Case 3-2011 — A 58-Year-Old Woman with a Mass in the Liver  

Oleh:

Cusack, James C. ; Clark, Jeffrey W. ; Curley, Steven A. ; Sahani, Dushyant V.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 364 no. 04 (Jan. 2011), page 362-370.
Topik: Gastrointestinal Oncology

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2011.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Dr. Serguei Melnitchouk (Surgery): A 58-year-old woman was seen in the multidisciplinary gastrointestinal oncology clinic of this hospital because of a mass in the liver. The patient had been well until 2 weeks earlier, when severe, sharp pain developed suddenly in the right upper quadrant. The pain did not radiate, and there was no nausea, vomiting, or food intolerance. During the day, the pain (which she rated at up to 7 on a scale of 0 to 10, with 10 indicating the most severe pain) was intermittent and increased with moving or coughing. That evening, she went to the emergency department of her local hospital and was admitted. Ultrasonography of the abdomen showed a mass, 11 cm in diameter, in the right lobe of the liver. Computed tomography (CT) of the chest, with the administration of contrast material, revealed subsegmental (discoid) atelectasis in the apical and posterior basal segments of the lower lobe of the right lung. CT of the abdomen revealed an area of hypodensity, 7.8 cm by 5.3 cm by 11 cm, in the right hepatic lobe, abutting the gallbladder. The lesion showed slight heterogeneous enhancement, less than that of the surrounding liver; no neovascularity during the arterial phase; and no discrete central scar. There was a hypodense lesion (4 mm in diameter) in the lateral aspect of the right kidney and a small hiatal hernia. Cytologic examination of a specimen from a fine-needle aspiration biopsy of the liver mass revealed small, malignant cells that expressed pancytokeratin and synaptophysin and had focal positivity for cytokeratin 7 and no expression of chromogranin, cytokeratin 20, or thyroid transcription factor 1 (TTF-1). The findings were thought to be consistent with small-cell carcinoma but did not indicate a site of origin. The patient was discharged home on the fourth day, with pain medications.

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