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08 June Acute leukemia
A 59-year-old woman presented with newly-onset oligoarthritis非对称性寡关节炎and extreme fatigue. 6 weeks earlier, she noted a gradual onset of pain and swelling in her right knee. 2 weeks before presenting for care, she began to experience pain in her left knee, followed by an onset of pain and swelling in her left ankle and left wrist. The pain in her joints worsened with movement. In the previous 2 weeks, she had noted fatigue and progressive dyspnea on exertion. On physical examination, the patient appeared fatigued. The left wrist joint was swollen, with a limited range of motion. Both knees were swollen, warm, erythematous, and painful on palpation. There was periarticular swelling, a reduced range of motion, and pain in her left ankle. The erythrocyte sedimentation rate(ESR) and serum ferritin level was strikingly high accompany with severe anemia. A bone marrow biopsy is warranted. A few days after admission, the patient’s body temperature rose to 39.1°C, and a rash appeared bilaterally on her anterior shins. Final Diagnosis: Acute leukemia 05 June Metastatic lung cancer
Welcome to Medical Insight , today is June 5, 2008. I’m Dr. Alex Roy. A 63-year-old man was admitted to the hospital because of a mass in the left kidney and pulmonary nodules. 5 months before admission, when mild nausea, loss of appetite, abdominal pain, and constipation developed, followed by fatigue, weight loss of 3.2 kg, and a nonproductive cough. Examination revealed scrotal varicoceles. CT revealed a mass in the left kidney, another mass in the left adrenal gland, and multiple pulmonary lesions. The imaging studies in this case were virtually diagnostic of renal-cell carcinoma with metastases. The first question in such a case is whether to perform a radical nephrectomy for both diagnosis and treatment or simply to obtain tissue through a biopsy procedure. the patient was healthy, he exercised daily, and his functional status was excellent. he was an excellent candidate for nephrectomy. The left kidney and left adrenal gland were submitted for pathological evaluation. And the diagnosis in this case is renal-cell carcinoma of the clear-cell type, Fuhrman grade 4, with sarcomatoid areas showing microscopical extension into perinephric fat, vascular invasion, and metastasis to the adrenal gland and lungs. Despite radical nephrectomy, additional treatment was required. |
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