Come on, Dr. Wu

Chapter 341: Status Improved

Wen Xinhan had a serious expression at first, but when he saw Wu Xiaofu coming to the door, he immediately smiled and waved.

Upon hearing this, Wu Xiaofu hurried inside.

When these directors came, some of them brought people with them. There were quite a few people in the small conference room at this time. However, the directors were all sitting, and the people they brought with them could only stand. They were probably there to listen and learn.

"Teacher Wen, what kind of medical record is this? It's so grand!"

There was a seat left next to Wen Xinhan, which seemed to be specially reserved for Wu Xiaofu. Wu Xiaofu and everyone had no objection, so he sat down directly. At this time, the consultation had actually been going on for more than ten minutes. When Wu Xiaofu came, everyone was still discussing that Wu Xiaofu was in a hurry to perform the operation, so he still came a little late.

Wen Xinhan pointed to the large screen in front and said to a doctor behind him, "Come on, report the medical history again."

Wu Xiaofu looked at the doctor, who looked familiar. She was the attending physician in Area A. It seemed that this case was hers.

"The patient is a 48-year-old female. A liver mass was found during a physical examination four years ago. The patient was found to have a liver mass four years ago but was not treated. Later, the patient had kidney failure due to diarrhea and dehydration and was rescued twice. Since the onset of the disease, the patient has not had dizziness, dry mouth, dry eyes, fever, headache, mild cough, no sputum, no palpitations, no nausea, vomiting, abdominal pain, or diarrhea."

"The patient had tuberculosis 35 years ago and has been cured. He denies a history of infectious diseases such as hepatitis. He claims to be allergic to penicillin. He denies a family history of the disease."

"The patient's abdomen was flat on physical examination, with no tenderness or rebound tenderness in the whole abdomen, no gastrointestinal pattern or peristaltic waves, no varicose veins in the abdominal wall, and no restriction in abdominal breathing. The lower edge of the liver was not palpable, the gallbladder was not palpable, Murphy's sign was negative, and the spleen was not palpable."

"Here are the patient's test results and imaging studies."

Dr. Lin didn't seem to be very familiar with the business and reported the medical records just like a resident doctor.

Well, it's just average. Although you can see that she wants to highlight the key points, it's still a little frowned upon.

Especially when it comes to the test results and imaging examinations, they are all presented at once without pointing out the key issues. This is not the level that the attending physician should have.

However, Wu Xiaofu was not familiar with the situation, so he did not say anything. By simply looking at the test results and imaging examinations, Wu Xiaofu was able to roughly understand the patient's condition.

"Come on, tell me, what do you think?"

Wen Xinhan looked at Wu Xiaofu. It seemed that everyone else had said almost everything and were just waiting for him, or maybe Wen Xinhan really valued Wu Xiaofu's opinion.

He nodded and looked at the other doctors, "Well, have you discussed this with the other directors before?"

"Well, let's put it this way. We have enough time anyway. Let's discuss it together."

At this moment, Wu Xiaofu clearly felt that many people were looking at him. It was understandable. Others had been discussing for most of the day and were about to end, but he was late. Now, because of him, they had to discuss it again. Other doctors would have let it go.

All of you present here are directors, with seniority. Although Wu Xiaofu has some abilities, it would be fine if we didn't give them seniority. If we really did give them seniority, their qualifications would definitely be higher.

But since Wen Xinhan has already spoken, we still have to give him the face he deserves and discuss the matter one more time. However, if Wu Xiaofu fails to come up with any surprising conclusions later, then don't blame them for retaliating against Wu Xiaofu, who is making rapid progress.

It was the first time for Cheng Shi and Jiang Bei to see so many big guys sitting together. Any one of them, at random, was the kind of person who could not even get what they wanted except for registering for an appointment or attending classes. If they could ever reach this level in the future, it would be enough to make them laugh.

However, upon closer inspection, our boss still has the upper hand.

Even though they had just started working, they still knew something about the etiquette of sitting in the conference room.

Just like now, Wen Xinhan, as the chief director, sits in the center position, with six department directors on his left and right, and below them are the directors who lead other groups.

However, the six department heads clearly arrived earlier, but they still left the seat next to Wen Xinhan empty and gave it to Wu Xiaofu. One can tell at a glance how close they are to each other, and it is obvious that Wu Xiaofu is closer to the chief director.

It's not just about the degree of closeness, but also the status. If you look closely, it's obvious that many people dare not speak out even if they don't like Wu Xiaofu.

Look, sitting here, we can tell at a glance that they are Boss Wen and Second Boss Wu.

Moreover, they believed that it was not only they who could see it, but other doctors in the conference room must be able to see it clearly as well. Area F had just been established and could only be regarded as a junior in the entire hepatobiliary surgery department. Its status was certainly not as good as that of the four areas ABCD that were established earlier. In terms of resources, the degree of inclination was certainly not high either.

But now that this has happened and the news has spread, I'm afraid that District F's status will rise sharply because of Wu Xiaofu.

Given this situation, it would be strange if the directors could have harmonious relationships with each other. You know, although there are six wards, it is still a department. In addition to the department's own resources, there are also resources allocated to the department by the hospital. How these resources are distributed to the six wards must also be based on closeness and importance.

Anyway, Cheng Shi and the others think that the boss is awesome and they must become like him in the future.

"The patient has a space-occupying lesion in the right lobe of the liver. T1WI shows low and slightly low signals, T2WI shows slightly high signals, and topography can be seen inside. The enhanced scan shows mildly uneven enhancement during the arterial phase, and delayed enhancement during the venous and equilibrium phases. I consider it to be a malignant space-occupying lesion, and primary liver cancer is the most likely cause."

The first person to speak was not one of the department heads, but a director of Area B. His focus was on the patient's abdominal MRI examination, because the image shown on the MRI film was still very clear, at least it was very clear at first glance, the high and low signals, and the morphology, clearly showed that it was a malignant space-occupying lesion.

“Space-occupying lesions in the right lobe of the liver, common lesions include primary liver cancer, hemangioma, liver metastasis and liver neuroendocrine cancer.

Primary liver cancer is often accompanied by cirrhosis, AFP positivity, and significant enhancement in the arterial phase of CT and MRI dynamic enhanced scans, with the enhancement gradually decreasing in the portal venous phase and delayed phase, showing a fast-in-and-fast-out enhancement pattern.

Hepatic hemangioma manifests as a characteristic light bulb sign on T2WI of MRI, and dynamic enhanced scanning shows patchy or nodular enhancement at the edge. The enhancement during the portal venous phase and delayed phase gradually fills in the center, showing a typical early-out and late-return enhancement pattern.

Liver metastases often have a history of primary tumors, cystic necrosis is common, and enhanced scanning shows a bull's eye sign. Larger lesions of hepatic neuroendocrine carcinoma are all located in the right lobe of the liver, and the enhancement is a "fast in and slow out" enhancement pattern.

This patient has no clear history of tumors, so metastatic tumors are not considered. His imaging findings are not consistent with hemangioma. Taking all these into consideration, both primary liver cancer and neuroendocrine cancer are possible. ”

Medical discussions are like this. At the beginning, it is just a simple patient condition, and then the more you discuss, the deeper you go. It is all professional vocabulary and professional judgment, just like what Director Chen of Zone E said now.

Like Area F, Area E was also newly established. Director Chen is currently sitting in the third seat on the right. In terms of seats, he is the lowest-ranking department director. However, everyone has to think carefully before expressing their opinions at this time. Director Chen is an old director with rich experience. His opinion can basically serve as the final diagnosis.

What's more, Director Chen's analysis basically led to their thinking. Those who were undecided before now had to nod their heads. It seemed that the results of primary liver cancer and neuroendocrine cancer should be within these two diagnoses.

"Primary liver cancer often has a history of hepatitis and cirrhosis, often accompanied by splenomegaly and portal vein widening. MRI dynamic enhancement is a "fast in and fast out" enhancement method. This patient denied a history of hepatitis, and the MRI enhanced scan did not conform to the "fast in and fast out" enhancement method.

Neuroendocrine carcinoma of the liver is rarely associated with a history of hepatitis and cirrhosis, and MRI dynamic enhancement is a "fast in, slow out" pattern, so in comparison, I prefer neuroendocrine carcinoma. "

This is Director Qin, the director of Area C. Based on Director Chen’s diagnosis, he made his own direct choice: neuroendocrine cancer.

"The patient had a history of diarrhea, and the possibility of an endocrine tumor should be considered. The enhancement pattern of the lesion is not like the "fast in and fast out" enhancement pattern of primary liver cancer.

Metastatic tumors usually have a history of tumors, but this patient has no relevant history. If the metastatic tumor is so large, the possibility of cystic necrosis is very high, but the imaging manifestations of this patient are not consistent. In summary, I think it is likely a neuroendocrine tumor. "

This is Director Feng, the director of the B area. The consultation discussion is like this. We start with the basic medical history analysis, then propose multiple possibilities, and then through step-by-step discussion, gradually eliminate various possibilities, and finally leave the most likely judgment. Just like now, after several directors' discussions, the target has been set on neuroendocrine cancer. Director Qin thinks it is neuroendocrine cancer, and Director Feng agrees. Both department directors think this is the diagnosis, so everyone must rely on this diagnosis.

Since we are relying on this diagnosis, there is no need to work backwards.

Assuming that the patient has neuroendocrine cancer, what should he look like? With this comparison, it becomes much clearer. Yes, it really does look like neuroendocrine cancer.

However, in a discussion, even when many people think that this should be the answer, there will be people who raise some objections.

Take the person in front of you for example.

"I think hepatic adenoma and neuroendocrine carcinoma are equally likely. Hepatic adenoma often has hemorrhagic necrosis, the solid part is uniformly enhanced, the portal vein and delayed phase are of equal or slightly higher density, there is a capsule, single lesions are more common, multiple lesions are rare, and women are more likely to have it.

Neuroendocrine carcinoma MRI showed lobed shape with clear boundaries, low signal and isohypomixis on T1WI, isohypomixis on T2WI and DWI, and irregular low signal inside. After enhancement, it showed a "fast in and slow out" enhancement mode. I think both are possible. "

This is the deputy director of the A area department. His surname is Hong. When there was a competition for the director positions of the E and F areas, Director Hong was the main contender. Unfortunately, he was one step behind and lost to Wu Xiaofu and Director Chen.

Director Hong is still feeling very angry. At this general meeting, he feels that if he doesn't show his presence, then even if there is a vacant seat in the future, it may not be his turn.

How to show presence? There must be different opinions. What's more, he is not showing different opinions just for the sake of showing different opinions. At least the newly added hepatic adenoma is very likely. If it turns out to be hepatic adenoma, then he will be eye-catching.

As for the fact that it turns out not to be the case in the end, that doesn't matter. It's just a discussion, not writing a medical record or making a final diagnosis. It doesn't matter. There won't be any loss anyway.

"I see that the most common type of cancer that you all see is neuroendocrine cancer. I also tend to be more inclined towards neuroendocrine cancer. Director Wu, what do you think?"

Everyone's eyes were focused on Wu Xiaofu. They had almost finished discussing this matter, and it would all depend on Wu Xiaofu's result. Well, they wanted to see if Wu Xiaofu could be innovative and come up with a diagnosis that they dared not think of otherwise.

If you just repeat what others say, there will be no point.

"Yes, it is indeed neuroendocrine cancer."

Ah!
Everyone looked at Wu Xiaofu in confusion. He was indeed just repeating what others had said. They said it was neuroendocrine cancer, and Wu Xiaofu also said that even if it was finally confirmed to be neuroendocrine cancer, Wu Xiaofu would not show any sign of anything.

But Wu Xiaofu's wording surprised them a little.

indeed!

Wu Xiaofu made a direct diagnosis. You know, this was not how they discussed it before. They used words like possibility, tendency, etc. By speaking this way, even if the discussion was wrong in the end, it would not be a big deal.

But Wu Xiaofu was too young to make the diagnosis directly. What if the later diagnosis was not neuroendocrine cancer? It would be too embarrassing. If Wu Xiaofu participated in a similar consultation in the future, it would be impossible for him to maintain his current status.

Originally, because Wu Xiaofu was very capable, even though Wu Xiaofu was young, people would not say that Wu Xiaofu was a talker and not reliable. However, this time he seemed a little unstable. If he was really wrong, they would have something to say about him in the future.

Well, the effect was very obvious. After hearing what Wu Xiaofu said, they couldn't say anything more to ridicule him.

The way Wen Xinhan and Lian Jingwei looked at Wu Xiaofu also changed. Wu Xiaofu was still Wu Xiaofu, as energetic as ever.

At this moment, they all seemed to remember that it was the same when they were young.

However, the current medical environment is like this. No matter what time it is, they cannot speak with certainty. Even if it has been confirmed, they have to say it is possible or perhaps, and 100% has to be said to be 90%.

Even if it is an internal meeting in the hospital, it is basically the same, because within the hospital, it is not that everything will be fine after you finish speaking. This is an internal consultation within the department. Look at the corner, there are real-time records.

Because of Wu Xiaofu's words, the entire conference room fell silent. At this moment, it seemed as if all the air had been sucked out.

Cheng Shi and Jiang Bei both sensed that something was wrong with the atmosphere.

It’s so awesome, so great, and it has to be our boss. After other directors finished speaking, it didn’t have this effect. They just looked at their own boss, this is the face of the show.

It was Wu Xiaofu who broke the silence.

"The incidence of neuroendocrine cancer is about 1.5/100,000, and it is more likely to occur in the gastrointestinal tract, pancreas, lungs and other parts of the body. Those that occur in the liver are mostly metastases from other organs. Neuroendocrine cancer that originates in the liver is extremely rare, accounting for 1% to 5% of liver tumors.

In fact, there is no age or gender preference, no specific clinical symptoms and signs, and no history of hepatitis or cirrhosis.

The patient's medical history is actually very similar, and the MRI results are also very clear. Everyone here is an experienced director, and they have seen more films than they have eaten. We rarely see neuroendocrine cancer, but we see a lot of primary liver cancer, hepatic adenoma, etc.

Does it look like that? No.

If we rule out the impossible, then the only thing left is the possibility. As for whether it is true or not, that is also easy to determine, just do a pathology test.

If it is really neuroendocrine carcinoma, typical neuroendocrine granules can be seen under the pathological microscope. In terms of immunohistochemistry, CgA, Syn, and NSE are neuroendocrine markers with high sensitivity and specificity, which are important bases for the diagnosis of neuroendocrine carcinoma. "

Pathology, everyone knows this, everyone couldn't help but roll their eyes, isn't it still without a confirmed basis, it's still speculation, but just like Wu Xiaofu said, exclude all the impossible, then only the possibility remains.

After Wu Xiaofu said this, everyone was more inclined to believe it was neuroendocrine cancer.

Wen Xinhan also nodded and said, "I also tend to think it's neuroendocrine cancer. Okay, let me say something behind closed doors. This patient is a family member of a leader. The pathology has been done, but we still have to wait. However, our treatment plan must be put first and cannot be delayed.

Now let's talk about, if it is really neuroendocrine cancer, how should we treat it? "

Leaders’ family members!

Everyone showed signs of enlightenment. No wonder Wen Xinhan was so anxious to gather so many of them together for a consultation. So that's the reason.

If the door is closed, the recorder won’t keep any record.

The treatment plan has been made in advance, but the pathology has not yet come out. If there is a mistake, it will be a waste. The importance of it is self-evident. People were actively discussing it just now, but now they have fallen silent.

This is not about finding their relationship. It's a serious matter and it would be difficult to deal with it if we get it wrong.

Wen Xinhan looked at everyone and couldn't help but shook his head. Finally, he looked at Wu Xiaofu. Wu Xiaofu smiled and continued, "Neuroendocrine cancer is a slow-growing, low-grade malignant tumor with a long survival period. The tumor is a tumor with rich blood supply. Interventional embolization and perfusion can achieve better treatment effects, which is much better than surgery.

Given the patient's current condition, I prefer embolization."

(End of this chapter)