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

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

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

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  1. 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

  2. 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

  3. 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

  4. Chest x-ray – normal • CT scan of abdomen:

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

  6. 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.

  7. Histopathology of the resected tumor shows the following after special staining:

  8. 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:

  9. Salient features Subjective salient features: • gradual abdominal enlargement and a palpable abdominal mass • feeling of abdominal fullness and early satiety • weight loss

  10. Salient features Objective 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

  11. 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.

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