Case 1B.M, 44 yo, female, married, Filipino,

Roman Catholic, born on December 24, 1958 in Romblon City, presently residing at Hagdan-Hagdan, Romblon and was admitted for the 1st time at FMC on October 17, 2008.

Chief Complaint: Mass at the back

History of present IllnessPatient was born with a pigmented patch on

her back, 2x2 cm., brown in color, located at T4 level, non tender, soft upon palpation. There was no other associated signs and symptoms noted.

28 years PTA, she noticed multiple cystic masses on her face, body, and extremities with a size ranging from 0.5cm x 0.5cm to 2cm x 2cm. There was no other associated signs and symptoms noted.

2 months PTA, she noticed that the mass at the back became pruritic. She also noticed that it was slowly growing. No other associated signs and symptoms noted. No consultation was done.

1 month PTA, the lesion grew bigger still associated with slight tenderness. Due to persistence of the above and condition, patient sought consult, hence the admission

Past Medical HistoryStab wound, umbilical area – 2003

Family History+ Heart disease (Mother)- Lung, liver, kidney diseases- HPN- Malignancies- DM

OB and Gyne HistoryPatient is a G2P2 (2002). She had her menarche at age 12,

moderate in flow, consuming 3-4 napkins/day. No associated dysmenorrhea. Subsequent menses were regular at 28-30 days interval.

Review of SystemConstitutional: (-) fever, (-) weight loss, (-)anorexiaHEENT: (-) sore throat, (-) ear discharge, (-) blurring of visionCNS: (-) headache, (-) dizziness, (-) LOCCVS: (-) palpitation, (-)tachycardia, (-) orthopneaResp: (-) hemptysis, (-) colds, (-) coughGIT: (-) vomiting, (-) abdominal pain, (-) diarrheaGUT: dysuria, (-) hematuria, (-) oliguriaNMS: (-) arthralgia, (-)myalgia, (-)edema

Physical ExamGeneral Survey: Conscious, coherent, ambulatory, febrile not in distressVS: BP:120/80mmhg

CR: 84/minRR: 20/minT: 37.9 CWt: 60 kg

HEENT: Pink palpebral conjunctivae, white sclera, no tonsillopharyngeal congestion, (-) NAD, cystic masses generally distributed on the face

Neck: supple, (-) CLAD

C/L: symmetrical chest expansion, no retractions, no lagging, (+) 22cm x 24cm mass over the thoracic area level T4, soft, warm by touch with minimal erythema, clear breath sounds, no wheezes, no crackles

Heart: adynamic precordium, normal rate, regular rhythm, no murmur

Abdomen: flabby (+) 5cm linear scar umbilical area soft, non tender, normoactive bowel

Extremities: full and equal pulse

Skin: (+) generalized multiple cystic masses ranging from 0.5 x 0.5cm to 3x3 on face, body and extremities.