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.

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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.

APPENDIX 1:

APPENDIX 2

CASE 832: ACUTE APPENDICITIS, Dr PHAN THANH HẢI, Dr LÊ THANH TÙNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A  29 year-old nurse with abdominal cramp crisis for 20 hours without fever and diarrhea.

Ultrasound  detected a # 25x12mm tubal structure at the RLQ with peritoneal fatty edema at the end of appendix in suspecting an acute appendicitis.

WBC: 16.4 H, hs CRP: 4.31H.

MSCT confirmed an inflamed appendix with fecolith inside.

Endoscopic surgery was done for removing the inflamed appendix in 24 hours from the onset.

CASE 831: FISHBONE MIGRATING, Dr PHAN THANH HẢI, Dr ÂU CHÍ NGHĪA, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 35 year-old man with a progressive swallowing pain for 2 weeks . He has been doutfull about a misswallowing of fishbone 5 weeks before.

Ultrasound detected a #13x1.8mm fishbone penetrating the salivary gland in the right submandibular region.

Oral endoscopy found out nothing.

MSCT confirmed the fishbone in the right submandibular region.

Surgery was done for removing the fishbone.

CASE 830: PANCREATIC CANCER and a REVIEW of the PERITONEAL CARCINOMATOSIS, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 58 year-old man with epigastric pain and flatulence for one month.

Ultrasound detected a # 21x27mm hypoechoic tumor of the pancreatic body and peritoneal carcinomatosis [PC]: a large amount # 4 liters of malignant ascites, metastatic lymph nodes and peritoneal cake.

Lab data showed increased CA 19-9 : 807 U/mL and CA 125: 95.7U/mL

MSCT confirmed the peritoneal carcinomatosis.

Surgery was done for the peritoneal node biopsy. The result was an adenocarcinoma grade 2 metastasis with the pancreatic origin.

Surgical report noted many  # 10mm nodes seeding on the peritoneum that made retractile the  epiploon and the mesentery. There was a #80 mm hard mass seemed to be the primary tumor at the mesenteric root of the transverse colon.

Histoimmunologic staining:CK7. CA 19-9 (+), CK 20 (+) localized, CDX2,  SATB2 (-). That were in correlation to adenocarcinoma grad 2 metastase to the peritoneum with the origin of the pancreas.

DISCUSSION :

Ultrasound detects easily the PC but difficultely finds out the origin of the PC.

There were 3 published cases of extraovarian primary PC,

2 published cases of malignant mesothelioma,

1 published case of mucinous carcinoma (unknown the origin),

In total, 5 cases of not having the origin, 1 case of unknown the origin. (pls. view cases 128, 164, 298, 332, 448).