rockeast
New User
Joined: 27 Jan 2005
Posts: 2
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 Posted: Sun Jan 30, 2005 11:46 pm Post subject: Difficult Diagnosis--Your advice is needed |
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Difficult Diagnosis
Brief Case Description: A 65-year-old (52.5 kilograms) Chinese woman was operated on January 7th in Nanjing, China, to remove gallstone using Laparoscopic cholecystectomy. During the operation, the surgeon surprisingly found significant collection of mucus fluid in the peritonea; the peritoneal and intestinal walls and other organs had connections with each other; some nodules were seen, especially around the appendix. The operation surgeon consulted another two surgeons, but could not form a consensus diagnosis. Both Pseudomyxoma peritonei and appendix mucus carcinoma with wide peritoneal metastasis were suggested as possibilities. The laparoscopic examination was videotaped and the mucus and peritoneal collagen samples were taken, along with the gallbladder, for pathological examinations.
Laboratory Findings: pelvic examination by B ultrasonic equipment revealed dwindled uterus; CT scanning of the lower abdomen found occupying change in the ileum and cecum area with fluid collection between uterus and rectum; muscus smear of the pathological samples revealed gathered abnormal cells, tumor possibility could not be ruled out. Peritoneal fiber, fat and muscle tissues were enriched with large number of acute and chronic inflammatory cells with mucus in the background.
Past History: The patient had a severe inflammation of the Fallopian tubes 30 years ago that caused the blockage of the tubes. In the mid 70s, she was often bothered with lower right abdominal pain, not knowing if it was the Appendix inflammation or not, which relieved with some treatment. She also had stomach upset with pain and gas from time to time. In the mid 90s, she was found to have inflammation of the gallbladder and gallstones by B ultrasonic diagnosis, which was treated by medications. In the same time period, EKG found the enlargement of left ventricle and upside-down T wave. Echocardiography found light close-up of the mitral valve. Blood pressure was not stable. Medications were regularly used. Abdominal pain and upset became more serious in recent years, especially after a meal. After traveling in last May, she had diarrhea for one month with black stools in no fixed form, and the abdominal pain became unbearable. So she decided to have the gallstones removed. The surgeon also sucked out some mucus collections in the peritonea. Other problems included frequent cold, rhinitis, joints and back pain.
Diagnosis: Doctors in Nanjing had different opinions about the diagnosis. In addition to Pseudomyxoma peritonei and appendix mucus carcinoma with wide peritoneal metastasi as suggested above, ovary mucus cancer was also suggested. Most were not sure if it was a cancer or a benign tumor. As to treatment, some suggested immediate surgical operation; others did not consider it meaningful; some suggested the operation could not clean all the metastasis out and the prognosis would be poor with possible recurrence. All agreed chemotherapy would not work.
Request for Help: The doctors and the patient family would like to hear from experts outside China on their opinions regarding the diagnosis and treatment. Any ideas, suggestions, advice and questions are welcomed and greatly appreciated. Please email your comments to this sender. Thank you so much for your possible help! |
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leo
Site Admin
Joined: 23 Sep 2004
Posts: 1574
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| Posted: Mon Jan 31, 2005 3:44 pm Post subject: Re: Difficult Diagnosis--Your advice is needed |
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Hello
Thanks for posting. This is indeed a very difficult case. The presence of abnormal cells does not definitely mean that this is cancer, but it most likely is. While I will not be able to give medical advice about this, I would be interested in knowing more details about the cells, including immunohistochemical profile and a detailed pathologistīs report.
best regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice. |
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