OpenOnco · Workup Brief · DIAGNOSTIC PHASE

Pre-tumor-board workup brief

DPLAN-PZ-DIAG-GBM-001-V1 · v1 · 2026-05-12

Patient

PZ-DIAG-GBM-001 · suspicion lineage: high_grade_glioma

Tissues: brain, left_frontal_lobe · Hypotheses: DIS-GBM, DIS-BRAIN-METASTASES

62M presents to neurology with progressive right-hand weakness + intermittent expressive aphasia (word-finding difficulty) × 3 weeks. No headache initially; recent onset mild morning headache + 2 episodes of focal motor seizure (right-hand twitching, no LOC). Brain_MRI_with_contrast: 4.2 cm left frontal mass with ring-enhancement, central necrosis, surrounding T2 vasogenic_edema, midline shift 4 mm. Left precentral cortex involvement. No leptomeningeal enhancement. Started dexamethasone 4 mg q6h + levetiracetam 500 mg BID. Imaging strongly suspicious for glioblastoma vs metastatic disease — biopsy required.

Workup steps (5)

1imaging MRI brain with gadolinium contrast
Detect parenchymal CNS lymphoma, leptomeningeal disease, and pre-treatment baseline for PCNSL induction. Required for staging in PCNSL/secondary-CNS lymphoma and any neurologic symptoms in systemic lymphoma. Gadolinium enhancement improves sensitivity vs non-contrast.
2lab Complete Blood Count with Differential
Baseline cytopenia assessment and ongoing monitoring of myelosuppression.
3lab Comprehensive Metabolic Panel
Електроліти (Na, K, Cl, HCO3), креатиnoн + BUN (renal function), глюкоза, кальцій, альбумін, total protein. Базова метаболічна оцінка перед будь-якою терапією + основа TLS risk + dosing adjustments.
4lab Liver Function Tests
Assess hepatic function — baseline + during BR cycles + DAA therapy + HBV reactivation monitoring.
5lab Coagulation Panel (PT/INR, aPTT, Fibrinogen)
Pre-biopsy assessment + DIC screen + baseline перед anticoagulant-affected procedures. Обов'язково перед excisional/core biopsy + bone marrow.

MDT brief

Discussion questions (1, 0 blocking)

DQ-DIFFERENTIAL
What is the differential diagnosis plan between hypotheses: DIS-GBM, DIS-BRAIN-METASTASES? Which molecular / IHC tests differentiate them?
Multiple hypotheses — must be differentiated before treatment discussion.
→ pathologist

MDT talk tree (2 steps)

#	Owner	Topic	Action
1	pathologist	Pathology confirmation	What is the differential diagnosis plan between hypotheses: DIS-GBM, DIS-BRAIN-METASTASES? Which molecular / IHC tests differentiate them?
2	radiologist	Specialist review	Stage / restaging imaging + biopsy guidance — radiologist.

Skills (required) — mandatory virtual specialists (2)

Pathologist (general) required
Any suspicion requires biopsy — pathologist plans site selection, IHC panel, ancillary tests.
Owns: DQ-DIFFERENTIAL
Radiologist required
Stage / restaging imaging + biopsy guidance — radiologist.

Technical MDT skill metadata (2/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).

Specialist	skill_id	Version	Last reviewed	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

plan_id: DPLAN-PZ-DIAG-GBM-001-V1 | version: 1 | generated: 2026-05-12T18:41:26.922188+00:00

Per FDA non-device CDS positioning (CHARTER §15): Diagnostic-phase MDT support: structure the workup, identify the team, surface unresolved questions. Not a medical device; not a treatment plan.

Per FDA non-device CDS positioning (CHARTER §15): DIAGNOSTIC PHASE — this output describes diagnostic workup only. Treatment plan generation is blocked until histology is confirmed (CHARTER §15.2 C7). Do not treat on suspicion.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.