A 78-year-old man was admitted to the hospital because of a stricture of the sigmoid colon.Five years earlier, a rectal mass had been found on a routine sigmoidoscopic examination. An examination with a flexible sigmoidoscope showed a sessile, slightly lobulated, polypoid mass, 3 cm in diameter, just within the anal sphincter. Microscopical examination of biopsy specimens suggested a solitary rectal ulcer. The carcinoembryonic antigen level was 1.2 m g per liter. A transanal excision of the mass was performed, and microscopical examination of the specimen confirmed the diagnosis of a rectal ulcer. Follow-up examinations with a flexible sigmoidoscope during the next two months showed complete healing of the surgical site.Four years before admission, an abnormality was felt in each prostatic lobe. The prostate-specific antigen level was 13.9 ng per milliliter. Microscopical examination of a biopsy specimen of the tumor revealed an adenocarcinoma, Gleason grade 3 (on a scale of 1 to 5). A computed tomographic (CT) scan of the abdomen showed three cyst-like low-attenuation foci in the liver, the largest of which was 2 cm in diameter, as well as a solitary left para-aortic lymph node, 9 mm in diameter, and scattered diverticula in the sigmoid colon. A radionuclide bone scan was normal. The tumor was treated with a total dose of 6840 cGy. The patient subsequently began to pass one to four stools daily, either solid or liquid. One year later, he began to note fresh blood with his stools, mainly on the toilet tissue. Anoscopic examination showed small external hemorrhoids. Examination with a flexible sigmoidoscope to the level of the splenic flexure showed moderate diverticulosis.Seventeen months before admission, the prostatespecific antigen level was 4.0 ng per milliliter. Monthly injections of leuprolide were started.Seven months before admission, the patient began to experience fatigue and intermittent lower abdominal cramps and to pass 5 to 10 semisolid daily stools with small amounts of fresh blood. The prostate-specific antigen level was less than 0.5 ng per milliliter. Five and a half months before admission, a CT scan of the abdomen (Fig. 1) showed thickening of the sigmoid colon, adjacent stranding, sigmoid diverticula, and para-aortic and left iliac lymphadenopathy. The largest lymph nodes were 2 cm in diameter. One month later, an examination revealed mild lower abdominal tenderness. A rectal examination showed blood-stained mucus, and an anoscopic study showed small internal hemorrhoids. An attempted colonoscopic examination revealed a fixed, irregular sigmoid stricture that prevented further passage of the endoscope. Moderate mucosal atrophy and telangiectases were seen low in the rectum. Microscopical examination of multiple biopsy specimens showed mild distortion of the glandular architecture and severe chronic inflammation of the muscularis mucosa. Four months before admission, the prostate-specific antigen level was less than 0.5 ng per milliliter. A barium-enema examination (Fig. 2) showed a long sigm...
A 64-year-old man was admitted to the hospital because of a productive cough during treatment for suspected Wegener's granulomatosis.The patient had been well until seven months earlier, when he began to have unsteadiness and rightsided tinnitus, with constant maxillary, nasal, frontal, and temporal pain, which was more prominent on the right side. Treatment with prednisone (40 mg daily) was begun, with considerable improvement of the headache. A biopsy of the left temporal artery showed no evidence of arteritis. Two months before admission, a test for antineutrophil cytoplasmic antibody (ANCA) was positive, with a perinuclear pattern of staining (P-ANCA), and an enzyme-linked immunosorbent assay was positive for antibodies to myeloperoxidase at a titer of 18 U (normal value, less than 2.8). Three weeks later, another ANCA test was positive, with a P-ANCA pattern and an antimyeloperoxidase-antibody titer of 6.8 U.Three weeks before the current admission, the patient was first admitted to this hospital because of right facial weakness with dysarthria.The results of an examination were normal except for an almost complete right peripheral facial palsy and sensorineural hearing loss in the right ear.The urine was normal. The levels of urea nitrogen, creatinine, uric acid, bilirubin, calcium, phosphorus, magnesium, and aspartate aminotransferase were normal. The results of other laboratory tests are shown in Tables 1 and 2. Radiographs of the chest showed scarring or subsegmental atelectasis at the base of the left lung. A computed tomographic (CT) scan of the head, obtained without the administration of contrast material because of a reported allergy, revealed mucosal thickening of the left maxillary sinus and a soft-tissue mass in the right petrous apex. A CT scan of the temporal bones (Fig. 1) revealed a soft-tissue mass with bony destruction involving the right petrous apex and the petrous carotid canal and extending along the right aspect of the clivus and the floor of the middle cranial fossa. A magnetic resonance imaging (MRI) study of the brain (Fig. 2), performed be-T ABLE 1. H EMATOLOGIC L ABORATORY V ALUES .
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.