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Wednesday, 28 December 2016

CASE 410: SOLITARY PULMONARY NODULE (SPN), Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM






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Man  66yo  diabetic, former smoking patient. Chest X-ray  is  nothing  abnormal detected.
CT total body  non CE   detected  one SPN which has size of  0.94 cm at  the left lung ( cT1, CT3).  CTCE  with dynamic scan  showed CE  rise from 14 HU to 74 HU.
Blood tests =  CYFRA 21-9,09  and  WAKO TEST  AFP=3.9;   AFP L3=19.3; DCP =25) another cancer markers  are normal.

What is your  suggestion for diagnostic and  therapy?
Operation thoracoscopy lobectomy, this tumor is hard and black central, tumor size  smaller than 1 cm.


Microscopic report is adenocarcinoma moderate differentiated.

REFERENCES:
NEjM 2006:355:1761.71





3 comments :

Le Huu Linh said...

9mm diamter SPN in old age former smoking patient, pet ct and nodule pulmonary biopsy is suggested in this case

chau phan said...

Risk factors for malignant pulmonary nodules include a history of smoking and older age.
Pulmonary solitary nodule (#9mm) with enhancement after contrast injection on CT scan. This nodule is the more likely it is to be cancerous.
The next step: PET CT or biopsy.

Võ Nguyễn Thành Nhân said...

This nodule is 9mm > 7mm and strongly enhanced after contrast injection, and smoking history is suspected early tumor. Different diagnosis is inflammatory pseudotumor.
Surgery or biopsy is suggested.