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Initial Presentation

A 46-year-old Caucasian male presents with persistent sore throat, cough, difficulty swallowing, hoarseness, and unexplained weight loss. He has a history of liver transplant two years ago and is on immunosuppressants. Physical examination reveals a neck lump. Imaging shows benign tumors in the lower neck indicating possible throat cancer. Given his medical history, family background, and examination results, we explore cancer causes, propose differentials, and discuss necessary tests. Positive HPV cell culture guides treatment options.

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Initial Presentation

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Presentation Transcript

  1. Initial Presentation • A 46-year-old Caucasian male complained a sore throat that does not go away, cough, difficulty in swallowing, hoarse voice, and unexplained weight loss.

  2. Hx Medical hx: • Had a liver transplant 2 years ago • Currently taking immunosuppressant Family Hx: • Both parents are clear from any chronic illnesses.

  3. Hx Cont’d Social/Occupational Hx: • Active lifestyle • Had divorced 5 times before; currently living with his new girlfriend • Used to be heavy drinker before the liver transplant • Non-smoker • No history of substance abuse

  4. Physical Examinations • BMI: 22 • BP: 115/72 mmHg • HR: 79 beats/minute • RR: 13 breaths/minute • Normal body temperature

  5. More Examination • Lungs are clear to auscultation and percussion, no rales or wheezes • No focal motor or sensory deficits • Examiner felt a lump in the neck

  6. DDx • What test should we order? • What organs should we check for?

  7. Imaging studies • Colonoscopy indicates benign tumors in the lower part of the neck

  8. Diagnosis ???

  9. Now that we know it’s throat cancer, what is the underlying cause of this? i.e. what causes cancer? Review his history Formulate another DDx and necessary tests

  10. Cell culture • Positive result on HPV

  11. Treatment ???

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