CASE 166: SWELLING of DISTAL THIGH, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 19 yo,  pain and swelling at distal right femur one month ago (see photo).

 

 

Ultrasound examination this thigh with linear and convex probe showed the mass was fro periosteum extending to muscle and destruction the bone  like sunray image.

 

 

Front and lateral X-ray films this mass were not clear, but MSCT revealed the mass being from periosteum and erosion the cortex of the femur bone with periosteal reaction both 2 sides.

 

 

Biopsy was done,   microscopic report was DISTAL FEMUR TUMOR. Report of biopsy of this tumor is OSTEOSARCOMA. THE TREATMENT CHOICE IS AMPUTATION THE LEG OR REGIONAL CHEMOTHERAPY.

CASE 165: A SUBCUTANEOUS WALL MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 38YO, ONE YEAR AGO SHE DETECTED A  SUB CUTANEOUS MASS AT RIGHT SUPERIOR QUADRANT, MORE AND MORE HARDENING AND CHANGING SKIN COLOR ABOVE IT.(SEE PHOTO)

ULTRASOUND SCANS THIS INTRAABDOMINAL WALL MASS, SIZE OF 7 CM, MULTISEPTATION HYPOECHOIC LIKE CYST, UNCOMPRESSIBLE. SEE 4 ULTRASOUND IMAGES.

MSCT WITH CE=IT IS A ROUND SUBCUTANEOUS TUMOR  NO INVASION TO MUSCLE. SEE 3 CT PICTURES.

MICROSCOPIC  REPORT  THIS CASE IS  DERMATOFIBROSARCOMA PROTUBERANS, IT IS LOW GRADE  SARCOMA.
Ref.:

CASE 164: ASCITES due to MALIGNANT MESOTHELIOMA, Dr PHAN THANH HẢI,MEDIC MEDICAL CENTER, HCMC. VIETNAM

Man 64 yo, for a long time abuse of alcohol, he himself detected abdomen distention.

At MEDIC,  ultrasound of abdomen and MSCT were done for him.

Blood tests:  normal liver function tests, normal renal function, protide total 6,08 g/L; CEA =195 UI/mL. Other cancer markers: CA 19-9, PSA, AFP, beta2 MICROGLOBULINE =1651 (N=2000). ANA negative.

ASCITES FLUID  removed by punction is cloudy yellowish.

Ascites fluid analysis: cytology no malignant cell, 75%  lymphocyte, protid 30,6g/L, sugar 5,3 g/dL, amylase not elevated.

CEA=   650 UI/L;   CA-125 =550 UI/L

ADA = NEGATIVE , PCR TB = NEGATIVE.

Summary =   With blood test and ascites fluid test results , we try to find out cancer by gastroscopy, colonoscopy.
MDCT TOTAL BODY and  MRI abdomen also no detected cancer.

LAPAROSCOPY DETECTED  MANY INTRAPERITONEAL AND PARIETAL SEEDINGS, AND ALSO ON GREAT OMENTUM. THE  COECUM AND  JEJUNUM WERE WALL-OFF AND  ADHERANT  TO THE  ABDOMINAL WALL. LIVER  SUSPECTED NORMAL.  

3 BIOPSIES RESULT  PERITONEAL  CARCINOMATOSIS.

Microscopic report is  mucineous adenocarcinoma  metastasizing to peritoneum.

Discussion: why the diagnosis of  this case  delayed for one month after onset of ascites.

Where is the primary cancer and what is the choice of treatment for for him from now on?

STAINING IMMUNOHISTOLOGICAL RESULT IS A MESOTHELIOMA.

AFTER  SPECIAL EXAMINATION  BY HISTOIMMUNO, THIS  REPORT IS INTRAPERITONEAL MALIGNANT  MESOTHELIOMA.

CASE 163: PELVIS PAIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 20yo PARA 1001, pain at pelvis for 3 days.

US scan ( Image 01: cross-sectional scan at pelvis.):  Uterus in normal size, fluid around uterus.

Image 02 : longitudinal scan at pelvis, uterus with thickening endometrium, fluid and mass at posterior fornix.

Image 03 scan at liver shows fluid at space of Morrison.

Image 04 and 05 are pulse Doppler at left and right uterine arteries.

MDCT of  abdomen shows fluid collection in pelvis with high density and enlarged ovaries both sites in  suspecting intraabdominal bleeding.

This patiend was sent to OB-GY HOSPITAL for ECTOPIC PREGNANCY or  LUTEINIC CORPUSCULAR RUPTURE.

In Ob-Gy  hospital, TVS ultrasound suspected  ECTOPIC PREGNANCY, BLEEDING INTRAABDOMEN.
Blood test betaHCG is of 0,3 mUI/mL (n <25mUI/mL). It means  not ectopic pregnancy, and  she had been discharged Ob-gy hospital  with diagnosis of Rupture of luteinic corpus   or Mittelschmerz painful ovulation.

 

Discussion: Doppler uterine artey with typical waveform notching is not gestationa status

 

CASE 162: INTRAMUSCULAR MASS of RIGHT THIGH, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 21 yo, painful sitting for 3 months at posterior site of the right thigh which irradiated to right foot.

Ultrasound at the posterior of right thigh detected one intramuscular elliptical mass of 15cmX 4 cm, hypoechoic, well-bordered.

Image 1: longitudinal scan at posterior site of right thigh.

Image 2 : longitudinal section in CDI, this mass near deep femoral artery.

Image 3 : cross-sectional scan.

Image 4 : cross-sectional scan with linear 12 MHZ.

2 pictures of MSCT  without CE injection.

THE CORE BIOPSY REPORT OF THIS MASS IS NEUROMA OF SCIATIC NERVE.

DISCUSSION:  IT IS INTRA MUSCULAR TUMOR IN POSTERIOR SITE OF THE RIGHT THIGH,  HYPOECHOIC,  HYPOVASCULAR ,  FUSIFORM , ALONG THE SCIATIC NERVE TRAIL. THE CROSS-SECTION  OF THIS TUMOR BY HIGH FREQUENCY LINEAR PROBE IS TYPICAL  NERVE STRUCTURE.

 CROSS-SECTION  ANATOMY REFERENCE