Search for the primary - Md.Sadiq

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In the Name of God, Most Gracious, Most Merciful : 

In the Name of God, Most Gracious, Most Merciful

A SEARCH FOR PRIMARY : 

A SEARCH FOR PRIMARY - Dr. Mohammad Sadiq Prof. M.A.Khan’s Unit M.M.C.R.I

CASE HISTORY : 

CASE HISTORY 50/M c/o swelling on L side of jaw 2 months Rapidly ? size No pain / difficulty in chewing Another swelling in L side of neck No c/o dyspnoea, dysphagia H/o loss of appetite, loss of weight + H/o backache + Smoker +, not an alcoholic 10/03/2008

O/E: : 

O/E: 10/03/2008

O/E: : 

O/E: 10/03/2008

O/E: : 

O/E: 10/03/2008

PROVISIONAL DIAGNOSIS : 

PROVISIONAL DIAGNOSIS ? CA Mandible with 2o deposit in Level III cervical nodes and abdominal wall 10/03/2008

WHAT NEXT ? …….. : 

WHAT NEXT ? …….. Admission & Routine Investigations Maxillofacial opinion 10/03/2008

ADMISSION – 10.3.08 : 

Maxillofacial opinion Routine incl CxR ADMISSION – 10.3.08

CxR : 

CxR 10/03/2008

Maxillofacial opinion : 

Maxillofacial opinion ? Odontogenic tumour ? Ameiloblastoma ? Radicular/Residual cyst ? Tumour arising from mandibular muscle Adv: OPG USG CT Head & Neck 10/03/2008

ADMISSION – 10.3.08 : 

Maxillofacial opinion Routine incl CxR ADMISSION – 10.3.08 OPG to r/o D/D ? Hilar enlargement

OPG : 

OPG 11/03/2008

USG – Neck : 

Moderately sized mixed echogenic lesion in region of angle of mandible on left side, extending to adjacent left submandibular region. Enlarged LN in Lt Middle deep cervical region ? Malignant lesion USG – Neck 11/03/2008

USG – Abdomen : 

Mild left hydrouretronephrosisSuggested CT/IVU evaluation USG – Abdomen 11/03/2008

CT SCAN – HEAD & NECK : 

CT SCAN – HEAD & NECK 17/03/2008

CT SCAN – HEAD & NECK : 

CT SCAN – HEAD & NECK 17/03/2008

CT SCAN – HEAD & NECK : 

CT SCAN – HEAD & NECK 17/03/2008

CT SCAN – HEAD & NECK : 

CT SCAN – HEAD & NECK 17/03/2008

USG Jaw & Neck : 

USG Jaw & Neck

FNAC – Jaw & Neck Swelling : 

1. Mandibular swelling L side of Jaw2. Midjugular node L side3. Axillary swelling FNAC – Jaw & Neck Swelling 14/03/2008 No.:282/08 Aspirate smears from mandibular swelling show few clusters of round to oval cells arranged in Haemmorhagic clusters Smears from cervical & axillary swelling show good cellularity with several clusters of round to oval cells with abundant pale cytoplasm & hyperchromatic nuclei. Moderate atypia seen Occasional binucleate forms seen. IMP: 2o carcinomatous depositAdvised biopsy for conformation

FNAC – Abdominal swelling : 

FNAC – Abdominal swelling 14/03/2008 No.:282/08 Aspirate smears from abdominal swellings show scattered & multiple clusters of round to oval cells with moderate pale cytoplasm & nuclei showing moderate atypia. Occasional binucleate forms seen. Background of pink material & fat cells. IMP: 2o carcinomatous depositAdvised biopsy for conformation

USG Jaw & Neck : 

USG Jaw & Neck ? MALIGNANT LESION FNAC Abdominal Swelling Jaw & Neck swelling 2o Carcinomatous deposit Adv: Biopsy & HPE

Biopsy report – Jaw swelling : 

Macroscopy: Multiple soft tissue fragmentsMicroscopy: Mucin secreting adenoCA (PAS+ve) with cribriform pattern in areas. Biopsy report – Jaw swelling 27/03/2008 No.: 453/08 ADV: Do UGI scopy to R/O GIT primary

USG Jaw & Neck : 

USG Jaw & Neck UGI scopy IVU ENT opinion USG/PSA normal

IVU : 

IVU 20/03/2008

UGI ENDOSCOPY : 

Scope passed upto D2 Oesophagus, OGJ : Normal Stomach : Body & Antrum inflammed Duodenum : D1, D2 normal Extraneous compression at 36 cm near OGJIMPRESSION: GASTRITIS UGI ENDOSCOPY 02/04/2008 Colonoscopy planned for 4/4/08

CT SCAN CHEST : 

CT SCAN CHEST 03/04/2008

CT SCAN CHEST : 

CT SCAN CHEST 03/04/2008

CT SCAN CHEST : 

CT SCAN CHEST 03/04/2008

CT SCAN CHEST : 

CT SCAN CHEST 03/04/2008

CT SCAN CHEST : 

CT SCAN CHEST 03/04/2008

CT SCAN ABDOMEN : 

CT SCAN ABDOMEN 03/04/2008

CT SCAN ABDOMEN : 

CT SCAN ABDOMEN 03/04/2008

CT SCAN ABDOMEN : 

CT SCAN ABDOMEN 03/04/2008

CT SCAN ABDOMEN : 

CT SCAN ABDOMEN 03/04/2008

CT SCAN ABDOMEN : 

CT SCAN ABDOMEN 03/04/2008

CT SCAN ABDOMEN : 

CT SCAN ABDOMEN 03/04/2008

FINAL DIAGNOSIS : 

CARCINOMA LUNG WITH WIDESPREAD SECONDARIES FINAL DIAGNOSIS 03/04/2008

HITS & MISSES : 

Chest X Ray on admission HITS & MISSES IVU on 20.3.08 FNAC BIOPSY The CT OPG

SO WHY PRESENT THIS CASE? : 

Pt has a huge centrally located primary tumour in the lung with widespread secondaries both in the lung as well as all over the body.BUT NO SYMPTOMS SUGGESTIVE OF CA LUNG SO WHY PRESENT THIS CASE?

We would like to thank… : 

The Dean, MMCRI Dept. of Maxillofacial surgeryDept. of PathologyDept. of Radiology We would like to thank…

Thank You : 

Thank You

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