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Premium member Presentation Transcript 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 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Search for the primary - Md.Sadiq drmdsadiq Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 141 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: April 01, 2009 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript 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