Female born 44 IBS Coxarthrosis hipjoint replacement 2010 Perforated appendicitis in youth HystSOE Leiomyoma 1991 Tumour in mandible operated x 3 ID: 434835
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Slide1
Casereport
-
Female
born -44. IBS.
Coxarthrosis
,
hipjoint
replacement -2010
-Perforated
appendicitis in youth
.
-
Hyst+SOE
/
Leiomyoma -1991
-
Tumour
in mandible operated x 3 (
ameloblastoma
)
-
Gallstones –surgical policlinic 2012. Mild symptoms. No surgery.
-Loose stools and “
hemorroidal
symptoms” since several years. Fresh blood frequent in stools
.
-Medication:
Paracetamol
on demand.
Imovane
.
No allergy for medicines.Slide2
Rectoscopy
131101 reaches 10-12
cm,”bleeding
from above”
-Colonoscopy 131119 “Adenoma at 25 cm (
polypectomy
-macroscopically radical), and cancer in
rectosigmoid
around 15 cm, 4 cm long”.
-
Rectoscopy
131128 “
Rectalcancer
starting at 14 cm”Slide3
-CT thorax/abdomen 131207 “2x 3mm unspecific finding in left lung+2 x3mm unspecific findings in liver+13 mm
adenomalike
finding in left suprarenal”(picture)
Slide4
MR 131205 : ”6cm long
tumour
in
rectum
growing
through
muscularis
layer
.
Several
up
to
7mm
lymfnodes
within
MRF,
metastatic
? T3b N1 M0, MRF negative”Slide5
-
MDT 131209 “Preoperative
Rapidostudy
? Long radio/chemotherapy? Low anterior resection after oncological treatment”
-
Oncologydepartment
140110 “Not included in
Rapido
study (metastatic growth in left suprarenal cannot be
excluded+ameloblastoma
). Long radio/chemotherapy “Slide6
-CT thorax/abdomen 140409. “No progress of unspecific findings in
lung+liver+left
suprarenal
” Slide7
-MR 140404 “Partial regress. No growth seen outside
muscularis
layer. Partial regress of suspected
lymfnodes. All lymfnodes 2mm or more from MRF. MRF negative. T2 N1 M0
.”
Slide8
-MDT 140428 “Low anterior resection (
loopileostomy
?) at Nyköping Hospital 140505. CT abdomen/suprarenal 3 months”Slide9
-Contact
Dr
Gunnar Lindgren
Södertälje Hospital 140429 “Bill Heald is coming for demonstration surgery. We cannot find any suitable patient for rectal cancer surgery-help !”
-
Contact
with patient 140430. “I don´t want to be any experimental patient-but what was the name of the surgeon that was going to operate?”
“Bill
Heald
?” Let me google him and come back in two hours.”
“I say yes to your suggestion. Just give me all instructions and see you in
Södertälje
on Wednesday”Slide10
Laboratory
Hb-117
Krea
46
S-k 4,1
S-Na 140
Alb
40
CEA 0,5 (131119)
L-166cm
W-66kgSlide11
Histopathology
Tumour:Adenoma
with high grade dysplasia with growth of invasive adenocarcinoma.
Polyp:Adenoma
with partially high grade dysplasia. Nowhere invasive
cancer.Small
area of stalk without dysplasia-could be radical.