Pediatrics - Neonatal
Sample Name: Neuroblastoma - Consult
Description: The patient is an 11-month-old with a diagnosis of stage 2 neuroblastoma of the right adrenal gland with favorable Shimada histology and history of stage 2 left adrenal neuroblastoma, status post gross total resection.
(Medical Transcription Sample Report)
REASON FOR VISIT: The patient is an 11-month-old with a diagnosis of stage 2 neuroblastoma here for ongoing management of his disease and the visit is supervised by Dr. X.
HISTORY OF PRESENT ILLNESS: The patient is an 11-month-old with neuroblastoma, which initially presented on the left when he was 6 weeks old and was completely resected. It was felt to be stage 2. It was not N-Myc amplified and had favorable Shimada histology. In followup, he was found to have a second primary in his right adrenal gland, which was biopsied and also consistent with neuroblastoma with favorable Shimada histology. He is now being treated with chemotherapy per protocol P9641 and not on study. He last received chemotherapy on 05/21/07, with carboplatin, cyclophosphamide, and doxorubicin. He received G-CSF daily after his chemotherapy due to neutropenia that delayed his second cycle. In the interval since he was last seen, his mother reports that he had a couple of days of nasal congestion, but it is now improving. He is not acted ill or had any fevers. He has had somewhat diminished appetite, but it seems to be improving now. He is peeing and pooping normally and has not had any diarrhea. He did not have any appreciated nausea or vomiting. He has been restarted on fluconazole due to having redeveloped thrush recently.
REVIEW OF SYSTEMS: The following systems reviewed and negative per pathology except as noted above. Eyes, ears, throat, cardiovascular, GI, genitourinary, musculoskeletal skin, and neurologic.
PAST MEDICAL HISTORY: Reviewed as above and otherwise unchanged.
FAMILY HISTORY: Reviewed and unchanged.
1. Bactrim 32 mg by mouth twice a day on Friday, Saturday, and Sunday.
2. G-CSF 50 mcg subcutaneously given daily in his thighs alternating with each dose.
3. Fluconazole 37.5 mg daily.
4. Zofran 1.5 mg every 6 hours as needed for nausea.
ALLERGIES: No known drug allergies.
LABORATORY STUDIES: CBC and comprehensive metabolic panel were obtained and they are significant for AST 51, white blood cell count 11,440, hemoglobin 10.9, and platelets 202,000 with ANC 2974. Medical tests none. Radiologic studies are none.
ASSESSMENT: This patient's disease is life threatening, currently causing moderately severe side effects.
1. Neuroblastoma of the right adrenal gland with favorable Shimada histology.
2. History of stage 2 left adrenal neuroblastoma, status post gross total resection.
5. Resolving neutropenia.
PROCEDURES AND IMMUNIZATIONS: None.
1. Neuroblastoma. The patient will return to the Pediatric Oncology Clinic on 06/13/07 to 06/15/07 for his third cycle of chemotherapy. I will plan for restaging with CT of the abdomen prior to the cycle.
2. Immunosuppression. The patient will continue on his Bactrim twice a day on Thursday, Friday, and Saturday. Additionally, we will tentatively plan to have him continue fluconazole since this is his second episode of thrush.
3. Mucosal candidiasis. We will continue fluconazole for thrush. I am pleased that the clinical evidence of disease appears to have resolved. For resolving neutropenia, I advised Gregory's mother about it is okay to discontinue the G-CSF at this time. We will plan for him to resume G-CSF after his next chemotherapy and prescription has been sent to the patient's pharmacy.
Keywords: pediatrics - neonatal, stage 2 neuroblastoma, adrenal neuroblastoma, mucosal candidiasis, neutropenia, carboplatin cyclophosphamide, pediatric oncology, adrenal gland, neuroblastoma, histology, nonerythematous, adrenal, gland, chemotherapy,