Name Mr.

ASHUQULLA ABDOLRAZIQ Lab No lab449038

AGE/SEX Male Perform Date 09-Dec-2023
Consultant Inch. ARIF SARWARI Pre Samples ?
DATE OF 09-12-2023 Regn. No. RE0532390
REPORTING
Discharge Summary
DISCHARGE OF REQUEST

FINAL DIAGNOSIS:

Left posterior frontal space occupying lesion? Low-grade glioma (final histopathology
Report awaited)

Operation Title and Date:

Left front parietal image-guided craniotomy and Fluorescein-aided microsurgical

Decompression of tumor done under general anesthesia on 23/07/2020 by
Dr. B. K. Nadeem

CHIEF COMPLAINT AND HISTORY:

The patient is admitted with complaints of sudden onset weakness of right upper limb
Since 15 days. Weakness was persistent and nonprogressive. The patient is a known
Case of ADHD since 2 years and was on behavioral therapy.
PERTINENT PHYSICAL FINDINGS:

On examination:
General examination: Normal
Vitals - Stable.
G/C - Normal
Higher mental function - Normal
Cranial nerve examination:
Visual acuity - Counting fingers at 6 feet in both eyes.
Visual fields - Normal
Fundus examination - Normal,
3'*. 4''. 6" nerve examination - Normal.
5' nerve examination - Normal.
7"nerve examination - Normal.
g' nerve examination - Normal.
Lower cranial nerve examination - Normal.
Motor system examination:
Power: Right side upper limb grade 3/5 and lower limb 4+/5
Handgrip: Right side weak
Sensory system examination: Normal.
Deep tendon reflexes: Normal and plantar reflexes were flexor bilaterally.
Cerebellar system examination: Normal
Name Mr. ASHUQULLA ABDOLRAZIQ Lab No lab449038
AGE/SEX Male Perform Date 09-Dec-2023
Consultant Inch. ARIF SARWARI Pre Samples ?
DATE OF 09-12-2023 Regn. No. RE0532390
REPORTING
DEPARTEMENT OF IMAGING

* EXAMINATION*
MRI BRAIN WITH CONTRAST
* REPORT DETAILS *

Multiplanar multiecho MRI of the brain has been performed 8 ml of Clariscan.

Clinical profile: The patient is known case of left frontal glioblastoma status post surgery and chemo Radiotherapy.
Previous outside MRI study dated 20/09/2022 was available for review. However, exact Comparison is not possible
due to technical differences.

Left parietal craniotomy status noted with underlying mild dura thickening and enhancement - postoperative.
Well-defined lobulated solid cystic lesion is noted in the left high frontoparietal region with involvement of the pre
Central gyrus. Cystic component appears hyperintense on T2 and FLAIR with few internal isointense septations
In addition, shows peripheral and septal enharicement (no enhancement previously). It measures about 3 x 2.5cms
(1.8 x 1.3 cms previously) and about 3.6 cms in supero-inferior extent (1.5 cm previously). The eccentric solid
Component shows T2 intermediate to mildly hyperintense solid component along the left lateral aspect now

Appears to be stretched and along elongated and measures about 2.5 x 1.4 cm in the coronal plane (2x 0.9 Cms
previously) and about 2 cms in AP dimensions (1.5 cms previously)

Note is made of associated mild surrounding ill -defined nonenhancing T2 FLAIR hyperintense edema with no
Restricted diffusion involving the left frontoparletal subcortical and deep white matter extending inferiorly up to
the adjacent portion of the left centrum semiovale (mildly increased since the previous study).

The brainstem and cerebellum appear unremarkable.

Ventricular system appears unremarkable. No evidence of hydrocephalous. No evidence of midline shift -

Herniation:

Major intracranial flow voids appear unremarkable. No leptomeningeal enhancement or other parenchymal
Enhancing lesions.

Minimal mucosal thickening noted in bilateral ethmoid air cells.

IMPRESSION:
The patient is known case of left frontal glioblastoma status post surgery and chemo radiotherapy. Previous
Outside MRI study, dated 09/12/2022 was available for review. However, exact comparison is not possible due to
Name Mr. ASHUQULLA ABDOLRAZIQ Lab No lab449038
AGE/SEX Male Perform Date 09-Dec-2023
Consultant Inch. ARIF SARWARI Pre Samples ?
DATE OF 09-12-2023 Regn. No. RE0532390
REPORTING
DEPARTEMENT OF IMAGING

Technical differences.

Left parietal craniotomy status noted with underlying mild dura thickening and enhancement - postoperative.

Well-defined lobulated solid cystic lesion now showing septal - peripheral enhancement, with an eccentric
irregular solid enhancing component in the left high frontoparietal region. The cystic component shows mild to
moderate increase in size since the previous study), with the solid component now stretched along its margin
and also appears more prominent, with mild increase in the surrounding T2 FLAIR hyperintense edema, These
findings suggest recurrent/ residual lesion along
With post, treatment changes and needs further follow-up.

Dr Barylai Noori MD.

Clinical Associate.

Report status: Validated / Dr. Baryalai , Noori

Comment:
MRI and CT are roughly equivalent in detecting metas- tases, high-grade gliomas, and meningiomas that are
common in this older age group; CT is particularly indicated when cost, facility access, pacemaker, cranial metal,
agitation, claustrophobia, or back or arthritis pains preclude MRI scanning
Age < 40 yr Any new onset of cognitive or emotional dysfunction if associated with headache, nausea and
vomiting, papilledema, seizures, or focal deficits Unresponsiveness to appropriate drug treatment of presumed
psychiatric disease
Comment:
MRI is preferable to CT because it more accurately detect! Low-grade astrocytomas and oligodendrogliomas,
which tend to occur in this age group

DR. Baryalai Noori - M.D.

CONSULTANT – RADIOLOGIST
Name : ASHUQULLA ABDOLRAZIQ Age : 32y Gender : Male

HH NO : 1767817 RT 20321 DATE: 29-DEC-2023

DIAGNOSIS : High-grade glioma

TRUEBEAM

Course : C1, VMAT-IGRT

Treatment Energy Dose/Fx #Fx Total Dose Start Date End Date
Site (cGy) (cGy
PTV1_T2 6X 180 25 / 25 4,500 14-Nov-2023 19-Nov-2023

PTV2_T1c 6X 180 8/8 1,440 20-Dec-2023 29-Dec-2023

Remarks: After immobilization and CT-MRI fusion based simulation, patient was planned for
VMAT treatment, with daily CBCT verification (IGRT). Dose received by the post operative
Tumour bed and edema is 45Gy, and by the surgical cavity is 59.4Gy. He also received
Concurrent daily temozolomide (75mg/m2) with RT. He tolerated the treatment well and is
Advised to come for follow up after 4 weeks.

Approve By : Dr ARYAN DAUDZAI

Date : 29-DEC-2023
Name Mr. ASHUQULLA ABDOLRAZIQ Lab No lab449038
AGE/SEX Male Perform Date 09-Dec-2023
Consultant Inch. ARIF SARWARI Pre Samples ?
DATE OF 09-12-2023 Regn. No. RE0532390
REPORTING
MOLECULAR PATHOLOGY REPORT
Final Report
Histone Mutation Detection Assay
Result: Negative for Histone mutations

Procedure: DNA was extracted using Qiagen kit and was subjected to PCR using specific
primers for H3.3
(H3F3A) and H3.1 (HIST1H3B). The PCR product was purified using EXOSAP-IT (USB) followed by
Big Dye
Terminator Cycle sequencing v 3.1 kit (ABI). Gene specific PCR and cycle sequencing was
performed in Veriti
Thermal cycler (ABl). Sequencing product purification was done using Big Dye X-Terminator Kit
(ABl) and was
Subjected to sequencing on 3500 Genetic Analyzer (ABl). The chromatograms were analyzed on
Sequence
Analysis software.

Interpretation:
Sequencing showed no alteration in the nucleotide sequence (ie showed AAG (Lysine]) at codon
27 on exon
of H3F3A, codon 27 on exon 1 of HIST1H3C genes and at codon 34 (I.e. showed GGG
[Glycine]on exon 1 of
H3F3A. HIST1H3B is uninterpretable due to non-readable sequence

Comments:
The tumor is negative for histone (H3.3K27, H3.3G34 & H3.1K27) mutations.

This test will not detect mutations outside of the target regions that may have clinical significance. This result must be
evaluated in conjunction with other clinical and laboratory parameters. The standardization and performance of the assay has
been determined by Molecular Pathology Laboratory, Amiri Hospital. This test is used for clinical purposes.

Analyzed By : JABAR ORYAKHAIL Finalized By: SONYA DANESH

 Dated 03/01/2024
TO WHOM IT MAY CONCERN

This is to certify that Patient Ashuqulla “Abdolraziq” is a diagnosed case of (frontal Brain
Tumor) Patient Needs urgent surgery!
The modern surgery of brain tumor is not available in Afghanistan as per the advice of Pakistan
hospital that patient received he has to travel Pakistan for treatment and medical equipment
Please process their request for the medical treatment
For any question, feel free to call me
0093796-08-08-08
Thanks & Regards:
Amiri Hospital
Dr. Mirwais Amiri