CASE 806: RCC in Young Patient, Dr PHAN THANH HẢI, Dr NGUYỄN PHƯỚC TOÀN , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 20 year-old man in general check-up without hematuria nor abnormal symptoms.

Ultrasound detected a #37 milimeter in diameter cystic mass at posterior face of the right kidney bulging the renal capsule. Lab data were in normal range.

MSCT confirmed the # 3X4 cm cystic tumor of the right kidney, BOSNIAK IV which bulged the renal capsule.

Endoscopic surgery removed the tumor with one half of the right kidney.

Result of the microscopic specimen was a clear cell RCC.

The patient still remains well in four years later follow- up.

CASE 805: BOWEL INTUSSUSCEPTION in Elderly Patient due to POLYP, Dr PHAN THANH HẢI, Dr TRẦN THÙY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 63 year-old woman with some painful cramp crisis for one month but which was  increasing more and more in one week before going to Medic Center.

Her past history noted right colectomy as infarcted colitis, managed thyroid cancer and radical hysterectomy.

Ultrasound detected the  #64x35 milimeter mass of the bowel intussusception at RLQ with vasculature of the mass that synchronously existed the GB stones and the #27 mm right adrenal tumor.

MSCT confirmed the bowel intussusception, right adrenal tumor and GB stones.

Surgery removed the bowel part with the polyp inside.

Microscopic result of the polyp was a mixed hemangioma.

Intussusception in elderly patient is usually due to a tumor and in our case that was a single polyp originated a mixed hemagioma.

REFERENCE:

CASE 804: SYNCHRONOUS GASTRIC and COLON CANCER, Dr PHAN THANH HAI, Dr PHAM CHI TOAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 50 year-old man with loss of weight, altered bowel habit, fatigue and abdominal pain.

Ultrasound detected gastric cancer and gastroendoscopy and MSCT confirmed later.

Gastric endoscopy and biopsy result.

MSCT

But there was a tumor of transverse colon which was proved by colonoscopy and histoanatopathological result.

Synchronous gastric and colon cancer is still rare, # 2.5% in male patient within 6 months.

CASE 803: GERMINOMA METASTASE, Dr PHAN THANH HẢI, Dr PHẠM HUỲNH BẢO TRÂN, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 42 year-old man with LLQ pain and  defecation troubles and some left neck lymph nodes for one week. He lost # 2kg. He denied to ask doctor his swollen right scrotum as ashamed of it.

Abdominal  and neck ultrasound detected some lymph nodes ( most big size # 51mm) into abdomen and retroperitoneum which were hypoechoic pattern maybe due to lymphoma infiltration.

Some 9-21 mm lymph nodes at left posterior triangular neck.

Lab data result has beta2 microglobulin elevated.

Histopathological biopsy result of the subclavian  node was lymphoma big cell. But histoimmunochemostaining was a germinoma metastase to lymph node.

Fuĺl body MSCT performed to evaluate the lymph nodes

But MSCT detected a # 46x58 mm right testicular tumor with metastase lymph nodes in the abdomen and retroperitoneum, at the groins and the subclavian region and left neck.

Scrotal ultrasound later confirmed a # 76x66x36 mm right testicular tumor and inguinal and pelvic lymph nodes metastase.

Surgery removed the right testicular tumor and 

planning of chemotherapy management. The patient remains well and ceases GI tract trouble.

Germinoma in elderly patient is rare entity and the ashamed feeling of his big scrotum was one dramatic cause for a difficult diagnosis.

CASES 801-802: WARTHIN TUMOR, Dr PHAN THANH HẢI, Dr PHẠM THỊ CẨM VÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases of Warthin tumor were detected by ultrasound Medic and removed successfully.

CASE 1:

A 48 year-old man was diagnosed Warthin tumor of his left parotid which was #19×37 millimiter hypervascular hypoechoic pattern with some small cystic lesions inside. Microscopic result was a Warthin tumor and removed later.

CASE 2:

A 68 year-old with managed liver tumor was detected Warthin tumor in the left parotid in period check-up by ultrasound.

A  # 16x10x21 milimeter hypoechoic cystic mass inside the left parotid was vascularised in low flow.

Microscopic and macrospecimen results were  the Warthin tumor.

REFERENCE:

CASE 800: SMALL BREAST CANCER INCIDENTALLY DETECTION, Dr PHAN THANH HAI, Dr JASMINE THANH XUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 66 year-old woman with a #10x7 millimeter spicular hypoechoic mass which invaded the skin above,  and a # 3.8 millimeter small node satellite, both of two lesions were nearby the nipple of the right breast. They were incidentally detected by ultrasound as small carcinoma, BI-RADS 4C. Strain elasticity was hard code. Axillary lymph nodes were inflamed nodes, LN-RADS 2.

Mammogram showed one right breast lesion beside the nipple, BI-RADS 4.

MRI confirmed the #11x9x10 millimeter tumor of the right breast, BI-RADS 5. Right axillary nodes still exist the hilus.

Results of core biopsy was an invasive breast carcinoma of no typical type, grade 2.

Histoimmunostaining result was an invasive carcinoma of the right breast.

CASE 799: ENDOCRINOLOGICAL PANCREAS TUMOR METASTASIZED LIVER, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THỤC QUYÊN, MEDIC MEDICAL CENTER, VIETNAM.

 A 65 year-old man with anorexia, epigastric pain and weight loss # 2kilogram for one month but without nausea nor jaundice.

Abdomen ultrasound detected some metastase nodes in the liver that may come from the tail of the pancreas tumor. 

A hypoechoic mass with peripheric Doppler signals at the spleen hilus # 35x29mm was revealed through the spleen window at the LUQ that leads to think about a pancreatic tail tumor.

Lab data was not any interesting clue for diagnosis.

MSCT confirmed a #30x40mm pancreas tumor of the pancreatic tail which captured CE irregularly,  hypodensity lower than pancreatic tisue and metastase liver nodes #10-45mm.

Biopsy of metastases liver nodule was done. The result of the liver biopsy was a poor differentialized adenocarcinoma ; and immunohistostaining was an endocrinological pancreatic tumor.

Endocrinological pancreatic tumor is still a rare entity and hardly to diagnose as it could appear anywhere. It has to combine some  modalities of the diagnostic imaging as the diversity and complexities of the endocrinological pancreatic tumor.

A chemotherapy had been planned for the patient.