Thursday, January 14, 2010

historial 1 Mauricio Pereira(09.09.06_08.10.08)&historial 2 Mauricio Pereira(16.02.09_15.12.09)


Chest CT scan.
Backgrounds of adrenal tumor surgery. No evidence of secondary locations of known primary. Elongation and aortic atheromatosis

Bone scintigraphy.
No evidence of secondary osseous atypia.


Brain CT scan.
No diagnostic impression.

CT scan of abdomen and pelvis.
Control of operated right carcinoma.
Retroperitoneal mass of infiltrating nature compatible with local tumor recurrence, which compromises the suprarenal portion of inferior vena cava.
Retroperitoneal adenopathy.
Focal hepatic hypovascular lesion compatible with a secondary location.

Chest CT scan.
Multiple bilateral pulmonary nodules compatibles with secondary locations.

After obtaining these results, I concur to Labiofam, at Havana, Cuba, and started on March the 30th a treatment with the Natural Toxin.
On April the 8th I hand in to 6 monthly cycles of chemotherapy with a duration of 7 days each, on Doxorubicin, Etoposide and Cisplatin (April-September). I’m medicated with 4 g. a day of Lysodern or Mitotane, which rises later to 6 grams a day. Currently I’m taking between 4-3 g. per day because it started to affect my difestion and quality of life.


Multislice computed chest tomography.
Control of lung metastasis of adrenal cancer with impressive progression (111 nodules in the right lung and 72 in the left one).
In the right adrenal region and in close relationship with the lower vena cava, multiple heterogeneous hypodense solid formations are revealed, which compress the vein in question.
Post-surgical sequels on the chest wall.


Breast ultrasound.
Suggestive finding of mild bilateral gynecomastia.


Thoracic helical CT.
Control of secondary pulmonary implants of adrenal cancer being treated. Stables in size, density and morphology in relation to the last exam on 11-Apr-2007.

Abdomen Helical CT.
Control of right renal cancer being treated. A solid nodular lesion persists, partially defined as hypodense without changes in relations to the exam on March 2007 of the segment VI of the right hepatic lobe.
A retroperitoneal mass persists in an interaortacaval position which runs in 42 mm. length and in 25 mm. maximum transverse diameter. Partial regression is observed in relation to April 2007 (Thorax CAT).
No new lesions have appeared.
Small right renal cyst.
Surgical clip in relation to the right adrenal gland region.


Thoracic helical CT.
Control of adrenal cancer with lung implants, stable in terms of number, distribution and size of lung nodules.

Helical CT Abdomen
Partial regression of the retroperitoneal mass in control. It takes a well defined elongated solid nodule morphology of 19x20 mm. (length x transverse). Second posterior nodule and the findings on the right liver lobe unchanged.


Computed tomography of chest, abdomen and pelvis.
Control of adrenal cancer. Stable lung metastases (Approx. 100 nodes total).
Higher retroperitoneal nodule unchanged.
No evidence of hepatic focal depression in this control.
No identification of the gallbladder that should be valued according to previous background.
Simple cortical bilateral cysts.


Certificate of discharge.

History. Operated adrenal carcinoma, which develops a relapse in retroperitoneum (operative bed), liver and lungs. He completed 6 cycles of chymoptherapy with partial response (good response in the liver and stabilization of pulmonary lesions). After chemoterpay the patient is in maintenance treatment with Mitotane and medical alternative treatments (Escozul). Subsequently he has a progression of the retroperitoneal tumor which causes pain. The patient was referred for evaluation. It is estimated feasible radiotherapy to the retroperitoneal tumor which is closely related to the right kidney.

Treatment. Modulated intensity radiotherapy to the retroperitoneum , 50 Gy in 20 fractions to the periphery of the white volume (CTV), with a dose of 60 Gy in 20 fractions to the macroscopic tumor. The dose to the right kidney and liver was kept within the tolerance levels. 4 coplanar fields where used with 5 segments each, and 18 MV X-rays. Start: 12-Dec-2007. End: 10-Jan-2008.

Tolerance: Excellent. The patient underwent quite tired during the treatments, but noted a significant pain relief. No other adverse effects.


Chest, abdomen and pelvis computed tomography.
History of treated right adrenal cancer. Signs consistent with local relapse and secondary lung lesions, which have not suffered modifications in relations to the previous review mentioned (Approx 70 nodules total).
Mild hepatomegaly. Signs suggestive of hepatic steatosis.
Simple bilateral cortical renal cysts.
Prostatic enlargement.


Multislice computed tomography of chest and abdomen.
Background of operated right adrenal cancer and recurred locally with lung metastases in control (10 nodules recognized in the right lung and 30 in the left lung). Partial but significant regression of the manifestations of basal neoplastic disease.


CT scan of abdomen and pelvis.
Stability of intra-abdominal neoplastic manifestations in relation to reference control.

Computed chest tomography.
Intrathroacic neoplastic manifestations stable (10 nodules in the left lung and 25 in the right lung).

Brain CT scan.
With a intravenous contrast medium, does not identify vascular abnormalities of importance.


Chest, abdomen and pelvis computed tomography.
The disease is stable in relation to it’s manifestations in the chest and abdomen from the preovious study.
(Pumonary nodules persists in numbers of 10 in the right lung and 25 in the left one).

Computed tomography of chest, abdomen and pelvis.

Radiological printing:
Backgrounds of treated adrenal cancer. Regarding the previous study mentioned, there is an impressive progress of neoplastic disease in relation to chest manifestations (20 nodules in the right lung and 25 in the left), as well as the emergence of focal hepatic injury.

CT scan of brain.

Radiological printing:
Uptake nodule at left parietal subcortical level, high in convexity at parasagittal level that as a first option may correspond to the location of known primary.


Skull Magnetic Resonance.

Radiological printing:
Nodular lesion in the left subcortical precuneus, with no other alterations. Given the background, the possibility of a secondary implant corresponds to the first diagnostic possibility.


Pathological report.

Clinical history: Distal esophageal injury.  Submucosa?
Conclusion: The morphological characteristics and immunophenotype support the diagnosis of Tumor of Esophagus Granullar Cells.


Chest, Abdomen and Pelvis CT Scan.
Radiological Printing:
According to tomographic criteria, the pulmonary metastatic deseases remained stable compared to prior study in February 2009. There is no other data to record.


Cerebral MRI.
Persistence of subcortical nodular lesion in the left precuneus projection, unchanged compared to previous exams. Given the base background, secondary locations can’t be discarded.


Brain Tomography
Diagnostic impression:
A history of adrenal Ca. Left uptake subcortical lesion may correspond to a secondary injury to the basic disease.

Chest. Abdomen and pelvis CT scan.
Backgrounds of suprarenal right metastatic cancer. Thoracic and abdominal manifestations are stable with respect to reference exam.


Brain MRI
Control of expansive process in the left precuneo with heterogenous-looking increase in volume, in relations to a previous exam of-Apr-2009.
Backgrounds of suprarenal carcinoma.

Chest, abdomen and pelvis CT scan.
Backgrounds of treated right adrenal cancer.
Evidence of significant progression of pulmonary and hepatic metastatic disease, greater than a 50% according to axial diameter criteria in relation to reference study.


Computed tomography of chest, abdomen and pelvis.
Radiological printing:
Backgrounds of right adrenal cancer metastatic to lung in liver, with significant progression of the pulmonary and hepatic metastasis disease.

Brain MRI
Radiological printing:
Image control suggests metastases at left parietal level, which presents an important growth in relation to previous MRI pf July 2009 (lesion measures 3.7 cm. x 2.7 cm. x 3.6 cm).

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