A 22-year-old woman presents with following characteristics. Patient Characteristics 1996: congenital megacolon secondary to intestinal Ganglioneuromatosis diagnosed at 3 years of age. She was treated with a partial colectomy. First presentation & physical examination The patient had Dysphagia and weight loss (weight: 38 kg) BP : 113/86 mmHg. Heart rate : 101 bpm Dermatofolliculitis grade 1-2 Marfanoid habitus.
Peculiar facies. Normal oral cavity Neck : enlarged thyroid size. Multiple cervical and supraclavicular lymph nodes Chest : normal cardiopulmonary auscultation. Kyphoscoliosis Abdomen : normal bowel sounds. No masses or organ enlargement Arms and legs : no edema or signs of thrombosis Lab Elevated tumor marker carcinoembryonic antigen (CEA): 126 ng/ml (<5) Other: Ionized calcium: 4.2 mg/dl (8.7-10.3) Parathyroid hormone (PTH): 66 pg/ml (10-55) Thyrotropin (TSH): 1.79 uUI/ml…
