Physical Examination: Blood pressure: 150/100 mmHg. No palpable enlargement of superficial lymph nodes was detected. Auscultation revealed normal and clear breath sounds in both lungs, without crackles or wheezes. The patient's heart rhythm was regular, and no murmurs were identified. The abdomen was soft and non-tender upon palpation. No edema was noted in either lower extremity.
Initial Diagnosis: Enlarged mediastinal lymph nodes, further investigation needed.
Abdominal CT: Multiple intrahepatic lesions observed, warranting further evaluation. Considerations include abscesses or metastases. If necessary, MRI can be performed for further assessment. Multiple small retroperitoneal lymph nodes were identified. Ultrasound examination revealed multiple lymph nodes in the bilateral supraclavicular and neck regions, with generally normal structures.
以下这段入院报告节选也来源于公开来源：中华医学会病理学分会第二十一次学术会议暨第五届中国病理年会 - 读片会
The patient was admitted due to the discovery of a pelvic mass during a physical examination four days prior. Gynecological examination revealed a 12 x 10 cm mass palpable behind the uterus. The mass was moderately hard, poorly mobile, and non-tender. A CT scan showed a large mixed cystic-solid mass in the pelvic cavity, located behind the uterus. On April 1, 2014, the patient underwent an exploratory laparotomy and mass excision under general anesthesia. During the surgery, a large mixed cystic-solid mass, approximately 12 x 12 x 10 cm in size, was found in the peritoneum behind the uterus and to its right. The mass had a smooth surface and a complete capsule, with a dark purple color. There was no adhesion to the uterus or adnexa. The original hospital's pathological diagnosis suggested a perivascular epithelioid cell neoplasm with high-risk aggressive behavior. A pathology consultation from a tertiary hospital in Nanjing City concluded that the mass was a poorly differentiated carcinoma, most likely a poorly differentiated adenocarcinoma.
Gross observation: A pelvic mass measuring 12 x 9 x 8.5 cm was identified as a cystic mass. A dark red nodule, 2.5 x 2 x 0.5 cm in size, was observed within the focal cyst wall. A nodular mass, 3.5 x 3.5 x 2.5 cm in size, was found at the posterior part of the broad ligament.
Chief Complaint: Persistent chest tightness and shortness of breath for over two months.
History of Present Illness: The patient began experiencing chest tightness and shortness of breath without any apparent triggers in early February. These symptoms worsened with physical activity and improved with rest. The patient did not report palpitations, fever, cough, or expectoration. Following admission, tests for Treponema antibody, HIV antibody/antigen, autoantibodies, antineutrophil antibodies, anti-glomerular basement membrane antibody, tuberculosis-specific T cells, and tumor markers all returned normal results. Pleural fluid culture did not reveal any bacteria, and pleural fluid smear did not show cancer cells. The pleural fluid test for Mycobacterium tuberculosis gene rpoB was negative. The patient has a history of diabetes and hypertension for over 10 years.
以下这段病理报告来源于公开来源：中华医学会病理学分会第二十一次学术会议暨第五届中国病理年会 - 读片会
Medical History: The patient is a 17-year-old male who was admitted to our hospital with the chief complaint of "a retroperitoneal mass discovered during a physical examination 3 days ago." A comprehensive abdominal ultrasound using color Doppler revealed a mixed echogenic (predominantly cystic) zone in the retroperitoneal region, closely situated to the upper and middle thirds of the right kidney, and the right lobe of the liver. This mass likely originated from the right kidney. The liver, gallbladder, pancreas, and spleen showed no apparent abnormalities. Blood flow in the portal vein was clearly visible. Unenhanced and enhanced MRI scans of the middle-upper abdomen identified a large space-occupying mass in the right-sided middle-upper abdomen, considered to be a cystic carcinoma of the right kidney.
Gross Pathology: Right kidney measured 25 x 19 x 10 cm. The cut surface displayed a cystic mass measuring 7 x 5 x 4.0 cm, filled with bloody fluid and with partial calcification of the cystic wall. The solid portion of the cystic mass was gray and gray-red in color with a crisp texture. A small amount of normal residual renal tissue was observed surrounding the mass. No obvious lymph node was present at the right renal hilum. The right adrenal gland consisted of a tissue measuring 5 x 3 x 2.5 cm with a cystic-solid cut surface and a dark brown color. Four right retroperitoneal lymph nodes were identified.
A 40-year-old female presented to the Affiliated Hospital of Xiangnan University with a 2-year history of hearing loss and tinnitus in her right ear. One month prior to her visit, the patient experienced a worsening of symptoms, including headaches and unsteady gait. A head MRI revealed an enlarged right internal auditory canal and a mixed cystic-solid nodule, which was causing significant compression of the brainstem. The patient was diagnosed with a right-sided acoustic neuroma.
Dr. Luo Zhongping, Director of the Department of Neurosurgery, led the team in discussing the case and emphasized the urgency of surgical intervention due to brainstem compression. A right-sided craniotomy for resection of the acoustic neuroma, with neurophysiological monitoring, was scheduled.
Contrast-enhanced brain MRI performed at our hospital revealed no significant abnormalities.
Bronchoscopic examination showed bronchial stenosis in the right lower lung lobe, with infiltrative changes and roughened mucosal surface, affecting the openings of the intermediate bronchus and middle lobe bronchus. A bite biopsy was performed in this region. Pathology of the right lower lobe indicated poorly differentiated carcinoma, consistent with adenocarcinoma. Immunohistochemistry (IHC) findings were positive for CK, NapsinA, TTF1, and ALK (D5F3).
Molecular testing showed no mutations in the EGFR gene using the Super-ARMS® EGFR kit.
Fine needle biopsy pathology of the right hepatic mass confirmed adenocarcinoma. IHC results were positive for ALK (D5F3), ALK-NC (-), Napsin A, TTF1, CK7, and SP-A.
A whole-body bone scan with emission CT performed on February 16, 2016, demonstrated increased bone metabolism in multiple areas throughout the body, suggesting widespread bone metastases. Numerous radiotracer-avid foci of varying sizes and morphologies were observed in the skull, sternum, all ribs, scapulas, cervical, thoracic and lumbar vertebrae, multiple regions of the pelvis, and long bones of the extremities. Both kidneys were visualized.
患者,男, 59岁,因“双上肢不自主震颤3年”于2006年4月8日入院,患者于3年前无明显诱因出现双上肢不自主震颤,静止时明显,情绪紧张时加重,睡眠时消失,曾在多家医院做头颅CT、MRI检查未见异常,诊断为“帕金森氏病”,以“美多芭125mg, tid, Po”,症状有所控制。1周前上述症状加重,伴明显焦虑、恐慌,入我院。既往无高血压、糖尿病、心脏病史。适龄结婚,育有1女, 4年前因车祸去世,爱人健康。体检:生命体征平稳,BP 110 /70mmHg,神清语利,定时定向力完整,问答切题,有时显紧张焦虑,双上肢静止震颤。行走转身自如,步态姿势正常,四肢灵活,肌张力不高,无齿轮样或折刀样、铅管样改变。心、肺、腹( - ) ;神经系统( - ) ;头颅CT、MR I( - ) ;血常规、生化( - ) 。入院后仍诊为帕金森氏病,但治疗效果欠佳。治疗或医患沟通病情时,患者四肢震颤、恐慌明显加重,有幻觉,肢体僵硬,谨小慎微,常觉“自己将遭遇极大不幸”。追问病史患者于入院前2年其父不幸突然病逝,患者受精神打击较大,自觉亲情失落,数日难以入睡。据此诊为广泛性焦虑症,给予心理治疗、奋乃静等处理, 1个月后基本痊愈。
The patient is a 59-year-old male admitted on April 8, 2006, due to involuntary tremors in both upper limbs for the past 3 years. The tremors began without any apparent trigger and were most noticeable at rest, worsening during periods of emotional stress, and disappearing during sleep. The patient underwent head CT and MRI scans at several hospitals, all yielding no abnormal findings. He was diagnosed with Parkinson's disease and prescribed Madopar (levodopa-carbidopa) 125 mg, taken orally three times daily, resulting in symptom improvement. However, one week prior to admission, his symptoms worsened, accompanied by significant anxiety and panic.
The patient has no history of hypertension, diabetes mellitus, or heart disease. He married at an appropriate age and had a daughter who tragically died in a car accident four years ago. His wife is in good health.
Physical examination: The patient's vital signs were stable, with a blood pressure of 110/70 mmHg. He was alert and oriented with coherent speech. His orientation and time judgment abilities were normal, although he occasionally appeared nervous and anxious. Resting tremor was observed in both upper limbs, but walking, turning, and gait were normal. Both upper and lower limbs demonstrated normal movement without any increase in muscle tone or signs of cogwheel, clasp-knife, or lead pipe rigidity. No abnormalities were found in the heart, lungs, abdomen, or nervous system. Head CT and MRI scans, as well as routine blood tests and blood chemistry tests, revealed no abnormalities.
The admission diagnosis remained Parkinson's disease, but the treatment response was suboptimal. During treatment and doctor-patient communication, the patient's limb tremors and panic worsened significantly. He experienced hallucinations, limb stiffness, a heightened sense of caution, and often felt as if a "great misfortune would befall him." Upon further investigation, it was discovered that the patient's father had suddenly passed away from illness two years prior, leaving the patient emotionally distraught and experiencing sleep disturbances for several days afterward.
Based on this information, the patient was diagnosed with generalized anxiety disorder and treated with a combination of psychotherapy and perphenazine. After one month of treatment, the patient showed significant improvement and was considered essentially cured.
A 60-year-old woman presented with a history of intermittent epigastric pain for over a month, which had worsened over the past four days. The patient first experienced epigastric pain without any apparent triggers more than a month ago. Magnetic resonance cholangiopancreatography (MRCP) performed at a local hospital revealed intrahepatic and extrahepatic bile duct stones. After receiving anti-infective medications and other symptomatic treatments, her symptoms improved.
On February 25, 2020 (four days prior to admission), the patient's epigastric pain recurred and was more severe than before. She sought care at a local hospital, where she was diagnosed with acute pancreatitis and intrahepatic and extrahepatic bile duct stones. Despite receiving symptomatic treatment, her symptoms persisted, prompting her to visit our hospital's emergency department. During this time, she also experienced intermittent hematochezia.
Past medical history: The patient underwent cholecystectomy and choledocholithotomy more than 20 years ago.
A Pt with Abdom Pain and Vomiting
A Patient with Abdominal Pain and Vomiting
A 39-year-old woman is admitted to you because of severe abdominal pain and vomiting. She states that her illness began about 3 days ago with midepigastric pain and nausea, and progressed to severe abdominal pain, nausea and vomiting. She describes her pain as crampy, without any radiation, and continuous throughout the day so that she cannot eat. She denies back pain, flank pain, diarrhea, dysuria, hematuria, cough or any similar episode of pain before. She denies eating any unusual foods, and her medications include NSAIDs for headaches, and oral contraceptives; she recently took a course of metronidazole for Trichomonas vaginitis. She is employed as a corporate vice-president, and lives with her daughter and husband. She does not smoke cigarettes and drinks alcohol only on social occasions. Her parents both died of cancer and she had a sister who committed suicide.
PE reveals a thin woman lying on her side in a fetal position. T 99, P 130, R 20, BP 100/82. SKIN - warm, dry without lesions. LN - none. HEENT - normal with dry mucosa. CHEST - clear. HEART - RRR 2/6 SEM; no rub or gallop. ABD - scaphoid with diffuse tenderness to light palpation especially in midepigastrium; voluntary guarding in all quadrants; no rebound; no organomegaly or palpable masses; BS absent. PELVIC - normal with normal rectum. Stool trace heme positive. NEURO - nonfocal.
Na 142, K 3.1, Cl 100, HCO3 36, BUN 25 Cr 1.2, glu 60
Hb 13.3, Hct 39.7, WBC 14.8 (88 segs, 10 bands, 2 lymphs)
UA – normal; ABG (RA) 7.50/38/64
AST 102; ALT 75; Alk Phos 126; LDH 140 Amylase 806; Lipase 180
EKG – Sinus tach 130/flattened T waves in V2-V6
CXR - atelectasis at both bases; small left pleural effusion
体检示，女患者身体偏瘦，蜷缩侧卧。体温 99华氏度，脉搏 130次每分，呼吸 20次每分，血压 100/82毫米汞柱。皮肤 — 温热、干燥、无病变。淋巴结 — 未及。五官 — 正常，粘膜干燥。胸部 — 无殊。心脏 — 心率平，收缩期喷射型杂音 2/6 ；无摩擦音或奔马律。腹部 — 轻压有弥漫性压痛，尤其是在腹中部；全腹所有象限都自发紧绷；无反跳痛；无器官肿大或可触及的肿块；无肠鸣音。盆腔 — 正常，直肠正常。粪便隐血阳性。神经 — 无局灶性异常
尿液 — 正常；动脉血气分析(RA) 7.50/38/64
心电图 — 窦性心动过速130/V2-V6T波低平
胸片 — 两肺底肺不张；左侧胸腔有少量积液
Managing Neutropenia in a Patient with Abdominal Pain Following Chemotherapy
MP is a 38-year-old woman who comes to the clinic with a temperature of 101F and complains of abdominal pain approximately 14 days after her last chemotherapy treatment.
Results of Last Visit
During her last appointment, MP denied fevers, chills, or other signs/symptoms of infection but, due to laboratory results, was initiated on levofloxacin 750 mg orally once daily as prophylactic therapy.
Relevant Medical History
• Diagnosis of triple-negative breast cancer
• Current therapies include cyclophosphamide and doxorubicin (AC) every 21 days x 4 cycles
• Ten days after receiving her last dose of chemotherapy, her complete blood cell count (CBC) results, showing neutropenia, are shown in Table/Slide 1.
• 目前的治疗包括环磷酰胺+多柔比星(AC)，21日 x 4个周期
Renal Cell Carcinoma Patient with Liver Mets
A 72-year-old male presents with fatigue and shortness of breath. On initial laboratory evaluation, he is found to have a hematocrit level of 55%. His past medical history is significant for hypertension, hyperlipidemia, coronary artery disease, and gastroesophageal reflux disease. Surgical history is only notable for cardiac stenting and tonsillectomy. He underwent contrast-enhanced CT, which revealed a large right renal mass with tumor thrombus extension into the renal vein (Slide 2) and a mass within the liver that was suspicious for a metastatic focus (Slide 3).
A Patient with Pleuritic Chest Pain and Dyspnea
A 63-year-old woman is admitted to the hospital because of acute dyspnea and right sided chest pain. She has a long history of medical problems including hypertension, and insulin dependent DM and chronic kidney disease. She sustained an inferior-lateral wall transmural myocardial infarction 5 years ago with a residual left ventricular ejection fraction of 30%. Three years ago, she underwent a left mastectomy for breast carcinoma and completed 6 months of adjuvant chemotherapy because of tumor involvement in 3 axillary lymph nodes (hormone receptors were negative).
She had been feeling relatively well lately until the day of admission when she noted the acute onset of dyspnea in the morning. This progressed throughout the day and was associated with pain in her right chest that increased upon inspiration, so she came to the Yale Emergency Department. She denied fever, cough, headache, abdominal pain, back pain, or light headedness. Her medications include insulin, Lasix, Lopressor, and an ACE-inhibitor.
PE reveals a dyspneic obese woman. T 99.4, R 32, P 120, BP 130/84. SKIN - no rash or lesions. LN - none palpable. HEENT - conj pink; Fundi - background but no proliferative retinopathy; oropharynx benign. CHEST - clear; mastectomy scar healed. COR - RRR without murmurs or rub. ABD - obese, soft, nontender without hepatosplenomegaly. NEURO - normal. EXT – benign without edema or erythema.
LABS Na 136, K 3.0, Cl 99, HCO3 24, Cr 1.7, glu 160
Hb 14.0, Hct 42.1, WBC 12.2 (normal differential), plts 375K
UA: clear/1.016/2+ protein/2+ glucose/no ketones, cells or casts
EKG: Stach 120/ Q waves in II, III, avF, V4-6; no change from
CXR: clear lungs, normal heart size
ABG (room air) pH 7.52/pCO2 22/pO2 51
动脉血气分析（未吸氧）：pH 7.52、pCO2 22、pO2 51
A Patient with Ascites
A 52-year-old woman was admitted to the hospital because of increased abdominal girth and evidence for new onset ascites. About two months prior to admission she noted unexpected weight gain of 10 lbs. This was followed by ankle swelling when she stood up for long periods, and progressed to the point that her clothes became too tight. She said it felt like she was pregnant.
Over the course of the last two weeks she noted increased fatigue, more difficulty sleeping and dyspnea on exertion. Today she claimed that her abdomen and shoulders hurt so she sought medical attention. She has a history of alcohol abuse over the past 20 years, and was hospitalized once for pancreatitis related to alcohol, but had no history of liver disease. She denied any chest pain, cough, change in bowel habits, jaundice, vaginal or rectal bleeding. She lives with her husband and has three healthy children. She has no family history of similar problems; her parents both died of heart disease.
P.E. reveals a thin woman with protuberant abdomen in mild respiratory distress. T 99oF; P 100; R 30; BP 120/80. SKIN - normal but with scattered spider angiomata. LN - none palpable. HEENT - conjuctivae normal; FUNDI - normal; oropharynx dry without lesions. CHEST - clear with decreased breath sounds at both bases about 1/4 way up; percussion note is dull over the same area and there is an absence of tactile fremitus at both bases. COR - JVP is 6 cm; RRR with no murmurs, gallops or rubs audible. ABD - protuberant but symmetrical on inspection; there are no palpable masses; liver and spleen are not palpable; there is mild tenderness throughout but no rebound pain; flank dullness and fluid wave are evident; BS are diminished but present. G/R - speculum exam is normal; rectum is normal; stool heme negative. NEURO - nonfocal. EXTREMITIES - 2+ edema.
LABS: Na 128, K 3.2, Cl 107, HCO3 17, BUN 4, Cr 0.5, glu192
Hb 13.0, Hct 39.0, WBC 10.5 (normal differential), plts 143 K
UA: clear/1.010/1+ protein; no glucose, ketones, cells or casts
EKG: NSR 100/nl intervals/no ST-T wave changes
CXR: bilateral pleural effusions; normal heart size