Maria Curie Emergency Clinical Hospital for Children

Hospital oncology
Examination date: 14.11.14 09:22
Presentation code 1446040
EXAMINATION SHEET
SOARE VLAD MIHAI
M 17 years
Date of birth: 14.06.1997
Paper
Personal number: 1970614420040
Mother first name--- Father first name--- Address--- Environment: Urban
Telephone--- District: Ilfov Place: Voluntari Country: Romania
Occupation: pupil/student Place of work--Family doctor: Tone Cosmina Telephone --- Seal code: C55612
Insurance house: CJAS Ilfov County: Ilfov Insurance card --- Discount --Certificate/coupon--- Medical remarks
Coming from: SECTION
Sending diagnosis:
Examination result
Right operated scapula Ewing post sarcoma status
Remaining right scapula of reduced dimensions, dysmorphic, osteocondensing, with
irregular contour, with metallic material present post surgery; without expansive
formations or pathological contrast medium uptakes detectable at this level.
IV right posterior costal arch with irregular contour (post surgery changes)
Epiphysis and right humeral proximal metaphysis with non-homogenous structure, with
alternation of osteocondensing and osteolithic areas, with no contrast medium uptake
(apparently degenerative changes, requires monitoring)
Nodular image of 51/30 mm, non-homogenous, iodophil, with starting point at the level
of right latero-thoracic pleura, with development towards pulmonary parenchyma.
Nodular image of 31/22 mm, located in the medium lobe, having contact with right
mediastinal pleura. Nodule of 12 mm in diameter, located in the right upper lobe,
associating fibrotic bands. Other a few peripheral pleural/pulmonary nodular images,
visible at the level of both pulmonary fields, with infracentimetric sizes.
Left pulmonary hilary adenopathy of 11 mm
Without mediastinal adenopathies.
Without pleura pericardic liquid effusion
At the level of hepatic segment II, subcapsular anterior, a nodular image of 18/12 mm is
highlighted, early hypercaptating and late iso-hypocaptating, suggestive for metastasis.
Conclusions:
Pleural and pulmonary metastases bilaterally. Hepatic metastasis.
Without CT semen of tumoral recurrence at the level of right shoulder.
Doctor: Dr. STOICA DANIELA MIHAELA

PROF DR. ALEXANDRU TRESTIOREANU ONCOLOGIC INSTITUTE FROM

BUCHAREST
Sos. Fundeni no. 252, district 2, Bucharest, RO-022338
Telephone: (+40)021/227.10.00, Fax (+40)021/318.32.62
www.iob.ro
Onco-paediatric section
Section head: Conf.dr. Monica Dragomir
Section head: Conf.dr. Monica Dragomir
Doctor in medical sciences Oncology
Primary doctor medical oncology
Specialist doctor paediatrician
Onco- paediatric competence
Certificate of supplementary studies in health
service management
Tel (+40)021/318.12.04
Monica.dragomir@iob.ro
Dr. Eugen Victor Gruber
Primary doctor paediatrician
Specialist doctor medical oncology
Competence on onco- paediatrics
Tel (+40) 021/2271500
Eugen.gruber@iob.ro
Dr. Codruta Ulpia Comsa
Primary doctor paediatrician
Intern medical oncology
Competence on general echography
Competence on paediatric oncology
Telephone (+40)021/2271519
Codruta.comsa@iob.ro
Dr. Monica Badoi
Primary doctor paediatrician
Specialist doctor medical oncology
Competence on paediatric oncology
Telephone (+40)021/2271519
Monika.badoi@iob.ro
Secretariat
Tel (+40)021/2271551
Fax (+40)021/2271452
Secretariat.oncopediatrie@iob.ro
Doctor on duty
Tel (+40)021/2271514
Treatment room:
Tel (+40)021/2271013
Office/Play room:
(+40)021/2271518
Tel

HOSPITAL DISCHARGE NOTE/

LETTER TO THE FAMILY DOCTOR
Name: SOARE VLAD MIHAIL
Personal number: 1970614420040
Date of birth: 14.06.1997
Domicile: Str. Busuiocului no.3, Voluntari,
Ilfov
FO: 12473/2014
Diagnosis code:
Diagnosis:
1. Ewing Sarcoma right scapula operated,
chemo treated. Local recurrence and
pulmonary metastases operated, chemo
treated
2. Toxic drug tubulopathy

Background of the disease:

The debut of the disease in February 2010 by the occurrence of a tumoral formation at the
level of right scapula. He comes for evaluation at M.S.Curie Hospital - Oncopaediatrics. The biopsy of the tumoral formation is performed within orthopaedics section
of the same hospital, histopathology and immune-histochemic tests are performed
suggestive for Ewing /PNET sarcoma.balance of extension of the disease negative (bone
scintigraphy, ...). From February 2010 chemotherapy is initiated according to EuroEwing
99 protocol 6 VIDE cures and one VAI cure pre-surgery in the period February-July
2010. On 03.08.2010 a surgical intervention was performed resection biopsy right
scapula excepting the glena. Post surgery, 7 VAI cures are performed (the end of
chemotherapy in December 2010).
Subsequently, periodic clinical-biological and imagistic evaluations are carried out
without signs of recurrence. It should be mentioned that during the evaluation from
December 2012 changes of the urine examinations (proteinuria, hematuria, glycosuria)
are noticed for which diet changes and treatment with Uralyt are instituted. In evolution,
he shows insignificant persistent proteinuria.
On the evaluation from June 2013 2 tumoral formations at the level of right axilla with
sizes of 4.3/7.6 cm and 2/1.4 cm local recurrence are detected during the echography.
The thorax CT exam highlights bilateral pulmonary metastases. A surgical intervention is
performed with the excision of tumoral formations at the level of right axilla (prof.dr.
Burnei, M.S. Curie Hospital, Orthopaedics). Subsequently, chemotherapy with Topotecan
/Cyclophosphamide (2 cures) is instituted in the period October- November 2013. In
January 2014 the surgical excision of right pulmonary metastases is performed (M.
Nasta Pneumophtysiology Institute, dr. Cordos), as well as a histopathologic exam (M.
Nasta Isntitute, dr. Magheran): pulmonary metastases of Ewing sarcoma. In March- April
2014 another 2 cures of chemotherapy with Cyclophosphamide/Topotecan are carried
out. The imagistic evaluations from March and June 2014 no longer highlight pulmonary
metastases, but on the evaluation from November 2014 (M.S. Curie Hospital, dr. Stoica)
he shows: Epiphysis and right humeral proximal metaphysis with non-homogenous
structure, with alternation of osteocondensing and osteolithic areas, with no contrast
medium uptake (apparently degenerative changes, requires monitoring). Nodular
image of 51/30 mm, non-homogenous, iodophil, with starting point at the level of
right latero-thoracic pleura, with development towards pulmonary parenchyma;
nodular image of 31/22 mm, located in the medium lobe, having contact with right
mediastinal pleura, nodule of 12 mm at LSD level; other a few peripheral
pleural/pulmonary nodular images, visible at the level of both pulmonary fields, left
pulmonary hilary adenopathy of 11 mm; at the level of hepatic segment II,
subcapsular anterior, a nodular image of 18/12 mm is highlighted, early
hypercaptating and late iso-hypocaptating, suggestive for metastasis.
On 05.12.2013 he comes for oncologic check-up second.
Clinical exam on admission: G=H=SC= good general condition, no fever. Pale
teguments, hydration, no eruptions, post surgery postero lateral right thorax scar. Cardio
pulmonary balanced. Supple abdomen, mobile with respiration, non painful
spontaneously or on palpation, without hepatosplenomegaly. Physiological dieresis. No
cervical stiffness.

Laboratory investigations:
Hemoleucogram
Tests 2

Results

Reference interval UM

WBC
RBC
HGB
HCT
MCV
MCH
MCHC
RDW
HDW
PLT
MPV
NEUT#
LYMPH#
MONO#
EOS#
BASO#
LUC#
NEUT%
LYMPH%
MONO%
EOS%
BASO%
LUC%
CH

3.48
4.83
13.9
43.3
89.5
28.7
32.1
13.4
2.60
218
9.4
2.12
0.88
0.24
0.18
0.03
0.10
60.9
25.2
7.0
3.1
0.9
2.8
29.7

4.0-10.0 10 /UL
4.2-6.1 10 6/UL
12-18 g/dl
37-52 %
80-98 fl
27-31 pg
33-37 g/dl
11.5-14.5 %
2.2-3.2 g/dl
150-400 10/ul
7.2-11.1 g/dl
2.5-7.7 10/ul
1.3-2.5 10/ul
0.3-2.5 10/ul
0.1-1.5 %
0.25-1.0 10/ul
0-0.4 10/ul
40-74%
19-48 %
3.4-9.0%
0-7%
0-1.5%
0-4%

BIOCHEMISTRY (DIMENSION RXL MAX) validated by: Anca Mirela Dr. Sasareanu,
on 05/12/2014 13:25
Tests 2

Results

Reference interval UM

Uric acid
LDH

1.3
212

2.6-7.2 mg/dl
81-234U/L

BIOCHEMISTRY (KONELAB 60) validated by: Anca Mirela Dr. Sasareanu, on

05/12/2014 13:25
Albumin
Direct bilirubin
Indirect bilirubin
Total bilirubin
Calcium
Ionic calcium
Chlorine (Cl)
Creatinine
CRP
Iron
Alkaline phosphatase
GGT
Glucose
Potassium (K)
Total proteins
Sodium (Na)
TGO
TGP
Urea

4.5
0.17
0.26
0.43
9.2
4.19
114
1.0
8
78
364
18
84
4.9
6.7
143
18
11
28

3.5-5.2 g/dl
0.0-0.30 mg/dl
0.00-0.70 mg/dl
0-1.2 mg/dl
8.2-10.7 mg/dl
4.20-5.20 mg/dl
98-107 mmoli/l
0.6-1.5 mg/dl
0-10 mg/L
50-175 ug/dl
40-136 U/L
0-55 U/L
70-120 mg/dl
3.5-5.2 mmoli/l
6.2-8.5 g/dl
135-150 mmoli/l
0-40 U/L
0-45 U/L
12-45 mg/dl

Urini (Urini Manual) validated by: Anca Mirela Dr. Sasareanu, on 05/12/2014 12:34
Urine summary

Uro-norm (0.1 mg/dl), GLU=++

(500 mg/dl), BIL-neg, KET=+
(15mg/dl), D=1.025, H=neg, pH-6.5
PRO=++(100 mg/dl), NT-neg, LEU-neg

Radiotherapy check-up (Dr. Mitulescu):

It is recommended to perform a cardiac ecography Mrs. Dr. Gheorghiu, 10.12.2014,
time 11.00, 10.12.2014
Dr. Codruta Comsa
Illegible signature and stamp
Dr. Comsa Codruta
Primary doctor Paediatrics
Specialist doctor medical oncology
Competence on paediatric oncology
Palliative care competence
Code: 932583
Section head doctor
Conf.dr. Monica Dragomir
Illegible signature and stamp