Patient Medical Report

Rt mastectomy

For staging

Head and neck: free Chest: Two hypermetabolic bilateral small internal mammary lyfph nodes; the most prominant one is within right side measuing 1.3x0.8 cm with SUVmax=5.9. • Few mildly hypermetabolic subcentimetric right costophrenic and bilateral cardiophrenic mediastinal lymph nodes (SUVmax=3.9) were noted • Picture of right mastectomy with no hypermetabolic suspicious right breast bed lesions • Few minimal to mild hypermetabolic subcentimetric right axillary lymph nodes (SUVmax=2.3). Mildly hypermetabolic small soft tissue density with focal calcification in the mid upper aspect of left breast (SUVmax= 2.5) Mildly hypermetabolic subcentimetric right upper arm subcutaneous nodule versus lymph node with SUVmax=2.8. Few non-FDG avid few small left axillary L.Ns. Non-FDG avid tiny right middle lobe nodular opacity. Non-FDG avid small right lateral chest wall nodule. In the abdomen & pelvis: • Heterogenous hypermetabolic omentoperitoneal thickening

Status post right mastectomy with no hypermetabolic suspicious right breast bed lesions. • Hypermetabolic omentoperitoneal deposits with malignant pelvic free fluid and metastatic small bilateral internal mammary and right mediastinal lymph nodes; concerning for right ovarian malignant lesion versus metastasis. Further evaluation is advised. • Non-specific mildly hypermetabolic small right upper arm subcutaneous nodule/lymph node along with few minimal to mild hypermetabolic subcentimetric right axillary L.Ns. For attention on follow-up. • Mildly hypermetabolic small mid upper left breast soft tissue density with focal calcification, for correlation with breast imaging modalities. • Other ancillary finding as described above.

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For histopatho

Evidence of right-sided mastectomy, no definite suspicious lesion deep to the scar area * Lymph node seen deep to the lateral aspect of the surgical scar, measuring about 9 mm, shows prominent cortex with preserved fatty hilum, FNA is advised. • Few thick cortex right axillary lymph nodes, FNA is advised • Heterogeneous echotexture of the left breast with prominent ducts and small scattered cysts. • Well-defined lobulated hypochoic lesion seen posteriorly at 11-12 o'clock of the left breast, measuring about 9x7 mm, showing foci of calcification, probably benign, follow-up is advised. • Left axillary lymph nodes, some of them show mild cortical thickening with preserved fatty hilum.

Thick cortex right axillary lymph nodes, however, no definite suspicious lesion deep to the scar area

BIRADS 4 A Recommendation - all studies FNA from the right axillary lymph nodes is advised • FNA from the lymph node seen deep to the lateral aspect of the surgical scar is advised Follow up Breast U/S after 4 months is advised • Annual mammogram is advised

For staging

Chest: free Abdomen: omental caking, peritoneal deposits Mild pelvic free fluid Liver,spleen,kidney free

Omental caking Peritoneal deposits Free pelvic fluid

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-DIFFUSE FAT STRANDING AND NODULAR THICKENING SEEN WITHIN THE VISUALIZED PART OF ABDOMINAL FAT AND PERITONEAL REFLECTIONS ALONG THE ANTERIOR AND LATERAL ASPECTS OF THE ABDOMEN (GREATER OMENTUM ), WHICH DEMONESTRATEED FOCI OF NODULAR PART CONTRAST ENHANCEMENT , RAISING CONCERN FOR PERITENOEAL CARCINOMOTOSIS/ OMENTAL -ILL DEFINED SUBCAPSULAR AREA OF T2 SIGNAL ALTERATION SEEN ALONG THE ANTERIOR INFERIOR, LIVER SURFACE (ANTERIOR ASPECT OF SEGMENT V1 / DEMONESTRATING HYPERENHANCEMENT RELATIVE TO THE ADJACENT • LIVER PARENCHYMA • ON ALL CONTRAST PHASES WITH FAINT DIFFUSION RESTRICTION ON DWIXIADC MAPS :LIKELY RELATED TO THE AFOREMENTIONED OMENTAL , PERITONEAL THICKENING , -MILD TO MODERATE AMOUNT OF FREE FLUID SEEN IN THE ABDOMEN AND PELVIS > -FEW PROMINENT UPPER ABDOMINAL AND BILATERAL CARDIOPHRENIC ANGLE LYPH NODES ARE SEEN THE LARGEST MEASURING ABOUT 0.6 CM IN THE RT CARDIOPHRENIC REGION -THE LIVER OTHERWISE APPEARS NORMAL SIZE AND SHAPE -THE GALLBLADDER APPEARS GROSSLY UNREMARKABLE WITH NO DEFENITE SIZABLE STONES INSIDE- -NO INTRA OR EXTRAHEPATIC BILE DUCT DIALATION • -THE PORTAL AND HEPATIC VEINS ARE NORMAL.

Peritoneal mets

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For pelvic MRI+ D&C Vs Diagnostic sampling by laparascopy (Suspected primary gynecological ca)

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