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An 18 Age - year Age - old Age college Occupation student Occupation was referred Clinical_event from Nonbiological_location the Nonbiological_location University Nonbiological_location Clinic Nonbiological_location for having low Lab_value hemoglobin Diagnostic_procedure (Hg 4.7 Lab_value g/dl Lab_value ).
He History was History completely History well History till one Date month Date back Date when he presented Clinical_event with easy Detailed_description fatigability Sign_symptom , postural Detailed_description dizziness Sign_symptom , palpitation Sign_symptom and dyspnea Sign_symptom .
He gave history of 30 History kg History weight History loss History over Duration the Duration past Duration 6 Duration months Duration .
On physical Diagnostic_procedure examination Diagnostic_procedure , he looked pale Sign_symptom , not jaundiced Sign_symptom or cyanosed Sign_symptom .
His vital Diagnostic_procedure signs Diagnostic_procedure were all within Lab_value normal Lab_value limits Lab_value , except for an elevated Lab_value heart Diagnostic_procedure rate Diagnostic_procedure ( 98/min Lab_value ).
Cardiovascular Biological_structure , respiratory Biological_structure and abdominal Biological_structure examinations Diagnostic_procedure were unremarkable Lab_value .
Primary investigations Clinical_event in our hospital Nonbiological_location revealed low Lab_value hemoglobin Diagnostic_procedure level ( 5.1 Lab_value g/dl Lab_value ), low Lab_value iron Diagnostic_procedure ( <10 Lab_value ug/dl Lab_value ), and a positive Lab_value occult Diagnostic_procedure blood Diagnostic_procedure test Diagnostic_procedure .
A provisional diagnosis of microcytic Disease_disorder hypochromic Disease_disorder anemia Disease_disorder for further workup was made.
Bone Diagnostic_procedure marrow Diagnostic_procedure aspirate Diagnostic_procedure and trephine Diagnostic_procedure biopsy Diagnostic_procedure revealed normocellular Lab_value marrow Lab_value , depicting normal Lab_value trilineage Lab_value hematopoiesis Lab_value .
Upper Biological_structure GI Biological_structure endoscopy Diagnostic_procedure showed erosive Detailed_description antral Biological_structure gastritis Disease_disorder with patchy Detailed_description ulcerative Detailed_description inflammation Sign_symptom .
Abdominal Biological_structure ultrasound Diagnostic_procedure showed a slightly Severity enlarged Sign_symptom liver Biological_structure with a rounded Shape echogenic Detailed_description lesion Sign_symptom in the anterior Biological_structure wall Biological_structure of Biological_structure the Biological_structure right Biological_structure lobe Biological_structure suggestive of hemangioma Disease_disorder .
The spleen Biological_structure was slightly Severity enlarged Sign_symptom and normal Lab_value in Lab_value echogenicity Lab_value with no focal Detailed_description lesions Sign_symptom .
Computed Diagnostic_procedure Tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan of the abdomen Biological_structure and pelvis Biological_structure showed a fairly Detailed_description large Detailed_description well Detailed_description defined Detailed_description soft Detailed_description tissue Detailed_description mass Sign_symptom located in the anterior Biological_structure upper Biological_structure pelvis Biological_structure and engulfing jejunal Biological_structure loops Biological_structure causing bowel Biological_structure wall Biological_structure thickening Sign_symptom .
The patient underwent an exploratory laparotomy Diagnostic_procedure and excision Therapeutic_procedure of the jejunal Biological_structure mass Sign_symptom .
Macroscopic Diagnostic_procedure examination Diagnostic_procedure revealed an 11 Volume × Volume 8 Volume × Volume 2 Volume cm Volume annular Biological_structure mass Sign_symptom located within Biological_structure the Biological_structure jejunal Biological_structure wall Biological_structure ulcerating Biological_structure through Biological_structure the Biological_structure mucosa Biological_structure and extending Biological_structure to Biological_structure the Biological_structure serosal Biological_structure surface Biological_structure .
Microscopic Diagnostic_procedure examination Diagnostic_procedure revealed a tumor Sign_symptom situated in the muscularis Biological_structure propria Biological_structure and extending Biological_structure to Biological_structure the Biological_structure mucosa Biological_structure and the serosa Biological_structure .
The neoplastic Coreference cells Coreference were arranged in predominantly Shape pseudoalveolar Shape pattern Shape (Fig.1a,b).
They Coreference were polygonal Shape in shape with variable Detailed_description amount Detailed_description of Detailed_description eosinophilic Detailed_description to Detailed_description clear Detailed_description cytoplasm Detailed_description (Fig.1c).
The nuclei Detailed_description were Detailed_description oval Detailed_description with Detailed_description vesicular Detailed_description chromatin Detailed_description and Detailed_description inconspicuous Detailed_description nucleoli Detailed_description .
Scattered Detailed_description osteoclast Detailed_description - like Detailed_description multinucleated Detailed_description giant Sign_symptom cells Sign_symptom were also identified (Fig.1b,c).
Frequent Detailed_description mitotic Sign_symptom figures Sign_symptom and necrosis Sign_symptom were noted.
All Biological_structure lymph Biological_structure nodes Biological_structure were not involved Sign_symptom by Sign_symptom tumor Sign_symptom .
Immunohistochemically Diagnostic_procedure , the neoplastic Coreference cells Coreference were strongly and diffusely positive Lab_value for S-100 protein Diagnostic_procedure (Fig.1d).
They were also positive Lab_value for vimentin Diagnostic_procedure .
Melanocytic Diagnostic_procedure markers Diagnostic_procedure ( HMB45 Diagnostic_procedure and Melan Diagnostic_procedure A Diagnostic_procedure ), neuroendocrine Diagnostic_procedure markers Diagnostic_procedure ( chromogranin Diagnostic_procedure A Diagnostic_procedure , synaptophysin Diagnostic_procedure and CD56 Diagnostic_procedure ), smooth Diagnostic_procedure muscle Diagnostic_procedure actin Diagnostic_procedure , desmin Diagnostic_procedure , CD34 Diagnostic_procedure , CD117 Diagnostic_procedure , cytokeratin Diagnostic_procedure and LCA Diagnostic_procedure were all negative Lab_value in the neoplastic Coreference cells Coreference .
Fluorescein Diagnostic_procedure in Diagnostic_procedure situ Diagnostic_procedure hybridization Diagnostic_procedure ( FISH Diagnostic_procedure ) analysis for EWSR1 Detailed_description break Detailed_description apart Detailed_description probe Detailed_description on paraffin Detailed_description - embedded Detailed_description tumor Detailed_description showed evidence of a 22q12 Sign_symptom rearrangement Sign_symptom in 197 Lab_value out Lab_value of Lab_value 205 Lab_value (96%) Lab_value of Lab_value interphase Lab_value nuclei Lab_value scored.
The native state of EWSR1 break apart probe will be seen as two adjacent or fused (overlapping) red/green (yellow) signals.
However, EWSR1 gene rearrangement presented as one red and one green separated signal (Fig.1e).
The patient did not receive chemotherapy Medication or radiotherapy Therapeutic_procedure .
During the clinical follow Clinical_event up Clinical_event , the patient remained disease Sign_symptom free Sign_symptom for 3 Duration years Duration until he presented Clinical_event with local Detailed_description recurrence Sign_symptom .
The treatment plan was surgical resection Therapeutic_procedure but the patient sought Clinical_event medical Clinical_event advice Clinical_event in a different Nonbiological_location institution Nonbiological_location where he died Outcome of the disease a Date year Date later Date .