Just so everyone is on the same page I will include the IMPRESSION section of Debs History and Physical from Dr. Bala.
IMPRESSION
This is a 40-year-old female with a history of extraskeletal myxoid chondrosarcoma of the left thigh, status post resection November 2007, followed by radiation treatment because of close deep surgical margin by about 2mm. The patient is currently admitted with severe pain throughout her body. MRI of the lumbar spine found recently was abnormal. MRI April 10, 2008 showed findings suggestive of bony metastasis, numerous punched out lesions along the vertebrae, MRI of the left lower extremity March 26, 2008 also showed several round abnormal areas along both femoral shafts suspicious for metastatic disease. Her lactic acid dehydrogenase is more than 2500. Platelets are quite low.
Possible differential diagnoses:
Metastatic sarcoma versus primary hematological malignancy, i.e. leukemia or myeloma. Serum protein and electrophoresis have been ordered. Will include a quantitative immunoglobulin.
Well, it ain't good news, but it at least sheds light on to why she has pain. The CT scan did show "spots" on the lungs and liver, but they were too small to do any biopsy on. Tomorrow we will meet with the Dr. again and find out more from all this poking and scanning.
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