Name Of the Patient : Mr. Ashish V. Koshe
Age: 18 Years (Male)
Date: 03/03/2000
Address : V. J. Khose.
N. R. C. Colony,
G.N. 39, Mohane Kalyan
Diagnosis : Known Case of C.A. Testis
Biopsy Report : Clinically Scrotal Wall Tumour.
Material sent : Outside slide & block for review 2 stained slides & 5 paraffin blocks.
Microscopically "High Grade malignant Tumour which is not a Lymphoma. This is a poorly differentiated Mesenchymal Tumour.
Status of the Patient : A. Operated 
B. Chemotherapy 2 Received
C. No Radition
Treatment Given :
Follow Up Investigation :
Prior to our Treatment :

The U.S.G. Scrotum Study Reveals : (09/10/1999)

  Right testis measures 3.9 x  2.9  x  2.2 cms and left testis measures 3.9 x 2.9 x 2.1 cms. Both testes reveal homogeneous reflectivity with no focal pathology. Both epididymes are normal. Notable feature is presence of a solid mass in right scrotal wall measuring 3.7 x 3.7 x 3.5 cms. Mass is solid with lobulated margins and on doppler examination reveals good vascularity. No cystic areas or calcification seen.
Comments :   Features are of a solid right scrotal lobulated extra testicular mass - ? Leiomyoma / Fibroma / Neuroma / Other soft Tissue Neoplasm.

USG of Upper Abdomen and Scrotum: (27/10/1999)
The liver is normal in size shape and shows a homogenous echo texture. No focal or  diffuse area of altered echogenicity is seen in the liver. There is no dilatation of the Biliary tree the gall bladder pancreas kidneys & Spleen are normal. No abdominal Lymphadenopathy or ascites is seen.

USG Scrotum:(27/10/1999)
Both Testes appears normal and shown homogenous echoginicity. Both epdidymes were normal. No focal / diffuse lesion seen in the above mentioned structure. A small encysted Hydrocoele is seen on the right. No obvious evidance of any abnormal mass noted. Impression post operative case of Scrotal wall tumour. USG studies shows a small encysted hydrocoele in the right.

FOLLOW UP AFTER OUR TREATMENT

INVESTIGATIONS:

Date

Serum B-HCG

CEA

09/04/2001

5.13

1.0

02/11/2000

-

1.0

27/11/2001

8.96

1.40

HAEMATOLOGY REPORT :                             

  Parameter 

 (02/11/2000)    

(09/04/2001)

  (27/11/2001)

Haemoglobin  14.10 gm/dl 14.00 gm/ dl 14.40 gm / dl
R.B.C. Count   4.70 
mill/cu mm
4.70 
mill/cu mm
4.80 
mill/cu mm
W.B.C. Count 8200 / cu mm  9800 / cu mm  4600 / cu mm

Differential Count
Neutrophils  56 % 51 %  45 %
Lymphosites  41 % 46 % 49 %
Eosinophils  3 % 3% 5 %
Monocytes  0 % 0 % 1 %
Basophils  0 % 0 % 0 %
Peripheral Smear Examination Normocytic & Normochromic Platelets are adequate Normocytic & Normochromic Platelets are adequate Normocytic & Normochromic Platelets are adequate
ESR 5 mm after 1 Hr. 18 mm after 1 Hr 10 mm after 1 Hr

CT SCAN OF ABDOMEN AND PELVIS (15/04/2000)
Patient is treated case of Ca right scrotal wall (Rhabdomyosarcoma) CT Scan of abdomen and pelvis has been done with and without intravenous contrast. Bowel loops were opacified with dilute gestro graffin. Liver is normal in size and shows homogeneous parenchymal density. No focal hepatic lesion or mass is noted. No subphrenic pathology is noted.
Gall Bladder is well distended with smooth outline. There is no evidence of any radio opaque calculi. No intra luminal mass is seen. 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 homogeneous 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 perinephoic pathology is noted. No renal or supra renal mass is noted. The peri and pera renal fat spaces are well maintained. The aorta and the venacava appear normal. No evidence of peri or para-aortic lymphadenopathy is noted.
Opacified bowel loops appear normal. No evidence of ascites is noted. The contrast filled urinary bladder shows normal outlines. The pelvic fat planes are well maintained and appear normal. The pelvic musculature and the bony pelvic walls show normal outlines. No abdominal or pelvic lymphadenopathy noted. The contrast enhanced pelvis vascular structures appear normal.

IMPRESSION:
Study is within normal limits.
No hepatic metastasis or lymphadenopathy or ascites.

CT SCAN OF ABDOMEN AND PELVIS (15/07/ 2000)
Patient is a known case of pleomorphic embryonal Rhabdomyosarcoma of the scrotal wall who has been operated for recurrence. Patient has also received chemotherapy. CT scan of abdomen and pelvis has been done before and after injection of intravenous contrast. Bowel loops were opacified with dilute gastro graffin. Few cuts have also been obtained for the scrotum. Liver is normal in size and shows homogeneous parenchymal density. No focal hepatic lesion or mass is noted. No subphrenic pathology is noted. Gall bladder is well distended with smooth outline. There is no evidence of any radio opaque calculi. No intra luminal mass is seen. Pancreas is seen in its entire length and is normal in size and configuration. No focal lesion, mass or pancreatisis is noted. The spleen is normal is size and shows homogeneous parenchyma. Both kidneys  are normal in size, shape, location and show equal and prompt excretion of contrast medium. The pelvic-calyceal system and the 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 evidence of pre or para aortic lymphadonopathies noted. Opacified bowel loops appear normal. No evidence of ascites is noted. The contrast filled urinary bladder shows normal outlines. Right scrotal sac appears bulky with a small hydrocoele. The adjacent scrotal wall appear thickened with nodularity. Both testis are well visualized and appear normal. Both spermatic cords are well visualized and appear normal. The pelvic fat planes are well maintained and appear normal. The pelvic musculature and the bony pelvic walls show normal outlines. There is no evidence of solid or cystic mass lesion in the pelvis or any evidence of pelvic/ inguinal lymphadenopathy. The contrast enhanced pelvic vascular structures appear normal.

IMPERESSION:
No Hepatic Metastasis // Abdominal // Pelvic / Inguinal Lymphadenopathy.
Right Scrotal sac appears Bulky with a small Hydrocoele. The adjacent scrotal wall appear thickened with nodularity. Both Testis are well visualized and appear normal. Both spermatic cords are well visualized and appear normal.

CT SCAN OF PELVIS & INGUINAL REGION:(01/11/2000)
Clinically patient is a treated case of Ca right scrotal wall (Rhabdomyosarcoma). Previous scan dated 15/7/2000 has been reviewed. CT scan of pelvis and inguinal region has been done before and after injection of intravenous contrast. The bowel loops have been opacified with oral contrast. Both the testis are well visualized and appears normal. Scrotal wall appears normal. No nodularity or thickening. No hydrocoele. Both spermatic cord appears normal. The contrast filled urinary bladder shows normal  outlines. The pelvic fat planes are well maintained and appear normal. The visualized bowel loops show normal appearance. The pelvic musculature and the bony pelvic walls show normal outlines. There is no evidence of solid or cystic mass lesion in the pelvis or any evidence of pelvic or inguinal lymphadenopathy. The contrast enhanced pelvic vascular structures appear normal.

IMPRESSION :
Both the testis are well visualized and appears normal. Scrotal wall appears normal. No Nodularity or thickening. No Hydroocele.
No evidence of Pelvic or Inguinal Lyphadenopathy.

CT SCAN OF ABDOMEN AND PELVIS (29/04/2002)
H/o treated case of rhabdomysarcoma of scrotal wall.
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 homogenous parenchyma density. No focal hepatic lesion or mass is noted. No subphrenic pathology is noted.

Gall bladder is well distended with smooth outline. There is no evidence of any radio opaque calculi. No intra luminal mass is seen.

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 pelvicalyceal system and ureters are normal. Bilateral external pelvis. No hydromephrosis 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, the vencava appear normal. No pre/para aortic or pelvic lymphadenopaphy noted.

Urinary bladder appears well distended with smooth outlines.

Prostate and both seminal vesicles appear normal.
Both the testies appear normal.
Opacified bowel loops appear normal.
No evidence of ascites.
IMPRESSION :
Study is within normal Limits.No Liver Metastasis, Lymphadenopathy or Ascites.

CT SCAN OF THORAX : (29/04/2002)
H/o treated case of rhabdomysarcoma of scrotal wall.
CT scan of thorax has been done. Multiple sections at 10 mm interval have been taken before and after injection of intravenous contrast.
Meidastinal 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 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. Both the lung fields appear normal. There is no evidence of any parenchymal lesion.
The bones appear normal.
IMPRESSION :
CT Scan of Thorax is within normal Limits. No Lung Metastasis, Lymphadenopathy or Pleural Effusion. 

Comment : As per as the CT scan , blood reports and clinically too, till today patient is completely under control(10/04/2003).
Cancer Patients by Appointment               


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