1. Diagnostics

2. HEMATOLOGY Laboratory Work-Up

3. NormalJune 23, 2010Remarks WBC4-11 x 10­ 9 /L8.08 x 10­ 9 /LNORMAL RBC4-6 x 10­ 9 /L4.82 x 10­ 9 /LNORMAL Hgb120-180g/L142g/LNORMAL Hct0.370-0.540%0.431%NORMAL MCV80-100fL89.4fLNORMAL MCH27-31pg29.5pgNORMAL MCHC320-360g/L329g/LNORMAL RDW-CV150-450 x 10­ 9 /L129 x 10­ 9 /LREDUCED Platelets2-4 x 10­ 11 /L3.1 x 10­ 11 /LNORMAL Neutrophil0.5-0.70.764SLIGHTLY ELEVATED Lymphocytes0.2-0.50.103REDUCED Monocyte0.02-0.090.082NORMAL Eosinophil0.0-0.060.047NORMAL Basophil0.0-0.020.004NORMAL APTT36.436.3NORMAL PT12-15 seconds12.5 secondsNORMAL

4. BLOOD CHEMISTRY Laboratory Work-Up

5. NormalJune 23, 2010Remarks BUN3.2-8.0 mmol/L2.46 REDUCED Creatinine53.133 umol/L71 ELEVATED Sodium135-145 mmol/L137 NORMAL Potassium4.0-4.5 mmol/L4.3 NORMAL Calcium2.12-2.75 mmol/L2.41 NORMAL Albumin38-51 g/L31 REDUCED AST0-34 U/L50 ELEVATED ALT0-30 U/L42 ELEVATED Total Bilirubin0-17.1 umol/L5.90 NORMAL Dir Bilirubin0-3.42 umol/L1.96 NORMAL Ind Bilirubin3.4-13.7 umol/L3.94 NORMAL Urate0.13-0.44 mmol/L0.31 NORMAL

6. URINALYSIS Laboratory Work-Up

7. NormalJune 23, 2010Remarks ColorYellowLight Yellow NORMAL TransparencyClear NORMAL SG1.016-1.0221.025 NORMAL Ph4.6-6.56.0 NORMAL Sugar(-) NORMAL Albumin(-) NORMAL RBC0-2/hpf4/hpf MICROSCOPIC HEMATURIA WBC0-5/hpf2/hpf NORMAL Casts3/hpf Bacteria(-)1/hpf POSSIBLE INFECTION Ketones+1 ELEVATED

8. MULTIPLE CONTIGUOUS AXIAL CT SCAN OF THE CHEST WITH IV CONTRAST Imaging Studies

9. Imaging Results

10. Well defined lobulated pulmonary mass with irregular margin with eccentric calcifications at the superior basal segment of the left lower lobe <1cm pulmonary nodule at the posterior basal segment of the right lower lobe With either linear fibrosis or subsegmental atelectasis at the anterobasal segment of the left lower lobe Pleural thickening, left lung Thoracic spondylosis

11. SURGICAL PATHOLOGY Tissue Diagnosis

12. April 26, 2010 Metastatic poorly differentiated adenocarcinoma

13. AFB SPUTUM Culture

14. June 26, 2010 Day 1: (-) AFB Day 2: (-) AFB

15. Diagnosis

16. Working Diagnosis Lung cancer, non-small cell (adenocarcinoma), stage 4, currently undergoing cobalt radiotherapy with possible malnutrition, kidney and liver damage. Rule out pulmonary TB.

17. The results of the biopsy confirm that indeed, the patient has a malignant tumor in the lung The enlarged supraclavicular lymph nodes indicate that the patient’s cancer is in stage 4

18. SCLC vs. NSCLC SCLCNSCLC Scant cytoplasmAbundant cytoplasm Hyperchromatic nuclei w/ fine chromatin pattern Pleomorphic nuclei w/ coarse chromatin pattern Indistinct nucleoliProminent nucleoli Diffuse sheet of cellsGlandular or squamous architechture

19. Pain when swallowing Decreased food intake GuconeogenesisMuscle wastinghypoalbuminemiaElevated AST, ALP Ketone body production