Diagnostics

HEMATOLOGY Laboratory Work-Up

NormalJune 23, 2010Remarks WBC4-11 x 10­ 9 /L8.08 x 10­ 9 /LNORMAL RBC4-6 x 10­ 9 /L4.82 x 10­ 9 /LNORMAL Hgb g/L142g/LNORMAL Hct %0.431%NORMAL MCV80-100fL89.4fLNORMAL MCH27-31pg29.5pgNORMAL MCHC g/L329g/LNORMAL RDW-CV x 10­ 9 /L129 x 10­ 9 /LREDUCED Platelets2-4 x 10­ 11 /L3.1 x 10­ 11 /LNORMAL Neutrophil SLIGHTLY ELEVATED Lymphocytes REDUCED Monocyte NORMAL Eosinophil NORMAL Basophil NORMAL APTT NORMAL PT12-15 seconds12.5 secondsNORMAL

BLOOD CHEMISTRY Laboratory Work-Up

NormalJune 23, 2010Remarks BUN mmol/L2.46 REDUCED Creatinine umol/L71 ELEVATED Sodium mmol/L137 NORMAL Potassium mmol/L4.3 NORMAL Calcium mmol/L2.41 NORMAL Albumin38-51 g/L31 REDUCED AST0-34 U/L50 ELEVATED ALT0-30 U/L42 ELEVATED Total Bilirubin umol/L5.90 NORMAL Dir Bilirubin umol/L1.96 NORMAL Ind Bilirubin umol/L3.94 NORMAL Urate mmol/L0.31 NORMAL

URINALYSIS Laboratory Work-Up

NormalJune 23, 2010Remarks ColorYellowLight Yellow NORMAL TransparencyClear NORMAL SG NORMAL Ph NORMAL Sugar(-) NORMAL Albumin(-) NORMAL RBC0-2/hpf4/hpf MICROSCOPIC HEMATURIA WBC0-5/hpf2/hpf NORMAL Casts3/hpf Bacteria(-)1/hpf POSSIBLE INFECTION Ketones+1 ELEVATED

MULTIPLE CONTIGUOUS AXIAL CT SCAN OF THE CHEST WITH IV CONTRAST Imaging Studies

Imaging Results

Well defined lobulated pulmonary mass with irregular margin with eccentric calcifications at the superior basal segment of the left lower lobe <1cm pulmonary nodule at the posterior basal segment of the right lower lobe With either linear fibrosis or subsegmental atelectasis at the anterobasal segment of the left lower lobe Pleural thickening, left lung Thoracic spondylosis

SURGICAL PATHOLOGY Tissue Diagnosis

April 26, 2010 Metastatic poorly differentiated adenocarcinoma

AFB SPUTUM Culture

June 26, 2010 Day 1: (-) AFB Day 2: (-) AFB

Diagnosis

Working Diagnosis Lung cancer, non-small cell (adenocarcinoma), stage 4, currently undergoing cobalt radiotherapy with possible malnutrition, kidney and liver damage. Rule out pulmonary TB.

The results of the biopsy confirm that indeed, the patient has a malignant tumor in the lung The enlarged supraclavicular lymph nodes indicate that the patient’s cancer is in stage 4

SCLC vs. NSCLC SCLCNSCLC Scant cytoplasmAbundant cytoplasm Hyperchromatic nuclei w/ fine chromatin pattern Pleomorphic nuclei w/ coarse chromatin pattern Indistinct nucleoliProminent nucleoli Diffuse sheet of cellsGlandular or squamous architechture

Pain when swallowing Decreased food intake GuconeogenesisMuscle wastinghypoalbuminemiaElevated AST, ALP Ketone body production