C10014771 / invoice 10000

Post MCT R/O, Day 11 Suture Removal:

History:
Going well. EDDU is all normal. 

Exam:
Surgery site looking ok. One end is a bit more scabby but healing. Sutures are removed with JC.
Advised to be gentle still for another 2-3 days. 

Plan: 
Revisit with TAC regarding Cushing's

Across the smears examined, cytological findings revealed moderate to marked red blood cell contamination accompanied by a mildly to
moderately increased population of hepatocytes (which generally displayed a uniform appearance) arranged in variably sized cell clusters/clumps. Some binucleate hepatocytes were seen within some of the hepatocyte cell clusters. Some of the hepatocytes also displayed mild hydropic degeneration within their cytoplasm. A mildly increased population of non-degenerate neutrophils and small lymphocytes was also seen scattered throughout the background (particularly in one of the 2 smears examined). No obvious micro-organisms were seen.

DIAGNOSIS
1) mild vacuolar (non-lipid) hepatopathy- hyperA 
2) suspect nodular regenerative hyperplasia or benign hepatic neoplasm- benign change or hyperplasia
3) possible mild mixed inflammation- unsure 

COMMENT
I could not see any obvious cytological evidence of an infective aetiopathogenesis present in the smears examined. Neither could I see
any obvious cytological evidence of malignancy in the smears examined.

The possibility of nodular regenerative hyperplasia could not be excluded here but was difficult to cytologically differentiate from a benign hepatic neoplasm (e.g. hepatic adenoma). 

The cause of the possible mild mixed cell inflammation (particularly if there is no obvious evidence of a peripheral leucocytosis) could not be definitively elucidated from the smears examined. 

Possible causes of hepatocellular cytoplasmic vacuolation/hydropic degeneration include metabolic/endocrine conditions as well as various types of hepatocellular injury associated with toxic insults and hypoxia.

Recommend biopsy and histopathological examination for further investigation and definitive diagnosis.

summary
- no evidence of MCT spread
- some hyperA changes
- some unexplained local inflam change  

rec biopsy in future if ongoing concern
can begin hyperA tx and have FU US in 3-6 months or if unwell


***

TAC called Amanda- no msg left 4.10pm but left text of number 510

Hi Amanda
I hope little Piper is doing well after her surgery. 

I already have the liver fine needle aspirate results for you. We see no evidence of cancer spread from the mast cell tumor and some changes which are associated with her hyperadrenal disease. There are some other cells which we aren't sure of the significance of - possibly a benign or regenerative issue and possibly some inflammation. I think we should recheck the liver with another ultrasound 3-6 months after we start with the Trilostane to treat her hyperadrenal disease. We can also so this sooner if she becomes unwell 

I have attached the histology here for you records.

Have a lovely night and please call on Monday to chat if you have questions- I wasn't able to get through to you today.
Cheers, Dr Tasha 

Staff member making call : AH 
Which family member spoken with: Amanda didn't answer left VM and sent SMS 

Recall reason: GA and lump removal 

Patient Report:
Demeanour - 
eating - 
drinking - 
urine - 
faeces - 

any problems with medicating? codeine 30mg half tab BID 
wound/s healing OK ? 
appointment made for revisit ?