A 60yr ols male presented withnpain abdomen . h/o weight loss , night sweats and loss of appetite. Patient was investigated, reports attached. Pls discuss how to proceed ????


rule out tuberculosis

Gastric Lymphoma is one possible DD to Adenocarcinoma in this Scenario.. Is there any h/o fever? I would suggest Repeat Endoscopy guided biopsy and/or U/S guided or CT guided biopsy from the largest node at Perigastric location for HPE and Immunohistochemistry including markers for Lymphoma - LCA/CD45, CD20, Cytokeratin, Her2Neu

In case of Gastric adenocarcinoma following 4 to cycles of EOX repeat PET CT for Response and if feasible proceed for Total Gastrectomy and D2 lymph node dissection followed by adjuvant Chemotherapy completion upto 8 cycles +/- Radiation therapy.

Inj.Trastuzumab may be added to EOX regimen if IHC for HER 2 neu is positive. In case of final dx of NHL after HPE and IHC CHOP +/- Inj. Rituximab for 6 to 8 cycles with PET-CT for Response after 3 to 4 cycles and at the end would be ideal

Tubercular infection or Carcinoma

it seems to be carcinoma stomach. must do endoscopy & CECT.

this is a case of carcinoma stomoch.. first stage it properly.. PET tends to overstage.. go for endoscopic ultrasound and CECT abdomen.. also do pleural tapping and send for cytology, chest xray and CT thorax.. FNAC from thyroid nodule.. if no evidence of metastatic disease is found and the lesion is found resectable then go for diagnostic laparoscopy and then proceed for surgery.. if disease is found metastatic or unresectable then send the pt for chemotherapy

most probably Koch 's abdomen

Koch's &malignancy to be ruled out.routine investigation , CAT abdomen with contrast if possible. Thanks.

Heamogram ESR LFT, KFT & CXR PA View. Endoscopy . Blood sugar F & PP electrolyte balance . CT scan abdomen . TFT . Conservative Management

Seems ca stomach with lung mets,UGIE to confirm histology.Then to decide for chemo regime
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