Anupama Goel, MD

A 45-year-old male with about a 30 pack-year history of smoking presented to his primary care physician in March 2010 with a cough of few days duration.

A 73-year-old woman presented with complaints of ongoing weight loss and intermittent abdominal discomfort. CT of the chest, abdomen and pelvis revealed a 4.3 cm × 3.8 cm spiculated left upper lobe mass and subcentimeter bilateral nonspecific pulmonary nodules. There was no evidence of mediastinal or hilar adenopathy. Imaging also revealed a 4.8 cm × 2.2 cm density in anterior abdominal wall involving the musculature, large amount of ascites, multiple omental masses. There was no evidence of bowel obstruction, but there was a 4.6 cm × 4.2 cm mesenteric mass contiguous with the walls of multiple small bowel loops, with infiltration of mesenteric fat. An FDG-PET/CT confirmed the left upper lobe spiculated mass with an standardized uptake value of 7, and several nonhypermetabolic subcentimeter bilateral lung nodules were also noted. The omental and peritoneal masses had mild-to-moderate metabolic activity with standardized uptake value between 1.7 and 3, and the mesenteric mass had standardized uptake value of 2.5. The anterior abdominal wall mass had standardized uptake value of 1.1.

The patient is a 40-year-old man diagnosed with HIV infection on routine screening in 2005. He was not started on antiretroviral therapy at that time. In January 2008, he developed fatigue, fevers, chills, night sweats, decreased appetite and a 5-lb weight loss. No acute infectious cause was found, and he was started on HAART therapy at that time. His fever did not abate with treatment, and he grew increasingly fatigued, eventually requiring hospitalization. He was found to have severe normocytic anemia with hemoglobin 6.6 gm/dL, white blood cell 4.2 with normal differential and platelets of 740,000 without evidence of hemolysis.