CASE 813: SPINE TUBERCULOSIS, Dr PHAN THANH HẢI, Dr PHÙ DUNG THÁI BIỂU, Dr TRẦN THỊ HỒNG VÂN, Dr TRẦN VĂN NAM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 44 year-old man with lumbago to the buttock for months, lumbar pain progressing in coughing and changing body position which failed in analgesics management. 

Ultrasound detected the #85x32mm left psoas muscle abscess with many hypoechoic foci in the upper of left psoas muscle maybe due to TB infection, and hypoechoic lesions in spinal thoracic and lumbar column.

MRI confirmed the vertebral lumbar column lesions from L2-S2 and the soft tissue inflammation of the left psoas muscle [L5-S1].

Lab data was only positive HCV. But positive with QuantiFERON-TB.

TB management of the spine has been done for 9 months. And treatment of HCV infection for 3 months. Lumbago reduced in the first month of treatment. HCV negative after 3 months. And at the 9th month, the spine lesions in recovery phase of TB treatment on Spine MRI.

QuantiFERON-TB in vitro, a ELISA technic (IGRAs) measures the adaptive immunity of T cell CD 4 and T CD 8 in releasing interferon gamma while in contact peptid of TB bacteria [sens 95.3%, spec 97.6%].

CASE 812: RENAL ARTERIAL STENOSIS, Dr PHAN THANH HẢI, Dr LƯƠNG THANH BỬU, Dr TRẦN THỊ THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 48 year-old diabetic woman with arterial hypertension for 6 years. BP: 211/116mmHg, HB: 89b/min

Lab data was still in normal values, but Doppler ultrasound detected stenosis 70% of the proximal part of the left renal artery and 30% of the right one due to atheroma.

MSCT Agio confirmed the stenosis of renal arteries due to atheromatous plaques.

Stenting successful of the left renal artery and the woman remains well, managed only Amlor per os 01c/day.

The arterial hypertension patient needs a Doppler ultrasound examination of the kidney and vessels to detect the stenosis of renal vessels.

CASE 811: ADOLESCENT PHYLLODES TUMOR (PT) and a REVIEW of P T in VMU, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, Dr TRƯƠNG THỊ MỸ HOÀNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 14 year-old female adolescent with a right breast tumor rapid progressing bigger for 4 months.

Breast ultrasound assessment was classified BI-RADS 4. Mixed tumor with cystic and solid parts, hypervascular, micro calcified, irregular border, spiculated margin. Biopsy result was benign phyllodes tumor.

But the result of histoimmunologicostaining was a malignant phyllodes tumor.

Phyllodes tumor is rare in adolescent. Only 20 cases were published in litterature. 

Two cases in adolescent [one 15 yo, another 14 yo] were published on our VMU.

In women, there were 11 cases of phyllodes tumor published on our VMU. Phyllodes tumor (1-3% breast tumor) comes from the fibrous tissue, 27 % malignant, growing rapidly with large size [ > 20 cm]. 

PTB is a very rare breast tumor in women aged 35 to 55 years. Our patient is younger but the progress of the tumor is the same in the literature: "unilateral, nodular, painless mass which has a history of the mass but that grows rapidly in the short term".

Phyllodes tumors (or phylloides tumors) are rare breast tumors that start in the connective (stromal) tissue of the breast, not the ducts or glands (which is where most breast cancers start). Most phyllodes tumors are benign and only a small number are malignant (cancer). American Cancer Society, July 2022.

REFERENCES:

1. REVIEW CASE 763 from Dr TRƯƠNG THỊ MỸ HOÀNG, MEDIC MEDICAL CENTER, HCMC.

2. CASE 292

3. REVIEW PT CASES 794-795 from Dr TRƯƠNG THỊ NGỌC TIẾN, MEDIC MEDICAL CENTER, HCMC.

4. CASE 654

5.

6. Phyllodes tumor: American Cancer Society.

CASE 810: ESOPHAGEAL DIVERTICULUM, Dr PHAN THANH HẢI, Dr TRẦN MỘC HIỆP, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 11 year-old  male child with the suspection of a 3rd branchial cleft cyst ?

Ultrasound detected an 12x18mm air -filled cystic lesion at the posterior face of the left lobe of thyroid. Water swallowing  made the aerial cyst moving and proved it belonging an esophageal diverticulum.

Later MSCT confirmed it an esophageal diverticulum. 

Reference

CASES 808-809: BLADDER TUMOR WITHOUT SYMPTOM, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAK CENTER, HCMC, VIETNAM

 Two cases with bladder tumor without symptom detected by chance by ultrasound.

CASE 1: 

A 51 year-old man with epigastric pain in general check-up.

Ultrasound detected a 5.4 mm small tumor nearby the neck of the bladder.

Urinary bladder endoscopy confirmed the bladder tumor. And the biopsy result was an urethelial carcinoma.

CASE 2: 

A 61 year-old man without sign of urinary tract troubles.

But ultrasound detected the 4.6x3.9mm bladder tumor.

Result of biopsy was urethelial carcinoma high malignancy.

Reference: