uy ik BROOKHAVEN NATIONAL LABORATORY | NAME UNIT NO. HOSPITAL of the MEDICAL RESEARCH CENTER UPTON, NEW 8-18-8¢R YORK DISCHARGE SUMMARY PAVILION 1 OPD -2not steady and only occurs at intervals for a week or two. It has increased in frequency lately. She has not noted any recent weight loss and her appetite has been féirly good except that when she had the pain on swallowing she does not eat well, Bowel habits have been normal with normal stools. She has had nocturia (2-3 times a night) but no dysuria. Up until two weeks ago she had been taking her thyroid medication regularly. This 29-year-old Marshallese woman appeared well-nourished and asymptomatic. The thyroid appeared to be of normal size with no apparent nodularity. However, lateral to the thyroid beneath the left sternocleidomastoid muscle near its insertion was a fairly hard mass of about 2-3 cm. in diameter, The mass was slightly tender to deep pressure, The mass had about doubled in size since the last examination about 5 months previously. No regional Lymph adenopathy was noted. Lymph nodes elsewhere were not notable. The breasts were normal. Examination of the chest was negative except for a soft systolic murmur noted over the aortic area, The abdominal examination was negative. Pelvic examination was negative, Thus there were no notable findings in this patient except referable to the neck region that would suggest a primary lesion. Do Not Write In Binding Margin PHYSICAL EXAMINATION; The thyroid workup was negative in all respects with normal serum thyroxin and cholesterol levels, Serum antithyroglobulin antibody titer was negative, The BMR was +4, 0; thyroid scans showed a normal gland and thyroid uptake before and after TSH stimulation were normal. EKG was normal, chest x-ray showed the heart to be top normal in size. The lung fields were clear, Barium enema and G.I, series were normal except for a soft tissue mass in the left upper quadrant of the abdomen which was thought possibly to be splenic in origin. A skeletal survey revealed no evieReR metastatic disease. A liver and spleen scan following the injection of c-sulfur colloid revealed the spleen to be normal in size but a questionable defect in the liver was noted. A BAP smear was negative for malignant cells. Except for slight anemic tendency and the presence of whipworm parasites in the feces the remainder of the laboratory findings were generally LABORATORY & X-RAY DATA: negative. HOSPITAL COURSE: A consultation was held with Drs. J.E. Rall and J. Robbins of NIH and Dr. B. Colcock of Lahey Clinic. The consensus was that the masa in the neck was quite likely to be of a malignant nature and surgical exploration was indicated. The patient was taken to the New England Baptist Hospital, Boston on August 18, 1968. On August 19th, Dr. B.P. Colcock surgically removed an oval well encapsulated mass weighing 6.8 Grams and measuring 2.5 x 2 cm, in diameter. Dr. W.A. Meissner of the New England Deaconess Hospital examined the tissues microscopically and reported the tumor to be a neurofibroma. Also present was a negative myelinated nerve and a lymph node showing chronic inflammation, Recovery from the surgery was uneventful and the patient was transferred back to this hospital on August 25, She was asymptomatic except for a slight soreness of the neck region. Her wound healed nicely except for a slight area of drainage at one corner. She was discharged from the Hospital on August 30th fit to travel back to her howe in the BNL 720A La) tux) a Cc> _ - 74 -