UNIVERSITY OF SANTO TOMAS (UST) FACULTY OF MEDICINE & SURGERY AND UST HOSPITAL

Medicine II GIRHO Big Group Discussions (BGD) in Hematology & Oncology

1ST MEETING: FRIDAY, APRIL 29, 2016

Section A: A1 Room 204 (Dr. Castillo), A2 Room 321 (Dr. Calma)
Section B: B1 Room 205 (Dr. Regala), B2 Room 405 (Dr. Julian)
PRESENTORS:
A1A: Abad-Abiera, A1B: Abilo-Agon, A1C: Aguas-Alemon, A1D: Alipio-Amorado;
A2A: Amoranto-Ang, Kevin A2B: Anselmo-Aquino, Marcelle, A2C: Aquino, Robert-Atal, A2D: AtanacioBaguisa
B1A: Cua-De Asis, B1B: De Castro-De Juras, B1C: Dela Vega-Delos Santos, B1D: De Mesa, Anna-Lerios
B2A: Dela Rosa, Gabriel-Diego, B2B: Dilig-Dimalanta, B2C: Dimatatac-Donato, B2D: Dugay-Eala

Case 1: A1A, A2A, B1A, B2A

J.K., a 35 year old housewife complains of progressive easy fatigability of about 3 months duration.
She also complains of dizziness, palpitations and lack of energy. ROS: no epigastric pain, hematochezia
nor melena, no easy bruising nor ecchymoses. Her menses have been characterized as 28 days cycle, 7
days duration, 3 days profuse flow, 5-6 fully soaked pads/day, no dysmenorrhea. LMP: two weeks before
consultation. P.E. Vital signs: BP: 110/70, PR: 100/min, regular; RR: 20/min, regular, Temp: 37.2 0C per
axilla, pale palpebral conjunctivae, no jaundice, no palpable lymph nodes, (+) soft blowing systolic murmur
in the left parasternal area, clear breath sounds, (-) hepatosplenomegaly, no pedal edema. CBC: Hb 60
g/L, Hct 0.21, RBC 3 x 1012/L, WBC 6 x 109/L, segmenters: 70%, lymphocytes: 25%, monocytes 2%,
eosinophils 3%, MCV 70 fl, MCH 20 pg, MCHC 28.5%, Platelets 450 x 109/L, Reticulocyte count: 1.5 x 10-3
Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis
Case 2: A1B, A2B, B1B, B2B
Mrs. MC is a 75 year old post-menopausal female who consulted because of progressive weakness
and loss of balance. She also complains of numbness and tingling sensation in all extremities. She has no
gastrointestinal complaints. She is hypertensive on Felodipine 5 mg per day, but not diabetic. She prefers
to eat vegetables and fish because of poor dentition. P.E. Vital signs: BP: 150/90, PR: 80/min, regular, RR:
21/min, regular, Temp: 35.50C. She is pale, has slightly icteric sclerae, and has a smooth, red tongue. She
has no lymph nodes, nor anterior neck mass. She has regular rate and rhythm, no murmurs. Lung
examination is normal. There are no abdominal masses palpated. She has some problems with gait but
has an otherwise normal neurologic examination. CBC: Hb 84 g/L, RBC 2.4 x 1012/L, Hct 0.26, WBC 9 x

109/L, segmenters 54%, lymphocytes 40%, monocytes 4%, eosinophils 2%, platelets 150 x 109/L, MCV 108
fl, MCH 35 pg, MCHC 36%
Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis

Case 3: A1C, A2C, B1C & B2C

Mrs. GS, a 50 year old female was referred for evaluation of anemia. She began to experience
easy fatigability about 5 weeks prior to consultation. Two months prior, she had cough and fever and was
diagnosed to have pneumonia. She was given antibiotics which included Cefuroxime 500mg BID. Her other
symptoms include passage of highly colored urine, weight loss of about 5 lbs in the last 2 months. P.E.
Vital signs: BP: 120/70, PR: 110/min, regular, RR: 23/min, regular, Temp: 37 0C. She had pale palpebral
conjunctivae, icteric sclerae, small cervical lymph nodes on both sides, no hepatomegaly and slight
splenomegaly. CBC: Hb 70 g/L, RBC 2.1 x 1012/L, Hct 0.21, WBC: 13 x 109/L, segmenters 80%, lymphocytes
20%, platelets 400 x 109/L, MCV 110 fl, MCH 34 pg, MCHC 33%, Reticulocyte count: 80 x 10-3/L. Peripheral
smear: spherocytes, anisocytosis and poikilocytosis.
Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis

Case 4: A1D, A2D, B1D, B2D

A 45/F came in for consult due to a 1 year history progressively enlarging mass on her left breast.
Patient consulted with a surgeon which advised biopsy of the mass but she did not comply and was lost
to follow-up until 1 month PTC when she noted ulcerations on her left breast with foul smelling discharge.
A biopsy done showed Invasive Ductal Carcinoma with immunohistochemical profile of ER+, PR+, Her2neu
+. Patient also complains of right upper quadrant pain, lower back and hip pain and >10kg weight loss
since 1 month PTC. On PE, patient is pale with left supraclavicular and axillary lymphadenopathies, (+) 10
x 12cm mass with ulceration over left breast, with hepatomegaly and right upper quadrant tenderness.
FH: (+) Colon cancer: uncle.

Discussion points:
1. What laboratory tests and ancillary procedures can be requested to adequately stage this
patient?
2. What treatment options can be offered for this patient?
3. What systemic treatment can be given for this patient with hormone positive and Her2 neu
positive breast cancer?

UNIVERSITY OF SANTO TOMAS (UST) FACULTY OF MEDICINE & SURGERY AND UST HOSPITAL
Medicine II GIRHO Big Group Discussions (BGD) in Hematology & Oncology

2nd MEETING: MONDAY, MAY 2, 2016

Section A: A1 Room 307 (Dr. Caguioa), A2 Room 219 (Dr. Calma)
Section B: B1 Room 205 (Dr. Regala), B2 Room 321 (Dr. Julian)
PRESENTORS:
A1A: Balbas-Bantigue, A1B: Battung-Baysic, A1C: Becina-Beza, A1D: Biso-Borbe;
A2A: Bringuelo-Butt, A2B: Cabling-Capalungan, A2C: Capati-Castillejos, A2D: Castro-Cavida
B1A: Elazegui-Enriquez, B1B: Espejo-Estrada, B1C: Falconi-Fernando, B1D: Ferrer-Fregil
B2A: Fuentebella-Galan, B2B: Gallardo-Garcia, Kenneth, B2C: Garcia, Maxine-Go, B2D: GochocoLagdameo

Case 1: A1A, A2A, B1A, & B2A

A 55 year old female was referred because her CBC showed Hgb of 20 g/dL, Hct 0.60, WBC
12,000/cu.mm, Neut 65%, Lymph 34%, Eos 1%, and Platelets of 500,000/cu.mm. She was admitted
because of right-sided extremity weakness, dizziness and headache and was diagnosed to have left
cerebral infarction. She has no prior history of hypertension or diabetes mellitus. She did not take
contraceptive pills. She is postmenopausal, G3P3. She has a family history of hypertension, no cancer.
ROS: occasional pruritus. Physical examination revealed facial plethora, LUQ mass 2 cm below the left
subcostal margin, and neurologic deficits as described earlier.
Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis
Case 2: A1B, A2B, B1B, B2B
Ms. RC, a 35 year old female, teacher from Nueva Ecija was referred because of gum bleeding and
petechiae on both lower extremities of 2 days duration. She had been having on and off myalgia
associated with joint pains and swelling of the hands, wrists, and knees for the past 3 months temporarily
relieved by Mefenamic Acid. LMP: 3 weeks prior to consult, 4 days duration, 2-3 pads per day. She is not
known hypertensive, diabetic or asthmatic. No significant diseases in the family. P.E. Vital signs: BP:
120/80, PR: 80/min, regular, RR: 20/min, regular, Temp: 37 0C. She has pink palpebral conjunctivae,
anicteric sclerae, no oral thrush, no lymphadenopathies, malar rash, no hepatosplenomegaly, petechiae
on both legs. CBC: Hb 125 g/L, Hct 0.37, WBC: 5 x 109/L, segmenters 80%, lymphocytes 20%, platelets 25
x 109/L.

Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis
Case 3: A1C, A2C, B1C & B2C
AT, a 20 year old male, came in due right knee pain and swelling which he noted 3 days prior while
he was cleaning the house, temporarily relieved by cold compress and Mefenamic Acid. No history of
trauma noted. Significant family history includes a hemophilic uncle. . P.E. Vital signs: BP: 120/80, PR:
106/min, regular, RR: 20/min, regular, Temp: 37.20C. He had pink palpebral conjunctivae, anicteric sclerae,
no lymphadenopathies, no hepatosplenomegaly. Labs: CBC: Hb 125 g/L, RBC 4.0 x 1012/L, Hct 0.38, WBC:
8.5 x 109/L, segmenters 64%, lymphocytes 30%, monocytes 3%, eosinophils 3%, platelets 165 x 109/L, MCV
95 fl, MCH 31 pg, MCHC 32%.
Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis
Case 4: A1D, A2D, B1D, B2D
A 40/F came in due to a progressively enlarging mass on her left neck which stated 8 months PTC.
She initially consulted with a general physician with assessment of TB adenitis for which she was given
anti Koch treatment for 6 months. Due to progression in size of neck mass despite treatment, patient was
referred to an ENT for which a biopsy done revealed an Undifferentiated Carcinoma. A nasal endoscopy
was done with note of a mass on the nasopharyngeal area. Biopsy of the nasopharyngeal mass also
showed the same result. Upon probing, patient also complained of having frequent tinnitus and decreased
hearing from her left ear since 3 months PTC. Physical examination was unremarkable except for a 5x4cm
mass on the left cervical area. She is a non-smoker but lives with husband who chain smokes. She is a nonalcoholic beverage drinker.
Discussion points:
1. What are the differential diagnosis for patients presenting with lymphadenopathies?
2. What laboratory tests and ancillary procedures can be requested to adequately stage this
patient?
3. What treatment options can be offered for this patient?

UNIVERSITY OF SANTO TOMAS (UST) FACULTY OF MEDICINE & SURGERY AND UST HOSPITAL
Medicine II GIRHO Big Group Discussions (BGD) in Hematology & Oncology

3rd MEETING: FRIDAY, MAY 6, 2016

Section A: A1 Room 321 (Dr. Castillo), A2 Room 405 (Dr. Calma)
Section B: B1 Room 205 (Dr. Regala), B2 Room 325 (Dr. Julian)
PRESENTORS:
A1A: Caylao-Chan, Lian, A1B: Chan, Nathaniel-Chianpian, A1C: Chiu-Chua, Joseph, A1D: Chua, NicoleCledera, Darlene;
A2A: Cledera, Thurl-Cobangco A2B: Cobankiat-Cortez, A2C: Coscos-Cruz, Ronald, A2D: Cruz, YiezzaLantin
B1A: Gonzales, Marvin-Grajo, B1B: Gregorio-Guiang, B1C: Guiao-Gutierrez, Heather, B1D: Gutierrez,
Karisse-Hermogenes
B2A: Hermogino-Hipolito, B2B: Hudencial-Inofanda, B2C: Jacinto-Jatico, B2D: Javier, Christopher-Jurilla

Case 1: A1A, A2A, B1A, & B2A

CR, a 46 year old Filipino female, complained of profuse menstrual flow for the past few months,
on and off fever, easy bruisability and shortness of breath on exertion for the past 3 weeks. She has no
headache, bone pain, nausea, vomiting, melena, hematochezia, dysuria, nor hematuria. She denies any
exposure to insecticides or other chemicals. Only diabetes runs in her family. Physical examination: BP:
100/70, PR 100/min, regular and full, RR of 24/min; pale, not jaundiced, no palpable cervical
lymphadenopathy. Cardiovascular and pulmonary examinations are normal, liver and spleen are not
palpable. Neurologic and musculoskeletal examinations are unremarkable. CBC showed: Hb 7.2 g/dL, Hct
0.21, WBC 245,000/cu.mm, neutrophils 25%, lymphocytes 15%, Blasts 55%, Mono 4%, Eos 1% and
Platelets of 65,0000/cu.mm.
Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis
Case 2: A1B, A2B, B1B, B2B
Mr. LM, a 45 year old male farmer, was referred due to abdominal enlargement and easy
fatigability. He noted early satiety and gradual abdominal enlargement for 3 months now. He has no
previous exposure to benzene or radiation. Only hypertension runs in the family. He is now known diabetic
or hypertensive. P.E. Vital signs: BP: 130/90, PR: 110/min, regular, RR: 22/min, regular, Temp: 37 0C. He
had pale palpebral conjunctivae, anicteric sclerae, no oral thrush, no lymphadenopathies, no
hepatomegaly, spleen palpable 12 cm below the left subcostal margin, no peripheral edema. CBC: Hb 65

g/L, Hct 0.20, WBC: 365 x 109/L, blasts 4%, promyelocytes 4%, myelocytes 12%, metamyelocytes 10%,
bands 8%, segmenters 32%, lymphocytes 19%, monocytes 4% eosinophils 3%, basophils 4%, platelets 680
x 109/L.
Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis

Case 3: A1C, A2C, B1C & B2C

CB, a 56 year old male, farmer, was referred for evaluation of anemia. Upon further history, he
has been having intermittent low back pain radiating to both lower extremities for 3 weeks now,
precipitated by movement and temporarily relieved by Diclofenac Sodium 50mg 2x/day. Lately, he
experiences easy fatigability and dyspnea on mild exertion. He is known hypertensive for 10 years now
maintaining on Losartan 50mg once a day, non-diabetic and non-asthmatic. P.E. Vital signs: BP: 160/90,
PR: 104/min, regular, RR: 22/min, regular, Temp: 370C. He had pale palpebral conjunctivae, anicteric
sclerae, no lymphadenopathies, no hepatosplenomegaly. Labs: CBC: Hb 75 g/L, RBC 2.5 x 1012/L, Hct 0.23,
WBC: 8.5 x 109/L, segmenters 70%, lymphocytes 25%, monocytes 2%, eosinophils 2%, basophils 1%,
platelets 155 x 109/L, MCV 92 fl, MCH 30 pg, MCHC 30%. Creatinine 3.5 g/dL. Ionized calcium 2.1 mmol/L
(1.12-1.32 mmol/L).
Discussion points:
1. What is your assessment? Give primary diagnosis and differentials.
2. Discuss your primary diagnosis in terms of:
a. Clinical manifestations/complications of the disease
b. Laboratory work-up
c. Management
d. Prognosis
Case 4: A1D, A2D, B1D, B2D
A 19y/o male came in due to chief complaint of testicular enlargement. Patient initially consulted
with a surgeon 2 months PTC for which a left orchiectomy was done. Histopathologic report revealed a
germ cell neoplasm consistent with yolk sac tumor. A CT scan of Chest and Whole abdomen revealed
retroperitoneal lymphadenopathies and multiple bilateral pulmonary nodules 1-2cm in sizes. Patient was
then referred to a medical oncologist.

Discussion points:
1. What are the different types of Germ Cell Tumor?
2. How do you differentiate Seminomatous from Nonseminomatous Germ Cell Tumor?

3. What laboratory tests can help differentiate between two types of germ cell tumors and help in
prognosticating this patient?
4. What treatment option can be offered for this patient?