Case 4 – History


Click Case Number to view all parts

Case 4

Transdiaphragmatic tumor


Please login, activate your subscription,
or explore access solutions.


Brief Past Medical History

 The patient was an elderly man in prior excellent health with history of possible asbestos exposure in the early 1970’s at a utility company.

He was admitted approximately one month prior with diagnosis of pneumonia.

The patient’s father died at age 68 of myocardial infarction.

There is no history of cancer in the family.


Hospital course

He was found to have a mass in the left chest that protruded through the rib cage under the skin.

It was determined radiographically to be of origin from the abdominal peritoneum, extending through the diaphragm and into the anterior chest wall under the skin.

A secondary mass was identified under the sternum, possibly adherent to the pericardial fat.

Initial biopsy was inconclusive.

A follow-up biopsy showed sarcomatoid malignant mesothelioma.

This history is obtained from the family.


Next: External exam

Discussion Questions

1. Summarize the patient history.

2. Was the patient’s cancer detected early or late in its course?

3. When a patient presents with advanced cancer, what does this tell you about their self-care (if functioning independently) or clinical care (if dependent on others for care)?

4. What factors need to be in place for a patient to be able to detect and seek care for a condition like cancer? How could you, as a provider, assist your patients in this process?

5. What is the connection between smoking and asbestos when it comes to cancer?