CASE 771: BOWEL G.I.S.T, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

A 38 year-old woman with a # 47x58 mm GIST of her small bowel at LUQ, and later MSCT confirmed it.

The author would like to describe the sonographic appearances of a bowel GIST: echo mixed, with hypoechoic or cystic areas in case of large tumor. The adhered GIST from one side developes out of the lumen, exophytic, while the other side is intact. Endoscopic ultrasound could represent the layers of the wall of the tumor and help to guide the tumor biopsy.

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Merriam- Webster

exo​phyt​ic  : tending to grow outward beyond the surface epithelium from which it originates. used of tumors compare endophytic.tending to grow outward beyond the surface epithelium from which it originates.

CASE 770: INSULINOMA (PNET, PANCREATIC NEUROENDOCRINE TUMOR), Dr PHAN THANH HẢI, Dr TRẦN THỊ TRÚC PHƯƠNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 66 year-old diabetic man with hypoglicemic crisis after meal 3-4 hours, Whipple's triad positive.

Lab data: FPG low, C-peptid (fasting) elevated

Ultrasound detected a  # 20#6.5mm mass at the pancreatic tail and some hepatic cyts.

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Cystic lesion of the pancreas tail # 2.6x2.2 mm with Doppler sign.

MSCT confirmed a 32x20mm PNET at the tail of pancreas: tissue density, highly captured contrast media.

Histoimmunopathologic stainning was a pancreatic neuroendocrine tumor [insulinoma].

References:

CASE 769: APPENDICULAR MUCOCELE, Dr PHAN THANH HẢI , Dr VÕ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 62 year-old woman in check-up with her past history of surgery for an intracrania hemorrhagia and ovarian cyst.

Abdominal ultrasound detected a RLQ cystic mass #47×27mm beside the right colon which filled off debris that maybe a mucocele or a  pseudomyxoma peritonei.

Lab data were normal.

MSCT confirmed an # 42x22 mm appendiceal mucocele.

Surgery removed  a cystic mass at the end of the appendix.

Histopathological result was mucocele low grade.

Reference:

CASES 767, 768: PARATHYROID TUMOR, Dr PHAN THANH HAI, Dr LY VAN PHAI, Dr VO THI THANH THAO, Dr HO KHANH ĐUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases of pararthyroid tumor were spontanously detected by ultrasound with renal stones, bone mineral density [BMD] measurement for osteoporosis  and the neck tumor.

Case 767: A 58 year-old woman with renal stones on abdominal ultrasound who went through neck ultrasound, BMD measurement and parathyroid hormone (PTH) lab data.

Her PTH was coming back post-op.

Case 768: Female patient 57 year-old with neck tumor.

References:

CASE 766: RENAL CLEAR CELL CARCINOMA, Dr PHAN THANH HẢI, Dr PHẠM THẾ ANH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 60 year-old woman with a cystic renal tumor on the left side which was detected by ultrasound.

MSCT confirmed the left renal tumor at the lower pole of the left kidney.

An ultrasound-guided renal biopsy was conducted at Medic Center.

Result of  renal biopsy was a renal clear cell carcinoma. And a surgery for the left renal tumor was done one week later the diagnostic was made.

The risk of seeding of tumor cell  in renal biopsy is very rare before removing the renal tumor by surgery.

CASE 765: MESENTERIC ABSCESS due to FISHBONE, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A male patient with his right flank pain for 3 days.

Abdominal ultrasound detected a # 12mm fluid-filled appendix with thin wall that was not enough to  diagnosing an acute appendicitis.

Lab data with hs CRP =56.91 represented an infectious syndrome of the abdomen.

To confirm the source of abdominal infection and ruling out an inflamed appendix, an abdomen MSCT was done.

MSCT detected a #14 mm fishbone in an  abscess at the left flank which was wall-off by the mesentery.

Surgery removed the abscess with fishbone succcessfuly which adhesived critically the transverse colon but no clue of coming from the bowel or colon.

MSCT is more sensitive in case of foreign body with high density like fishbone in the abdomen.