Doctor's Life Simulator

Chapter 76 Synovial chondrosis or synovial sarcoma, or others?
Soon everyone came to the meeting room of the hand surgery department. Li Lian'an quickly prepared the materials and made tea.

"Directors, let me briefly introduce the patient's situation to you first, and then come over to discuss with you after Director Tian has calmed down the patient."

Li Lian'an is still very sensible and understands the rules. He has no qualifications to give opinions for this level of consultation.

He handed the printed materials to all the bosses respectfully. When he walked past Qin Lang, he frowned slightly. However, he still gave Qin Lang a copy of the materials. The displeasure in his heart It is very well hidden: "Put garlic in the pig's nose, pretending to be an elephant!"

After all, to be able to become Tian Bo's son-in-law, his city is still very deep.

After arranging everything in an orderly manner, it is time to introduce the patient's situation:

"Experts, the situation of this patient is as follows. The patient, male, is 41 years old. He was admitted to the hospital three days ago because of the discovery of a tumor in his left wrist for one year and numbness in his left hand fingers for three months. One year ago, the patient had no obvious incentive to appear on his left wrist. The mass in the lower part is soft, no tenderness, and the movement is limited, and the mass gradually increases later, so it should not be taken seriously."

At the same time as the introduction, Li Lian'an showed the photos of the patient's wrist at the same time, in a clear and orderly manner, and obviously cooperated with Director Tian Bo in various reports and consultations.

"Three months ago, the patient experienced numbness of the first, second, and third fingers of the left hand, and limited movement. Afterwards, the symptoms gradually aggravated, and numbness of five fingers of the left hand occurred, with limited movement. The patient had a history of gout for 1 years and had not taken uric acid-lowering drugs. No special symptoms Family history."

After hearing Li Lian'an's introduction, several directors in the conference room also had some guesses in their minds, and then signaled to continue.

Li Lian'an nodded, and continued to expand in detail in line with the reading speed of the experts:

"Special examination showed that there was a subcutaneous mass of about 4cmX4cm on the palm side of the patient's left wrist. The skin color was normal, the muscle temperature was not high, the texture was firm, the boundary was clear, the position was fixed, and there was no pain when pressed. There was no obvious shrinkage of the left thenar muscle. The left index finger was extremely flexed and deformed, the flexion of the left wrist was slightly limited, the adduction of the left thumb was limited, and the flexion of the five fingers of the left hand was normal. The extension was slightly limited, and a round mass of about 5cmx3cm was seen on the left joint, with skin color Red, slightly elevated local skin temperature, tough texture, clear border, fixed position, no pain when pressed, normal movement of left elbow joint; blood supply and sensation in other fingers are normal."

Hearing Li Lian'an's introduction, it was obvious that such a large tumor surprised several experts, and the pressure was painless and the position was fixed, so several directors were a little hesitant.

"continue!"

Li Lian'an began to introduce laboratory tests:
". White blood cells 10.55×109 L-1, carbohydrate antigen 724 17.55 U m L-1, uric acid 651 μmol L-1, C-reactive protein 13.6 mg L-1, high-sensitivity C-reactive protein 11.1 mg· L-1"

Looking at these data, several experts still couldn't confirm it, and they also aroused their enthusiasm for competition, especially Director Tian Hua and Director Qian Mubai in the field of hand surgery.

The two looked through the materials again, and Li Lian'an also talked about the imaging examination at the same time:
". The color Doppler ultrasound of the tumor on the left wrist surface showed an echogenic mass with a size of about 43 mm × 36 mm × 17 mm. It was oval in shape with a discernible border, uneven internal echo, and attenuation at the rear. There were punctate blood flow signals inside and around the mass, not Rich."

Then the directors looked at the MRI results of the left wrist joint.

When the directors began to diagnose, Director Tian Bo also rushed back to the conference room from the ward, and he came in with a sincere tone:

"It really made everyone laugh, and thanks to everyone who organized this expert consultation today, the patient and family members are now emotionally stable, and they are looking forward to us finding out the real cause of the disease. On behalf of the hand surgery department, I would like to thank you in advance."

Tian Bo soon came to Li Lian'an's side, asked about the progress, and then took over the report position, while Li Lian'an obediently held a small notebook and sat on the second row of chairs at the far end of the conference table , dare not cross the line and line up with the major directors.

Tian Bo also glanced at Wei Guoqiang and Qin Lang from the corner of his eye, but he was also laughed out of anger, this Qin Lang was really ignorant, and pretended to read the medical records carefully.

I really thought that I had learned some free flap transplantation operations, so I dared to join in hand surgery, did I understand him?

However, Tian Bo's status is there, so naturally he won't show it, and he doesn't bother to compete with Qin Lang. How can he pretend to ask Qin Lang for advice?

It's normal for a small doctor of his level to be questioned by a big director like himself, and he can't hold back a fart.

Tian Bo gave several directors some time to think, and first put forward some of his ideas:
"Gentlemen, I'll start by throwing bricks and stones, and talk about my opinion. Combined with the imaging data, there is a mass in the left carpal tunnel, a small amount of effusion in the left common deep flexor tendon sheath, a small amount of effusion in the left inferior radial ulna joint, and a small amount of effusion in the left carpal tunnel. Median nerve damage, wrist, motor and sensory microscopic involvement, predominantly myelin damage with some axonal damage."

"So, now I have two inferences. It is suspected to be synovial sarcoma, and it may be synovial chondroma. However, the treatment options for the two inferences are very different. If it is treated according to synovial sarcoma, then it is necessary to strive for extensive resection. Otherwise, if there is a recurrence, extensive amputation is required, and it may even spread to the lungs through the blood, and there may also be lymphatic metastasis. Once the first-stage treatment is not complete, according to experience, the 5-year survival rate after recurrence is only 20% to 50%!"

"However, if it is just a benign synovial chondroma, a self-limiting lesion, synovial resection or incomplete resection is sufficient. Destruction is not necessary to preserve the patient's tissue function."

Hearing Tian Bo's two completely different directions of diagnosis and completely different treatment plans, several directors in the conference room also made difficulties.

Indeed, for the patient, wide excision, when treated as a synovial sarcoma, poses the least risk to the physician, but leads to overtreatment.

After all, once a wide resection is performed, the patient's wrist is basically useless.

However, if it is treated conservatively as a synovial sarcoma, if it is a malignant synovial sarcoma, if the treatment is not timely, it will lead to recurrence, spread and metastasis, which will be life-threatening.

Tian Huazai looked at the various materials carefully, and it was basically the same as Tian Bo's judgment: "It's really not possible, we can only perform tumor resection on the left wrist and left joint, and then judge the nature of the tumor during the operation, and further adjust the operation. plan."

Director Qian Mubai has a different opinion:
"Synovial chondrosis is a rare and conscientious lesion that occurs frequently in the joint cavity and is characterized by the formation of multiple cartilage nodules in the synovium of the joint, tendon sheath, and synovium. The general symptoms are pain, swelling, and movement of the affected joints. In X-ray films and CT images, the floating body is manifested as a single ring or multiple ring calcifications, and MRI examination can show the erosion of synovium and bone.”

"Synovial sarcoma is a highly malignant soft tissue tumor originating from the synovium, bursa, and tendon sheath. It can also cause a mass in the wrist and cause deformity. The imaging (X-ray or CT) feature is mainly a soft tissue mass. There may be calcification or ossification in the lesion, and a few cases may be accompanied by extensive osteoid tissue formation."

"However, we see that the patient's physical examination and imaging features are very similar, but there are very subtle differences, and the differences are only instinctive based on years of experience. So, I am thinking , Is it possible that it is a more rare disease? It’s just that I don’t have a specific direction for a while, but my suggestion is to spend more time and energy before the operation, under the argument, do not blindly remove it, try to do it The damage to the patient is minimal, and the tissue and function of the patient are preserved as much as possible!"

"Give me some more time, Director Tian, ​​and arrange another enhanced scan."

Hearing Qian Mubai's words, everyone felt ashamed of themselves. They deserved to be the director of the hand surgery department of Huashan Hospital affiliated to Aurora University. His persistence and tenacity alone made him worthy of being called a famous doctor.

And when everyone continued to discuss, an electronic voice also appeared in Qin Lang's mind:

[New task: find out the real cause of the patient through the simulation of a single case, and guide the directors to confirm the real cause of the patient through inferences.Task reward: 1 life simulation point. 】

Qin Lang also admired it in his heart, as expected of Director Qian Mubai, this patient is really a rare third condition.

[Consume 1 life simulation point to start a single case simulation! 】

PS: Thanks to 20170608150747831 for the reward of 100 coins!
(End of this chapter)