It’s our pleasure to have professors
ideas about Mrs. Maryam Sobhani ;a 54 year old lady presented with vague pain on chest wall just below right breast ,which was intermittent . No weight loss,no sweating,no fever ,and no other symptoms.
In her past history she had done whole body PUVA for a unknown dermatologic problem 20 years ago.
No positive family history.
She was advised to do sonography and soon showed a tumors lesion ,hyper vascular and hypoecho ,56*37*34 mm in portahepatis near pancreatic head and another lymph node about 16*13 precaval region.spleen was reported normal (although is was reported large spleens in subsequent CT!)
Endoscopy showed Antral gastritis and deodenal ulcer.
Colonoscopy showed splenic flexure cessile polyp (which unfortunately we don’t have pathologic report of these 2 lesion)
CT scan of lung;LUL nodule 5 mm (metastatic!) lingular sub segmental atelectasis ,increased antral thickness,splenomegaly, multiple mesentric LAP and large lymph node about 47*53 mm near gastrohepatic ligament .
Asymmetric density in right breast was reported in lung CT which was not worked up more.
Neck CT was consistent with cervical LAP.
EUS guided bx of the portohepatis mass was malignant epithelial cells consistent with metastatic adenocarcinoma.
Pathologist Second opinion was compatible with HD .
MDT panel recommended
1-rebiopsy and tissue confirmation is necessary .
2-PET CT to identify which lymph node is better to be biopsied
3-laboratories including LDH,tumor markers and other biochemical tests.
4-mammography for better characterization of breast mass incidentally reported in lung CT.
5-follow biopsy report of deodenal ulcer and resected polyp of colon.
Dr Jaber Ansari
Dr Ardalan Azmoodeh