CASE 797: PELVIC ABSCESS and DIVERTICULITIS, Dr PHAN THANH HẢI, Dr PHAN NGUYỄN THIỆN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 54 year-old  diabetic woman with left lower quadrand pain for one year.  About one week before entering Medic Center, she got fever, cold and shivering and LLQ pain more and increasing CRP.

Abdominal ultrasound detected one left pelvic #46x56x64mm septated mass beside the sigmoid colon cannot ruling out an ovarian tumor.

MSCT confirmed a pelvic abscess with a high density foreign body inside # 2 mm.

Endoscopic surgery revealed an abscess due to colonobladder fistula. Then an open surgery performed to remove the pelvic abscess which was from an inflammed diverticulum and penetrated the urinary bladder,  and to create an artificial anus at the LLQ and cystostomy. The foreign body could not find out.

Post-op the patient was getting better but still in urinary infection.

It was a rare of case of complicated diverticulitis.

CASE 796: INTRARENAL AVM, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 47 year-old woman with lumbago for 7 months but without hematuria. She doubted that may due to  practice belly twirling.

Ultrasound detected incidentally an upper pole renal cystic lesion # 13x23mm in B mode with aliasing sign on Doppler ultrasound.  RI = 0.3-0.5 and V= 130-230 cm/sec. It maybe an intrarenal AVM.

MSCT confirmed an intrarenal AVM that created an intrarenal aneurysm and managed stenting successfully the AVM.

Doppler ultrasound could differentialize an intrarenal aneurysm from a renal cystic lesion while B mode ultrasound could not to do.

CASE 794-795: PHYLLODES TUMOR, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Case 1: 

A 52 year-old woman with left breast tumor and bloody stool. Her past history noted an ovarian cancer for 3 years.

Ultrasound detected a pelvic mass and metastase liver nodes. Left breast noted  2 tumoral masses classified BI-RADS 5 with axillary lymph nodes.

In pelvis ultrasound revealed a left mass maybe a recurrent left ovarian tumor which metastasized her liver.

MSCT confirmed 18-35 mm left breast tumors and left pelvic tumor which invaded the sigmoid colon and metastase liver nodes.

Core biopsy of the left breast tumors was malignant phyllodes.

Left breast mastectomy was done and managed the recurrent left ovarian tumor with metastases in Cho ray hospital.

Post-op result of the left breast tumor was malignant phyllodes non invaded the skin and the nipple.

Case 2:

A 31 year-old woman PARA 1001 with left breast tumor growing bigger rapidly for one year after cessation of breastfeeding her 14 month child. Her history noted small left breast tumor since 2022.

Ultrasound detected a BI-RADS 4a multinodular breast tumor.

Mammography noted a left phyllodes in full of the left breast volume.

Core biopsy result was a benign fibroadenoma of the left breast.

Surgery removed the left breast tumor. The specimen result was a benign phyllodes.

Phyllodes tumor (1-3% breast tumor) comes from the fibrous tissue, 27 % malignant, growing rapidly with large size [ > 20 cm].

CASE 793: INFLAMMATORY BREAST CANCER, Dr PHAN THANH HẢI, Dr TRẦN THÙY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 31 year-old woman with the right breast appearing bigger fastly than the left one and covered by the red skin its upper part. The right breast felt hard and tumorless in touching.

Breast ultrasound with elastography detected some axillary lymph nodes and the breast tissue being distortion. That is belonged a breast cancer BI-RADS 5 classified.  Maybe it is a breast infiltrated lymphoma or an inflammatory breast cancer.

Breast MRI confirmed an inflammatory breast cancer BI-RADS 5 and metastase axillary lymph nodes.

But results of histopathology of lymph node FNAC was breast carcinoma and nonspecific chronic inflammation.

Histopathological result of the breast specimen by core biopsy was chronic inflammation non specific (N 61) of the breast.

In consultation later, a chemohistoimmunostaining was done and the result was an invasive breast carcinoma of no special type, grade 3.

Inflammatory breast cancer (IBC) is a rare entity among the breast cancer [1-5%]. The cancer cells may obstruct the lymphatic vessels then make the breast being swollen and covered by the red skin as an inflammation breast.

CASE 792: FISHBONE PENETRATED the ESOPHAGUS GOING to the MEDIASTINUM and REENTERING the ESOPHAGUS , Dr PHAN THANH HẢI, Dr LÊ HỮU LINH, Dr HỒ KHÁNH ĐỨC, BINH DAN HOSPITAL and MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A  41 year-old woman misswallowed a fishbone for 5 days.

In Medic Center, MSCT and upper GI endoscopy detected a fishbone penetrating her esophagus which was going to the mediastinum and may enter the descending thoracic aorta.

 

At the emergency department of Binh Dan hospital, an open surgery for thorax was done. The result showed not any thoracic aorta lesion nor fishbone inside the mediastinum.

But the C-arm on the operation table revealed the fishbone changing its direction from transversal to longitudinal position.

An endoscopy was performed in the operation detected the fishbone coming back to the esophagus. And it was removed successfully by via endoscopy.

Fishbone came back to the esophagus is an incredible event. Patient and doctors were stunned by the fact that may have to go through an operation for reconstruction the thoracic aorta in finding the fishbone somewhere, but fortunately not have to do.