CASE 510: MITTELSCHMERZ SYNDROME, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 27 yo with  hypogastric pain. Ultrasound in emergency detected bleeding intra abdomen.

US 0=  fluid under liver area in  Morrison’s space.

US 1  = sagittal scanning at pelvis,  thickening of endometrium  and an amount of blood around pelvis.

US 2 =  transverse section at pelvis, right ovary too big  in comparison  to left one.

US 3 =  sagittal  mass at right  ovary.

Emergency blood test report  Hct 20%;  Hb 10 g/L; beta HCG  negative.

MRI 1 of abdomen detected  one mass at right  ovary.

MRI 2=  sagittal scanning of pelvis, retrouterus bleeding.

MRI 3=  frontal view of  right/left ovaries,  bleeding from right ovary.

Diagnosis is  bleeding from right ovary in Mittelschmerz syndrome.

Operation  removed 1000 ml blood clot  and right ovarian  rupture (photo) .

Mittelschmerz (German: "middle pain") is a medical term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently.

CASE 509: PANCREAS TUMOR, Dr PHAN THANH HẢI, Dr NGO VIET THI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman  25 yo with history of  epigastric pain and  jaundice slowly for one month.

Ultrasound of liver:   big liver  with dilatation of the biliary system.  

US 1=  CBD  is in dilatation  # 2cm.

US 2 =  tumor from the head of pancreas and in extension to CBD.

US 3 =  head of pancreas tumor.

Ultrasound makes diagnostic that  pancreas head tumor moves to CBD.

MSCT  with CE  diagnoses again  pancreas head tumor.

CT 1 :  tumor looks like cystic pattern.

CT 2 : contrast enhancement in delay phase due to intratumoral bleeding.

CT 3 : vascular supply for this tumor.

CT  report by radiologist is pancreas tumor in invasion to CBD.  

Blood tests  =   CA19-9 = 4.96;  CEA= 0.56;   AFP=  0.3  

Summary of this case =  Young woman 25 yo has got  tumor of head pancreas in invasion to CBD.

Operation of Whipple is done.

MICROSCOPIC REPORT IT IS  SOLID PSEUDO PAPILLARY TUMOR  IT IS BENIGN  TUMOR OF PANCREAS 
 KNOWN AS   FRANKZ TUMOR.

COMMENT :  IN THIS CASE,  BLOOD TESTS CEA AND CA19-9 ARE NORMAL, THAT ARE  SAME IN REPORT  IN  REFERENCE CASE REPORT  BY WJG   2005.

REFERENCE =

CASE 508: GALLBLADDER PSEUDOTUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN PHÚ HỮU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 26 yo with subhepatic pain post prandial for a long time.

Ultrasound of abdomen:

US 1=  intercostal scan,  liver is normal,  biliary tract no dilated, and  gallbladder (GB)  adheres in liver border  by 2 portions, one near the GB neck  filling by bile fluid and GB fundus covered by a solid mass with  size of 3 cm which is.well limited inside GB.

US 2=  Color Doppler (CDI):  no thickening of GB wall, no hypervascular in GB wall, and  no detected vascular supply for this mass. But no posterior shadowing of this mass with  little enhancement of the posterior wall.

US 3= the GB fundus is covered by this mass but the wall is intact. This mass has no motion.  

Sonologist suggested  a tumor of  GB  like GB adenomyomatosis.

MRI of the biliary tract.:

MRI 1=   the biliary tract has no stone and GB is filled by tumor at GB fundus.

MRI 2 = GB  has 3 portions, the middle portion  is hyperdense and adherent to liver. The GB wall is thickening like tumor and enhanced with gado.

MRI 3 = crossed section of the GB at middle portion, GB wall thickening and GB lumen is small.

Radiolodist report   is tumor of GB.

Laparocholecystectomy was performed.

Photo 1 =   the GB wall is well intact.

Photo 2,3 =  inside content of  material of black pigment like coffee waste. The GB wall is normal without tumor.

Pathology report is pigment sludge and inflammation of GB.

Conclusion=  Pseudotumor of GB  by intragallbladder sludge tumefaction. 

Reference  pdf  case report.

CASE 507: URACHUS TUMOR, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 54 yo with dysuria.

Abdominal  ultrasound at hypogastric region.

US 1=  longitudinal section over  suprapubic area, reveales one mass  from  abdomen wall and connected to urinary bladder wall  at urachus site. This mass is mixed structure with cystic and solid parts.

 US 2 = crossed section of this mass.

 US 3 =Not detected any tumor in combination of 2 pictures of scanning of intraurinary bladder.

MSCT  scan of  urinary system with CE.

CT 1:  crossed-section  over urinary bladder.

CT 2:  sagittal scanning, this calcified tumor is  related to urinary bladder wall and urachus.

CT 3:  frontal view.

CT 4:  3D view of urinary system.

Radiologist report is  urachus tumor  looked like teratoma.

Operation to remove completely cystic tumor filled with mucus.

Conclusion: Ultrasound and CT make diagnostic of urachus cystic teratoma.

Pathological report is cancer of urachus tumor.

CASE 506: RENAL SINUS INFLAMMATORY PSEUDO- TUMOR, Dr PHAN THANH HẢI, Prof NGUYỄN TUẤN VINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 64 yo with clinical nocturia.

Renal ultrasound detected abnormal at right kidney.

US1 : Right big renal hilus and hyperechoic.

US 2:  Crossed-section of right kidney  shows hilus vascular compression.  

US 3:   Small size of right kidney  pelvis.

US 4:   In elastographic ultrasound, right renal hilus is hard.

MRI of  abdomen.

MRI 1 = Right kidney in normal size, no hydronephrosis but renal hilus is covered by one mass  look like a tumor.

MRI 2 =  Mass of  solid structure covered the right renal hilus.

MRI 3 = In frontal view, right pelvic kidney is small by this mass compressed.

Endoscopic surgery=  right pelvic kidney is  normal  without tumor.

Laparoscopy  detected  the abnormal fatty mass covered the hilus kidney. Biopsy  no tumor detected.

Microscopic report is  inflammed fatty tissue of renal hilus, that is a pseudotumor.

Reference : Hilus renal fatty stranding.