| | Department of Medicine > Education > Medical Students > Third Year Medical Students > Hematology/Oncology Cases | Hematology/Oncology Cases
 Case 1: Breast Cancer
Case 2: Colon Cancer
Case 3: Lung Cancer
Case 4: Prostate Cancer
Case 5: Lymphoma
Case 6: Leukemia
Case 7: Anemia
Case 8: Thrombocytopenia
Case 9: Bleeding
Case 10: Thrombosis
| Objectives & Cases | Hematology/Oncology Objectives
Objectives & Cases Index | | | Case 1: Breast Cancer | A 52 year-old modestly overweight post-menopausal female smoker presents with a palpable breast mass: BCPs used from age 18 to 34
No family history of breast cancer
One 18 year-old daughter
Mammogram (1st ever!) reveals 2.5 cm spiculated mass
Core biopsy: ER/PR positive, HER-2 amplified, grade 2 invasive ductal carcinoma Lumpectomy reveals tumor size 3 cm, 2 sentinel lymph nodes identified with cancer - Is additional treatment needed?
- What are the options?
| | Case 2: Colon Cancer | A 63 year-old veteran presents with fatigue, anorexia, weight loss, darkening stools, right lower quadrant abdominal pain, and constipation all worsening x 4 months Hematocrit 25%, MCV 69 fL, nl. chems.
Colonoscopy finds ascending colon mass with evidence of recent bleeding
Exploratory laparotomy finds, completely resects a 6 cm. moderately differentiated adenocarcinoma metastasized to 4 of 11 regional nodes
No other metastases found on additional studies - Is additional treatment needed?
- What are the options?
- What are the likely outcome(s)?
| | Case 3: Lung Cancer | A 64 year-old smoker, a longtime maid at a local hotel, presents with hemoptysis after 3 months of right chest discomfort.
Lung adenocarcinoma resected
T2N0M0 disease diagnosed; performance status 1 - Is additional treatment needed?
- What are the Options?
Disease relapses in lungs and liver; performance status now 2 3. Is more treatment helpful?
4. What are the options? | | Case 4: Prostate Cancer | A 55 year-old black male presents:
First screening PSA 5
Exam and TRUS nl.
sextant biopsy nl. - What are the options?
5 years later:
PSA 10
0.5 cm nodule on exam and TRUS, biopsy: Gleason 3 Ca
2. What are the options?
8 years later:
Low back pain
PSA 20
Mild anemia
Bone scan multifocally positive
3. What are the options?
4. What is the likely course?
Son is now 40 years-old:
5. What are the Recommendations?
| | Case 5: Lymphoma | A 24 year-old white female presents with 2 months of fatigue, fever, night sweats, weight loss, cervical and supraclavicular adenopathy, dry cough. Appropriate investigation” finds Stage II-B Hodgkin’s lymphoma. - Is this treatable or curable? How?
9 mos. after finishing treatment, the disease relapses in the neck, is re-treated.
2. How is the disease retreated?
Three years later, the patient re-presents only with fatigue. Careful evaluation finds no relapse.
3. What is likely happening
4. What are the recommended interventions?
| | Case 6: Leukemia | A 38 year-old man presents with left upper quadrant abdominal discomfort after 6 months of progressive fatigue, anorexia, weight loss, early satiety
Exam finds enlarged spleen
Hgb 7 g/dl, plts 100K, WBC 327K
All stages of granulocytic maturation on diff, t(9;22) on cytogenetics - What is the Diagnosis?
- Is it curable?
- What are the Treatment options?
Relapses 2 years later:
4. What are the treatment options?
| | Case 7: Anemia | Three 72 year-old white men, each with a 20-year history of HTN and DM, each presents with new fatigue x 6 months:
ROS o/w essentially negative. Exam of all three: sl. pale. Pt. A: Creatinine 1.9, Hct 24%, MCV 63 Pt. B: Creatinine 1.9, Hct 24%, MCV 87 Pt. C: Creatinine 1.9, Hct 24%, MCV 105 - What are the Differential diagnoses?
| | Case 8: Thrombocytopenia | A 39 year-old black female presents with a one week history of worsening mental status, fever, epistaxis:
Unremarkable G2P2A0 (in her 20s) and had had a cold a month earlier but o/w no significant PMH
Exam: T102, obtunded, bruised, mildly jaundiced. Urine appears brownish.
Hct 25%, plts 8K, creatinine 3.9 - What is the differential diagnosis?
- What other tests would you order?
- What are the expected results?
- How would you treat the most likely diagnosis?
| | Case 9: Bleeding | An 83 year-old woman found by neighbor unconscious on floor at home. Exam in ER: barely arousable, left facial droop, epistaxis, bleeding lacerated tongue, right hemiparesis, irregularly irregular heart rhythm, extensive extremity and trunk bruising. Neighbor says patient lives alone, increasingly demented in the last year, and chronic mild bruising began to get much worse two weeks ago. - What is the differential diagnoses?
- What studies should be ordered?
- What is the treatment?
| | Case 10: Thrombosis | A 45 year-old black female with a 5 year history of lupus presents to ER with acute severe dyspnea and chest pain Exam: In distress, HR 120, RR 36, BP 90/60, 100.0F
Distended neck veins
RV heave, clear lungs, tender and slightly swollen right calf - What is the differential diagnosis?
- What studies should be ordered?
- What is the treatment?
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