Diagnostics

HEMATOLOGYLaboratory Work-Up

Normal June 23, 2010 Remarks

WBC 4-11 x 10 9/L 8.08 x 10 9/L NORMAL

RBC 4-6 x 10 9/L 4.82 x 10 9/L NORMAL

Hgb 120-180g/L 142g/L NORMAL

Hct 0.370-0.540% 0.431% NORMAL

MCV 80-100fL 89.4fL NORMAL

MCH 27-31pg 29.5pg NORMAL

MCHC 320-360g/L 329g/L NORMAL

RDW-CV 150-450 x 10 9/L 129 x 10 9/L REDUCED

Platelets 2-4 x 10 11/L 3.1 x 10 11/L NORMAL

Neutrophil 0.5-0.7 0.764 SLIGHTLY ELEVATED

Lymphocytes 0.2-0.5 0.103 REDUCED

Monocyte 0.02-0.09 0.082 NORMAL

Eosinophil 0.0-0.06 0.047 NORMAL

Basophil 0.0-0.02 0.004 NORMAL

APTT 36.4 36.3 NORMAL

PT 12-15 seconds 12.5 seconds NORMAL

BLOOD CHEMISTRYLaboratory Work-Up

Normal June 23, 2010 Remarks

BUN 3.2-8.0 mmol/L 2.46 REDUCED

Creatinine 53.133 umol/L 71 ELEVATED

Sodium 135-145 mmol/L 137 NORMAL

Potassium 4.0-4.5 mmol/L 4.3 NORMAL

Calcium 2.12-2.75 mmol/L 2.41 NORMAL

Albumin 38-51 g/L 31 REDUCED

AST 0-34 U/L 50 ELEVATED

ALT 0-30 U/L 42 ELEVATED

Total Bilirubin 0-17.1 umol/L 5.90 NORMAL

Dir Bilirubin 0-3.42 umol/L 1.96 NORMAL

Ind Bilirubin 3.4-13.7 umol/L 3.94 NORMAL

Urate 0.13-0.44 mmol/L 0.31 NORMAL

URINALYSISLaboratory Work-Up

Normal June 23, 2010 Remarks

Color Yellow Light Yellow NORMAL

Transparency Clear Clear NORMAL

SG 1.016-1.022 1.025 NORMAL

Ph 4.6-6.5 6.0 NORMAL

Sugar (-) (-) NORMAL

Albumin (-) (-) NORMAL

RBC 0-2/hpf 4/hpf MICROSCOPIC HEMATURIA

WBC 0-5/hpf 2/hpf NORMAL

Casts 3/hpf

Bacteria (-) 1/hpf POSSIBLE INFECTION

Ketones +1 ELEVATED

MULTIPLE CONTIGUOUS AXIAL CT SCAN OF THE CHEST WITH IV CONTRAST

Imaging Studies

Imaging Results

Imaging Results

• Well defined lobulated pulmonary mass with irregular margin with eccentric calcifications at the superior basal segment of the left lower lobe

• <1cm pulmonary nodule at the posterior basal segment of the right lower lobe

• With either linear fibrosis or subsegmental atelectasis at the anterobasal segment of the left lower lobe

• Pleural thickening, left lung• Thoracic spondylosis

SURGICAL PATHOLOGYTissue Diagnosis

April 26, 2010

Metastatic poorly differentiated adenocarcinoma

AFB SPUTUMCulture

June 26, 2010

• Day 1: (-) AFB• Day 2: (-) AFB

Diagnosis

Working Diagnosis

Lung cancer, non-small cell (adenocarcinoma), stage 4, currently undergoing cobalt radiotherapy with possible malnutrition, kidney and liver damage. Rule out pulmonary TB.

• The results of the biopsy confirm that indeed, the patient has a malignant tumor in the lung

• The enlarged supraclavicular lymph nodes indicate that the patient’s cancer is in stage 4

SCLC vs. NSCLCSCLC NSCLC

Scant cytoplasm Abundant cytoplasm

Hyperchromatic nuclei w/ fine chromatin pattern

Pleomorphic nuclei w/ coarse chromatin pattern

Indistinct nucleoli Prominent nucleoli

Diffuse sheet of cells Glandular or squamous architechture

Pain when swallowing

Decreased food intake

Guconeogenesis

Muscle wasting

hypoalbuminemia

Elevated AST, ALP

Ketone body production