A 56-year old male farmer from Laguna is admitted because of an abdominal mass. History of the...

A 56-year old male farmer from Laguna is admitted because of an abdominal mass.

History of the Present Illness: • 5 months PTA, he noticed gradual abdominal enlargement and a

palpable abdominal mass. This was accompanied by a feeling of abdominal fullness and early satiety. He also noticed weight loss of around 10 lbs.

ROS: Unremarkable

Personal History:

• The patient smokes around 10-15 sticks of cigarettes a day for the past 20 years. He drinks 2-3 bottles of beer every day.

• He has had no previous hospitalization.

Physical Examination:

• BP 150/90; PR 78 bpm; RR 15 cpm; Temp 36.7; Weight: 130 lbs; Height: 5 ft 7 in

• HEENT - pinkish palpebral conjunctivae; no palpable cervical lymph nodes

• Heart and Lungs: essentially unremarkable

• Abdomen: palpable mass at the periumbilical area with a smooth surface, non-tender, with ill-defined borders, measuring around 10 cm at its widest diameter. It is also not ballotable and does not move with respiration. Bowel sounds are normal.

• Rectal exam: ⊖

Admission Work-ups:

– Blood tests

• Hemoglobin 130, Hematocrit 40, WBC 8000/cumm; PMN 70, lymphocytes 25, eosinophils 5

• Total Protein 75, Albumin 55, Globulin 20

• PT: 13 sec, Control 12 sec; APTT: 40 sec

– Chest x-ray – normal

– CT scan of abdomen:

• On the 2nd hospital day, he undergoes a diagnostic procedure. Histopath is shown below:

• On the 4th hospital day, he undergoes surgery. Operative findings:

– A 15-cm encapsulated mass is found located at the retroperitoneum adherent to the ascending colon. The tumor does not involve the aorta nor the inferior vena cava.

– Liver is normal

– Resection of the tumor with R hemicolectomy is done.

• Histopathology of the resected tumor shows the following after special staining:

• Post-operative course is uneventful. • Eighteen months after surgery, he comes back

complaining of persistent cough with weight loss. Chest x-ray and Chest CT scan are done and show the following:

Salient features

Subjective salient features:• gradual abdominal enlargement and a

palpable abdominal mass • feeling of abdominal fullness and early satiety• weight loss

Salient featuresObjective Salient features:

• palpable mass at the periumbilical area with a smooth surface, non-tender, with ill-defined borders, measuring around 10 cm at its widest diameter. It is also not ballotable and does not move with respiration.

• Total Protein 75, Albumin 55, Globulin 20

• PT: 13 sec, Control 12 sec; APTT: 40 sec

Salient features

• Operative findings: 15-cm encapsulated mass located at the retroperitoneum adherent to the ascending colon. The tumor does not involve the aorta nor the inferior vena cava.