CHIEF COMPLAINT: Leiomyosarcoma of the anterior right tibia.

PRESENT ILLNESS: Mr. [**Known lastname **] is a 43 year-old man
with a newly diagnosed leiomyosarcoma involving the soft
tissues anterior to the right tibia.  He had initially
detected a lump on the anterior surface of his right lower
extremity in [**2126-10-25**].  He was sent for an
ultrasound, which revealed a solid area of 2.6 by 1.0 cm that
was nontender to touch.  He did not seek any further
evaluation for this until [**2127-8-25**] when he began to
awaken in the night with pain in the area of the lump.  He
then received an MRI scan, which noted to be a slightly
increased interval in size to 3 cm and he was at this point
referred to Dr. [**Last Name (STitle) **] for orthopedic evaluation.  He was
seen on [**2127-10-13**] at which time Dr. [**Last Name (STitle) **] received
the CT scans that were performed on [**2127-10-14**] as well
as an MRI and a bone scan and plain films.  The bone scan did
show some mild increase uptake in the right tibia and the
distal left femur.  The plain film of the left distal femur
showed evidence of an enchondroma.  A CT and MRI were
significant for a periosteal reaction in the bone adjacent to
the small subcutaneous mass of low signal abnormality, which
did enhance diffusely and measured approximately 6 to 7 cm.
At this point biopsy was recommended.  He was taken to the
Operating Room by Dr. [**Last Name (STitle) **] on [**2127-11-17**] for an
incisional biopsy.  Final pathology report indicated a
malignant spindle cell neoplasm consistent with a
leiomyosarcoma.  The tumor was moderate cellular with
moderate cytologic atypia and rare mitosis.  Flow cytometry
revealed poly clonality to the B cells and mature lineage
antigens from B cells and T cells indicating no evidence for
a hematologic origin for this malignancy.  The surgical plan
of treatment was to take the patient to the Operating Room
for wide local excision of his leiomyosarcoma of the right
tibia followed by immediate reconstruction by the Plastic
Surgery Service with a gracilis free flap and split thickness
skin graft to cover the wound.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of connective and other soft tissue of lower limb, including hip
Mal neo soft tissue leg
Admission Date:  [**2128-2-16**]     Discharge Date:  [**2128-2-23**]

Date of Birth:   [**2084-9-4**]     Sex:  M

Service:  ORTHOPEDIC

CHIEF COMPLAINT:  Leiomyosarcoma of the anterior right tibia.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 43 year-old man
with a newly diagnosed leiomyosarcoma involving the soft
tissues anterior to the right tibia.  He had initially
detected a lump on the anterior surface of his right lower
extremity in [**2126-10-25**].  He was sent for an
ultrasound, which revealed a solid area of 2.6 by 1.0 cm that
was nontender to touch.  He did not seek any further
evaluation for this until [**2127-8-25**] when he began to
awaken in the night with pain in the area of the lump.  He
then received an MRI scan, which noted to be a slightly
increased interval in size to 3 cm and he was at this point
referred to Dr. [**Last Name (STitle) **] for orthopedic evaluation.  He was
seen on [**2127-10-13**] at which time Dr. [**Last Name (STitle) **] received
the CT scans that were performed on [**2127-10-14**] as well
as an MRI and a bone scan and plain films.  The bone scan did
show some mild increase uptake in the right tibia and the
distal left femur.  The plain film of the left distal femur
showed evidence of an enchondroma.  A CT and MRI were
significant for a periosteal reaction in the bone adjacent to
the small subcutaneous mass of low signal abnormality, which
did enhance diffusely and measured approximately 6 to 7 cm.
At this point biopsy was recommended.  He was taken to the
Operating Room by Dr. [**Last Name (STitle) **] on [**2127-11-17**] for an
incisional biopsy.  Final pathology report indicated a
malignant spindle cell neoplasm consistent with a
leiomyosarcoma.  The tumor was moderate cellular with
moderate cytologic atypia and rare mitosis.  Flow cytometry
revealed poly clonality to the B cells and mature lineage
antigens from B cells and T cells indicating no evidence for
a hematologic origin for this malignancy.  The surgical plan
of treatment was to take the patient to the Operating Room
for wide local excision of his leiomyosarcoma of the right
tibia followed by immediate reconstruction by the Plastic
Surgery Service with a gracilis free flap and split thickness
skin graft to cover the wound.

HOSPITAL COURSE:  The patient was taken to the Operating Room
as planned on [**2128-2-16**] where he received a wide
local excision of the leiomyosarcoma of the right tibia
followed by a gracilis free flap from the right leg with
split thickness skin graft from right upper thigh to the
right lower leg.  The operation went well without any
apparent complications and he was transferred to the PACU in
stable condition.  He had an excellent flap signal in the
PACU, which was checked with doppler and a V.A.C. was placed
prior to leaving the Operating Room and was set at 125 mmHg.
The patient was initially kept on bed rest and he was started
immediately on an aspirin for flap anticoagulation
protection.  The flap checks continued q one hours for a
total of 48 hours without any complications and he was
started on a diet on postoperative day two, which he
tolerated well and was advanced without any apparent
complications.  He remained afebrile in his postoperative
course with a stable hematocrit and stable chemistry panel.
His pain control was managed initially with an epidural by
the Acute Pain Service, which infused until postoperative day
three when he was found to be tolerating po well at which
time he was switched to OxyContin 20 mg po b.i.d. with
Oxycodone for breakthrough pain.

The V.A.C. dressing was taken down on postoperative day
number five for evaluation revealing nearly complete 100%
split thickness skin graft take and his flap continued to
look well with excellent doppler signal.  The donor site of
his split thickness skin graft was covered with Xeroform
dressing and was blow dried 30 minutes t.i.d. With good
effect.  He was started initially on leg dangling exercises
for five minutes three times a day, which was slowly
increased through his hospitalization to a maximum of 15
minutes three times a day.  He was made touch down weight
bearing With crutches and mobilized by physical therapy on
postoperative day number six, which he tolerated well without
any apparent complications.  On postoperative day number
seven the patient was found afebrile ni good condition
without any complaints of pain and he was cleared by the
plastics team for discharge with follow up in one week and
for daily dressing changes with Xeroform and a Kerlix wrap to
the site of his flap and split thickness skin graft.

From an orthopedic perspective Dr. [**Last Name (STitle) **] cleared the
patient for weight bearing as tolerated to his right lower
extremity and the patient will follow up with outpatient
physical therapy to regain strength in his right leg.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Home.

DISCHARGE MEDICATIONS.
1.  Aspirin 325 mg po q day.
2.  OxyContin 20 mg po b.i.d. for 10 days.
3.  Oxycodone 5/325, one tablet po q 4 to 6 hours prn pain.
4.  Colace 100 mg po b.i.d.
5.  Keflex 500 mg po q.i.d. for one week.

DISCHARGE INSTRUCTIONS:  Diet, resume a regular diet.
Activity, the patient may weight bear as tolerated to the
right leg.  He is to follow up with outpatient physical
therapy as needed.  He was cleared by plastic surgery to do
15 minute leg dangles three times a day starting today on
[**2128-2-23**] and he should increase this by five minutes
every day until a maximum of 30 minutes per day.  The patient
was instructed to call his physician or return to the
Emergency Department if he developed any fevers or chills,
temperature greater then 101.5 degrees, redness, swelling,
discharge from the surgical site or if he is unable to eat or
drink.

FINAL DIAGNOSES:
1.  Leiomyosarcoma of his right lower extremity.
2.  Status post wide local excision of a leiomyosarcoma of
the right leg With prophylactic plate fixation, gracilis free
flap with split thickness skin graft on [**2128-2-16**].

RECOMMENDED FOLLOW UP:
1.  The patient is to follow up with Dr. [**Last Name (STitle) **] within two
weeks.  He should call to schedule this appointment.
2.  The patient is to follow up with the [**Hospital 3595**] Clinic
within one week.  He was given the number to follow up and to
make this appointment.






                          [**Name6 (MD) 251**] [**Last Name (NamePattern4) 14200**], [**MD Number(1) 54319**]

Dictated By:[**Last Name (NamePattern1) 22434**]

MEDQUIST36

D:  [**2128-2-23**]  08:55
T:  [**2128-2-25**]  08:39
JOB#:  [**Job Number 54320**]
{'Malignant neoplasm of connective and other soft tissue of lower limb, including hip'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Leiomyosarcoma of the anterior right tibia.

PRESENT ILLNESS: Mr. [**Known lastname **] is a 43 year-old man
with a newly diagnosed leiomyosarcoma involving the soft
tissues anterior to the right tibia.  He had initially
detected a lump on the anterior surface of his right lower
extremity in [**2126-10-25**].  He was sent for an
ultrasound, which revealed a solid area of 2.6 by 1.0 cm that
was nontender to touch.  He did not seek any further
evaluation for this until [**2127-8-25**] when he began to
awaken in the night with pain in the area of the lump.  He
then received an MRI scan, which noted to be a slightly
increased interval in size to 3 cm and he was at this point
referred to Dr. [**Last Name (STitle) **] for orthopedic evaluation.  He was
seen on [**2127-10-13**] at which time Dr. [**Last Name (STitle) **] received
the CT scans that were performed on [**2127-10-14**] as well
as an MRI and a bone scan and plain films.  The bone scan did
show some mild increase uptake in the right tibia and the
distal left femur.  The plain film of the left distal femur
showed evidence of an enchondroma.  A CT and MRI were
significant for a periosteal reaction in the bone adjacent to
the small subcutaneous mass of low signal abnormality, which
did enhance diffusely and measured approximately 6 to 7 cm.
At this point biopsy was recommended.  He was taken to the
Operating Room by Dr. [**Last Name (STitle) **] on [**2127-11-17**] for an
incisional biopsy.  Final pathology report indicated a
malignant spindle cell neoplasm consistent with a
leiomyosarcoma.  The tumor was moderate cellular with
moderate cytologic atypia and rare mitosis.  Flow cytometry
revealed poly clonality to the B cells and mature lineage
antigens from B cells and T cells indicating no evidence for
a hematologic origin for this malignancy.  The surgical plan
of treatment was to take the patient to the Operating Room
for wide local excision of his leiomyosarcoma of the right
tibia followed by immediate reconstruction by the Plastic
Surgery Service with a gracilis free flap and split thickness
skin graft to cover the wound.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of connective and other soft tissue of lower limb, including hip'}
