Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
Please predict the final diagnosis. Is there good concordance between your prediction and actual care patient received?
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Chief complaints:
A 67-year-old male was referred to the surgical oncology clinic for abdominal pain and a growing portocaval mass.

History of present illness:
He reported a one-year history of aching abdominal discomfort, nausea, and 10-pound weight loss. His review of systems was unremarkable other than abdominal pain and weight loss.

Personal and family history:
His medical history was notable for hepatitis C treated with pegylated interferon and ribavirin two decades prior and poorly controlled hypertension. He did not carry a diagnosis of cirrhosis and had never had pancreatitis. He had previously undergone an exploratory laparotomy and appendectomy four decades prior under circumstances the patient could not recall, as well as a remote laparoscopic cholecystectomy. He was a one pack per week smoker. He had no prior family history of gastrointestinal malignancy.

Physical examination:
On physical exam, he was a well-appearing, overweight (body mass index 28.6) male with well-healed midline laparotomy and laparoscopic scars, no abdominal distension or tenderness, and no scleral icterus or jaundice.

Laboratory examinations:
His complete blood count was notable for a hemoglobin of 10.4 g/dL, metabolic panel was notable for a creatinine of 1.36 mg/dL (estimated glomerular filtration rate of 57 mL/min), aspartate aminotransferase of 61 U/L (but normal alanine aminotransferase, alkaline phosphatase, and bilirubin levels), and tumor markers were notable for a carcinoembryonic antigen level of 2.9 ng/mL and carbohydrate antigen 19-9 level of 52 U/mL.

Imaging examinations:
He had undergone serial intravenous-contrasted computed tomography (CT) scans of the abdomen and pelvis leading up to surgical referral, which demonstrated an enlarging portocaval lesion from 3.6 cm × 2 cm eight months prior to 5.2 cm × 3.2 cm. CT also demonstrated hepatic steatosis, but no abnormal pancreatic, biliary, hepatic, or duodenal lesions.

He had undergone an upper endoscopy that demonstrated duodenal erythema, ulceration, and a possible submucosal mass. An endoscopic ultrasound demonstrated a mixed cystic-solid mass between the pancreas and inferior vena cava, as well as a normal-appearing pancreas, biliary system, and liver. Fine needle aspiration demonstrated rare fragments of cytokeratin 8/18 and arginase-1 positive atypical cells with hepatoid differentiation, negative for CD34, SOX10, synaptophysin and chromogranin immunohistochemical stains.

Treatment and follow-up:
The patient underwent open surgical resection of a 5.2 cm × 5.5 cm encapsulated retroperitoneal mass via a right subcostal incision. He had dense right upper quadrant adhesions between the omentum, colon, small bowel, and the gallbladder fossa that was able to be safely dissected free. No evidence of metastatic foci was present. The liver appeared steatotic but was without evidence of cirrhosis. After mobilization of the hepatic flexure and duodenum, the portocaval mass was exposed, mobilized, and resected from adjacent duodenum, pancreatic head, portal structures, and inferior vena cava. Post-operatively, the patient recovered well and was discharged on post-operative day (POD) 6.

He re-presented on POD 9 with bilious emesis and was found to have a leukocytosis of 15.9 × 103/µL with a 5.1 cm × 5.0 cm × 8.4 cm rim-enhancing collection in the resection bed associated with compressive mass effect on the duodenum. CT-guided aspiration of the fluid yielded hematoma with no organisms on gram stain or culture. The patient had marked symptomatic improvement and was discharged home on hospital day 4 of his readmission.

Final diagnosis:
Pathologic evaluation revealed vague nodules of large polygonal cells with eosinophilic granular to clear vacuolated cytoplasm, steatotic and clear-cell changes, increased mitosis, necrosis and rare hyaline bodies, positive for cytokeratin 8/18, pancytokeratin, HepPar1, arginase-1, glypican-3, and CA-9, and negative for cytokeratin 7/20, synaptophysin, chromogranin, DOG-1, CD117, PAX-8, SF-1, SOX-10, and Melan-A. A thin rim of peri-lesional lymphoid and fibrous tissue suggested a near-completely replaced lymph node.
A gadobutrol-contrasted magnetic resonance imaging (MRI) abdomen was obtained, which demonstrated a 1.2 cm lesion in segment VIII with late arterial enhancement, fatty sparing, and intrinsic T1 hyperintensity, but no washout on delayed images, and two 1.2 cm lesions in segments II and VII with late arterial enhancement and no washout or pseudocapsule. Alpha fetoprotein (AFP) was 23.3 ng/mL.

Based on the patient's symptoms, laboratory results, and imaging findings, I predict the top 2 disease causes for this patient case are:

1. **Hepatocellular carcinoma (HCC)**: The patient's history of hepatitis C, elevated liver enzymes, and imaging findings of a growing portocaval mass suggest a possible diagnosis of HCC. The presence of rare fragments of cytokeratin 8/18 and arginase-1 positive atypical cells with hepatoid differentiation on fine needle aspiration also supports this diagnosis.
2. **Metastatic cancer**: The patient's weight loss, abdominal pain, and elevated tumor markers (carcinoembryonic antigen and carbohydrate antigen 19-9) suggest a possible diagnosis of metastatic cancer. The presence of a mixed cystic-solid mass between the pancreas and inferior vena cava on endoscopic ultrasound also raises concern for metastatic disease.

Final diagnosis:
The final diagnosis is **Hepatocellular carcinoma (HCC)**, as confirmed by the pathologic evaluation of the resected tumor, which showed characteristic features of HCC, including vague nodules of large polygonal cells with eosinophilic granular to clear vacuolated cytoplasm, steatotic and clear-cell changes, increased mitosis, necrosis, and rare hyaline bodies.

Concordance between prediction and actual care:
There is good concordance between my prediction and the actual care the patient received. The patient underwent surgical resection of the tumor, which is a common treatment approach for HCC. The post-operative complications, including bilious emesis and a rim-enhancing collection in the resection bed, are also consistent with the diagnosis of HCC. The patient's recovery and discharge from the hospital also support the diagnosis and treatment approach.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
What do you think of the treatment? How may AI prediction help the patient to do early treatment of cancer ?
##

Chief complaints:
A 67-year-old male was referred to the surgical oncology clinic for abdominal pain and a growing portocaval mass.

History of present illness:
He reported a one-year history of aching abdominal discomfort, nausea, and 10-pound weight loss. His review of systems was unremarkable other than abdominal pain and weight loss.

Personal and family history:
His medical history was notable for hepatitis C treated with pegylated interferon and ribavirin two decades prior and poorly controlled hypertension. He did not carry a diagnosis of cirrhosis and had never had pancreatitis. He had previously undergone an exploratory laparotomy and appendectomy four decades prior under circumstances the patient could not recall, as well as a remote laparoscopic cholecystectomy. He was a one pack per week smoker. He had no prior family history of gastrointestinal malignancy.

Physical examination:
On physical exam, he was a well-appearing, overweight (body mass index 28.6) male with well-healed midline laparotomy and laparoscopic scars, no abdominal distension or tenderness, and no scleral icterus or jaundice.

Laboratory examinations:
His complete blood count was notable for a hemoglobin of 10.4 g/dL, metabolic panel was notable for a creatinine of 1.36 mg/dL (estimated glomerular filtration rate of 57 mL/min), aspartate aminotransferase of 61 U/L (but normal alanine aminotransferase, alkaline phosphatase, and bilirubin levels), and tumor markers were notable for a carcinoembryonic antigen level of 2.9 ng/mL and carbohydrate antigen 19-9 level of 52 U/mL.

Imaging examinations:
He had undergone serial intravenous-contrasted computed tomography (CT) scans of the abdomen and pelvis leading up to surgical referral, which demonstrated an enlarging portocaval lesion from 3.6 cm × 2 cm eight months prior to 5.2 cm × 3.2 cm. CT also demonstrated hepatic steatosis, but no abnormal pancreatic, biliary, hepatic, or duodenal lesions.

He had undergone an upper endoscopy that demonstrated duodenal erythema, ulceration, and a possible submucosal mass. An endoscopic ultrasound demonstrated a mixed cystic-solid mass between the pancreas and inferior vena cava, as well as a normal-appearing pancreas, biliary system, and liver. Fine needle aspiration demonstrated rare fragments of cytokeratin 8/18 and arginase-1 positive atypical cells with hepatoid differentiation, negative for CD34, SOX10, synaptophysin and chromogranin immunohistochemical stains.

Treatment and follow-up:
The patient underwent open surgical resection of a 5.2 cm × 5.5 cm encapsulated retroperitoneal mass via a right subcostal incision. He had dense right upper quadrant adhesions between the omentum, colon, small bowel, and the gallbladder fossa that was able to be safely dissected free. No evidence of metastatic foci was present. The liver appeared steatotic but was without evidence of cirrhosis. After mobilization of the hepatic flexure and duodenum, the portocaval mass was exposed, mobilized, and resected from adjacent duodenum, pancreatic head, portal structures, and inferior vena cava. Post-operatively, the patient recovered well and was discharged on post-operative day (POD) 6.

He re-presented on POD 9 with bilious emesis and was found to have a leukocytosis of 15.9 × 103/µL with a 5.1 cm × 5.0 cm × 8.4 cm rim-enhancing collection in the resection bed associated with compressive mass effect on the duodenum. CT-guided aspiration of the fluid yielded hematoma with no organisms on gram stain or culture. The patient had marked symptomatic improvement and was discharged home on hospital day 4 of his readmission.

Based on the patient's symptoms, medical history, and imaging results, I predict the top 2 disease causes for this patient case are:

1. **Hepatocellular carcinoma (HCC)**: The patient's history of hepatitis C, poorly controlled hypertension, and liver steatosis on imaging suggest a possible underlying liver disease. The presence of a growing portocaval mass, elevated tumor markers (CEA and CA 19-9), and cytokeratin 8/18 and arginase-1 positive atypical cells on fine needle aspiration are consistent with HCC.
2. **Pancreatic neuroendocrine tumor (PNET)**: The patient's symptoms of abdominal pain, weight loss, and nausea, along with the presence of a mixed cystic-solid mass between the pancreas and inferior vena cava on endoscopic ultrasound, suggest a possible PNET. The negative immunohistochemical stains for CD34, SOX10, synaptophysin, and chromogranin do not rule out PNET entirely.

Regarding treatment, the patient underwent open surgical resection of the retroperitoneal mass, which is a reasonable approach given the size and location of the tumor. However, the patient's post-operative complications, including bilious emesis and a rim-enhancing collection in the resection bed, highlight the complexity of the case.

AI prediction can help the patient in several ways:

1. **Early detection**: AI-powered algorithms can analyze imaging data and identify subtle changes in the tumor's size, shape, and texture, allowing for earlier detection and treatment.
2. **Personalized treatment planning**: AI can help identify the most effective treatment strategy based on the patient's individual characteristics, such as tumor biology, medical history, and genetic profile.
3. **Predicting post-operative complications**: AI can analyze pre-operative data and predict the likelihood of post-operative complications, allowing for more informed decision-making and proactive management.

In this case, AI prediction could have potentially helped identify the patient's risk of post-operative complications, such as the rim-enhancing collection in the resection bed, and guided more targeted interventions to prevent or mitigate these issues.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
##

Chief complaints:
A 67-year-old male was referred to the surgical oncology clinic for abdominal pain and a growing portocaval mass.

History of present illness:
He reported a one-year history of aching abdominal discomfort, nausea, and 10-pound weight loss. His review of systems was unremarkable other than abdominal pain and weight loss.

Personal and family history:
His medical history was notable for hepatitis C treated with pegylated interferon and ribavirin two decades prior and poorly controlled hypertension. He did not carry a diagnosis of cirrhosis and had never had pancreatitis. He had previously undergone an exploratory laparotomy and appendectomy four decades prior under circumstances the patient could not recall, as well as a remote laparoscopic cholecystectomy. He was a one pack per week smoker. He had no prior family history of gastrointestinal malignancy.

Physical examination:
On physical exam, he was a well-appearing, overweight (body mass index 28.6) male with well-healed midline laparotomy and laparoscopic scars, no abdominal distension or tenderness, and no scleral icterus or jaundice.

Laboratory examinations:
His complete blood count was notable for a hemoglobin of 10.4 g/dL, metabolic panel was notable for a creatinine of 1.36 mg/dL (estimated glomerular filtration rate of 57 mL/min), aspartate aminotransferase of 61 U/L (but normal alanine aminotransferase, alkaline phosphatase, and bilirubin levels), and tumor markers were notable for a carcinoembryonic antigen level of 2.9 ng/mL and carbohydrate antigen 19-9 level of 52 U/mL.

Imaging examinations:
He had undergone serial intravenous-contrasted computed tomography (CT) scans of the abdomen and pelvis leading up to surgical referral, which demonstrated an enlarging portocaval lesion from 3.6 cm × 2 cm eight months prior to 5.2 cm × 3.2 cm. CT also demonstrated hepatic steatosis, but no abnormal pancreatic, biliary, hepatic, or duodenal lesions.

He had undergone an upper endoscopy that demonstrated duodenal erythema, ulceration, and a possible submucosal mass. An endoscopic ultrasound demonstrated a mixed cystic-solid mass between the pancreas and inferior vena cava, as well as a normal-appearing pancreas, biliary system, and liver. Fine needle aspiration demonstrated rare fragments of cytokeratin 8/18 and arginase-1 positive atypical cells with hepatoid differentiation, negative for CD34, SOX10, synaptophysin and chromogranin immunohistochemical stains.

Based on the patient's symptoms, medical history, laboratory results, and imaging findings, I predict the top 2 disease causes for this patient case to be:

1. **Hepatocellular Carcinoma (HCC)**: The patient's history of hepatitis C, weight loss, and abdominal pain, combined with the imaging findings of an enlarging portocaval lesion and hepatic steatosis, suggest a possible diagnosis of HCC. The fine needle aspiration results showing cytokeratin 8/18 and arginase-1 positive atypical cells with hepatoid differentiation also support this diagnosis.
2. **Pancreatic Neuroendocrine Tumor (PNET)**: The patient's symptoms of abdominal pain and weight loss, along with the imaging findings of a mixed cystic-solid mass between the pancreas and inferior vena cava, suggest a possible diagnosis of PNET. The endoscopic ultrasound findings of a normal-appearing pancreas, biliary system, and liver, as well as the negative immunohistochemical stains for CD34, SOX10, synaptophysin, and chromogranin, do not rule out this diagnosis.

Both of these diagnoses require further evaluation and confirmation with additional testing, such as a liver biopsy or a pancreatic biopsy, to determine the definitive diagnosis.