Patient 17
A 16-year-old girl with a small bowel obstuction and abdominal adenopathy
A 16-year-old girl with a history of irritable bowel syndrome pressents to the emergency department with stabbing periumbilical abdominal pain. Over the previous 3 months she has noted weight loss, progressive abdominal fullness, and two to three loose stools per day.
Physical Examination: Blood pressure 105/65mmhg, pules 110, temperature 38.4℃. General: thin; in moderate pain. HEENT:anicteric.Lympnotes: no adenopathy. Cardiovascular:tachycardic, no murmurs. Chest:clear to auscultation. Abdomen:moderate distention,mild periumbilical tenderness, decreased bowel sounds. Extremities:no edema.
Laboratory Findings:WBC 12/uL (80% neutrophils,16% lymphocytes), hemoglobin 12.1g/dL, platelets350,000/uL.Biochemistryprofile: normal. Liverfunctiontests:normal. Chestradiograph:normal. Abdominal CT: small bowel obstrution due to abdominal lymphadenopathy.
Course:The patient is taken to the OR and undergoes segmental resection of the obstructed jejunum and a lymph node biopsy.The pathology of the lymph node biopsy reveals diffuse infiltration of the nodeby large pleomorphic lymphocytes with horseshoe-shaped nuclei. Immunostains show that these cells are positive for CD30, CD25, and CD3, but negative for CD20 and CD15(see Figures).
Questions: What is the most likely diagnosis? Which additional tests should one order to distinguish different prognostic groups?
谢谢!!
回答的两位有点专业精神啊,用翻译器翻译的话我还发上来干什么啊~~~
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