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Diagnostics
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HEMATOLOGYLaboratory Work-Up
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Normal June 23, 2010 Remarks
WBC 4-11 x 10 9/L 8.08 x 10 9/L NORMAL
RBC 4-6 x 10 9/L 4.82 x 10 9/L NORMAL
Hgb 120-180g/L 142g/L NORMAL
Hct 0.370-0.540% 0.431% NORMAL
MCV 80-100fL 89.4fL NORMAL
MCH 27-31pg 29.5pg NORMAL
MCHC 320-360g/L 329g/L NORMAL
RDW-CV 150-450 x 10 9/L 129 x 10 9/L REDUCED
Platelets 2-4 x 10 11/L 3.1 x 10 11/L NORMAL
Neutrophil 0.5-0.7 0.764 SLIGHTLY ELEVATED
Lymphocytes 0.2-0.5 0.103 REDUCED
Monocyte 0.02-0.09 0.082 NORMAL
Eosinophil 0.0-0.06 0.047 NORMAL
Basophil 0.0-0.02 0.004 NORMAL
APTT 36.4 36.3 NORMAL
PT 12-15 seconds 12.5 seconds NORMAL
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BLOOD CHEMISTRYLaboratory Work-Up
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Normal June 23, 2010 Remarks
BUN 3.2-8.0 mmol/L 2.46 REDUCED
Creatinine 53.133 umol/L 71 ELEVATED
Sodium 135-145 mmol/L 137 NORMAL
Potassium 4.0-4.5 mmol/L 4.3 NORMAL
Calcium 2.12-2.75 mmol/L 2.41 NORMAL
Albumin 38-51 g/L 31 REDUCED
AST 0-34 U/L 50 ELEVATED
ALT 0-30 U/L 42 ELEVATED
Total Bilirubin 0-17.1 umol/L 5.90 NORMAL
Dir Bilirubin 0-3.42 umol/L 1.96 NORMAL
Ind Bilirubin 3.4-13.7 umol/L 3.94 NORMAL
Urate 0.13-0.44 mmol/L 0.31 NORMAL
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URINALYSISLaboratory Work-Up
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Normal June 23, 2010 Remarks
Color Yellow Light Yellow NORMAL
Transparency Clear Clear NORMAL
SG 1.016-1.022 1.025 NORMAL
Ph 4.6-6.5 6.0 NORMAL
Sugar (-) (-) NORMAL
Albumin (-) (-) NORMAL
RBC 0-2/hpf 4/hpf MICROSCOPIC HEMATURIA
WBC 0-5/hpf 2/hpf NORMAL
Casts 3/hpf
Bacteria (-) 1/hpf POSSIBLE INFECTION
Ketones +1 ELEVATED
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MULTIPLE CONTIGUOUS AXIAL CT SCAN OF THE CHEST WITH IV CONTRAST
Imaging Studies
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Imaging Results
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Imaging Results
• Well defined lobulated pulmonary mass with irregular margin with eccentric calcifications at the superior basal segment of the left lower lobe
• <1cm pulmonary nodule at the posterior basal segment of the right lower lobe
• With either linear fibrosis or subsegmental atelectasis at the anterobasal segment of the left lower lobe
• Pleural thickening, left lung• Thoracic spondylosis
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SURGICAL PATHOLOGYTissue Diagnosis
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April 26, 2010
Metastatic poorly differentiated adenocarcinoma
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AFB SPUTUMCulture
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June 26, 2010
• Day 1: (-) AFB• Day 2: (-) AFB
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Diagnosis
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Working Diagnosis
Lung cancer, non-small cell (adenocarcinoma), stage 4, currently undergoing cobalt radiotherapy with possible malnutrition, kidney and liver damage. Rule out pulmonary TB.
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• The results of the biopsy confirm that indeed, the patient has a malignant tumor in the lung
• The enlarged supraclavicular lymph nodes indicate that the patient’s cancer is in stage 4
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SCLC vs. NSCLCSCLC NSCLC
Scant cytoplasm Abundant cytoplasm
Hyperchromatic nuclei w/ fine chromatin pattern
Pleomorphic nuclei w/ coarse chromatin pattern
Indistinct nucleoli Prominent nucleoli
Diffuse sheet of cells Glandular or squamous architechture
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Pain when swallowing
Decreased food intake
Guconeogenesis
Muscle wasting
hypoalbuminemia
Elevated AST, ALP
Ketone body production