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Suffering from type 2 diabetic. Ultrasound of abdomen and pelvis done. What does the report suggest?

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General Surgeon
Practicing since : 2008
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SIR WE HAVE DONE FOLLOWING TESTS (CASE HISTORY) PATIENT NAME-XXXXXXX,AGE -76 YRS,(FEMALE)HAVING LONG STANDING DIEBETIC TYPE-2,COMPLAINED ABT ASCITIC FLUID RETENTION.1ST WE DID U S OF ABDOMEN & PELVIS.RESULT OR IMPRESSION:CHRONIC MEDICAL RENAL DISEASE GRADE -III,MILD SPLENOMEGALY,MILD TO MODERATE ASCITES,THEN WE DID FLUID EXAMINATION-FLUID EXAMINATION(22.09.2012) : SPECIMEN-ASCITIC FLUID,COLOR-PALW YELLOW,VOLUME-08 ML,CLOT-NIL,SUGAR(GLUCOSE)-1588 MG/DL,PROTEIN-1.2MG/DL,ADENOSINE DEAMINASE ACTIVITY-08 U/L,GRAM STAIN-NO BACTERIA SEEN,Z.N STAIN OF AFB-NEGATIVE,CYTOLOGY TOTAL COUNT-225 CELLS/CUMM,DIFFERENTIAL COUNT:CYTOSMEAR FROM CENTRIFUGED DEPOSITS SHOWS: LYMPHOCYTES-70%,MESOTHELIAL CELL-25%,POLYMORPHS-5%,NO MALIGNANT CELL SEEN.AFTER WE DID CA 125,RESULTS 42.00 U/ML,CA-19.9 RESULTS-126.91 U/ML,AFTER THIS WE PERFORMED PLAIN & CONTRAST(BOTH ORAL & IV)ENHANCED CT SCAN OF WHOLE (29.09.2012)ABDOMEN,IMPRESSION:FEATURES ARE SUGGESTIVE OF 1)MODERATE ASCITES,2)MILD THICKENED ANTERO-PYELORIC WALL OF STOMACH,3)RIGHT RENAL CYST.4)MINIMAL RIGHT SIDE PLEURAL EFFUSION.SUGGESTED :UPPER GI ENDOSCOPY.AFTER THIS WE DID ENDOSCOPY ON 30.09.12 IMPRESSION- FEATURES OF GASTRO-DUODENITIS.KINDLY SUGGEST WHAT TO DO?
Posted Tue, 23 Oct 2012 in Diabetes
 
 
Answered by Dr. Grzegorz Stanko 36 minutes later
Hello!

Thank you for the query.

According to symptoms like stomach ache and ascites and elevated Ca-19.9 marker it looks like we are dealing with cancer. It is very important to find the place where it is. So my first question is if during the endoscopy has been taken any samples for histopathology?
Has this person lost weight during last couple of months?
The next step you should take is to have transvaginal USG (to rule out ovarian cancer), colonoscopy (to rule out colon cancer) and if stomach hystopathology will be negative, there might be surgery necessary to look at stomach wall (as there is always a risk of so called linitis plastica stomach cancer (which is very hard to detect with endoscopy) and pancreas cancer (it can be missed by CT).

Hope this will help. Feel free to ask further questions.
Regards
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