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What Do My Lab Test Reports Indicate?

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Posted on Mon, 16 May 2016
Question: Hi Doctor,

Please find the attached report. Can you answer the following couple of questions?
1. Does this look like malignant brain tumor?
2. What should be the next plan of action

CAT scan of abdomen and pelvis (with iv contrast) came clear
doctor
Answered by Dr. Krishna Kiran Kannepalli (10 hours later)
Brief Answer:
Admit him. Arrange for a biopsy ASAP

Detailed Answer:
Hello,
Thank you for the query. This is what I would suggest.

I do not know the clinical picture of the patient right now. If he has vomiting and headache, I would have him admitted and initiate measures to decompress the raised intracranial pressure.
I would involve a multidisciplinary team consisting of a neurosurgeon, pathologist and an oncologist.
I would desist from starting him on steroids as lymphoma is a strong possibility here and giving steroids will mask the final diagnosis as the tumor would melt with even a single dose of steroid if it were to be a lymphoma.
I would start him on Mannitol. Arrange for a stereotactic biopsy of the lesion ASAP and have a pathologist read the slide on site. I would then start him on steroids and wait for the final histopath before deciding on the final course of action. I would desist from doing a lumbar puncture at this stage as it could lead to coning in the setting of raised intracranial pressure.
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Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
Dr.
Dr. Krishna Kiran Kannepalli

Oncologist, Surgical

Practicing since :2004

Answered : 59 Questions

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What Do My Lab Test Reports Indicate?

Brief Answer: Admit him. Arrange for a biopsy ASAP Detailed Answer: Hello, Thank you for the query. This is what I would suggest. I do not know the clinical picture of the patient right now. If he has vomiting and headache, I would have him admitted and initiate measures to decompress the raised intracranial pressure. I would involve a multidisciplinary team consisting of a neurosurgeon, pathologist and an oncologist. I would desist from starting him on steroids as lymphoma is a strong possibility here and giving steroids will mask the final diagnosis as the tumor would melt with even a single dose of steroid if it were to be a lymphoma. I would start him on Mannitol. Arrange for a stereotactic biopsy of the lesion ASAP and have a pathologist read the slide on site. I would then start him on steroids and wait for the final histopath before deciding on the final course of action. I would desist from doing a lumbar puncture at this stage as it could lead to coning in the setting of raised intracranial pressure.