Linfoma maligno pulmonar tratado com Nerium oleander. CASE REPORT

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1 Linfoma maligno pulmonar tratado com Nerium oleander CASE REPORT Diagnosis: Malignant lymphoma, lung cancer A 60-year-old woman experienced pain in her left chest, cough, and general weakness in She presented to a physician who prescribed some specific and non-specific anti-rheumatic treatments. A chest x-ray taken on October 9, 1992 showed a shadow covering the lower two-thirds of the left lung ( Appendix MG1 ). She was admitted on 17 October 1992 to Aydin State Hospital. On physical examination, there was dullness, and the breathing sound was noted to be low over the left lung. The patient had fever. Laboratory findings showed an inflammatory syndrome, with white blood cell count of 27x10 3 /µl, erythrocyte count of 3.21x10 6 /µl, hemoglobin content of 10 g/dl. Some of the differential count percentages were as follows: Segmented neutrophils: 85 %; Lymphocytes: 13 %; Eosinophils: 2%. 2,000cc of serofibrous fluid was removed by punctum, and the patient was treated with antibiotics. Pleural biopsy and histopathological examination of the specimen were performed, and the patient was diagnosed with malignant lymphoma ( Appendix MG2 ). The computed tomography (CT) scan, performed on 27 October 1992, demonstrated a tumoral mass of 30.7mm x 23.4mm in the left lung ( Appendix MG3 ). The patient was advised to refer to Tepecik Chest Diseases Hospital (TCDH) in Izmir for further examination. The patient's husband, who was diagnosed with lung cancer three years ago and who was treated by Dr. Ozel, took his wife on 2 November 1992 to Dr. Ozel. Her general condition was very poor. She could only walk with the help of others. Auscultation revealed that basal two-thirds of the left lung did not participate in breathing, and that dullness was present. Dr. Ozel recommended the family to take the patient to TCDH; however, the patient and her husband insisted in trying N.O. treatment. A test dose of 0.3cc of N.O.I. caused the patient's body temperature to rise to 38.2 o C. She was placed on a regimen of 0.3cc dose of N.O.I. to be given daily, six days per week. It was advised to adjust the dosage according to maximum fever. The patient's medical condition ameliorated gradually. X-ray taken on November 30, 1992 demonstrated remarkable regression of the tumor ( Appendix MG4 ). The patient presented to Dr. Ozel on 18 January 1993 with an x-ray taken on the same date ( Appendix MG5 ). There was no tumoral mass demonstrated, and the patient was living normal daily life with no complaints. There was no more increase in fever after N.O.I. injections, and the patient was placed on a maintenance regimen with 0.3cc dose of N.O.I. to be administered once every two days. The patient came to Dr. Ozel for a follow-up on 20 May She had no complaints, and there was no change in the body temperature after N.O.I. injections. The patient was recommended to end the maintenance treatment. A follow-up x-ray taken on 11 July 1994 revealed no pathological finding ( Appendix MG6 ). Another follow-up radiograph was taken on 14 May 1998; it revealed clear lungs, no infiltrates, effusions, or mass lesions ( Appendix MG7 ). The patient was in remission. She was last contacted in 2002, and she was in remission. CASE REPORTS Diagnosis: Malignant lymphoma, lung cancer APPENDIX MG1 Chest radiograph taken on 9 October 1992 demonstrates shadow covering the lower two-thirds of the left lung.

2 CASE REPORTS Diagnosis: Malignant lymphoma, lung cancer APPENDIX MG2 Medical report issued on October 27, 1992: Malignant lymphoma + lung cancer. Click here for the first page of the original report... Click here for the second page of the original report R.T. (Republic of Turkey) Ministry of Health Aydin State Hospital Patient Acceptance Number: SUMMARY AT THE DISCHARGE Patient's First Name, Name: M. G. Admittance day: 17 October 1992 Clinic where the patient was bedded: Chest Clinic Discharge date: 27 October 1992 Age : Complaints : Pain on left side, weakness have been continuing for the last 15 days. The patient visited a physician for this reason, and she was given specific and non-specific antirheumatic therapies. She was admitted to our hospital when the pain and her fever increased. Clinical Findings (in short): Dullness, presence of weak breathing sound on the left side. Pleuritis findings are present. Roentgenogram Findings: Appearance of liquid on the left side. Laboratory Findings: Hb 10g Leukocyte: 27,000 Erythrocyte: 3,210,000 Leukocyte differentiated: Segment 85% Lymphocyte 13% Eosinophil 2%

3 Physical condition and Findings at the discharge time: Puncture + biopsy were performed. Puncture ( 2,000 cc serofibrinous fluid was removed ). Riwalta (-) Blood sugar: 81 The result of pleural biopsy was reported to be malignant lymphoma. Antibiotics (Pilpesozan 2 gr/day for 4 days) were administered because the patient had fever. Since computer aided lung tomography revealed mass, the patient is discharged having in mind the surgery. Final Diagnosis: 1/ Malignant lymphoma 2/ Lung cancer Recommendations : The patient's tumoral mass is local. There is no LAP, and no bronchial obstruction. It is recommended that the patient is referred to Tepecik Chest Diseases Hospital for further examination and surgery. Doctor's Name, First Name: (as personal seal) Specialist Dr. Memduh CINALIOGLU Chest Diseases Specialist Diploma #: 78 AA 016 Registration # (end of personal seal) SIGNATURE Signature P.S. This document will be issued in duplicate, one copy will be given to the patient, the other one will be kept in her file. CASE REPORTS Diagnosis: Malignant lymphoma, lung cancer APPENDIX MG3 CAT scan and report on October 27, 1992: Tumoral mass of 30.7mm x 23.4mm in the left lung. ( click here for the original report ) BILSAT A.S. AYDIN SAGLIK TURIZM BILGISAYAR SAN. TIC. A.S. Hasanefendi Mahallesi, 17 sokak no. 45 AYDIN (Yeni Kizilay Binasi Devlet Hastanesi yani) Tel: Patient: M.G. Age: 60 Date: October 27, 1992 Dear Colleague Dr. Memduh Cinalioglu Thorax CAT scan of the patient was performed with contrast. Parenchyma tissue, aerations, and vascularization are shown to be natural in the right lung from the apex till the base, and in the left lung in the upper lobe. A lobular mass, taking lobular contrast, having no air bronchogram, having no definite invasion to the surroundings, and having a size of 30.7 x 23.4mm is revealed in the posterior segment of the bottom lobe of the left lung. No bronchi obstruction is observed. Bronchopneumonia condensations are observed in the posterior segments of the bottom lobes of both lungs, but more emphasized in the left one. No bronchiectasis is dedected. The contours of the right diaphragm are regular, and the sinuses are patent. Pleural effusion is present on the left side. From the mediastinum window; trachea, ascending aorta, arcus aorta, descending aorta are observed to be regular as wall and calibration wise. There is a LAM in the left hilus. Soft tissue and bone formation around the thorax wall are normal.

4 CONCLUSION: Tumoral mass, which does not make bronchi obstruction in the posterior segment of the bottum lobe of the left lung, and LAM in the left hilus. Respectfully Dr. Gulsen Yavuzbas/signature - -

5 CASE REPORTS Diagnosis: Malignant lymphoma, lung cancer APPENDIX MG4 X-ray taken on November 30, 1992: Shadow covering only up to 2cm from the base of the left lung. CASE REPORTS Diagnosis: Malignant lymphoma, lung cancer

6 APPENDIX MG5 Roentgenograph taken on January 18, 1993, and the evaluation report : No tumoral mass.( click here for the original report ) DOCTOR Date: January 18,1993 NAMIK TAVUS ROENTGEN SPECIALIST Ultrasonography and roentgen diagnosis LABORATORY Dear Colleague, The roentgenogram of your patient Mrs. M.G. demonstrated that: The transverse diameter of the heart is within normal limits. No active parenchymal lesion is observed at the lung sites. Pleural thickening calls attention on the left side. Both hilar sites and mediastinum are regular. Yours Sincerely, Signature (Address) Cumhuriyet Caddesi No: 5/A Phone: AYDIN CASE REPORTS Diagnosis: Malignant lymphoma, lung cancer APPENDIX MG6 Follow-up x-ray taken on July 11, 1994: No tumoral mass.

7 CASE REPORTS Diagnosis: Malignant lymphoma, lung cancer APPENDIX MG7 Follow-up x-ray taken on May 14, 1998: No tumoral mass.

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