This is a 58-year-old woman with fecal incontinence (Caucasian Amazon), who consulted for recurrent diarrhea, repeatedly treated with antiparasitic agents for material found in the stool.
The patient was referred to the Clinical Teaching Hospital Colombia in Bogotá.
He had dilatation of the extrahepatic bile duct demonstrated by magnetic resonance imaging (cholangioresonance).
She had lactic dehydrogenase levels of 337 mg/dl and had no report of serum calcium.
In the review by systems, he reported discomfort and significant weight loss; no skin manifestations were observed.
She had a history of chronic nonspecific hysterectomy, cholecystectomy, intestinal obstruction secondary to pelvic adhesions and frequent urinary tract infections.
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After a non-diagnostic biopsy of the ampulla of Vater, the patient required a pancreatoduodenectomy.
In the duodenal mucosa it was observed a pleomorphic lymphoid neoplasia of large cells, with diffuse expression of CD3, CD4 and CD56; CD20 and focal CD30, a proliferation index (MIB1) of peripheral tissue
The absence of bone marrow involvement was determined by histology and flow cytometry.
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Considering adult T-cell leukemia as a differential diagnosis, an ELISA test for HTLV1/2 was ordered, which was positive and confirmed by a Western Blot test, also positive for HTLV-1 (presence of GPI- bands).
The type of adult T-cell leukemia/lymphoma identified corresponded to an aggressive lymphoma.
The patient received five cycles of combined chemotherapy (CHOP) before her death.
No postmortem studies were performed.
