樵客
講述親身經曆，感悟天地人生
3/22/2018
在平靜了一年半後，癌細胞又開始活躍了。
一個月前PET顯示左肺內原發灶suv上升，右跨關節前下方軟組織條柱狀增生，高攝入值，提示可能新轉移灶。
二周前CEA11.2，A醫生將我的病情在每周腫瘤會診時與相關同行討論。認為可能複發，有新轉移灶；也可能有腸道癌變。
安排了一糸列會診尋求解決方案。在本周一，見了腫瘤外科醫生。周二見了放療醫生。
並約了一糸列檢查。今天（3/22/2019，周四）上午十點做右跨關節周軟組織活檢，下午二點胸腔穿刺。下周做腸鏡。
7:50AM 離家。
8:10AM 到辦公室，啟動數據更新程序，發送前日臨床檢查異常數據報告給各臨床醫生。
8:30AM 趕到外科手術候診大廳，簽到，糸上腕標，簽了需知和Consent。等號
9:05AM 還在等叫號。經曆過二年半的診治休養，我們也有充分的心理準備，能夠坦然麵對。大廳裏的其他病人家屬親友也少有焦慮不安的。
10:00AM 被帶手術室外，等。
10:05AM 進入準備室。換上被手術的袍子，紮了靜脈針，與助理醫生討論了將要做什麽及細節，簽了手術協議書，在移動床上躺著，等待。
將要進行：鎮靜劑加局部麻醉，CT指導下針穿取樣。
自昨晚上七點後，食水未進，快要餓暈了。
10:30AM 仍在等待, 也許是最無奈的選擇。
11:00AM 等，剛才已小睡一會
11:10AM 護士敲門通知：前麵那個延遲，請等待……
在看網絡小說“相聲大師”，順便學學練練，爭取來年春節再當回網上段子手
11:30AM 終於進了手術室，打了鎮靜劑，加了鼻管。在反複掃描定位後，局麻，穿針，再次定位。終於穿到地方。最後再掃描確認，接下來，取了三小塊樣品。
12:15PM 回到觀察室，繼續監控血壓心率血氧飽和度。
1:15PM 觀察1小時後，給了注意事項和聯係電話。換衣。叫來社工用輪椅送到做胸穿的科室
1:25PM 鑒到，被告之不能進食，繼續饑餓中，等待。
1:45PM被帶入診室，再次測血壓量體溫，還有：等待。
2:10 換手術裝，再次簽免責。
2:15 超聲探查，醫生驚呼：好多水啊。局麻，進針，沒有液體流出，再進，仍無液體，換個方向再進，仍抽不出來，醫生放棄了
2:45PM 離開處置室，回家。以後再和A醫生商量換個胸外科醫生。
3:20到家，先嚼兩片全麥麵包，微波爐熱粥，餓得不行了
3:40PM 要休息睡一會。
今天碰到兩個醫生，跨骨穿刺的那位真正有水平。新發病灶在關節周圍，位置深，附近布滿動靜神經，肌腱。術前討論時，反複查看所有CT、PET和X-ray, 尋找最佳進針角度深度。術中反複用CT定位五次，確認無誤，取樣。術後兩小時，與平時感覺無異。
另一位，實在不敢恭維，連個胸水都抽不出來，也配幹胸外。再次想念當初的B醫生，業務熟練，為人謙和。給我抽了三次胸水，一次氣管鏡檢和一次胸腔鏡檢。第一次抽時還沒開始其它檢查，我倆私聊，他根據胸水，篤定“非小細胞肺癌”。可惜不在這工作了。
附：病理報告
Case Report
| Clinical Information | |||
| 61 year old male with history of stage-4 adenocarcinoma of the lung, presents with soft tissue mass of right hip. | |||
| FINAL DIAGNOSIS | |||
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A. Soft tissue, right hip, IR guided biopsy:
- Low grade fibroblastic proliferation; see comment.
- Negative for carcinoma.
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| Amendment electronically signed by Matthew R. Lindberg, MD on 4/11/2018 at 1:12 PM Electronically signed by Matthew R. Lindberg, MD on 3/27/2018 at 1:48 PM |
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| Comment | |||
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By immuonhistochemistry, the lesional cells are focally positive for SMA, and negative for desmin, S100 protein, pankeratin, and nuclear beta-catenin. Overt histologic features of malignancy are not identified. Mitotic activity is sparse, and there is no necrosis. The differential diagnosis includes predominantly fibromatosis, fasciitis, and low grade myofibroblastic sarcoma.
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| Gross Description | |||
| Specimen A is received in formalin, labeled with the patient's name, Gonghe Dai, medical record number, 001051883, and RIGHT HIP BX. The specimen consists of four cores of tan tissue measuring 2.5, 2.4, 0.6 and 0.2 cm in aggregate. Specimen A is submitted entirely in a biopsy bag inside a yellow biopsy cassette A1. Brandeon A. Harris 03/22/2018 |
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| Microscopic Description | |||
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Performed if applicable.
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| Attestation | |||
| Matthew R. Lindberg, MD Electronically Signed on 3/27/2018, 1:48 PM I have reviewed the pertinent gross findings, any and all microscopic slides and the Resident's/ Fellow's interpretations. I have made appropriate editorial changes and have rendered the final diagnosis. |
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| SPECIAL AND ADDITIONAL PROCEDURES | |||
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Analytic Specific Reagents were developed with performance characteristics determined by UAMS Immunohistochemistry Lab. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. When used, this test is used for clinical purposes. It should not be regarded as investigational or for research. Controls are routinely performed on all Analytic Specific Reagents and are verified for acceptability. This Laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as qualified to perform high complexity clinical laboratory testing.
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