1 / 17

Combine Conference (8, Jan. 07’ )

Combine Conference (8, Jan. 07’ ). Case report Reporter :NS R2 洪培恩 R3 吳孟庭. Case 1. 方 X , 68 Y/O, male ID: 001876582H Admission date: 95/12/12 ~ Chief complaint: Progressive weakness of R't side limbs and dizziness with falling down accident for 5 days. History.

verda
Download Presentation

Combine Conference (8, Jan. 07’ )

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Combine Conference (8, Jan. 07’) Case report Reporter :NS R2 洪培恩 R3 吳孟庭

  2. Case 1 • 方X, 68 Y/O, male • ID: 001876582H • Admission date: 95/12/12 ~ • Chief complaint: Progressive weakness of R't side limbs and dizziness with falling down accident for 5 days

  3. History • Personal Hx: Smoking 1PPD for 30 years Past Hx: Hypertension for 10+ years • He was brought to 台大雲林分院 and brain MRI on 95/12/11 revealed L't parietal and frontal tumor lesion, suspected metastatic tumor. • Visit our NS OPD, Cons’ alert, MP:R‘t side limbs,Gr 2 • Admission for further evaluation and treatment

  4. Neurologic Examination • Consciousness: E4V5M6 • Pupil: R/L: 3.0/3.0 without light reflex • Babinski sign: bilateral no response • No R-L disorientation, no dysphagia • Increased DTR, MP- RUE/RLE:Gr 2/2 • CN: intact • Sensory function: intact

  5. LaboratoryData Date Na (mEq/l) K (mEq/l) Cre (mg/dl) Ca(mg/dl) 144 4.1 0.7 8.6 Date WBC (/cumm) Hb (g/dl) Platelet (/cumm) Neu (%) Lym (%)15000 13.0 187K 81.4 11.5Tumor markersAFP 1.32 ng/ml CA-199 13.30 Unit/mlCEA 2.78 ng/ml SCC < 0.3 ng/mlFree-PSA 0.57 ng/ml

  6. Image study • CxR: Slight prominent bil. hilar regions • Sono,Abdomen: non-significant finding • Chest CT(contrast) on 12/14: Bullous formation in left upper lung, small subpleural infiltration in both lowers Small lymphadenopathy in subaortic region of mediastinum

  7. Operation(mass effect and for diagnosis) • 2006/12/18 Left F-T-P craniotomy with removal of tumor under Brainlab navigator • OP finding Gray brown soft tissue mass was found about 3 and 5 cm in size over left frontal and parietal region, respectively • Froxen section:high grade malignancy

  8. Post op course • Seizure episode x 1 (Depakene level: 39.9 ug/ml) • Biopsy report: Peripheral T-cell lymphoma, unspecified. • Consult CCRT WBRT(2000cGy/8fr.) start on 12/27 • For complete lymphoma staging  CT,abdomen: No abnormal LAPs in the abdomen Gallium scan: Increased uptake in the bil. pul. Hili • Bone marrow examination: not representative, No lymphoma is seen

  9. Further treatment • Rehabilitation • Suggest chemoport placement and systemic chemotherapy

  10. Final diagnosis • Peripheral T-cell lymphoma with CNS metastasis

  11. Peripheral T Cell Lymphoma • They represent 7% of all cases of non-Hodgkin's lymphoma. • T-cell prolymphocytic leukemia a high white blood cell count, usually characteristic prolymphocytic morphology, and expression of surface CD3 with either CD4 or CD4 and CD8 • T-cell large granular lymphocytic leukemia most often CD3, CD8, CD57, and TIA-1 expression. • aggressive NK-cell leukemias, and • adult T-cell lymphoma/leukemia..

  12. Clinical Characteristics • Median Age, years : 61 y/o • B Symptoms, % : 50% • Bone Marrow Involvement, % : 36% • Gastrointestinal Tract Involvement, % : 15% • % Surviving 5 years : 25%

  13. Diagnosis • Mostly CD4+, but a few will be CD8+, both CD4+ and CD8+, or have an NK cell immunophenotype. • No characteristic genetic abnormalities have yet been identified, but translocations involving the T cell antigen receptor genes on chromosomes 7 or 14 may be detected. • human T-cell lymphoma/leukemia viruses I and II (HTLV-I and HTLV-II), Epstein-Barr virus (EBV), and human herpesvirus 8 (HHV-8) sequences as previously described. • The neoplastic nature of a T-cell infiltrate is established by histologic features in combination with failure to determine an inflammatory cause and demonstration of monoclonality of T-cell receptor genes.

  14. Immunohistochemistry • Indirect biotin-avidin method --detect the antigens. • Monoclonal antibodies used in the tests were for detecting CD20, CD30, and anaplastic lymphoma kinase (ALK) ; CD3, CD4, CD8, CD56, CD57, Ki-67, granzyme B, pancytokeratin, and glial fibrillary acidic protein and TiA-1.

  15. Stage evaluation of patient • Physical examination • Documentation of B symptoms • Laboratory evaluation • Complete blood counts • Liver function tests • Uric acid • Chest radiograph • Calcium • Serum protein electrophoresis • Serum B2-microglobulin • CT scan of abdomen, pelvis, and usually chest • Bone marrow biopsy • Lumbar puncture in lymphoblastic, Burkitt's, and diffuse large B cell lymphoma with positive marrow biopsy • Gallium scan (SPECT) or PET scan in large-cell lymphoma

  16. Treatment • Treatment regimens are the same as those used for diffuse large B cell lymphoma, but patients with peripheral T cell lymphoma have a poorer response to treatment.

  17. Thank you for attention

More Related