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A 59 Age - year Age - old Age man Sex was referred Clinical_event to the general Nonbiological_location surgery Nonbiological_location department Nonbiological_location of our hospital Nonbiological_location for a one Duration - month Duration history Duration of progressive Detailed_description dysphagia Sign_symptom for solids Detailed_description , which was not associated with malnutrition Disease_disorder or significant weight Sign_symptom loss Sign_symptom .
The patient had recently undergone esophagogastroduodenoscopy Diagnostic_procedure in another Nonbiological_location hospital Nonbiological_location , which revealed a bleeding Detailed_description , ulcerative Detailed_description lesion Sign_symptom in the middle Detailed_description third Detailed_description of the esophagus Biological_structure , but no biopsy Diagnostic_procedure had been collected.
The medical past history included COPD Disease_disorder diagnosed in 1999 Date and a myocardial Disease_disorder infarction Disease_disorder in 2002 Date .
The patient had smoked Activity approximately 25 Detailed_description cigarettes Detailed_description per Detailed_description day Detailed_description for several years.
Physical Diagnostic_procedure examination Diagnostic_procedure was unremarkable Lab_value .
Computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) of the chest Biological_structure and abdomen Biological_structure revealed stenosis Sign_symptom involving a 5 Distance - cm Distance segment Detailed_description of Detailed_description the Detailed_description middle Detailed_description third Detailed_description of the esophagus Biological_structure with no other lesions Sign_symptom in the thoracic Biological_structure or Biological_structure abdominal Biological_structure organs Biological_structure .
Barium Diagnostic_procedure studies Diagnostic_procedure disclosed a swelling Sign_symptom in the esophageal Biological_structure wall Biological_structure 7 Distance cm Distance above Biological_structure the Biological_structure cardia Biological_structure with an ulcerative Detailed_description pattern Detailed_description , which reduced Lab_value the diameter Diagnostic_procedure of the lumen Biological_structure to 5 Lab_value mm Lab_value .
An endoscopic Detailed_description biopsy Diagnostic_procedure of the oesophageal Biological_structure mass Sign_symptom demonstrated poorly Detailed_description differentiated Detailed_description ( G3 Lab_value ) squamous Disease_disorder cell Disease_disorder carcinoma Disease_disorder .
Mid Detailed_description - distal Detailed_description esophagectomy Therapeutic_procedure was performed with oesophagogastric Therapeutic_procedure anastomosis Therapeutic_procedure and gastric Biological_structure tube Biological_structure reconstruction Therapeutic_procedure .
Pathological Diagnostic_procedure examination Diagnostic_procedure of the surgical Coreference specimen Coreference confirmed the biopsy Diagnostic_procedure diagnosis of poorly Detailed_description differentiated Detailed_description ( G3 Lab_value ) SCC Disease_disorder .
The tumor Coreference , which measured 3 Distance cm Distance of Distance length Distance , had infiltrated Sign_symptom the oesophageal Biological_structure wall Biological_structure and the surrounding paraesophageal Biological_structure fat Biological_structure .
Surgical Diagnostic_procedure margins Diagnostic_procedure were tumor Lab_value - free Lab_value , as the seven Quantitative_concept perigastric Biological_structure limph Biological_structure - nodes Biological_structure dissected Diagnostic_procedure ( pT3 Lab_value N0 Lab_value ).
The postoperative Diagnostic_procedure period Diagnostic_procedure was quite unremarkable Lab_value , and a contrast Detailed_description enhanced Detailed_description x Diagnostic_procedure - ray Diagnostic_procedure obtained on the 9th Date POD Date showed normal Lab_value esophageal Diagnostic_procedure and Diagnostic_procedure gastric Diagnostic_procedure transit Diagnostic_procedure .
On the 14th Date POD Date , the patient was discharged Clinical_event with an oncology Nonbiological_location referral Clinical_event for routine medical follow Clinical_event - up Clinical_event .
Nine Date months Date after Date the operation, CT Diagnostic_procedure and esophagogastroduodenoscopy Diagnostic_procedure were repeated.
The imaging Diagnostic_procedure study Diagnostic_procedure revealed mild Severity splenomegaly Sign_symptom with multiple Quantitative_concept nonspecific nodules Sign_symptom within the organ Biological_structure (Figure ​1).
The patient was virtually asymptomatic Sign_symptom with the exception of a vague sensation of mild Severity discomfort Sign_symptom in the left Biological_structure upper Biological_structure quadrant Biological_structure of Biological_structure the Biological_structure abdomen Biological_structure .
FNAC Diagnostic_procedure of the spleen Biological_structure revealed a pattern of numerous inflammatory Sign_symptom cells Sign_symptom admixed Sign_symptom with Sign_symptom large Sign_symptom cells Sign_symptom displaying immunohistochemical positivity Lab_value for several cytokeratins Diagnostic_procedure (Figure 2).
The specimen was Gram Diagnostic_procedure stain Diagnostic_procedure - negative Lab_value .
A bone Biological_structure - marrow Biological_structure biopsy Diagnostic_procedure was negative Lab_value for metastatic Diagnostic_procedure involvement Diagnostic_procedure .
The diagnosis was isolated metastases Disease_disorder of the spleen Biological_structure with inflammatory Detailed_description and necrotic Detailed_description alterations Sign_symptom .
The patient was referred Clinical_event to our centre Nonbiological_location for splenectomy Therapeutic_procedure , which was performed as a routine procedure to role out, also, a spontaneous Detailed_description rupture Sign_symptom of the spleen Biological_structure .
On 12th Date December Date 2007 Date , the patient had transabdominal Detailed_description total Detailed_description splenectomy Therapeutic_procedure with splenic Biological_structure and celiac Biological_structure artery Biological_structure lymph Therapeutic_procedure node Therapeutic_procedure dissection Therapeutic_procedure .
The postoperative Diagnostic_procedure course Diagnostic_procedure was uneventful Lab_value .
On the 7th Date postoperative Date day Date , Doppler Detailed_description ultrasonography Diagnostic_procedure revealed portal Detailed_description - tree Detailed_description patency Sign_symptom with no signs of thrombosis Disease_disorder .
Ten Date days Date later Date , the patient was discharged Clinical_event with a stable Lab_value platelet Diagnostic_procedure count Diagnostic_procedure ( 780,000/mm3 Lab_value ), Hb Diagnostic_procedure 10.9 Lab_value g/dL Lab_value , and a WBC Diagnostic_procedure count Diagnostic_procedure of 16,500/mm3 Lab_value .
Pathological Diagnostic_procedure examination Diagnostic_procedure of the spleen Biological_structure described multiple Quantitative_concept nodules Sign_symptom containing medium Detailed_description to Detailed_description large Detailed_description - sized Detailed_description cells Detailed_description , some Detailed_description of Detailed_description which Detailed_description were Detailed_description keratinized Detailed_description .
The nodules Sign_symptom were mostly Texture solid Texture with areas Detailed_description of Detailed_description central Detailed_description necrosis Detailed_description (Figure ​3).
The findings were consistent with metastases Disease_disorder of SCC Disease_disorder .
Thereafter, the patient was referred Clinical_event to the oncology Nonbiological_location department Nonbiological_location of our hospital Nonbiological_location , where he received two Dosage 3 Dosage - day Dosage cycles Dosage ( separated Detailed_description by Detailed_description a Detailed_description 3 Detailed_description - week Detailed_description interval Detailed_description ) of systemic Detailed_description chemotherapy Medication based on 5 Medication - fluorouracil Medication ( 800 Dosage mg/day Dosage IV Administration ) and cisplatin Medication ( 20 Dosage mg/day Dosage ).
Three Date months Date after Date the splenectomy Therapeutic_procedure , multiple Quantitative_concept liver Biological_structure metastases Disease_disorder were seen on the CT Diagnostic_procedure scan, and cutaneous Biological_structure metastases Disease_disorder were also present.
The patient died Outcome 9 Date months Date later Date .