Dr. D.¥. PATIL HOSPITAL & RESEARCH CENTRE, PIMPRI, PUNE - 411018. J Date : pr) New re pt] Ee TTP whawse OY 1 Cor Chea te de dagheres pnt te Longe cua, Sin ee a reop i ayer a> A pr © 4 Tp coh 3 2 lek Cor [FR ay) aA pea aes Dr. Vika MO (Radi Reg. No. Kothavade o 1 Oncolog 8/044 eeRuby Ailcare” OUAGNOSTIC MAGING SERVICE f& eae) 2 z Services Pvt.Ltd. i) Testa Wee}: “eane’ CIN: UBSTOPN2005PTCO20949 PATIENT'ID ‘MRN-196832 DATE, 10-Jun-2023 \ MRI BRAIN (PLAIN) \\_[LIMITED MR STUDY OF BRAIN WAS PERFORMED AS REQUESTED] (71, T2 AND FLAIR WEIGHTED IMAGES WERE TAKEN IN AXIAL PLANE] + Evidence of few varying sized areas of altered signal intensity are seen in right frontal , high frontal cortical sub cortical regions abutting the posterior part of interhemispheric fissure and right cerebellum. These are heterogeneously hypo to hyper intense on T2W e & FLAIR and hypo to iso intense on T1W images. Moderate to large degree of perilesional edema is seen around the lesions. + Mass effect is seen as effacement of adjacent CSF spaces, 4th ventricle with resultant dilation of bilateral lateral ventricle suggestive of obstructive hydrocephalous. + Mild to moderate degree of generalized brain atrophy disproportionate to the age of the patient and periventricular white matter ischemic change: Rest of the brain parenchyma reveals normal signal intensity on all the sequences, Gray-white matter differentiation is maintained. Brain stem and left cerebellum reveal normal signal intensity. Rests of the ventricles and basal cisterns are normal. Bilateral thalami, basal ganglia and internal capsule are normal. Major flow voids are normal. Bilateral internal auditory canal and 7th-8th nerve complexes are normal. Minimal mucosal thickening is seen in bilateral ethmoid and sphenoid sinuses. G@ IMPRESSION : MR FEATURES ARE SUGGESTIVE OF : ‘+ Few varying sized lesions right frontal, high frontal cortical sub cortical regions abutting the posterior part of interhemispheric fissure and right cerebellum with moderate to large perilesional edema, mass effect and resultant hydrocephalous as described. POSSIBILITY OF METASTASIS. NEEDS CONTRAST ENHANCED STUDY, MR SPECTROSCOPY CLINICAL CORRELATION AND FURTHER EVALUATION. Ard Yatra. Dr Aah amar Contant alos hg 01030 j Bate (oneal fa} ey )¥.€.™ Hospital, 141 Foor, Sant Tukaram Nagar, Pimpr 18 uJupiter Hospital = Patient First Nuclear Medicine Name MRNo, 200702 AgeGender + 06096 997M Bil Nunber —_: 16B-2023-000648 Refred By = DrJipal Reddy ResuitNo: NB-2023-0001576 Bemition — ; Whol Body FDG PEDCT scan Invest Date: 1610672023 - 94405 AM pr : Resut Date: 1610672023 -11:3020 AM E18 EDG PETCT Scan Protocol: F-18 FDG PET/CT scan was performed from vertex to toe on GE Discovery 1Q PET-CT scanner, 45- (60 mins after intravenous administration of 5.84 mCi F18-Fluorodeoxyglucose (FDG). Intravenous contrast was administered. A semi-quantitative analysis of FDG uptake was performed by calculating SUVmax based upon body ‘Weight and expressed in g/ml. A separate breath hold CT scan of lung with 1.25 mm slice thickness was also acquired. The fasting blood sugar level at the time of F-18 FDG tracer injection was 152 mg/dl. Serum creatinine |. Tmg/dl. No immediate adverse contrast media reactions noted. Indication: Brain lesion under evaluation. Findings: FDG PET-CT Done on : 16/06/2023. Ring enhancing lesions seen in right frontal region and cerebellum (largest measuring approximately 29.4 X 28.3 ‘mum in right cerebellum). FDG uptake seen in right cerebellar lesion (SUVimax 7.0). Perilesional oedema seen. , No significant cervical, supraclavicular or axillary nodes seen. FDG avid enhancing soft tissue lesion with spiculated margin scen in upper lobe of right hing (approximately ‘measuring 2.9 X 2.9 X 2.2 em SUVmax 10.3) Emphysematous changes seen in both lungs. Fibrotic changes and eakified nodule seen in upper lobe of left lang Tiny cakified nodule seen in lower lobes of both lungs near fissure. Tiny nodule seen in lower lobe of left hing - 100 tiny to characterize. No significant mediastinal adenopathy or pleural effusion noted. Non FDG avid small hypodense lesions seen in both labes of liver (0.6 X 0.5 em in segment VI) - likely simple cysts. Bilateral simple renal cortical cysts seen, The spleen, pancreas,adrenals appear unremarkable No significant abdominopelvie nodes seen. No evidence of ascites noted, No obvious FDG avid Iytic or sclerotic skeletal lesion seen. Focal FDG uptake seen posterior to right knee (SUV max 4.6) - more likely inflammatory, Rest of the scan is unremarkable and represents physiological tracer distribution Prited By ;KUNALOO44I Print Date Tine : 1610672023 1631.27Jupiter Hospital Patient First Nuclear Medicine ‘Laxman Bandu Rangdat AgsGenler — : 0600609/Make Rofed By: Deda Reddy Eumimtion —_ : Whole Body FDG PETICT sean Impression: Scan findings reveal: + Ring enhancing lesions seen in right frontal region and cerebellum with perilesio metastatic. a ‘+ Metabolically active soft tissue lesion seen in upper lobe of right lung- likely primary malignancy. Suggested histopathological correlation. + No evidence of active disease elsewhere in the present study. ys DR KUNAL SHANA, MBBS, MD ‘CONSULTANT NUCLEAR MEDICINE, oedema = likely Printed By : KUNALO0441 Print Date/Time : 16/06/2023 163127 Page 2 0f2 Tet 020-2790 2790 NABH, ‘Wits, we upterhospital comune cancer Patient Name: MR. RANGDAL LAXMAN BANDU / MRN-T-1868 ‘Age/ Gender: 61Yr /M ‘Address: Pune, MAHARASHTRA Ward/Bed: GENERAL WARD/BED 1 Req. Doctor: Dr. RAJEEV SHRIVASTAVA Regn. Number: TLIPD-23-24-174 Request Date : 24-06-2023 11:12 AM Reporting Date : 26-06-2023 03:06 PM Report Status : Finalized ‘Acceptance Date: 24-06-2023 02:23 PM Sample ID: HISTOA309 HISTOPATHOLOGY SMALL SPECIMEN HPR No- OH/884/23 Suspected Carcinoma lung with brain mets PET-CT: Ring enhancing lesion seen in right frontal region & cerebellum with perilesional oedema, likely metastatic. Metabolically active soft tissue lesion seen in upper lobe of right lung, likely primary malignancy Nature of Specimen: Right lung mass - CT guided biopsy Gross: Received in formalin with labelled patient's name, MR no & designated “Right lung mass biopsy * are multiple grey black soft tissue cores longest measuring 1.2 cm [Alll processed in one block]. Microscopy: Section shows cores of lung parenchyma infiltrated by a tumor arranged in nests composed of polygonal cells having round to oval hyperchromatic nuclei, prominent nucleoli and moderate eosinophilic to clear cytoplasm. Foci of necrosis seen. Definite glandular! squamous differentiation not identified. Impression: Right lung mass - CT guided biopsy: Non small celllung-carcinoma. _ Note: Suggested Immunohistochemistry for exact categorization. eo Dr. Deepa Puntambekar Reg. No, -13-14777 MD Pathologist Consultant Onco-Pathologist ‘Scan the QR code to download your e-report IMR. RANGDAL UAXMAN BANDU / MRN-T-1868 Page 1 of 1 Reg. NO.: TLIPD-23-24-174Onco-Life Cancer Centre Pvt. Ltd. @S une Cancer Centre Patient Name: MR. RANGDAL LAXMAN BANDU / MRN-T-1868 Age /Gender: 61Yr /M Address: Pune, MAHARASHTRA, Req. Doctor: Dr. RAJEEV SHRIVASTAVA Regn. Number: TLOPD-23-24-1022 Request Date : 27-06-2023 12:32 PM Reporting Date : 03-07-2023 12:01 PM Report Status : Finalized ‘Acceptance Date: 27-06-2023 01:40 PM ‘Sample 1D: HISTOA311 IMMUNOHISTOCHEMISTRY (IHC) IHC No:200/23 Clinical details: Suspected Carcinoma lung with brain mets PET-CT: Ring enhancing lesion seen in right frontal region & cerebellum with perilesional oedema, likely metastatic. Metabolically active soft tissue lesion seen in upper lobe of right lung, likely primary malignancy HPR of Right lung mass biopsy: Non small cell lung carcinoma. Nature of Specimen: Right lung mass - CT guided biopsy ‘est performed: Immunohistochemistry Testing Performed on Block Number: OH/884/23 IHC Result: Tumor cells are diffusely positive for TTF-1, Napsin. Tumor cells show patchy focal positivity for p63 and p40. Impression: Right lung mass - CT guided biopsy: Immunoprofile favor Adenocarcinoma, compatible with Lung primary. Note: In view of patchy positivity for p63 and p40, a possibility of Adenosquamous carcinoma cannot be excluded. - The internal and external IHC controls have been found to be satisfactory. - All IHC protocols have been performed on fully automated Ventana Benchmark GX System. - Primary antibody clones: TTF-1 - SP141 (Roche); Napsin - EP190 (Cell marque); p63 - 4A4 (Roche); p40 - BC28 (Roche). END OF REPORT 2s Dr. Deepa Puntambekar Reg. No. - 13-1477 MD Pathologist Consultant Onco-Pathologist Scan the QR code to download your e-report MR. RANGDAL LAXMAN BANDU / MRN-T-1868 “Page 1 of 1 Reg. NO.: TLOPD-23-24-1022