Table 2.
Timeline of patient’s history and medical interventions
Dates
|
Summary from initial and follow-up visits
|
Diagnostic testing
|
Intervention/results
|
2012 and 2017 | Routine colonoscopy | 1 cm polypoid lesion in rectum | Removed endoscopically → well-differentiated neuroendocrine tumor |
May/June 2019 | Presents with abdominal pain | CT, MRI, FDG/PET → two liver lesions | CT-guided biopsy → poorly differentiated carcinoma with neuroendocrine features |
September 2019 | Presents for surgical intervention | Presents for surgical intervention | Resection of the 2 liver lesions → Final diagnosis of combined liver tumor |
October 2019 | Post-surgical follow-up | CT and FDG/PET → New liver lesion in dome | Additional imaging was advocated |
March 2020 | MRI revealed new portocaval lymphadenopathy | Endoscopic ultrasound-guided FNA of lymph nodes | Lymph nodes positive for metastatic adenocarcinoma |
May 2020 | Final oncology consultation after imaging | Initiation of cisplatin and gemcitabine chemotherapy | |
October 2020 | Presents to hospital with altered mental status | Found to be in shock due to a combination of GI bleed/sepsis | Patient expired, despite medical treatment |
CT: Computed tomography; FDG: Fluorodeoxyglucose; FNA: Fine needle aspiration; GI: Gastrointestinal; MRI: Magnetic resonance imaging; PET: Positron emission tomography.