4. DETAILED HISTORY
BIODATA:
30 year old female, para 4+0 , married, housewife, NKCM, resident of Karachi
came via OPD with complaints of
PRESENTING COMPALINS:
Recurrent swelling on palmer side of right hand – 15 months
5. HISTORY OF PRESENTING COMPLAINT
According to the patient she was in USOH 2-3 years back then she noticed
swelling on palmer side of right hand.
Gradual in onset
Progressively increasing in size
Around pea sized
Soft to firm
Irreducible
immobile
6. HOPC (CONT)
Associated with
1. On and off pain.
Not associated with
1. Skin changes,
2. Discharge,
3. Fever
4. Trauma
5. Weight loss
7. HOPC (CONT)
Not aggravated or relieved by any maneuver.
There were no other similar swellings in her body.
8. SYSTEMIC REVIEW
CNS: No history of irritability, fits and unconsciousness.
CVS: No history of palpitations, bluish discoloration, cold sweats
Respiratory system: No History of dyspnea, stridor , cough
9. PAST HISTORY
PAST MEDICAL HISTORY:
No significant medical history.
PAST SURGICAL HISTORY:
Excision of swelling on same site in April 22( 8 months back).
10. FAMILY HISTORY
Her mother is alive and healthy and father died due to natural cause.
No family history of TB,CANCER, DM, HTN or autoimmune diseases.
11. DRUG HISTORY
• No significant drug history
PERSONAL HISTORY
• Normal appetite
• Normal sleep
• No history of addiction
12. GYNECOLOGICAL HISTORY
No history of Menorrhagia, Dysmenorrhea, Dyspareunia
She has regular menstrual cycle.
She has 4 kids both born via SVD.
No history of contraceptive usage
No history of treatment for infertility.
14. GENERAL PHYSICAL EXAMINATION
A young patient, normal height and built, well oriented in time, place and
person.
Vitals:
BP: 110/90mmhg
Pulse: 99 bpm
Temp: Afebrile
RR: 20 bpm
O2 Sat: 99 % in room air .
She had no signs of pallor , jaundice, cyanosis or edema.
Her cervical, axillary and inguinal lymph nodes were not palpable
15. RELEVANT EXAMINATION
Swelling on right hand palmer side , on previous surgical site scar.
Around 4 *4 cm
Immobile
Irreducible
Non-tender
Non –fluctuant.
Skin pinch negative
Slip sign negative.
16. CNS EXAMINATION
GCS -> 15/15
Upper and lower limbs had normal tone, power and reflexes.
Cranial nerves were intact.
17. RESPIRATORY AND CVS EXAMINATION
Respiratory examination: Patient had a respiratory rate of 20 bpm. She had
no nasal flaring. On auscultation, there was normal air entry on the both
sides. There were no added sounds.
CVS: S1 + S2 audible.
18. ABDOMINAL EXAMINATION
Abdominal contour was normal. No abnormal swelling , pulsation or scar
marks was seen, cough impulse negative, carnet sign not appreciated, gut
sounds audible.
20. IMAGING FEATURES
Radiological findings consistent with biopsy proven core of GCT (GIANT
CELL TUMOR ) of the tendon sheath within the second intermetacarpal
space.
22. SURGICAL PROCEDURE
AAA measures BRUNERS incision given and the swelling completely
excised and sent for histopathology.
23. BIOPSY OF THE MASS
Pale white well circumcised lesion which reaches to peripheral margin.
Microscopic: spindle cell lesion composed of proliferating vaguely nodular
to lobular architecture of bland spindle shaped cells, with compressed
vascular channels. There were few myxoid areas.
Findings suggestive of recurrent GIANT CELL TUMOR.
