AUSTIN CANCER CENTER

Experienced specialists. Advanced treatment. The standard for compassionate care.

MRN:
PATIENT:
DOS:
DOB:
TOV:
Chief Complaint:

A150448
BABU,JOSE
12/04/2015
10/29/1983
Follow Up Visit
"I'm not doing well."

Doctor:

Benjamin J. Downie, M.D.

HEMATOLOGIC-ONCOLOGIC PROBLEM LIST:

1. Rhabdomyosarcoma of the epididymis, right sided, metastatic, with pulmonary involvement, diagnosed in
the setting of a right-sided testicular mass, prompting testicular ultrasound on 10/24/2014, revealing an
extratesticular mass on the right side with CT imaging ofthe abdomen and pelvis on 12/03/2014 revealing an
incidental finding of gallbladder sludge but no evidence of metastatic disease with repeat ultrasonography on
12/26/2014 revealing a new heterogeneous extratesticular mass in close proximity to the previous,
communicating with the previously seen smaller mass, prompting right-sided orchiectomy performed on
12/3112014 by Dr. Koushik Shaw, revealing what was initially reported as an epithelioid leiomyosarcoma,
measuring 8.5 em in maximal dimension, grade 3, diffusely involving the peritesticular space with necrosis
involving approximately 50% of the total tumor volume with all margins negative for tumor and no evidence of
LVI noted with subsequent review at M. D. Anderson altering this diagnosis to rhabdomyosarcoma of the
epididymis. PET/CT imaging performed on 03/13/2015 revealed multiple pulmonary metastases with several
foci of markedly increased activity seen in the lungs bilaterally, corresponding to pulmonary nodules seen on
the CT portion of the exam with a maximum SUV of which was seen in a lesion of the infrahilar left lower lobe,
measuring 16.4, with a suspicion for small soft tissue metastases in the scrotal raphe, as well as a suspicion for
small metastases in the left prostate, though this could not be confirmed on CT and was not clinically palpable
at the time ofPET/CT imaging by Dr. Koushik Shaw.
- Status post initiation of induction chemotherapy with Cytoxan, doxorubicin, and vincristine on 03/10/2015,
alongside Neulasta growth factor support and dexrazoxane, as cardioprotectant. The patient developed a
neutropenic fever one week after his first cycle of therapy.
- Status p~st progression documented on PET/CT imaging at MD Anderson August 2015, prompting transition
to gemcitabine/Taxotere therapy on 08/25/2015.
Status post development of shortness of breath and cough with CT imaging performed on 11117/2015
revealing interval development of a right-sided pleural effusion with right pleural-based metastases and bulky
lymphadenopathy, all of which was new compared to PET/CT imaging having been performed one month prior
on 10/2112015 atM. D. Anderson Cancer Center.
- Status post transition to third-line therapy with irinotecan 30 mg/m2 on days #1 through #5, Temodar 100
mg/m2 on days #1 through #5 orally, and vincristine 2 mg flat dose with Neulasta growth factor support to be
dosed every 21 days.
RADIATION ONCOLOGY: Terry Boyle, MD I George R. Brown, MD I Stephen L. Brown, MD I Shannon Cox, MD
Paiman Ghafoori, MD I Matthew McCurdy, MD I Douglas J. Rivera, MD I Kirsten A. Warhoc, MD
HEMATOLOGY I MEDICAL ONCOLOGY: Benjamin J. Downie, MD I Allison E. Gorrebeeck, MD

Gerald Hagin, MD I Brian J. Shimkus, MD I Sanjay Vin (Vinjamaram), MD

NEURO ONCOLOGY: Brian Vaillant, MD
SURGEONS: Jane C. Nelson, MD, FACS I Caroline H. Coombs-Skiles, MD, FACS I Sherrie Parker, MD
Phone: Appt. Line 512.505.5500 I Medical Records 512.334.2898 I Fax: 512.334.2702 I www.AustinCancerCenters.com

Page 2 of3
PATIENT: BABU, JOSE

DOB: 10/29/1983

MR: A150448

PAST MEDICAL HISTORY:

1.
Seizure disorder, suffered initially in 2011 while driving, prompting initiation of Keppra, which the
patient remains on to this day.
2.
Status post right-sided orchiectomy, as detailed above.
MEDICATIONS: Keppra twice per day.
ALLERGIES: No known.
INTERVAL HISTORY: Mr. Babu has progressive shortness ofbreath. He has a PleurX in that drained 50 cc
yesterday, 150 cc the day before. He has diffuse anasarca.
FAMILY HISTORY: Negative for known oncologic conditions.
SOCIAL HISTORY: The patient is married and had a daughter born in 2014. He was married in 2012. He
and his wife are from India. The patient works in IT. He denies any tobacco, alcohol, or illicit drug use. He
lives in North Austin with his family.
REVIEW OF SYSTEMS:
GENERAL: See above in Interval History.
SKIN: No reported skin, hair, nail changes; no reported itching, rashes, sores, lumps, nor moles.
HEAD, EYES, EARS, NOSE and SINUSES: No reported trauma; no reported visual changes, blurriness or
itching; no reported hearing loss, tinnitus, vertigo, earache; no reported rhinorrhea, stuffiness, sneezing, itching,
allergy nor epistaxis.
NECK: No reported swollen neck, mass, nor goiter.
LYMPHATIC:
No reported anterior or posterior cervical, supraclavicular, axillary, nor inguinal
lymphadenopathy.
CHEST: See above in Interval History.
CARDIAC: See above in Interval History.
BREAST: No reported masses, lumps I bumps, skin changes, nor discharge.
GI: Patient endorses some bloating.
GENITAL: No reported discharge, bleeding, nor pain.
.
URINARY: No reP.orted change in urinary output, frequency, hesitancy, hematuria, nocturia, nor incontinence.
EXTREMITIES: See above in Interval History.
NEUROLOGIC: No reported focal paralysis, change in mental status, seizUres, headaches, loss of sensation,
numbness, tingling, tremors, nor vertigo.
PSYCHIATRIC: No reported change in mood, anxiety, nor memory.
HEMATOLOGIC: See above in Interval History.
PHYSICAL EXAMINATION:
Vital Signs: Weight up 4 pounds to 184 pounds, temperature 97.9, pulse 118, respiratory rate 40, blood
pressure 120/80.
GENERAL: The patient is a pleasant 32-year-old male in no acute distress.
SKIN: Peftinent" for generalized pallor.
HEAD: Normal size and shape, no trauma noted.
EYES: Pupils equal, round, and reactive to light. No evidence of conjunctival pallor. No scleral icterus.

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Page 3 of3
PATIENT: BABU, JOSE

DOB: 10/29/1983

MR: A150448

NOSE/SINUSES: Symmetrical, nontender, normal mucosa without turbinate inflammation. Sinuses nontender
to palpation.
MOUTH/THROAT: Moist mucous membranes. No ulceration noted. Normal dentition. No pharyngeal
erythema.
NECK: Supple. No masses, goiter, tracheal deviation, nor bruit appreciated.
LYMPHATIC: No anterior I posterior cervical, supraclavicular, axillary, nor inguinal lymphadenopathy.
CHEST: Patient has diminished breath sounds at the bases.
CARDIAC: Regular rate and rhythm. No murmurs, gallops, nor rubs appreciated.
BREAST: Deferred.
ABDOMINAL: Normal bowel sounds, soft, nontender and nondistended. No masses nor organomegaly
appreciated.
GENITAL-URINARY: Deferred.
EXTREMITIES: Patient has 2+ to 3+ lower extremity edema.
NEUROLOGIC: Deferred.
DATA: None.
IMPRESSION & PLAN: Mr. Babu is a 32-year-old male with metastatic rhabdosarcoma of the epididymis
with pulmonary involvement and pleural-based disease who has progressed rapidly and will be transitioned to
third-line therapy with vincristine, irinotecan and oral Temodar as detailed above with Neulasta growth factor
support and will plan to fly out of the country to India the weekend following. We will fill up paperwork to
make arrangements for home oxygen. Will fill out paperwork for FMLA. We are going to increase his pain
meds to include MS Cantin, write for some Roxanol, and will see the patient back next week to see how
treatment goes.

Electronically Approved By: Benjamin J. Downie, M.D. on 12/4/2015 4:09:47 PM

D: 12/04/2015 15:08
T: 12/04/2,015 15:33
cc: Koushik Shaw, M.D., FAX: 512-973-3036
Natalie Burger, M.D., FAX: 512-451-0977
Dejka Araujo, M.D., FAX: 713-794-1934
Dominic Dekeratry, M.D., FAX: 512-819-9335

AUSTIN CANCER CENTER

Experienced specialists. Advanced treatment. The standard for compassionate care.

PATIENT: BABU, JOSE

Attending MD: Benjamin J. Downie, M.D.

MR# A150448

DOB: 10/2911983

Date of Service: 12/03/2015

I have discussed the patient's case with Dr. Dejka Araujo, cell phone (713)410-6397. I have discussed with her
the patient's progression of metastatic disease with a malignant pleural effusion. She has recommended
initiation of palliative vincristine, irinotecan, and Temodar therapy with vincristine dosed at 2 mg flat dose IV,
irinotecan dosed at 30 mg/m2 days 1 through 5, and Temodar dosed at 100 mg/m2 orally days 1 through 5 with
the addition ofNeulasta growth factor support. We will make arrangements to move forward with said therapy
beginning early next week and we will also order PET/CT imaging to establish a new baseline. The patient has
been made aware of our plan as detailed here.

Electronically Approved By: Benjamin J. Downie, M.D. on 12/4/2015 4:09:47 PM

D: 12/03/2015 17:22
T: 12/03/2015 19:13

RADIATION ONCOLOGY: Terry Boyle, MD I George R. Brown, MD I Stephen L. Brown, MD I Shannon Cox, MD
Paiman Ghafoori, MD I Matthew McCurdy, MD I Douglas J. Rivera, MD I Kirsten A. Warhoe, MD
HEMATOLOGY I MEDICAL ONCOLOGY: Benjamin J. Downie, MD I Allison E. Gorrcbceck, MD
Gerald Hagin, MD I Brian J. Shimkus, MD I Sanjay Yin (Vinjamaram), MD
NEURO ONCOLOGY: Brian Vaillant, MD
SURGEONS: Jane C. Nelson, MD, FACS I Caroline H. Coombs-Skiles, MD, FACS I Sherrie Parker, MD

Phone: Appt. Line 512.505.5500 I Medical Records 512.334.2898 I Fax: 512.334.2702 I www.AustinCancerCenters.com