CASE 370:PLEURAL EFFUSION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 21 yo  fever and  cough , thorax pain in breathing

Chest XRays suspection  of pleural effusion.

CT scan  with CE of the chest:

CT1: cross- section=.pleural effusion both 2 sites.

CT2 .frontal section.

CT3:   frontal section in anterior  mediastium detected  one mass at retrosternum.

Blood test of WBC not raising.

Pleural tap  removed  yellowish liquid, but  analysis was lower ADA level.

TRANS THORACIC ULTRASOUND AT SUPRASTERNUM DETECTED ONE   RETROSTERNUM MASS, LOOKED LIKE LYMPH NODE (US1).

PLEURO-ENDOSCOPY FOR EXPLORATION= NON DETECTED  INTRA PLEURAL LESION AND REMOVED THIS  RETROSTERNUM MASS( MACRO)

MICROSCOPIC REPORT  THIS MASS IS NORMAL TISSUE OF THYMUS GLAND.

CASE 369: DUODENUM TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 60 y.o., health check-up  by ultrasound of  abdomen detected  one mass  nearby gallbladder, size around 3-4 cm.

US 1: this mass  near  gallbladder and  duodenal bulb.

US 2: no  relation to  liver hilus.

  

Endoscopy report that  lumen of duodenum D2 is compressed by external mass (see endoscopy picture).

MSCT  of abdomen with CE

CT1:  this mass is  from  duodenum D2.

CT2 :  patient in rotation  for good vision of pyloris and duodenum mass at D2.

CT3: sagittal section of this mass is CE enhanced.

Preoperative diagnosis is duodenum wall tumor which was  suggested to GIST.

Operation  resection of  tumor and  performed gastro-enterostomy.

Microscopic report of this tumor is GIST.

Reference:

Duodenal gastrointestinal stromal tumor

http://www.sciencedirect.com/science/article/pii/S1743919112007649

CASE 368: METRORRHAGIA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Women 52 yo  post menopause  2 years, vaginal bleeding.

US1:  cross- section  of uterus, normal size uterus   with  thicknening  endometrium ( more than 2cm).

US2:  CDI  no abnormal  uterine vascular supply.

US 3:thickening endometrium and cystic mass at cervix.

MRI  with gado.

MRI1= uterine cavity is  large  and thickening  endometrium,  some filling defected at fundus of uterus.

MRI2=longitudinal scan showed  the  abnormal endometrium  penetrated to uterus muscle.

Based on  clinical status , ultrasound and MRI, ObGy doctor suggested that  endometrium carcinoma.
OPERATION of  HYSTERECTOMYand  OMENTECTOMY (SEE MACRO).

Macroscopic report  of  this tumor is endometrium adeno carcinoma  invasive to myometrium..

CASE 367 : INTRAORAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

Boy  04 yo, difficulty  swallowing for 3 months.  No fever, no pain. Clinical  ENT  doctor’s  examination  is suggestion of tonsil  tumor at right side  (photo).

X-Rays of  the neck AP and lateral view: this mass  is  calcified,   irregular border,   precervical spinal bone, size of  4 cm ( film 1, 2)

US examination of this mass:

US 1: Longitudinal scan  the mass with  strong shadowing cannot  inside this mass.

  

US 2: Cross-section view.

US 3: Relation of this mass with carotid and  cervical spinal bone.

CT scan= CT 1:sagittal view , CT 2:  cross- section  with PA view,  CT3: cross-section with AP view.

Based on clinical, X-Rays , ultrasound and CT, what is your diagnosis?
Based on  X-Rays and CT  some doctors  suggested  teratoma of oropharynx, or enchondroma.

MRI ( 2 pictures sagittal and  section) radiologist  diagnosis is  chondroma.

Operation today  removed one  hard mass   looked like  stone.
Microscopic  report of this mass is fibrous dysplasia ossificans progressiva which is  same as  myositis ossificans

REFERENCE :  case  report.

CASE 366 : LUNG HEPATIZATION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 60 yo, cough, dypsnea.

Chest X-rays:(picture: very  bright left lung).

 

Ultrasound  scanning position on the back (photo)

U S 1:  scanning of the upper  portion of  left  lung, air  inside solid mass.

U S 2: lower portion of the mass=  echostructure  looked like structure of liver.

U S 3: vascularity of this mass.

U S 4 :small mass arround in  lobar bronche  is  consolidation of the lung, no pleural effusion.

CT 1  scanning  with  CE  detected  the mass  in left upper lobar bronche enhanced with CE.

Conclusion: Lung  consolidation on ultrasound  looked like  liver (hepatization of the lung)

CASE 365: MULTIPLE INTRAMUSCULAR TUMORS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman  60 yo being treated   lymphoma large B cell  stage IV by chemotherapy for 5 months.

One week ago she herself detected  many  subcutaneous nodules  palpable  at  forearm right and left, neck and  right parotid area, no painful.

 ULTRASOUND=

US 1=tumor  intramuscular right  forearm, round  border, very  low echo density.

US 2=cross-section, lesion at forearm.

US 3=CDI  Doppler vascular  structure of this mass, hypervascular.

US 4=longitudinal scanning   with  CDI.

US 5=CDI with PW,   RI = 0,70.

US 6 = small intramuscular nodule  at posterior of  neck.

US 7= SWE of mass in right  parotid.

Do you thing  it is lymphoma  in muscle?  

Biopsy of this mass  is large  B cell lymphoma, same as  result pre-treatment.

Conclusion: LYMPHOMA  LARGE B CELL  AT THE DIFFUSE STAGE  CAN MAKE  MULTIPLE NODULES  IN MUSCLES.
Reference: