Presentation of Case A 57-year-old man was admitted to the hospital because of confusion and a hemorrhagic disorder. He was well until three years earlier, when an asymptomatic upper abdominal mass was found on routine examination; no lymphadenopathy was noted. The hematocrit was 43 per cent, the white-cell count 4800, and the platelet count 186,000. An ultrasound study of the abdomen (Fig. 1) showed a large soft-tissue mass in the left upper quadrant, which involved the root of the mesentery; numerous enlarged retroperitoneal lymph nodes, including paraaortic lymph nodes, were evident. An upper gastrointestinal series (Fig. 2) revealed caudad displacement.
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