Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: penicillins / bactrim / shellfish derived / dilaudid attending: chief complaint: neck pain major surgical or invasive procedure: : anterior t1 corpectomy(full) c7, t2 corpectomy(partial) : posterior c5-t4 fusion with icbg history of present illness: the patient is a 38 year old female who saw dr. in neurosurgery clinic on , for neck pain radiating to the right scapula. the pain began in and has become increasingly worse. she also has weakness in the right hand. she reports decreased sensation in the lateral aspect of the rue. the patient has no known cancer history. she has no bowel or bladder abnormalities. she has no sob or chest pain. past medical history: allergies and asthma s/p c-section social history: married, resides at home with twin four-year olds family history: no history of malignancy physical exam: exam on discharge: awake, alert to person, place and date. full strength/sensation in all extremities with the following exception: right finger intrinsics are and and right grip is 5-/5. there is decreased sensation to light touch over the right 4th and 5th digits. anterior and posterior wounds are clean, dry and intact. pertinent results: labs on admission: 03:30pm blood wbc-10.0 rbc-4.67 hgb-13.3 hct-40.8 mcv-87 mch-28.5 mchc-32.6 rdw-13.5 plt ct-367 03:30pm blood pt-12.4 ptt-32.4 inr(pt)-1.0 03:30pm blood glucose-91 urean-9 creat-0.7 na-138 k-4.2 cl-102 hco3-27 angap-13 04:40am blood calcium-9.0 phos-3.4 mg-2.0 labs on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:05am 10.4 3.16* 9.4* 27.9* 88 29.7 33.6 13.9 608 -------------------- imaging: -------------------- ct torso ct thorax: thyroid gland is unremarkable in appearance. heart is normal in size. there is no pericardial effusion. the abdominal aorta has a normal course and caliber. pulmonary vasculature is within normal limits. no enlarged hilar, mediastinal or axillary lymph nodes are identified. airways are patent. lungs are clear. there is mild atelectasis at the right lung base. no pleural effusions. of note, there is heterogeneous enhancement of the breast tissue, with areas of tiny nodular enhancement, bilaterally. ct abdomen: the liver is homogeneous in contrast enhancement without abnormal enhancing mass identified. there is no intrahepatic biliary ductal dilatation. portal and hepatic veins are patent. spleen, gallbladder, pancreas, and adrenal glands are unremarkable in appearance. kidneys demonstrate prompt and symmetric uptake and excretion of contrast. the visualized bowel is unremarkable in appearance without bowel wall thickening, inflammatory changes or obstruction. the abdominal aorta has a normal course and caliber. no enlarged intraperitoneal, retroperitoneal or mesenteric lymph nodes are identified. ct pelvis: bowel loops are unremarkable in appearance. uterus and ovaries are visualized. there is a nabothian cyst. no free fluid within the pelvis. no enlarged pelvic lymph nodes are identified. there is large destructive lesion eroding the t1 vertebral body and right pedicle. there is a soft tissue mass associated with this which is extending posteriorly into the cervical canal resulting in superior and leftward displacement of the thecal sac. this mass extends into the right neural foramen. no other osseous lesions are identified. impression: 1. large soft tissue mass eroding the entire t1 vertebral body and extending posteriorly into the central canal with posterior and leftward displacement of the thecal sac and complete effacement of the right neural foramen. 2. no other osseous lesions or metastasis within the chest, abdomen or pelvis. 3. heterogeneous nodular enhancement of the breast tissue bilaterally. multifocal dcis to be excluded and correlation with mammogram is recommended, especially in the setting of a lytic osseous lesion. ct c-spine 1. expected post-operative findings, immediately status post t1 corpectomy. 2. overall alignment maintained. 3. continued extensive bone destruction of the right pedicle and lamina of the t1 vertebral body with associated soft tissue density, better-evaluated very recent (metronorth mri) non-enhanced mri of . ct c-spine interval posterior spinal fusion from c4-t3 without immediate hardware complication. unchanged anterior spinal fusion at c6-t1. ct c-spine prelim impression: unchanged postop appearance of cervical and thoracic spine with no fractures noted. the imaging extends down from the craniocervical junction down to t8 vertebral body. note added at attneding review: i agree with the above interpretation, but note that the artifacts arising from fusion hardware obscure nearly all intraspinal soft tissue detail at the surgical levels. there is no evidence of hardware loosening or fracture. brief hospital course: patient was admitted from nsurg office for further evaluation of newly identified t1 lesion. upon admission, she was placed in a cervical collar, and ct torso obtained to evaluate for alternate solid mass disease. this was grossly unremarkable. mammogram was also obtained of the bilateral breasts on to evaluate for possible lesions. this was negative for any malignancy. cardiothoracic surgery was consulted for possibility of providing exposure of t1 body anteriorly, but it was decided that it was not necessary, and neurosurgery performed the procedure independently. on , ms. went to the or for t1 and t2 corpectomies. she tolerated the procedure well and was transferred to the icu to recover. her neurological exam remained stable, in fact slightly improved, and her pain was well controlled as well. she was transferred out of the unit to the floor on . the patient continued to have weakness in the intrinsic muscles on the rue as well as numbness in the last 2 digits in that hand. she had some difficulty swallowing and was placed on a modified diet. she had a swallowing evaluation and they agreed with the modified diet. on the patient went back to the or for stage ii of her procedure, which was a posterior fusion from c5-t3. she tolerated the procedure well and a hemovac drain was placed. this remained in until . she was out of bed with pt and ambulated well. her pain was well controlled on a mso4 pca, which was weaned off to po on . she was ambulating well and voiding and doing well with a regular diet. she developed a new lue numbness at her forearm and 5th digit. ct imaging was unchnaged. she was on a bowel regimen for constipation buthad flatus. she was discharged to home on , with follow up arranged for the same day. medications on admission: claritin 10neurontin 300 tid, vicodin prn, flonase 200 mcg, discharge medications: 1. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 2. loratadine 10 mg tablet sig: one (1) tablet po daily (). 3. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*0* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. oxycodone 5 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain: for breakthrough pain only. disp:*60 tablet(s)* refills:*0* 7. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). disp:*60 tablet sustained release 12 hr(s)* refills:*0* 8. methocarbamol 500 mg tablet sig: 1.5 tablets po qid (4 times a day). disp:*180 tablet(s)* refills:*0* 9. 3 way cammode discharge disposition: home with service facility: all care vna of greater discharge diagnosis: t1 osteolytic lesion **path: giant cell tumor of bone discharge condition: neurologically stable discharge instructions: diet: ?????? you may resume your normal diet. ?????? you can help avoid constipation by eating a balanced diet including: fruits, vegetables, and whole grains (like multi-grain bread, cereals, and bran muffins). ?????? you may also take fiber supplements and over-the-counter stool softeners or laxatives such as colace or dulcolax ?????? you may find that softer foods or thick liquids are easier to swallow initially after surgery, but swallowing should become progressively easier. activity: ?????? a hard collar has been ordered for you, wear it at all times except for when shaving or bathing. when the collar is off, keep your head in the same position as if the collar were still applied. ?????? avoid lifting overhead. ?????? avoid pushing/pulling and lifting over 15 lbs. ?????? walking is a good exercise. go for at least four short walks a day, even if inside your home. ?????? do not drive while still required to wear the collar. ?????? do not drive if you are taking pain medications, muscle relaxants, or if you are in pain. ?????? do your breathing exercises every two hours. ?????? use your incentive spirometer 10 times every hour that you are awake. ?????? you may resume sexual activity when this is comfortable for you. ?????? you can return to work when you feel ready. however, you must stay within the pound weight lifting restriction ?????? half days might be better at first. wound care: ?????? you may shower(incisional area down), however try not to let the water run directly over the incision. you not soak the incision in a bathtub or pool for 4 weeks. if your wound gets wet, gently , not rub the wound dry. ?????? your incision was closed with dissolvable under the skin. there are steri-strips in place, and these should stay on until the fall off on their own. the edges may begin to curl, and these may be trimmed(this is for the front part of your neck). you have in the back of your neck that must be removed. ?????? you may remove the dressing after 2 days after surgery. if there is still a small amount of bloody drainage, you can place a new sterile gauze dressing, otherwise you can leave the wound open to air. pain: ?????? hoarseness, sore throat, or difficulty swallowing may occur in some patients and should not be cause for alarm. these symptoms usually resolve in 1 to 4 weeks. ?????? take your pain medication as prescribed. you will likely only require narcotic pain medication for 2-3 days. after that timeframe, over the counter tylenol or acetaminophen will be sufficient. medications: ?????? take all of your medications as ordered. you do not have to take pain medication unless it is needed. it is important that you are able to cough, breathe deeply, and be comfortable enough to walk. ?????? do not use alcohol while taking pain medication. ?????? medications that may be prescribed include: ?????? narcotic pain medication such as dilaudid, percocet or vicodin ?????? muscle relaxant such as robaxin, flexeril or valium. take these as needed for muscle spasm. they will make you sleepy, so do not drive while taking these medications ?????? an over the counter stool softener for constipation (try dulcolax, milk of magnesia or ?????? correctal at first and magnesium citrate or fleets enema if needed). miscellaneous: * you have had a fusion, do not use non-steroidal anti-inflammatory drugs (nsaids) (e.g., aspirin; ibuprofen, advil, motrin, nuprin; naproxen sodium, aleve) for 6 months after surgery. nsaids may cause bleeding and interfere with bone healing. * do not smoke. smoking delays healing by increasing the risk of complications (e.g., infection) and inhibits the bones' ability to fuse. when to call the doctor ?????? a temperature of 101.5??????f or above ?????? increased redness, soreness, swelling or foul-smelling drainage from the incision ?????? new or increased numbness, tingling, or weakness in any extremity ?????? new onset of bladder or bowel incontinence. ?????? inadequate pain relief ?????? nausea or vomiting ?????? shortness of breath ?????? pain in your calf important instructions regarding emergencies and after-hour calls ?????? if you have what you feel is a true emergency at any time, please present immediately to your local emergency room, where a doctor there will evaluate you and contact us if needed. due to the complexity of neurosurgical procedures and treatment of neurosurgical problems, effective advice regarding emergency situations cannot be given over the telephone. ?????? should you have a situation which is not life-threatening, but you feel needs addressing before normal office hours or on the weekend, please present to the local emergency room, where the physician there will evaluate you and contact us if needed. followup instructions: follow-up appointment instructions ??????please return to the office in days (from your date of surgery) for removal of your staples/ and a wound check. although we try to be thorough, we may miss or staples. please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. ??????please call ( to schedule an appointment with dr. , to be seen in 6 weeks. ??????you will need an mri of the cervical spine(levels c1-t5) with & without gadolinium contrast. you also have an appointment scheduled with , md at the cancer institute on at 4pm. his office is located at: . the office phone number and fax are: (office), (fax), should you need to change your appointment or need additional directions to the building. procedure: imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges dorsal and dorsolumbar fusion of the anterior column, anterior technique other excision of joint, other specified sites excision of bone for graft, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique other cervical fusion of the posterior column, posterior technique insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae fusion or refusion of 4-8 vertebrae diagnoses: other constipation myelopathy in other diseases classified elsewhere major osseous defects extrinsic asthma, unspecified neoplasm of uncertain behavior of bone and articular cartilage 

Answer: The patient is high likely exposed to