Name Of the Patient : Mrs Mehtab A Pathan.
Age: 40 Years Female
Date: 29-03-2000
Address :  Kalva Hafiz Buld. Opp Jama Masjid, 1st Floor Room No 1- Thane, 
Maharashtra India.
Diagnosis
Known case of CA Breast with adenoca. of rt ovary.
Biopsy Report: (15-06-2002)
BIOPSY(04/04/1995)
Gross : Mass measuring 3x 2x 1.5 cms
Microscopy : Sections of the submitted mass reveal the structure of a tumour composed of islands of anaplastic cells showing glandular and ductular arrangement. They are seen infiltrating the supporting fibrocollagenous stroma. Areas of necrosis and tumour giant cell formation are seen at places. Mitotic figures are ocassionaly seen. Focal aggregates of lymphocytes are seen at places. Lymphatic invasion is seen in one of the sections.
IMPRESSION: Histology is consistent with the diagnosis of a moderately differentiated infiltrating Duct Carcinoma
BIOPSY(06/04/1995)
Gross : Breast with axillary tissue received in single mass measuring 21x 10x 6 cms.
Microscopy : Multiple sections of the mastectomy specimen were studied histologically. They reveal the evidence of an infiltrating duct carcinoma which is reaching upto the base of resection. Areas of necrosis, tumour giant cell formation and focal aggregates of mixed inflammotary cells are seen at places. Lymphatic invasion is also seen at places. The overlying skin and the nipple are free from the tumour.Out of six lymphnodes which are resected from axillary tissue, all show reactive hyperplasia with no evidence of metastasis. 
IMPRESSION : Infiltrating Duct carcinoma
Axillary lymphnodes - Reactive hyperplasia.

SHORT HISTORY ABOUT CASE
Patient came with diagnosis right Ca breast dated 6/04/1995
Histopathology report : Invasire ductal larcinoma 
Patient got operated in 1995 with no chemo / radiation
Later patient came with recurrence on same location in 1996 ( after 1 year)
She took 24 sittings of radiation.
Then again operated.
After operation patient underwent 32 sittings of radiation and 12 cycles of chemo.
After that patient complained of continuous fever with chills, pain in abdomen for 2 months.
So went for scan on 10/02/2000(scan given below)
Then on 16/02/2000 - operated Panhysterectomy
c omentectomy removal of sigmoid colon, end to end anastomosis done.
BIOPSY REPORT : Sigmoid colon with right ovarian massess.
Moderately differenciated adenocarcinoma rt parametrium and paracolic lymphnode contain tumour deposits.
No metastasis in right iliac lymphnode. After this patient directly came on 29/03/2000.
with ca 125 level of 4486.8 u/ml(14/2/2000)
After that till today onwards our treatment  continues.

Status of the Patient: A. Operated. 
B. 12 chemotherapy.
B. 25+32 Radiation
Treatment Given: Only Homoeopathic medicine after recurrence.
Follow Up Investigation:
CT SCAN OF ABDOMEN AND PELVIS(10-02-2000)(Previous to our treatment)
A plain and post contrast C.T. study of the abdomen and pelvis was performed. Oral contrast had been administrated.
Operated case of Ca breast - three years ago - status post radiotherapy.
There is an evidence of a mixed density mass lesion with cystic area in the pelvis, extending from the pouch of Douglas to mid abdomen, It shows heterogeneous enhancement on contrast enhanced scans. It measures 11.9 x  6.9 x  18.8 cm. The part of the mass in the pelvis is mainly cystic with evidence of small air pockets in it. 
It is inseparable from the wall of sigmoid colon. Ovaries are not visualized separately.
There is reflux of orally administrated contrast medium into the gall bladder.
The liver, spleen, suprarenals, pancreas and kidneys appear normal.
Enlarged Common iliac lymph nodes are noted bilaterally.
There is no evidence of ascites.
Uterus and urinary bladder appear normally.
Visualised bones appear normal. 
CONCLUSION:
Abnormal, heterogenously enhancing mixed attenuation mass with cystic area and small air pockets, suggestive of malignant neoplasm with fistulous bowel communication. Organ of origin is difficult to ascertain, ? sigmoid, ? ovarian. Bilateral enlarged common iliac lymph nodes, suggestive of nodal metastases.

Sonography Study of Abdomen ( 17-10-2000)
Liver is normal in size and echotexture.
No focal lesion noted in liver parenchyma.
Porto-Venous complex is normal. Portal vein is normal.
Intrahepatic biliary radicles and C.B.D. are normal.
Gall blader is Contracted.
Spleen & pancreas are normal in size and echotexture.
Both kidneys are normal in size, shape, position and echotexture.
No evidence of any hydronephrosis or calculi noted.
Both ureters are not dilated & hence normal.
Urinary bladder is grossly normal.
I.V.C. and Aorta are normal.
No evidence of any obvious ascites or enlarged lymph nodes noted in abdomen.
IMPRESSION:
Essentially normal Study.

CT SCAN OF THORAX (08-11-2000)
Patient is a known case of operated Ca breast and Ca ovary. CT scan of thorax has been done. Multiple sections at 10 mm interval have been taken before and after injection of intravenous contrast.
Right breast and pectoralis muscles are not seen -H/O surgery.
Mediastinal vascular structures show normal anatomical disposition. The trachea is central, both the main bronchi are well seen appear normal.
No Evidence of mediastinal lymphadenopathy noted.
Few fibrotic scars are noted in right upper lobe anterior segment.
No evidence of lung metastasis noted.
bony thorax appears normal.
No evidence of lytic or sclerotic lesion noted.
IMPRESSION:
CT scan study of chest is within normal limits.
No lung metastasis/ mediastinal lymphadenopathy noted.

CT SCAN OF ABDOMEN AND PELVIS (10-11-2000)
Patient is a known case of operated breast and Ca ovary.
CT Scan of abdomen and pelvis has been done with and without intravenous contrast.Bowel loops were opacified with dilute gastrograffin.
Liver is normal in size and shows homogenous parenchymal density. No focal hepatic lesion or metastasis are noted.No subphrenic pathology is noted.
Gall bladder is well distended with radioopaque calculi.
Pancreas is seen in its entire length and is normal in size and configuration. No focal lesion, mass or pancreatitis is noted.
The spleen is normal in size shows homogenous parenchyma.
Both the kidneys are normal in size, shape, location and show equal and prompt excretion of contrast medium. The pelvi-calyceal system and ureters are normal. No hydronephrosis or perinephric pathology is noted. No renal or supra renal mass is noted. The peri and para renal fat spaces are well maintained.
The aorta and the venacava appear normal. No evicdence of pre and para aortic lymphadenopathy is noted. Opacified bowel loops appear normal.
No evidence of ascites is noted.
Urinary bladder is well distended and opacified.
Uterus and ovaries are not seen (H/O Pan hysterectomy)
The pelvic fat planes are well maintained and appeared normal.
The pelvic musculature and the bony pelvic walls show normal outlines.
No pelvic lymphadenopathy noted.
The contrast enhanced pelvic vascular structures appear normal.
IMPRESSION :
Radioopaque calculi in Gall bladder.
Rest of the abdomen is within normal limits.
No evidence of hepatic metastasis/abdominal lymphadenopathy or ascites noted.

CT SCAN OF THORAX(19-01-2002)
Operated Ca of Ca right breast and right ovary.
CT Scan of thorax has been done.Multiple sections at 10 mm interval have been taken before and after injection of intravenous contrast.
Absence of right breast.(h/o surgery).
No local recurrence.
Mediastinal vascular structures show normal anatomical disposition.  The trachea is central, both the main bronchi are well seen and appear normal.
The pre and para tracheal spaces and subcarinal spaces are well seen and appear normal.
There is no evidence of lymphnode enlargement.
Both the main pulmonary arteries are well seen and pre vascular spaces appear normal.
There is no evicdence of hilar or para hilar lymphnode enlargement noted.
The mediastinal fat planes are well maintained and appear normal.
The cardiac size and configuration is within the normal limits.
The bones appear normal.
IMPRESSION:
Study is within normal limits.
NO local recurrence. 
No Lung metastasis / Lymphadenopathy/ pleural effusion.

CT SCAN OF ABDOMEN AND PELVIS :(19/01/2002)
     Operated Ca of Ca right breast and right ovary. Plain and contrast CT scan of abdomen and pelvis has 
been done.Bowel loops were opacified with oral gastrograffin. Liver is normal in size and shows 
homogeneous parenchyma density. No focal hepatic lesion or mass is noted. No subphrenic pathology is noted. Gall Bladder calculi. No changes of cholecystitis. Pancreas is seen in its entire length and is normal in size and configuration. No focal  lesion, mass or pancreatitis is noted. The spleen is normal in size and shows 
homogeneous parenchyma. Both the kidneys are normal in size and shape, location and show equal and 
prompt excretion of contrast medium. The pelvicalceal system and ureters are normal. No hydronephrosis 
or perinephric pathology is noted. The peri and the pararenal fat spaces are well maintained. The aorta and 
the venacava appear normal. No pre/para aortic lymphadenopathy noted. Urinary Bladders appears well 
distended with smooth outlines. Uterus and ovaries are not seen (h/o surgery) No local recurrence. No 
abdominal / pelvic lymphadenopathy noted. Opacified bowel loops appear normal. No evidence of ascites.
IMPRESSION : 
Cholelithiasis - No changes of Cholecystitis
No local recurrence. No liver Metastasis/lymphdenopathy / ascites.

Sonography Study Abdomen (17/12/2002)
LIVER, SPLEEN & PANCREAS are normal in size and echotexture. No focal lesion noted. 
Porto-venous complex is normal. Portal vein is normal. Intrahepatic biliary radicles  & C.B.D. are normal. 
Gall Bladder is not well distended. Its Wall thickness is normal. MULTIPLE GALL STONES NOTED. 
Both Kidneys are normal in size , shape, position & echotexture. No evidence of any hydronephrosis or calculi noted. Both ureters are dilated & hence normal. Urinary Bladder is Empty. H/O HYSTRECTOMY 
NOTED. I.V.C. & Aorta are normal. No evidence of any obvious ascites or enlarged lymph nodes noted in abdomen.
IMPRESSION :- Multiple Gall Stones Noted.
Intrahepatic biliary Radicles & C.B.D. are normal. No Calculi noted within Lumen of C.B.D. H/O 
Hysterectomy noted.

X-ray Study of :- Cervical Spine : - A.P. & Lateral View.
Normal cervical lordosis is well maintained.
CHANGE OF CERVICAL SPONDYLOSIS NOTED
No bony erosion noted.Vertebral bodies, laminae, pedicles & spinousprocesses are normal. No evidence 
of any pre or paravertebral soft tissue swelling noted. No evidence of any cervical rib noted.

HAEMATOLOGY REPORT :

Parameter 11/08/2001 09/06/2001 29/03/2000 18/05/2000 04/04/2001 07/02/2001

 

Haemoglobin  11.30 gm/dl 11.30 gm/ dl 10.80 gm / dl 12.20 gm / dl 12.20 11.30gm/dl
R.B.C. Count   3.70 
mill/cu mm
3.70 
mill/cu mm
3.60 
mill/cu mm
4.10 mill/ cu mm 4.10

3.70mill/cumm

 

W.B.C. Count 9200 / cu mm  7800 / cu mm  8200 / cu mm 8200 / cu mm 9600/ cu mm 10200/cumm

 

Differential Count

Neutrophils  46 % 62 %  58 % 52% 60% 72
Lymphosites  53 % 37 % 39 % 47% 36 27
Eosinophils  0 % 0% 3 % 0% 1 0
Monocytes  1 % 1% 0 % 1% 3 1
Basophils  0 % 0 % 0 % 0% 0 0
Peripheral Smear Examination Normocytic & Normochromic Platelets are adequate Normocytic & Normochromic Platelets are adequate Microcytic and Hypochromic Macrocytes few, Platelets are adequate Normocytic & Normochromic Platelets are adequate Normocytic & Normochromic Platelets are adequate Normocytic& Normochromic Platelets are adequate
ESR 45 mm after 1 Hr. 45 mm after 1 Hr 50 mm after 1 Hr 22 mm after 1 Hr 25mm after1 Hr

44 mm after 1 Hr

BLOOD EXAMINATION REPORT (Cancer Tumour Marker)

Date Ca 125 CEA SR. Beta HCG CA 15.3
14/02/2000 4486.8
29/03/2000 825.64 U/ml 1.9 ng/ml
7/02/2001 175.00 U/ml
04/04/2001 137.00 U/ml
09/06/2001 60.40 U/ml 1.9 ng/ml 8.55mIU/ ml 9.80 U/ ml
11/08/2001 58.80 U/ ml 1.5 ng/ml
23/03.2002 70.08 U/ml
29/06/2002 15.04 U/ml 1.9 ng/ml 3.16 mIU/ml 16.6 U/ml

 

Comment  As per the result of CT Scan and blood investigation - tumour marker i.e. Ca 125 clinically too, patient is completely under control till today(10/04/2003).
Cancer Patients by Appointment               


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