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Portosystemic Encephalopathy in Hepatocellular Carcinoma

Adult male with a history of hepatitis C, non-Hodgkin’s lymphoma (NHL) and hepatocellular carcinoma. Patient treated for NHL with CHOP-R 4 years ago. However, post-treatment, he had continued presumed bone marrow suppression. He was diagnosed 2 years later with HCC and underwent TACE with good effect. Since the TACE, the patient has had persistent and worsening hepatic dysfunction with portal hypertension and ascites. Recently, the patient developed encephalopathy and was treated, as described below, with fast return to consciousness.

Left Ventricular Dysfunction and Aortic Stenosis

62-year-old female with systolic heart murmur for 6 years. Her first echocardiogram showed mild to moderate LV dysfunction with regional wall motion abnormality. The second echocardiogram the left ventricular function was interpreted as normal, there was left ventricular hypertrophy and severe aortic stenosis. The expert recommends to perform another third echocardiogram. If the patient has truly left ventricular function and severs aortic stenosis then aortic valve replacement surgery is recommended, even if she is asymptomatic.

Anemia due to blood loss in obscure intestinal bleeding

43 years old patient without any notable pathologies in anamnesis. After two episodes of severe hematochezia the patient underwent EGD, Colonoscopy, digestive system X-rays with contrast medium and capsule endoscopy camera (digestive system micro camera) without any pathological evidences

Metastatic non small cell lung Cancer

67 year old male, previously a heavy smoker, suffering for 2 months from weakness, diminished appetite and weight loss. Tests showed a mass in right arm, possibly attached to muscle, and tenderness in right ribs. Chest CT showed a mass in LLL, lung foci, suspected secondary spread and masses in upper abdomen. CT guided biopsy from right lung mass was consistent with non small cell carcinoma with extensive necrosis. SPECT bone scan showed many focal findings in the vertebrae L,D2,7, most of the ribs bilaterally and in the limbs- suspected for secondary pathology.

Well differentiated mixed acinar and bronchoalveolar adenocarcinoma of the lung

An occasion chest X-ray of a 74-year-old female revealed a thickening in her left lung, and the tumor was latter typified as non-small cell lung cancer. Her staging chest CAT scan was consistent with a primary tumor in the lingular sub-segment together with millimetric parenchymal nodules suspected as secondary. She underwent a lingular segmental resection of the left lung. The histological report described a mixed acinar and non-mucinous bronchoalveolar adenocarcinoma of the lung.

Metastatic, Non Small Cell Lung Cancer

67-year-old with multiple co morbities: Heart, renal, vascular, hypertensive. His biopsy showed left lower lobe lung mass that was a TTF-1 Non small cell lung cancer- most likely an adenocarcinoma. Multiple small nodules < than 1cm were noted without certain etiology, together with “masses” in the upper abdomen and left arm. Recommended therapy includes single agent Vinorelbine.

Metastatic, Non Small Cell Lung Cancer – further opinion

67-year-old with multiple co morbities: Heart, renal, vascular, hypertensive. His biopsy showed left lower lobe lung mass that was a TTF-1 Non small cell lung cancer- most likely an adenocarcinoma. Multiple small nodules < than 1cm were noted without certain etiology, together with “masses” in the upper abdomen and left arm. Recommended therapy includes single agent Vinorelbine.

Stage 4 Neuroblastoma

1.5-year-old male suffered from eye swelling. His MRI revealed expansive lesion of left lateral orbital wall origin, with compression on the lateral rectus muscle. Later he was hospitalized due to fever and vomiting in left orbital lesion, suspecting a metastatic neuroblastoma. His eye examination revealed exophthalmus of the eye with exophoria and light dysfunction of the lateral rectus. His biopsies were indicative of stroma-poor neuroblastoma.

Stage 4 Neuroblastoma – additional opinion

1.5-year-old male suffered from eye swelling. His MRI revealed expansive lesion of left lateral orbital wall origin, with compression on the lateral rectus muscle. Later he was hospitalized due to fever and vomiting in left orbital lesion, suspecting a metastatic neuroblastoma. His eye examination revealed exophthalmus of the eye with exophoria and light dysfunction of the lateral rectus. His biopsies were indicative of stroma-poor neuroblastoma.