CASE 841: LIVER TUMOR or RENAL TUMOR RCC, Dr PHAN THANH HẢI, Dr PHAN HỮU BỘI HOÀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 69 year-old hypertensive woman underwent flatulence without anorexia in 2 weeks. Her past history noted GI hemorrhagia 2 years before. BP: 122/88 mmHg, HR: 88b/min.

Ultrasound represented a #13x11cm solid tumor maybe a liver tumor.

Lab data noted positive HCC risk and HCV infected.

But MSCT detected a tumor which suspected a GIST  tumor or mesenteric tumor.

A surgical investigation for biopsy was performed. And the results of biopsy and immunologic staining  were a chromophobe RCC.

We learn that try to having all proves may get an appropriate diagnosis.

CASE 840: MRKH SYNDROME: Dr PHAN THANH HẢI, Dr TRẦN LÃM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 20 year-old married woman is waiting for pregnancy for 4 years. Since sixteen years old, she was diagnosed primary amenorrhea with small uterus.

Abdominal ultrasound revealed the solitary ectopic right kidney, a pelvic cyst and undecided uterus.

Cardiac ultrasound noted a # 4 mm patent ductus arteriosus.

Chest X-Ray noted an elevated right diaphragm.

MSCT confirmed an solitary ectopic right kidney and no uterus on  an amenorrhea woman may be belonged to the Mayer - Rokitansky - Kuster - Hauser syndrome 

The late conclusion is the MRKH syndrome type 2: amenorrhea and some cardiac, urologic, musculoskeletal anomalies.

REFERENCE:

CASEs 837-838-839: HYPOPHARYNGEAL CARCINOMA, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THỤC QUYÊN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

3 cases of male patient with dysphasia, hoaráeness, sore throat and hard  cercvical lymph nodes.

Ultrasound revealed the hypopharyngeal tumor in the late stage with cervical lymph nodes.

Case 1 : Man 51 year-old with a right pyriformis sinus tumor and lymph nodes metastasis.

Case 2: Man 47 year-old with right pyriformis sinus tumor and right submandibular nodes  in mass metastasis.

Case 3 :Man 67 year-old  with left pyriformis sinus tumor and left cervical lymph nodes metastasis.

CASE 836: PARASITIC HEPATIC ABSCESS, Dr PHAN THANH HẢI, Dr LÊ THANH TÙNG, Dr LÊ THANH LIÊM, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 41 year-old infected HBV man ten years before now was no fever with a colicky pain at RUQ last night. 

Abdominal ultrasound revealed a  #5.1x3.7 cm hepatic abscess in the right hepatic lobe, a small hemangioma, a sludge in gallbladder and a right renal cyst.

Lab data noted  WBC : 13.3 H and a positive sero Fasciola sp Elisa.

MSCT confirmed an abscess of the liver maybe due to parasite.

An amount of chocolate-like fluid was drained out and antibiotics were managed.

CASE 835: CYSTIC LYMPHANGIOMA in MASSETER SPACE, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 28 year-old girl with a doubtful mass at her left face which only appears in prone position for 20 years. That mass is yet diagnosed from many clinics since 8 years old. 

Fig 1: Swollen left cheek and unclear the left nasolabial groove were in bending and sitting position.

Fig 2: The left cheek was not swollen and the existence of the left nasolabial groove before bending of the head.

Face ultrasound detected nothing in supine position. But in bending down her head the left nasolabial groove disappears. Then the left cheek was swollen and ultrasound revealed a #35x15mm echoic cystic lesion into the left masseter space. 

MSCT non CA confirmed the cystic lymphangioma in the left masseter space in two positions : supine  (upper line) and prone (lower line)

The girl was pleased with the explanations but she denies any procedure of FNAC or puncture for sclerotherapy that may causing any scar of her face.

The cystic lymphangioma in the masseter space is a rare entity. The story which we learned about of the case is paid attention at something doubtful of the patient’ complaint and trying to find it out. In that case it only was the appropriate position to detect a ghost mass on the left cheek of the nice girl.

REFERENCES:

1. 2020 Hong Kong Journal of Paediatrics. Vol 13. No. 4, 2008 - Imaging Features of Common Non-nodal Neck Masses in Children.

2. PMC- J Oral BiRes. 2018 Sep-Dec; 8(3): 200–202.

published online 2017 Jun 13.

doi: 10.1016/j.jobcr.2017.06.001.PMCID: PMC6107903 PMID: 30191108 - Lymphatic malformation of the masseter.

3. Radiology Key Fastest Radiology Insight Engine 2.3 Hemangiomas and Vascular Malformation.

Malformation

CASE 834: A Giant Schwannoma of Vagal Nerve Sheath Mimicking A Lymph Node Necrosis, Dr PHAN THANH HẢI , Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 49 year-old man with a big painless mass at the lower part of his neck on the right side. The mass gots bigger rapidly causing cough in hard squizzing.

CT Scan noted a #8.5x2.9cm right lymph node necrosis or metastase. The lungs were intact.

But MRI suspected a big lymph node abscess.

Ultrasound detected a # 3x8cm big mass which had a cystic pattern between the neck vessels and adhered the vagal nerve of the right neck ; maybe a giant cystic degeneration schwannoma of the right vagal nerve sheath.

Surgery removed the right mass of the neck; the result post-op was a cellular schwannoma of the nerve sheath of the right vagal nerve.

CASE 833: FAMILIAL PHEOCHROMOCYTOMA, Dr PHAN THANH HAI, Dr PHAN THİ MINH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 10 year-old boy with sweating and severe headache episodes since September 2024; his HTA 160/100 mmHg in theses episodes.

Also, in June 2024, his mother was diagnosed pheochromocytoma at MEDIC CENTER and remains well post-op.

Ultrasound noted both adrenal glands normal.

But lab data showed 10 times increased both catecholamines in blood : 2414.3 H and urine: 736.5H.

⁷

MSCT detected two ectopic pheochromocytoma on the left side: one adhered the adrenal gland and other was between the IVC and the aorta.

A medical management plan  was applied carefully before the surgery for removing the two pheochromocytoma.

Surgery removed successfully the two ovale pheochromocytomas and the left adrenal: the left one adhered to the left adrenal and the other one was between the IVC and the aorta.

The catecholamines come back post-op but the lucky boy and his mother has stiĺl been in following up for many years.

Thank of his mother's disease the boy was diagnosed accurately and solved his severe illness in time.

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