
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[] |
She did not store grains at home and had no known contact with chemicals or ionizing radiation .
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[] |
Clinical signs on examination included wasting , mild pallor , a tinge of jaundice but well hydrated , afebrile and no palpable lymphnodes .
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[] |
She had palmer erythema but no clubbing and parotid enlargement .
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[] |
Respiratory , cardiovascular and neurological examinations were unremarkable .
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[] |
Abdomen was grossly distended with distorted contour in the upper half and visibly distended anterior abdominal wall veins draining away from the umbilicus .
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[] |
Liver was enlarged 12 cm below the costal margin with a span of 17 cm .
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[] |
The liver was hard , nodular with irregular edge , mild tendernes and had a bruit on auscultation .
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[] |
The spleen was not palpable but with demonstrable mild ascites and bipedal eodema up to the mid shin .
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[] |
Symphysio fundal height was 26 cm , with longitudinal lie and breech presentation .
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[] |
Fetal heart rate was 134 bpm and regular .
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[] |
Rectal and vaginal examination were unremarkable .
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[] |
Initial diagnosis of hepatocellular Carcinoma in pregnancy was made .
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[] |
Laboratory assesment revealed HB- 10 . 3 g / dl , WBC 10200 cells / dl ; Neutrophils 59 . 3 % , lymphocytes 26 . 1 % , Monocytes 10 . 1 % and Eosinophils 2 . 7 % .
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[] |
Platelets 350000 / ul .
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[] |
Normal bilirubin but GGT and AST were raised ( 4 times upper limit ) .
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[] |
Total protein and albumin were low , 44 g / L and 29 g / L respectively with INR- 1 . 3 . HBsAg was positive , HBeAg negative with HBV DNA level of 126869 IU / ml \ ( Viral load ) .
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[] |
VDRL positive but TPHA not done .
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[] |
Alphafeto protein ( AFP ) > 50000 KU / L .
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[] |
She tested negative to HIV and HCV .
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[] |
Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lessions .
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[] |
The liver measured 17 . 2 cm and there was mild ascites .
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[] |
Pelvic scan revealed a 27 week , 3 day old fetus , with active fetal movements .
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[] |
A revised diagnosis of hepatocellular carcinoma on a cirrhotic liver with decompensation in pregnancy was made .
|
[
{
"entity_text": "hepatocellular carcinoma on a cirrhotic liver",
"type": "CLINENTITY"
}
] |
She was managed with analgesia , furosemide , spironolactone and lamivudine added for prevention of mother to child trasmission of the hepatitis B infection .
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[] |
The plan was to allow pregnancy to continue to at least 32 completed weeks to improve the chance of neonatal survival .
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[] |
However because of the progressive unbearable abdominal pain , pregnancy was terminated at 30 weeks 3 days by successful induction of labour .
|
[
{
"entity_text": "abdominal pain",
"type": "CLINENTITY"
}
] |
The outcome was a fresh stillbirth weight 1 . 2 kg .
|
[] |
Pain was markedly reduced post delivery and was discharged home after 5 days .
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[] |
She was booked for a follow up visit at the gastrointestinal clinic .
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[] |
She was seen at the clinic at 2 weeks and four weeks post discharge but was lost to follow up afterwards .
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[] |
We report the case of a male patient , 79 years old , diabetic for 10 years on metformin , hypertensive for 5 years on amilodipine ; occasional alcoholic weaned 4 years ago .
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[] |
He was initially admitted for mental confusion with sudden onset dysarthria dating back 48 hours before .
|
[
{
"entity_text": "mental confusion",
"type": "CLINENTITY"
},
{
"entity_text": "dysarthria",
"type": "CLINENTITY"
}
] |
Initial assessment found Glasgow score ( GCS ) of 12 / 15 ( eye opening at 5 , verbal response at 2 , motor response at 5 ) , symmetrical and reactive pupils , without feeling-motor deficit , normal osteotendinous reflexes , slightly polypneic at 24 cycles / min , pulsed oxygen saturation ( SpO 2 ) at 97 % in ambient air , he was tachycardic at 115 bpm and hypertensive at 160 / 95 mmHg , his capillary blood glucose at 2 . 24 g / L , and glycosuria on the urine dipstick test without ketonuria .
|
[
{
"entity_text": "tachycardic",
"type": "CLINENTITY"
},
{
"entity_text": "hypertensive",
"type": "CLINENTITY"
}
] |
The patient was apyretic .
|
[] |
Arterial gas testing showed normal corrected anion gap metabolic acidosis , with hypokalaemia at 3 mmol / L and normal lactatemia at 0 . 43 mmol / L .
|
[
{
"entity_text": "hypokalaemia",
"type": "CLINENTITY"
}
] |
Diagnosis of diabetes decompensation was made despite absence of ketone bodies on urine dipstick test .
|
[] |
After conditioning , the patient was put on a hydration regimen with hypokalaemia correction and insulin therapy , and then referred to intensive care for additional management in face of non-improvement in his neurological condition .
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[] |
A brain scan was performed objectifying multiple parietal ischemic foci , chest scanner showed a thickening of the septal and foci of bronchial dilation without sign of pneumopathy linked to COVID- 19 infection ; abdominal ultrasound did not show any abnormalities .
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[] |
An electrocardiogram was performed showing no electrical signs of hypokalaemia or repolarization disturbances , transthoracic echocardiography was normal , as was ultrasound of supraortic trunks .
|
[
{
"entity_text": "hypokalaemia",
"type": "CLINENTITY"
}
] |
Laboratory workup showed an elevated C-reactive protein ( CRP ) of 45 . 5 with negative procalcitonin ( 0 . 04 ng / ml ) , white blood cells at 12 , 500 ( PNN at 9280 and normal lymphocytes at 2140 ) , no thrombocytopenia , normal ferritinemia , fibrinogen levels elevated to 5 . 37 and negative D-dimers .
|
[
{
"entity_text": "elevated C-reactive protein",
"type": "CLINENTITY"
},
{
"entity_text": "thrombocytopenia",
"type": "CLINENTITY"
}
] |
Natremia , magnesemia , corrected serum calcium , phosphoremia and thyroid assessment was normal .
|
[] |
SARS-CoV- 2 reverse transcription polymerase chain reaction ( RT-PCR ) by nasopharyngeal swab was negative , COVID- 19 serology ( IgM and IgG ) was also negative .
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[] |
Faced with concept of ischemic lesions on a brain scan , anticoagulation at a prophylactic dose , antiplatelet aggregation with aspirin and statins were initiated as well as an antibiotic therapy at a meningeal dose with ceftriaxone pending results of the lumbar puncture which subsequently showed a clear liquid with a high proteinorachia at 0 . 58 g / l ( normal between 0 . 15 and 0 . 45 ) , a normal glycorachia / blood sugar ratio at 0 . 58 ( normal at 0 . 5 ) ; with a culture showing less than 3 elements , sterile after 24 hours .
|
[] |
Cerebral Magnetic resonance angiography performed on day 2 of admission showed signs in favor of vascular leukopathy , with some calcifications in basal ganglia and cortical atrophy .
|
[
{
"entity_text": "calcifications in basal ganglia",
"type": "CLINENTITY"
},
{
"entity_text": "cortical atrophy",
"type": "CLINENTITY"
}
] |
Electroencephalogram showed signs of epilepsy , which prompted us to retain the diagnosis of nonketotic hyperglycemia-related epileptic seizures .
|
[
{
"entity_text": "epilepsy",
"type": "CLINENTITY"
},
{
"entity_text": "epileptic seizures",
"type": "CLINENTITY"
}
] |
Anticonvulsant treatment was started with sodium valproate .
|
[] |
The Patient worsened neurologically despite correction of his metabolic acidosis , he was intubated on day 3 of his admission ( day 5 of symptoms onset ) .
|
[] |
A cerebral computerized tomography ( CT ) scan was performed without showing any progressive lesions .
|
[
{
"entity_text": "lesions",
"type": "CLINENTITY"
}
] |
Faced with installation of lymphopenia ( HIV serologies 1 and 2 negative ) with increased CRP , a multiplex RT-PCR in protected distal bronchial sample as well as in Cerebrospinal fluid ( CSF ) were performed , the first was positive to SARS-CoV- 2 .
|
[] |
Reverse transcription polymerase chain reaction of SARS-CoV- 2 in CSF was positive but with a cycle threshold ( CT ) of 38 . 6 .
|
[] |
The diagnosis of SARS-CoV- 2 encephalopathy was retained .
|
[
{
"entity_text": "SARS-CoV- 2 encephalopathy",
"type": "CLINENTITY"
}
] |
The patient is still in intensive care .
|
[] |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week ’ s duration .
|
[
{
"entity_text": "epigastric pain",
"type": "CLINENTITY"
}
] |
There was no vomiting or weight loss .
|
[
{
"entity_text": "vomiting",
"type": "CLINENTITY"
},
{
"entity_text": "weight loss",
"type": "CLINENTITY"
}
] |
Bowel movements were normal .
|
[] |
Clinical examination at the time was unrevealing .
|
[] |
An abdominal ultrasound examination was reported as normal .
|
[] |
The patient ’ s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution .
|
[] |
The CT scan showed a large tumour ( 6 cm in largest diameter ) in the body and tail of pancreas with no evidence of metastasis .
|
[
{
"entity_text": "tumour",
"type": "CLINENTITY"
},
{
"entity_text": "metastasis",
"type": "CLINENTITY"
}
] |
She was prepared for exploratory laparotomy .
|
[] |
The pancreas was explored through the gastrocolic omentum .
|
[] |
The body and tail of the pancreas including the tumour were resected .
|
[
{
"entity_text": "tumour",
"type": "CLINENTITY"
}
] |
