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T1 Age 22 33 58-year-old T2 Personal_background 34 39 white T3 Personal_background 40 48 Hispanic T4 Sex 49 54 woman T5 History 62 104 history of uveal melanoma in her right eye T6 Clinical_event 122 130 admitted E1 Clinical_event:T6 T7 Sign_symptom 152 160 jaundice E2 Sign_symptom:T7 T8 Sign_symptom 175 179 pain E3 Sign_symptom:T8 T9 Biological_structure 165 174 abdominal R1 MODIFY Arg1:T9 Arg2:E3 T10 Duration 184 191 10 days E4 Duration:T10 T11 Diagnostic_procedure 207 223 laboratory tests E5 Diagnostic_procedure:T11 T12 Diagnostic_procedure 241 261 complete blood count E6 Diagnostic_procedure:T12 T13 Diagnostic_procedure 288 295 amylase E7 Diagnostic_procedure:T13 T14 Diagnostic_procedure 306 321 total bilirubin E8 Diagnostic_procedure:T14 R2 SUB_PROCEDURE Arg1:E6 Arg2:E5 R3 SUB_PROCEDURE Arg1:E7 Arg2:E5 R4 SUB_PROCEDURE Arg1:E8 Arg2:E5 T15 Lab_value 266 286 within normal limits R5 MODIFY Arg1:T15 Arg2:E6 T16 Lab_value 297 304 136 U/L R6 MODIFY Arg1:T16 Arg2:E7 T17 Lab_value 323 333 6.37 mg/dL T18 Diagnostic_procedure 341 356 direct fraction E9 Diagnostic_procedure:T18 R7 SUB_PROCEDURE Arg1:E9 Arg2:E8 T19 Lab_value 360 370 5.30 mg/dL R8 MODIFY Arg1:T19 Arg2:E9 T20 Diagnostic_procedure 400 419 computed tomography E10 Diagnostic_procedure:T20 T21 Diagnostic_procedure 421 423 CT E11 Diagnostic_procedure:T21 R9 IDENTICAL Arg1:E11 Arg2:E10 T22 Biological_structure 390 399 abdominal T23 Detailed_description 373 388 Cross-sectional R10 MODIFY Arg1:T22 Arg2:E10 R11 MODIFY Arg1:T23 Arg2:E10 T24 Detailed_description 425 438 with contrast R12 MODIFY Arg1:T24 Arg2:E10 T25 Sign_symptom 465 471 lesion E12 Sign_symptom:T25 T26 Detailed_description 449 464 low-attenuating R13 MODIFY Arg1:T26 Arg2:E12 T27 Biological_structure 489 504 pancreatic head T28 Area 516 524 4 × 3 cm R14 MODIFY Arg1:T27 Arg2:E12 R15 MODIFY Arg1:T28 Arg2:E12 T29 Biological_structure 532 571 thinner section of the distal bile duct R16 MODIFY Arg1:T29 Arg2:E12 T30 Diagnostic_procedure 666 673 EUS-FNA E13 Diagnostic_procedure:T30 #1 AnnotatorNotes E13 Endoscopic ultrasound fine needle aspiration biopsy T31 Clinical_event 609 634 multidisciplinary meeting E14 Clinical_event:T31 T32 Coreference 675 678 EUS E15 Coreference:T32 R17 IDENTICAL Arg1:E15 Arg2:E13 T33 Sign_symptom 887 918 vascular or lymph node invasion E16 Sign_symptom:T33 A1 POLARITY E16 NEG T34 Coreference 931 938 EUS-FNA E17 Coreference:T34 R18 IDENTICAL Arg1:E17 Arg2:E13 T35 Sign_symptom 758 764 lesion E18 Sign_symptom:T35 T36 Detailed_description 688 693 solid T37 Detailed_description 695 707 heteroechoic T38 Detailed_description 713 743 predominantly hypoechoic areas T39 Detailed_description 745 757 well-defined R19 MODIFY Arg1:T39 Arg2:E18 R20 MODIFY Arg1:T38 Arg2:E18 R21 MODIFY Arg1:T37 Arg2:E18 R22 MODIFY Arg1:T36 Arg2:E18 T40 Texture 770 786 regular contours R23 MODIFY Arg1:T40 Arg2:E18 T41 Area 798 810 3.1 × 2.6 cm R24 MODIFY Arg1:T41 Arg2:E18 T42 Biological_structure 823 864 between the head and neck of the pancreas R25 MODIFY Arg1:T42 Arg2:E18 T43 Detailed_description 953 970 with a 22G needle T44 Detailed_description 971 998 using the fanning technique R26 MODIFY Arg1:T43 Arg2:E17 R27 MODIFY Arg1:T44 Arg2:E17 T45 Diagnostic_procedure 1007 1025 cytology specimens E19 Diagnostic_procedure:T45 T46 Lab_value 1062 1091 discohesive dispersed pattern R28 MODIFY Arg1:T46 Arg2:E19 T47 Lab_value 1105 1132 variation in size and shape T48 Shape 1143 1154 epithelioid T49 Shape 1159 1173 spindle-shaped T50 Biological_structure 1039 1044 cells T51 Biological_structure 1174 1179 cells T52 Shape 1185 1197 plasmacytoid T53 Shape 1202 1207 round T54 Biological_structure 1208 1214 nuclei R29 MODIFY Arg1:T53 Arg2:T54 R30 MODIFY Arg1:T52 Arg2:T54 R31 MODIFY Arg1:T54 Arg2:T51 R32 MODIFY Arg1:T49 Arg2:T51 R33 MODIFY Arg1:T48 Arg2:T51 R34 MODIFY Arg1:T46 Arg2:T50 R35 MODIFY Arg1:T47 Arg2:T51 R36 MODIFY Arg1:T50 Arg2:E19 R37 MODIFY Arg1:T51 Arg2:E19 T55 Sign_symptom 1453 1461 necrosis E20 Sign_symptom:T55 T56 Sign_symptom 1466 1476 hemorrhage E21 Sign_symptom:T56 T57 Diagnostic_procedure 1220 1237 nuclear chromatin E22 Diagnostic_procedure:T57 T58 Lab_value 1241 1249 clumping T59 Lab_value 1254 1263 irregular T60 Lab_value 1269 1301 excessive parachromatin clearing T61 Biological_structure 1332 1345 macronucleoli T62 Detailed_description 1323 1331 multiple T63 Detailed_description 1313 1319 single R38 MODIFY Arg1:T62 Arg2:T61 R39 MODIFY Arg1:T63 Arg2:T61 T64 Biological_structure 1360 1369 cytoplasm T65 Detailed_description 1351 1359 abundant R40 MODIFY Arg1:T65 Arg2:T64 T66 Lab_value 1375 1403 deep brownish-black granules R41 MODIFY Arg1:T58 Arg2:E22 R42 MODIFY Arg1:T59 Arg2:E22 R43 MODIFY Arg1:T60 Arg2:E22 R44 MODIFY Arg1:T61 Arg2:E22 R45 MODIFY Arg1:T64 Arg2:E22 R46 MODIFY Arg1:T66 Arg2:E22 T67 Therapeutic_procedure 1514 1526 exenteration E23 Therapeutic_procedure:T67 T68 Therapeutic_procedure 1543 1564 duodenopancreatectomy E24 Therapeutic_procedure:T68 T69 Detailed_description 1570 1587 Whipple procedure R47 MODIFY Arg1:T69 Arg2:E24 T70 Biological_structure 1500 1513 right orbital R48 MODIFY Arg1:T70 Arg2:E23 T71 Sign_symptom 1602 1615 complications E25 Sign_symptom:T71 A2 POLARITY E25 NEG T72 Diagnostic_procedure 1629 1646 surgical specimen E26 Diagnostic_procedure:T72 T73 Biological_structure 1671 1676 cells T74 Detailed_description 1654 1670 undifferentiated R49 MODIFY Arg1:T74 Arg2:T73 R50 MODIFY Arg1:T73 Arg2:E26 T75 Lab_value 1683 1720 extended disposition of brown pigment T76 Biological_structure 1739 1747 pancreas T77 Biological_structure 1756 1783 serosa of the duodenal wall T78 Sign_symptom 1722 1734 infiltrating E27 Sign_symptom:T78 R51 MODIFY Arg1:T76 Arg2:E27 R52 MODIFY Arg1:T77 Arg2:E27 R53 MODIFY Arg1:T75 Arg2:E26 R54 MODIFY Arg1:E27 Arg2:T73 T79 Diagnostic_procedure 1785 1805 Immunohistochemistry E28 Diagnostic_procedure:T79 T80 Diagnostic_procedure 1823 1830 Melan-A E29 Diagnostic_procedure:T80 T81 Diagnostic_procedure 1832 1837 HMB45 E30 Diagnostic_procedure:T81 T82 Diagnostic_procedure 1839 1847 vimentin E31 Diagnostic_procedure:T82 T83 Diagnostic_procedure 1849 1862 S-100 protein E32 Diagnostic_procedure:T83 T84 Diagnostic_procedure 1880 1891 cytokeratin E33 Diagnostic_procedure:T84 T85 Disease_disorder 1934 1942 melanoma E34 Disease_disorder:T85 T86 Detailed_description 1924 1933 malignant R55 MODIFY Arg1:T86 Arg2:E34 T87 Detailed_description 1913 1923 metastatic R56 MODIFY Arg1:T87 Arg2:E34 T88 Lab_value 1867 1875 negative T89 Lab_value 1810 1818 positive R57 SUB_PROCEDURE Arg1:E29 Arg2:E28 R58 SUB_PROCEDURE Arg1:E30 Arg2:E28 R59 SUB_PROCEDURE Arg1:E31 Arg2:E28 R60 SUB_PROCEDURE Arg1:E32 Arg2:E28 R61 MODIFY Arg1:T88 Arg2:E33 R62 MODIFY Arg1:T89 Arg2:E29 R63 MODIFY Arg1:T89 Arg2:E30 R64 MODIFY Arg1:T89 Arg2:E31 R65 MODIFY Arg1:T89 Arg2:E32 T90 Medication 1993 2005 chemotherapy E35 Medication:T90 T91 Detailed_description 1984 1992 adjuvant R66 MODIFY Arg1:T91 Arg2:E35 T92 Date 1944 1957 At the moment E36 Date:T92 T93 Nonbiological_location 2012 2035 outside oncology clinic R67 MODIFY Arg1:T93 Arg2:E35 * OVERLAP E1 E2 E3 E4 R68 MODIFY Arg1:E4 Arg2:E3 R69 MODIFY Arg1:E4 Arg2:E2 R70 BEFORE Arg1:E4 Arg2:E5 R71 BEFORE Arg1:E5 Arg2:E10 * OVERLAP E10 E12 R72 BEFORE Arg1:E12 Arg2:E14 R73 BEFORE Arg1:E14 Arg2:E13 * OVERLAP E13 E18 E16 R74 BEFORE Arg1:E16 Arg2:E19 T94 Diagnostic_procedure 1436 1446 background E37 Diagnostic_procedure:T94 R75 SUB_PROCEDURE Arg1:E37 Arg2:E19 R76 MODIFY Arg1:E20 Arg2:E37 R77 MODIFY Arg1:E21 Arg2:E37 * OVERLAP E19 E22 R78 BEFORE Arg1:E22 Arg2:E23 R79 BEFORE Arg1:E23 Arg2:E24 * OVERLAP E24 E25 R80 BEFORE Arg1:E25 Arg2:E26 * OVERLAP E26 E28 E34 R81 SUB_PROCEDURE Arg1:E33 Arg2:E28 R82 BEFORE Arg1:E34 Arg2:E36 * OVERLAP E36 E35