CASE 651: PERITONEAL ABSCESS DUE TO FOREIGN OBJECT (FISH BONE), Dr PHAN THANH HẢI, Dr CHÂU NGỌC MINH PHƯƠNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 67 year-old male patient, presented with periumbilical and left lumbar pain for one month that was not response to treatment.

Abdominal ultrasound detected one mixed echogenic mass in the left lumbar mesentery with the diameter of 84 x 47mm. The conclusion was: Suspected mesenteric infarction (Differential diagnosis: Intra-abdominal Abscess) – Hepatic Steatosis – Abdominal Aortic Atherosclerosis.

MSCT of the abdomen showed a foreign object similar to a toothpick near the abdominal wall, right above the umbilicus, with a lenghth of 21 mm. The greater omentum surrounded the foreign object forming a mass with the diameters of 60 x 45 mm.

During operation, surgeons removed a foreign object which was highly suspected as a fish bone after dissecting the abscess in the greater omentum. The two adhering loops of small intestines were separated and reinforced with stitches.

 

  

 

Conclusion: Physicians should be on high alert when patients with abdominal pain not responding to the treatment. Abdominal ultrasound and MSCT help guiding the appropriate diagnosis for the case.

CASE 650: SOFT TISSUE TUMOR, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 52 year-old patient with a mass at her right frontal region, no pain, no changed skin color.

Ultrasound detected a subcutaneous hypoechoic with vascular signals which was noted a vascular tumor but not invasive frontal  bone. Elastography was medium hard than other tissue around.

Histoanapathologic result was benign cystic hemangioma.

CASE 649: CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ THANH THẢO, Dr TRẦN CHÍ ĐỦ, Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIET NAM.

 A  68 year-old male patient with jaundice in ruling out of head of pancreas tumor from Tra vinh province went to Medic Center for an exact diagnosis before a surgical treatment.

Ultrasound ruled out pancreatic tumor and noted intrahepatic bile duct dilatation and 2 sides pleuresia. Gallbladder was not big with some sludge.  Wall of bile duct thickening # 6-7mm, hyperechoic, CBD diameter 1.24mm existed 0.66--1.2 mm bile sludge at the beginning of CBD. Sign of bile duct tumor was unclear.

Later biliary MRI performed and the result was a tumoral infiltration in bile duct  that made collapse biled duct at the hepatic umbilicus leading to dilatation of intrahepatic bile ducts. Maybe there was an other thought about of stricture of bile duct due to cholangitis.

Surgery was done that detected bile duct tumor #1x2 cm.  Removed bile duct tumor, GB,  and  connecting hepatic duct  to jejunum by Roux-en-Y. Anapath was CholangioCarcinoma grade 2 invasive.

CASE 648 : SKIN ULTRASOUND, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC , VIETNAM

 A 90 year-old male patient with a painless node at right angle of his mouth. His past history was a left kidney cancer that had been cured for 5 years.

Skin utrasound  by VINNO M86 system with linear probe 16MHz and 23MHz. 

Focal cystic lesion # 9x4mm,  represented mixed structure in subcutaneous layer, with fluid, non vascular, well limitted capsule. Elastography was green code that means a medium hardness. A benign mucous cyst was noted.

CASE 647: PILOMATRIXOMA of MALHERBE, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, Dr LÊ THÔNG LƯU, Prof. NGUYỄN SÀO TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

A 11 year-old female patient with a small cyst on left side of her neck for 5 months. A TB regimen started for a while.

Ultrasound detected a cyst of subcutaneous layer on left side of the neck, well-limited, round, with a dark line adhered the skin. Echostructure is mixed: cystic and some trabecular thicker semisolid structures inside which are like septation. It exists some septa with colored signal arterial type.

Discussion:

Common cystic lesion in subcutaneous layer adhering the skin usually named sebaceous cyst, epidermoid cyst. But in this case, a very small dark incontinuous in upper border of the cyst helps thinking to a skin hair. That is the key of a pilomatrixoma which is still a rare entity of habit in clinic.

The cyst was entirely removed.

Histopathogic result is a benign tumor of

the hair follicle matrix, name Pilomatrixoma or  Calcifying Epithelioma of Malherbe.

References:

CASE 646: WARTHIN'S TUMOR, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, Dr NGUYỄN TUẤN CƯỜNG, Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 69 year-old male doctor patient with sputum cough for one week went over to Medic for a check-up.

Ultrasound detected hepatosplenomegaly, and thickening of the wall of sigmoid colon with lymph nodes inside abdomen. On the neck, a parotid tumor at the lower pole (tail of parotid) exists on the right side.

Pathologic result of sigmoid colon was tubular adenoma and slight dysplasia.

Gastroendoscopy revealed an ulcer at lesser curvature and edema of gastric corpus.

Core biopsy of the parotid tumor proved Warthin 's tumor of the right parotid with pathologic result.

ABSTRACT

A male doctor 69 year-old patient with sputum cough for one week.  He got a submandibular mass in suspecting lymphoma or parotid tumor. But on the neck, ultrasound revealed parotid tumor that was concluded a Warthin 's tumor with pathological result of core biopsy.

Morever the doctor patient suffers from a benign tumor of sigmoid colon, gastritis with ulcer and hepatosplenomegaly, and fortunatly gets over the lymphoma haunting.

References

1. Warthin Tumor: Papillary Cystadenoma Lymphomatosum "occurs in the tail of the parotid in aged men". [DeGowin's Diagnostic Examination, 2004].

2.