Morbidity and Mortality Conference. Stephen K. Liu, M.D. February 27, 2002. Initial Presentation - Feb 2001. A 76 y/o male presented to his physician’s assistant at the VA Medical Center in WRJ with a chief complaint of a dry cough for several months. Initial Presentation.
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Morbidity and Mortality Conference
Stephen K. Liu, M.D.
February 27, 2002
Past Medical History
Basal Cell Carcinoma
Quit smoking over 50 yrs ago, no alcohol misuse
Retired insurance agent
Previously enjoyed racquetball and rowing.
father - lung CA
brother - prostate CA
Gen: Somnolent but arousable, ill appearing, cachectic
VS: T 97.5 BP 150/84 HR 86 RR 30
SpO2 85% RA 96% 4L NC
HEENT: PERRL, EOMI, OP-dry MM, no erythema
Neck:Supple, no LAD, JVP < 5 cm
CV:RRR, no S3 or S4
Resp:Decreased BS L>R, dull to percussion 2/3 up lung fields, minimal air movement in apices , decreased tactile fremitus at both bases
Abd: ND, +BS, Soft, NT, no palpable masses or HSM, no palpable inguinal LN
Ext: No edema, no palpable axillary adenopathy
Neuro: Arousable with some difficulty, oriented to date but not to place
T.Bili - 0.7
Alk Phos - 52
AST - 34
ALT - 30
GGT - 38
89%Gran 7%lymphs 3%monos
0.1%eos 0.1% baso
130 90 23
4.5 32 0.7
PT - 12.8
INR - 1.0
PTT - 49.2
Homogeneous population of lymphocytes with a scant to moderate amount of vacuolated cytoplasm.
Poorly cohesive small lymphocytes with irreg. hyperchromatic nuclei, some with eosinophilic cytoplasm; rare plasma cells.
By flow cytometry:
Monoclonal kappa light chain, CD19+, CD20+, slight CD23, CD10-, CD5-. C/w B-cell lymphoprolif. disorder.
Diagnosis: B-cell lymphoma
11/13 - heparin flushes and allopurinol d/c’d
11/20 - first dose of CHOP