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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Stephen K. Liu, M.D.
February 27, 2002
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 CAHistory
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 - 38Laboratory Data
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
12/20 nuclei, some with eosinophilic cytoplasm; rare plasma cells.