CASE 582: INSULINOMA, Dr PHAN THANH HAI, Dr HUYNH TRAC LUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN  25YO  with  HYPOGLYCEMIA COMA MANY TIMES  IN EMERGENCY  HOSPITAL.   

AT MEDIC, BLOODTESTS:  

FASTING GLUCOSE  (FPG) = 2.4  (N=3.9-5.9 mmol/mL)    

Insuline=   71.3  ( N= 2.6-24.9 microUI/mL) 

C-PEPTIC FASTING = 7.45 ng/mL (N =1.1-4.4 mUI/mL)

BLOOD TEST RESULTS SUSPECTED INSULINOMA.  

ULTRASOUND of  PANCREAS IS NORMAL  BUT SMALL ACCESSORY  SPLEEN EXISTS (US 1, US 2, US 3).

MSCT SPECTRAL CONTRAST of PANCREAS  NON DETECTED PANCREAS TUMOR BUT CLEARLY VIEWING ACCESSORY SPLEEN (CT1/CT2).

MRI of PANCREAS   DETECTED  SMALL TUMOR AT THE TAIL of PANCREAS #1.5 CM  SUSPECTED  INSULINOMA.

Operation removed small tumor at the tail of pancreas  (ope, macro1, macro2).

MICROSCOPIC REPORT IS  ENDOCRINE PANCREATIC  ADENOMA  (INSULINOMA).

CONCLUSION = CASE OF TYPICAL INSULINOMA IN CLINICAL   BUT ULTRASOUND and CT CANNOT DETECT THIS SMALL TUMOR, EXCEPT MRI.

Reference    CT perfusion of pancreas  detected insulinoma.

  

  

CASE 581: RETROPERITONEAL GIANT LIPOMA, Dr PHAN THANH HAI, Dr TRAN THI NGA, MEDIC MEDICAL C, HCMC, VIETNAM.

Man 35 yo with distention of abdomen slowly  after liposuction intra abdominal  wall.

Ultrasound of abdomen detected big mass from epigastric to hypogastric area,  hypovascular and echostructure like fatty tissue. 

US 1: the mass near the liver border  hypovascular

US 2: crossed-section at epigastric  this mass  around  AMA.  

US 3: crossed-section at umbilic area,  aorta and IVC no replaced.

US 4: sagittal middle abdomen   aorta and vci  

ultrasound  report is big lipoma intra abdomen.

MSCT CE    

CT1  CROSSED SECTION  L KID  DEPLACEMENT  

CT2  FRONTAL VIEW   BIG LIPOMA  WITH HU  IS 30UI

CT3  FRONTAL SECTION THIS TUMOR IS RETROPERITONEUM DEPLACEMENT BOWEL TO RIGHT SITE

CT4  3D VIEW  HS L KIDNEY ROTATION  

CT REPORT IS RETROPERITONEUM LIPOMA  

OPERATION  REMOVED 7 KG  TUMOR  AND MICROSCOPIC REPORT IS LIPOMA.

REFERENCE CASE

CASE 580: COLON INTUSSUSCEPTION, Dr PHAN THANH HẢI, Dr LÊ ÐÌNH TÍN, MEDIC MEDICAL CENTER, HCMC, VIET NAM.

WOMAN 54yo DURING TREATED HYPERTHYROIDISM  SHE HAD GOT DIARRHEA WITH MUCUS MANY TIMES AND PAIN IN LLAQ.

EMERGENCY ULTRASOUND OF ABDOMEN  DETECTED  ONE MASS INTRA SIGMA COLON  WITH TARGET SIGN IMAGE ( US 1, US 2), SIZE 5 CM  INDUCED  COLON INTUSSUSCEPTION    AND THYROID HYPERVASCULAR PATTERN  ( US 3).

FOR DIAGNOSTIC PERFORMED COLON ENEMA WITH BARYUM (X-RAY 1, X-RAY 2)  SHOW ONE MASS INTRA SIGMA COLON  5CM IN SIZE.

MSCT OF ABDOMEN:   THIS MASS IS HYPODENSITY HU  LIKE LIPOMA .

ENDOSCOPY OF COLON  DETECTED TUMOR BUT BIOPSY RESULT IS  MUCOSAL INFLAMATION.

WAIT FOR TREATED HYPERTHYROIDISM STABLE TO SURGERY IN SAFETY.

Operation  detected  tumor of descending colon near  splenic angle. Macroscopic is like lipoma, wait for microscopic report.

MICROSCOPIC REPORT IS  LIPOMA    

REFERENCE   CASE REPORT  

CONCLUSION  =  LIPOMA INTRACOLON  INDUCED COLON INTUSSUSCEPTION.