Siraraj Oncology request for Sheryl

[d2g]

I can't find the previous messages on this topic so I hope this works.

I got the pathology summary report today from Bangkok Pattaya Hospital.

They said I could pick up the biopsy slides and other paper work next Friday(6Dec.)

Following is a retyped copy of the summary.

 

Formalin fixed specimen labeled with the patients name and accession number and unlabeled oviously cut ellipse of light brown skin and subcutaneous tissue measuring 4.2x1.5x1.5 cm. The cut section

shows a rubbery orange yellow area, measuring 1.5x1.5x1.3 cm close to the deep margin.

                          Sections A1-A3: Lesion with peripheral and deep margins IV

                                                                                             NUTPACHA CHOTIKAWICHEAN M.D.

Microscopic Description

Sections show solid growth pattern pf the tumor cell aggregation that is composed of large, round to oval

polygonal cells, with hyperchromatic nuclei, inconspicuous nucleoli, and a varying amount of eosinophilic cytoplasm. The

tumor also shows increased increased mytotic activity, including atypical forms.

 

PATHOLOGIC DIAGNOSIS

 

MASS AT LOWE RIGHT CHEST;

POORLY DIFFERENTIATED NEOPLASM

PLEASE REQUES IHCS (/AE1AE3, CK7, CK20,P63, S-100, SOX-10, CD45, AND CD30 IN BLOCK

A1 TO DEFINATE TYPE OF TUMOR CELLS

 

After  get the remaining paper work and the biopsy slides I will make an appointment with the Siraraj oncology dept. per your 

suggestion.

Could you suggest specific Dr(s) to request for appt?

Thank you

                                                                                   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Sheryl]

Prof.Dr. Apichat Asavamongkolkul

He is a leading specialist in musculoskeletal oncology including soft tissue tumors

 

At Siriraj and also Bangkok Hospital (Bangkok) and  Bumrungrad. Bummers more convenient location, Siriraj lower cost, Bangkok Hospital being affiliated with BPH might be easier in terms of arranging subsequent follow up in Pattaya if needed..take your pick

 

https://www.bumrungrad.com/doctors/Apichat-Asavamongkolkul

https://bhqdoctors.bdms.co.th/bdms/pages/eng/doctorProfile.php?id=614

http://www.siphhospital.com/en/home

 

From the biopsy results you list, they have not diagnosed malignancy, they were unable to determine. "Tumor" and "neoplasm" can be benign or malignant, often people hear tumor and assume cancer. Maybe it is but equally maybe it is not.

 

Additional examination of the tissue sample by a pathologist will be the first step but as you usually can't go directly to pathologist see Prof. Apichart first

[d2g]

Sheryl, there aren't words to describe my gratitude for your assistance.

As soon as I get the rest of the documentation I will make an appointment to see Dr. Apichat.

I think I will go to Bumrungrad because trips to Bangkok are very hard for me at the best.

I had heart surgery there 14 yrs. that went well also.

My deepest thanks to you

 

[d2g]

I now finally have a diagnosis, sebaceous carcinoma.

Dr. Apichat says that he only treats bone cancer patients.

Sheryl, could you suggest an Oncologist at Bumrungrad that specializes in treating sebaceous carcinoma.

I will be very grateful for any advice you may offer.

[Sheryl]

Prof. Jane Manonukol at Siriraj has far and away the most expertise in this type of cancer of anyone in Thailsnd.

 

Should be able to see her through their private wing. 

www.siphhospital.com/en/home

 

As far as I have been able to discover  she is not at any other hospital.

 

I know it is a trip for you but this is an aggressive and comparatively rare cancer. 

 

Might it be possible to return to your home country for care? If so I tecommend ot. If not then I recommend Siriraj.

[d2g]

Thank you very much for the very helpful, fast response.

the link no longer works, I will have my wife(Thai) call Siriraj hospital and make an appointment to see Dr. Manonukol.

If it becomes necessary to return to the U.S. for treatment,the least difficult place for me would be the UCLA medical center in Los Angeles.

I have a medical history there and a friend nearby to stay with.

If essential I could go to Anderson cancer center in Houston, Mayo clinic or?

Any information, suggestions you could offer would be deeply appreciated.

[Sheryl]

Have her call 1474 that is the call center for the private wing.

 

UCLA has some good dermatologists.  However the only published work on treatment of sebaceous carcinomas there I find are old and those doctors now deceased.  You could call their Derm dept and ask if any now on staff have experience with this.  310 825 6911 

[d2g]

Thanks again Sheryl, you have been the ray of light for me in this experience.

[d2g]

Siriraj hospital has told my wife that Dr. Jane Manonukol is not employed at the hospital.

Is there a national register for doctors in Thailand to determine where she now works?

[macleans]

Have your wife google him (he's a male doctor) using his Thai name and surname "เจน มโนนุกุล" with quotation marks.

 

From the search results, it seems like he's already retired but still holding an emeritus professorship at Siriraj. I also looked into the website of the department of dermatology at siriraj (in Thai), but did not see his name listed in any of the divisions (see the link), especially the dermatopathology division where his name's supposed to be listed if he still works there (https://www2.si.mahidol.ac.th/department/dermatology/About-Us/Pathology-Division).

 

Perhaps you can ask your wife to call the department and ask if and where he still practices.

Edited January 14, 2020 by macleans

[d2g]

Thank you again.

We are following up on your suggestions.

If this effort is unsuccessful, could you recommend an Oncologist at Bumrungrad hospital.

I have been pleased with care there in the past and would like to consult there before trying to arrange a trip back to the U.S.

Thanks in advance for any information you may provide.

[Sheryl]

An oncologist is not where to start with this. the first line of treatment is surgical excision and needs to be done rather urgently as this is a very aggressive type of cancer. A dermatologist manages this sort of treatment and will refer to a radiation oncologist if he/she thinks it advisable.

 

It is also an extremely rare and often misdiagnosed type of cancer, which raises the question of whether the path report is totally reliable.

 

If you can make the trip, the best person to see given Prof. Jane's unavailability would be Dr. Anna at Bangkok Pattaya Hospital as cancers of the skin is her specific specialty. Also, she has a pathologist she uses whom she has confidence in (I am not sure if in country or she sends slides out) and a second opinion on those slides (which you should get if you have not already) would be a good idea.

 

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=7&depid=2

 

I have myself driven to Pattaya just to see her and I am further away than Bangkok. It was well worth it.

 

While there are some good dermatologists at Bumrungrad I doubt any of them have experience with this type of skin cancer, indeed none of them are what I would consider expert in seven more common skin cancers as these are rare in Thais (sebaceous carcinomas are rare in everyone).

 

https://www.mayoclinic.org/diseases-conditions/sebaceous-carcinoma/cdc-20352957

[d2g]

Thank you very much.

I have had three tumors on my chest and back removed at Bumrungrad, all were diagnosed as sebaceous carcinoma after some confusion and repeated pathologist tests.

Bangkok Pattaya is is very convenient for me.

I will make an appointment to see Dr. Anna today.

Based on the results of that consultation I will consider the decision to return to the U.S.

Your advice has been invaluable to me, thank you very much.