Subject(s)
Colon/pathology , Lanthanum/adverse effects , Pelvis/diagnostic imaging , Renal Dialysis/adverse effects , Ulcer/etiology , Aged, 80 and over , Calciphylaxis/diagnosis , Carcinoma/surgery , Colectomy , Colon/drug effects , Colonic Neoplasms/surgery , Diagnosis, Differential , Humans , Lower Extremity/diagnostic imaging , Lower Extremity/pathology , Male , Olecranon Process/surgery , Pelvis/pathology , Prostatic Neoplasms/surgery , Radiography , Ulna Fractures/surgery , Upper Extremity/pathology , Weight LossABSTRACT
Struma ovarii is the presence of thyroid tissue as the major cellular component in an ovarian tumour. Papillary carcinoma in struma ovarii is exceptionally rare. We report a case of papillary carcinoma in struma ovarii in a postmenopausal 51-year-old female who initially presented clinically with hyperthyroidism. Serology, however, did not confirm hyperthyroidism. During a re-admission to our hospital later that year she appeared to have had periods of postmenopausal vaginal haemorrhage. An abdominal mass was located by radiography and pathological investigation revealed a papillary carcinoma in struma ovarii. Some striking features of this unusual presentation of importance to the internal medicine physician are discussed.
Subject(s)
Carcinoma, Papillary/diagnosis , Ovarian Neoplasms/diagnosis , Struma Ovarii , Carcinoma, Papillary/surgery , Diagnosis, Differential , Endosonography , Female , Follow-Up Studies , Humans , Middle Aged , Ovarian Neoplasms/surgery , Ovariectomy/methods , Tomography, X-Ray ComputedABSTRACT
A 76-year-old man presented with diffuse progressive abdominal pain. He had undergone endoscopic retrograde pancreaticocholangiography (ERCP) 5 weeks earlier for jaundice and increased levels of liver enzymes. A dilated biliary duct with multiple concrements had been seen, and a plastic endoprosthesis was placed. During a follow-up ERCP the stent was not found, and the obstruction was still present. Another stent was placed. Abdominal x-ray revealed migration of the first endoprosthesis to the distal jejunum and signs of ileus and free gas. CT showed that the stent was stuck in a perforated diverticulum of the sigmoid, surrounded by an abscess mass. The stent was removed by laparotomy, the perforation was closed, and a double-loop stoma was made. Two weeks after initial recovery, abdominal pain recurred. CT revealed a second dislocated stent with a perforation of the jejunum. Laparotomy was performed again with removal of the stent and repair of the perforation. Migration is a known complication of biliary endoprosthesis placement, and should be considered in cases of abdominal pain after ERCP. Perforations rarely occur and mostly affect areas of the bowel that are fixed or that present obstacles to normal elimination. Two perforations within a short period of time is an extremely rare complication of migration.
