CASE 279: RETROPERITONEAL PELVIC SCHWANNOMA, Dr PHAN THANH HẢI- Dr LÊ TUẤN KHUÊ. MEDIC MEDICAL CENTER, HCMC, VIETNAM

MALE PATIENT 42 yo, from CA MAU PROVINCE, GETTING  HIS LOWER ABDOMEN BIGGER  AS 3 MONTH WITHOUT ANY SYMPTOM.

HE WAS TRANSMITTED TO CANCER HOSPITAL AND BINH DAN HOSPITAL.

ON CYSTOSCOPY HIS URINARY BLADDER WAS PRESSED FROM OUTSIDE.

ULTRASOUND AT MEDIC DETECTED A HUGE MASS IN PELVIS, CENTRAL NECROSIS.

AT BINH DAN HOSPITAL, COLONOSCOPY WAS PERFORMED AND THE RESULT WAS SIGMOID COLITIS.

AND CT of BINH DAN HOSPITAL REVEALED A HUGE RETROPERITONEAL MASS IN PELVIC REGION.

OPERATION  WAS DONE TO REMOVE THE TUMOR WHICH WAS of 15X20cm IN SIZE FROM ANTERIOR OF URINARY BLADDER TO PROMONTORY of SACRUM.

THE RESULT of HISTOPATHOLOGY AND HISTOIMMUNOLOGIC STAINING WAS A SCHWANNOMA.

REFERENCE:

CASE 278: UNKNOWN ASCITES, Dr PHAN THANH HẢI-Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 30 YO   ABDOMINAL PAIN  SOME MONTHS AGO,   ABDOMEN WAS DISTENTION AND  CANNOT EATING, NO FEVER  NO TRAUMA OR TUBERCULOSIS IN  HISTORY.
ABDOMEN ULTRASOUND  DETECTED ASCITES  WITH  BOWEL  ADHERENCE IN MASS, LIKE COCOON  SIGN ( 2 VIDEO).

MSCT of ABDOMEN WITH  CE REVEALED  NORMAL LIVER  WITHOUT TUMOR ( SEE  CT  3 PICTURES).

PUNCTURE of ASCITES SHOWED OLD  BLOODY  FLUID. ANALYSIS RESULTED NORMAL AMYLASE,  ADA, AND  CA 125.

PATIENT WAS ADMITTED HOSPITAL IN  EMERGENCY FOR  BOWEL  SUB-OBSTRUCTION.

LAPAROSCOPIC OPERATION   DETECTED  OLD BLOOD  WITH  ADHERENT FIBRIN  WHICH MADE BOWEL  AS A BALL (COCOON),  CANNOT FIND OUT THE BLEEDING SITE. NO TUMOR DETECTABLE, AND BIOPSY OF  ONE  OF PARIETAL PERITONEAL AREA THICKNESS.

MICROSCOPIC REPORT WAS  HEMORRHAGIC PERITONITIS.

WHAT IS THE  PLAN OF TREATMENT FOR THIS PATIENT ?.

CASE 277: CLOSE BY KNEE JOINT TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 21 YO   PAIN  NEAR  THE  LEFT   KNEE  AFTER  PLAYING  FOOTBALL.
 X-RAY FIRST OF LEFT KNEE AREA D ETECTED ONE MASS  INTRA
MUSCLE WITH  CALCIFICATION  AND ADHERENT TO FEMUR BONE  WITH SIGN OF PERIOSTEAL  EROSION.

ULTRASOUND OF THIS MASS  REVEALED  HYPOECHOIC PATTERN WITH CALCIFICATION INTRA MASS,
HYPOVASCULAR,  SIZE  ARROUND 4 CM.

ELASTOGRAM  SHOWED THAT MASS WAS HARD AND CENTRAL NECROSIS.

MRI  OF THIS MAS PROVED COMING FROM THE FEMUR BONE AND IN   EXTENSION OUT  TO
MUSCLE, LOOKED LIKE  BONE TUMOR (SEE  MRI 1, 2, 3 ).

PET CT   MADE STAGING  THIS TUMOR WAS  LOCAL  INVASION   HIGH
UPTAKED  18 FDG, SUSPECTED OSTEOSARCOMA.

OPEN  SURGERY  BIOPSY FOR  MAKING SURE  DIAGNOSIS.

WAIT FOR MICROSCOPY REPORT.

MICROSCOPIC REPORT WAS  PERIOSTEAL SARCOMA.

WHAT IS  PLAN of TREATMENT FOR THE  21 YO YOUNG PATIENT?