SLE and Carcinoid Tumours.
History of present illness:
known case of SLE controlled on steroids but presented with ecchymosis & severe resistant thrombocytopenia to all measures (pulse steroids, Ig ,etc) so bone marrow asp.& biopsy
showed infiltration by malignant cells no megacariocytes.
breast lumps bilaterally invistigateg in perpheral hospital and reassured (benign).
Past surgical history:
prednisolone 50 mg
married and has 4 kids
well . PERFORMANCE = 0
37 DEGREE CELSEUS
98% on Room Air
Head, ears, eyes, nose & throat:
moon face BUT no butterfly , discoid lupus,OR mouth ulcers.
no LN enlargement
BILATERAL BREAST MASSES WITH PEUDORANGE AND RETRACTED NIPPLE NO DISCHARGE
NORMAL HEART SOUNDS
no hepatosleenomegally or abd masses
CONCIOUS ORIENTED NO CRANIAL NERVE PALSY
normal power , sensation , coordination.
ecchymosis allover skin and piticheal RASH
WBC 4.1 hg 98 g/l MCV 80 COOMBS( -ve ) platelets less than 10.
NORMAL RENAL , LIVER FUNCTION.
NORMAL C3 , C4 . ESR = 21 CRP (-VE)
Anti DNA = (-VE) , ANA = (+VE) 1 IN 160
dense breast tissue in mammography. ct chest abdomen and pelvis normal apart of breast masses. no axillary LN.
tumour markers all normal.
malignant infiltration of bone marrow.
TRUCUT biopsy :only fibrasis.
breast execion biopsy : malignant infiltration
ER , PR ,Her2 all negative.
severe thrmbocytopenia with breast cancer, how to deliver chemotherapy and what to give?
diffcult case for management?
Plan of treatment:
weekly chemotherapy with Taxol / cisplatin
Results of treatment:
recovery of platelets count to 45 .
breast lumps softer.
but presentd to ER with epistaxis and wheeses.
more staines on pathology slides showed chromogranin positvity: suggest carcinoid tumour.
though thrombocytopenia is common in SLE due to consumption , but other causes is to be kept on mind and bone marrow biobsy is mandatory before commencingany ANY treatement modalities.
carcinoid syndrome appears after recovery of platelets as serotinin stored in platelets.
The following are comments made by other users of this site and are not in any way an opinion of thirdspace.org or its staff.