CASE 414 : PANCREAS S P E N, Dr PHAN THANH HẢI, Dr PHÓ ĐỨC MẪN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

15 yo girl with epigastric pain.

Ultrasound  detected one 7cm mass, solid and cystic mixed echo at  tail of pancreas (US 1,2).

MSCT  with CE of this mass represented  round mass at the tail of pancreas, CE low enhanced ( CT1, CT2).

MRI with gado  (MRI 1, MRI 2, MRI 3, frontal view).

Radiologist reported  that solid  tumor of pancreas in suspecting of malignancy.

Blood tests: CA19-9 is low level, and other cancer markers are normal.

Operation (foto)  This round  border mass  pulled stomach and no evidence of spreading intra abdomen cavity.

Frozen section the mass and  microscopic report is  SPEN (solidary pseudo papillary  epithelial neoplasia of pancreas).

Conclusion: SPEN of pancreas.

REFERENCE:

http://casereports.bmj.com/content/2016/bcr-2016-218403.full

CASE 413: INFANTILE HEMANGIOENDOTHELIAL of LIVER, Dr PHAN THANH HAI, Dr PHAM THI NGOC TUYET, Dr LE ANH TUAN, Dr LE QUANG THONG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

In  2008, a 5 months old  female baby with  abdomen distention and ultrasound scanning of her abdomen  detected  multiple echo poor  in her great liver ( US 1).

MRI of  liver  with gado  found out  multiple  white spots   with central  low enhancement, looked  like jack fruit appearance ( MRI 1, MRI 2).

CT of  liver non CE  also  found out multiple  black spot  inside her big liver ( CT1).

Blood test   with AFP = 76ng/mL.

Radiologist and hepatologist suggested that infantile hemangioendothelioma of liver,  no need of special treatment.

Reviewing of  this  case in  Jan  2017, now she is 9 year-old in well status, and  liver ultrasound  finds out only some small calcifications in her liver.

Conclusion: Multiple focal lesions of liver hemangioendothelial at neonate period now spontaneous regression for 9 years follow-up.

Update case 413 from Dr NGUYỄN ĐỨC TRÍ, CHILDREN N0 2 HOSPITAL

Today 18 Jan 2017, I see  an another case  looked  like the case 413 which is on a male 4 months old baby with abdomen distention.

Ultrasound and CT with CE  find out many round spots like jack fruit appearance.

Suspection of  a second case of liver infantile multiple hemangioendothelioma.

Wait and see  follow-up this case but how long to make sure the diagnosis?

REFERENCE:

CASE 412: SKIN PAPILLOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 65 yo  reported  this tumor at the  back of right  ear helix  that is  itching (see foto).

Seeing this tumor is superficial from skin with vegetation.

Ultrasound  with  high resolution  probe 12 MHz shows  this tumor is   superficial  of the derma layer,  no penetration to deep  cartilage  of  ear helix.  Color Doppler  detected  small vascular supply in tumor.

Biopsy  report is  papilloma.

CASE 411: ACCESSORY LIVER LOBE (ALL), Dr PHAN THANH HẢI - Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC VIETNAM

Boy 10 yo with  mass  at  RUQ. Ultrasound  detected  one mass size of 6cm at lower liver,  mobile and   its structure  as the liver tissue. Vascular supply from hepatic artery.

MSCT with CE showed  this mass is  in separation with liver,  hypervascular,  contrast enhance very fast  and artery supply come from  hepatic artery ( CT1,  CT 2, CT  3).

In operation, this mass  is  near the gallblader, connected with the liver by Glisson capsule, the structure surface  like liver.

Resection of this pedicule, macroscopic  structure  is looked  like liver tissue.

Microscopic  report it is normal liver tissue.

Conclusion: This liver mass  is  accessory liver lobe (ALL)​​.

REFERENCE:

CASE 410: SOLITARY PULMONARY NODULE (SPN), Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  66yo  diabetic, former smoking patient. Chest X-ray  is  nothing  abnormal detected.

CT total body  non CE   detected  one SPN which has size of  0.94 cm at  the left lung ( cT1, CT3).  CTCE  with dynamic scan  showed CE  rise from 14 HU to 74 HU.

Blood tests =  CYFRA 21-9,09  and  WAKO TEST  AFP=3.9;   AFP L3=19.3; DCP =25) another cancer markers  are normal.

What is your  suggestion for diagnostic and  therapy?
Operation thoracoscopy lobectomy, this tumor is hard and black central, tumor size  smaller than 1 cm.

Microscopic report is adenocarcinoma moderate differentiated.

REFERENCES:
NEjM 2006:355:1761.71