Dear Docotors & Reserachers,
I would appreciate if any suggestions or comments are given to us for this
case which might help this bright young boy.
The case is of a 23y old software engineer from India who was to commence
his advance studies in US from Fall this year.
The boy has some kind of stain or pain on the back of his right should for
last about two months which was considered a normal strain and pain killers
or anti-inflamatories were given by general physician. The pain would come
and go and no other signs were seen. After over a month of this prolonging,
the orthopad carefully examined the boy and finding something heavy in chest
advised Chest X-Ray and other routine blood tests. The Chest X-Ray showed
pleural effusion in the right lung.
The boy has a history of Pleuricy (TB) glands in childhood and was
successfully treated at the age of about 13 years.
Initially it was considered as plain case of pleural effusion and AKT
treatment was recommended along with steriods for two weeks. But as a
routine, the fluid was also tapped. About 480 cc of fluid was drawn. The
cytology of the pleural fluid after confusion at the local level path lab
was sent to a speciality lab which diagnosed metastatic adenocarcinoma.
Immediately a CT scan was done for the chest region and it was found that "
Small right pleural effusion with pleural based nodules and right basal
A second tapping was also done with the help of ultrasound and about 1 lt
fluid was drawn and sent to three different labs of Bombay. And a CT scan of
the abdomen-pelvis was also done which showed no signs of abnormality or any
The results of three different cytology labs were as under:
1. Smears reveal clusters and fronds of round to oval tumor cells containing
acidophilic or vacuolated cystoplasm and central or ecentric, large,
coaarsely heprchormatic nuclei. Many signet ring cells are present. Several
reactive mesothelial cells and a few leucocytes are also present.
Diaganosis : Adenocarcinoma in Right Pleural Fluid
(probably primary sites include: stomach, pancreases and colon)
2. Papillar cluster of metastatic adenocarcinoma cells seen
3. The semars and cell blocks are extremely cellular. Single, morular and
papillary clusters of medium to large cells with abundant cytoplam, clear to
vacuolated at times and irregular hyperchormatic nuclei are present.
Nucleoli are occassionally noted. A vague acinar arrangement of cells is
also noted. Also present are lymphocytes and a few normal mesothelical
cells. Mucin stains are negative in the abnormal cells.
Diagnosis. Pleural fluid - malignant cells of probable metastatic
Remarks : A maligant Mesothelioma is a strong possibility in this case. It
is therefore recommended that immunocytochemical staining for CEA or LeuM-1
or ultrastructural examination for surface microvilli in the prsence/absence
of a glycolcalceal ocat to be carried out on the fluid to distinguish the
Metastatic adencocarcinoma for a Carcinomatous Mesothelioma.
The boy does not have any other symptom. He is pure vegetarian,
non-alcholic, non-smoker and non user of tobbaco in any form.
His family history does have cancer. His mother was operated for a breast
cancer and his maternal grandfather had a prostatic cancer at the age of 80
The boy is been seen and is under top oncologists of Bombay, India who say
that an adenocarcinoma at this age seems to be a very rare possibility with
no signs of primary and no symptoms otherwise. Anyhow a immunocyto is
already given along with blood marker tests. A GI and Colon Scopy is also
planned to rule out the possibility.
They are planning for chemotherapy at least for two cycles after receipt of
the above reports and rule out surgery or radiations. There are also
indications that if it is adenocarcinoma, then response from chemotherapy is
not very encouraging.
We request Oncolink to provide with their esteemed opinion, comments,
suggestions or remarks on this case which might help this young and bright
boy. If desired, we will send copies of the reports or courier slides to
any doctor or labs anywhere in the world or the boy can be sent to any
hospital in the world immediately if promising treatment is available.
With Best Regards
Anoop K. Gupta
Fax: 91-11-291 6611
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