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    68 year white male with newly found liver mets. For CT biopsy next Friday (I have to let his warfarin wear off first). I'm interested on what everyone might guess is the primary site.

    Some history --

    In November presents with a GI bleed. Found to have a superficial gastic ulcer with malignant cells. Undergoes gastrectmony and is found to have a localized, St. Ia gastric cancer. Also a second lesion, unrelated -- a carcinoid.

    Now with pelvic discomfort. CT shows liver mets and thickening of the rectosigmoid. Just a a polyp with atypia biopsied, going for laser ablation and further biopsy on the same day as the liver biopsy.

    No symptoms of carcinoid. So place your bets --- I'm betting on colon cancer.

  • #2
    MALToma
    Mel
    There is no place like 127.0.0.1

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    • #3
      Pancreas

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      • #4
        Originally posted by ivanchemist
        68 year white male with newly found liver mets. For CT biopsy next Friday (I have to let his warfarin wear off first). I'm interested on what everyone might guess is the primary site.
        Some history --
        In November presents with a GI bleed. Found to have a superficial gastic ulcer with malignant cells. Undergoes gastrectmony and is found to have a localized, St. Ia gastric cancer. Also a second lesion, unrelated -- a carcinoid.
        Now with pelvic discomfort. CT shows liver mets and thickening of the rectosigmoid. Just a a polyp with atypia biopsied, going for laser ablation and further biopsy on the same day as the liver biopsy.
        No symptoms of carcinoid. So place your bets --- I'm betting on colon cancer.
        Endometrial, oops

        Colorectal
        Looking for EMR

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        • #5
          Why give him a second primary?

          Gastric
          Last edited by lapdoc; 02-10-2005, 11:26 PM. Reason: sp.
          Lapdoc

          "Never underestimate the courage of the non-combatant"

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          • #6
            My thinking was gastric vs. carcinoid vs. colon. The gastric primary was tiny, almost in situ and thus unlikely to metastasize.

            I favor colon.

            Maltoma would spread to the nodes, not liver (it's a low=grade b cell lymphoma). The CT report didn't mention a pancreatic mass, but I've seen pancreatic ca w/out a pancreatic mass in the past.

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            • #7
              I'd bet colon.
              I recommend biting off more then you can chew to anyone
              I certainly do
              I recommend sticking your foot in your mouth at any time
              Feel free


              Alanis Morisette

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              • #8
                I should have the path on Monday. To further make life interesting -- there's a moderate elevation of urinary 5HIAA (50/24 hours, with a normal <30)

                If this was available two weeks ago, would you cancel the biopsy ?

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                • #9
                  No, because this sets the stage for carcinoid syndrome, and controlling the syndrome will be based on whether these mets show carcinoid. Without liver mets, typically no clinical carcinoid syndrome.

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                  • #10
                    Well the pathology is available, and isn't very helpful. The radiologist get a needle cytology, and a core. The needle was positive for malignancy, and the core wasn't. Additionally, the cytologic specimen can't be sent for markers.

                    Chromograffin is also up. If the patient appears to have resectable mets, the patient goes to the OR.

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                    • #11
                      Additional info -- the colonic polyp had invasive ca. The patient will need an exploration to allow removal of the involved segment of the colon. I will ask the surgeon to re-biopsy the liver at that time.

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