Search

A Woman with Infertility A 31-year-old woman with a history of primary amenorrhea and infertility was seen in the fertility center to discuss family-planning options. She had minimal body hair and ...

A 70-year-old woman was seen in this hospital because of vaginal bleeding. An endometrial-biopsy specimen showed a poorly differentiated malignant neoplasm that was suggestive of mixed mullerian tumor (carcinosarcoma). A diagnostic and therapeutic procedure was performed.

A 63-year-old man was admitted to this hospital because of a mass in the left kidney, associated with abdominal pain, weight loss of 3.2 kg, and cough. Physical examination disclosed scrotal varicoceles; imaging studies disclosed a mass in the left kidney, a mass in the left adrenal gland, and multiple pulmonary nodules. A diagnostic procedure was performed, and management decisions were made.

A 54-year-old woman was seen in the gynecologic oncology clinic because of a pelvic mass that was associated with urinary frequency and urgency, pelvic pain, fever, and weight loss. A large, central pelvic mass was noted on examination, and imaging studies showed a complex solid and cystic mass with ascites. The evaluation and management of malignant tumors of the ovaries and fallopian tubes are discussed by a multidisciplinary team.

A 45-year-old woman noted a mass in her lower abdomen that was intermittently painful. An examination disclosed a slightly tender mass, 4 cm in diameter, on the right side of the lower abdomen. Imaging studies showed a solid mass in the right lower abdominal wall. A diagnostic procedure was performed.

Presentation of Case An 18-year-old man was admitted to the hospital because of back and leg pain and a nondiagnostic biopsy specimen from a paravertebral mass. The patient had been well until eight months earlier, when the back pain began. Despite the use of ibuprofen and local application of ice, the pain increased, and three months before admission, pain developed in the right lower leg. A chiropractor obtained a radiograph of the spine, which revealed a compression fracture at the L3 vertebra. About one month before admission, a computed tomographic (CT) scan of the lumbosacral spine, obtained at another facility, . . .

Presentation of Case A 32-year-old man was evaluated for a lesion of the urinary bladder. The patient had been well until 16 months earlier, when he had an episode of perineal pain associated with painful ejaculation and a brown, curdled ejaculate. There was no hematuria. His condition improved after treatment with ciprofloxacin. He had had no previous genitourinary symptoms except for the long-standing presence of dribbling after voiding. Four months before the evaluation, the patient was seen at this hospital because of urinary frequency of four days' duration, with intermittent passage of small blood clots in the urine, vague discomfort . . .

Preface This millennial year is also a centennial year, and since the Case Records were conceived about a century ago, it is fitting to recount the circumstances of their origin on the occasion of the first Case Record of 2000. In its first issue of the 20th century, the Boston Medical and Surgical Journal, later to become the New England Journal of Medicine, published “The Case Method of Teaching Systematic Medicine” (1900;142:31-6), an article submitted by Walter B. Cannon, a senior student at Harvard Medical School who would later become the George Higginson Professor of Physiology at the medical school. . . .

Presentation of Case A 67-year-old woman was admitted to the hospital because of nausea and increasing confusion. The patient had undergone excision and radiation therapy for carcinoma of the left breast 13 years before admission and for carcinoma of the right breast 7 years later. Eight years before admission, she had a hysterectomy with bilateral salpingo-oophorectomy for ovarian carcinoma. Two years before admission, a sigmoid resection with a colostomy was performed because of recurrent tumor. The patient had undergone multiple chemotherapy regimens, including cyclophosphamide, methotrexate, and fluorouracil for breast cancer and paclitaxel, cisplatin, and carboplatin for ovarian cancer. Eighteen days . . .