Dear Ones,
I have come into contact with Mr XY (aged 65 years) a field geologist by profession who presented to me with a 5 months history of excessive tiredness and weight loss of 13kgs. His past medical history was unremarkable. He has a reported family history of cancers to both his paternal and maternal family roots.
On examination, he was weak, cachexic, afebrile (T=36.5 degrees Celsius), sitting BP = 115/78mmHg, PR=97 beats/minute and RR = 13 Breaths/minute. Systemically, he has numerous erythematous-like lesions over his hands, feet with prominent cervical lymphadenopathy. Otherwise, the rest of the systems are unremarkable for potential pathological insults on exam.
Several investigations were done to his credits that involved a full blood count that revealed normochromic, normocytic anaemia (Hb=8g/dL, MCV = 78fL) as the only aberrant finding. Chemistry panel (that included serum electrolytes, liver and renal function tests) done was insignificant apart from mild hyponatraemia. Thyroid panel tests were all within normal range. Both echocardiography and electrocardiography findings were normal. Additional tests ordered included a 24-hour urine protein electrophoresis, eosophageal gastro-duodenoscopy as well as colonoscopy that were all insignificant of any potential pathology. HIV serology was negative and so were the HbsAg, HCsAg, anti-HBV and anti-HCV test results. Imaging studies done included a chest radiology, abdominal ultrasonography as well as CT of the abdomen, in which the following characteristic findings were found (see the attached files). At present, the patient has been scheduled to a surgeon for a biopsy removal (cervical lymphnode biopsy excision) .
Questions:
1. from the CT-scannographs, what could be considered in a list of provisional diagnosis?
2. How best to treat the patient (should the diagnosis be radiological?) given the radiographic pictures?
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