CASE 148: GALLBLADDER CANCER POST TRAUMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

ARTER TRAUMA, WOMAN 59 YO PAIN IN RIGHT COSTAL AREA .

ULTRASOUND ABDOMEN DETECTED ABNORMAL GALL BLADDER, BIGGER THAN NORMAL, AND NO BILE FLUID INSIDE.

( Fig 01 GB in  BLACK AND WHITE, Fig 02 in CDI, Fig 03 in DOPPLER SW, Fig 04 CROSS- SECTIONAL GB).

CDI SHOWED THE LUMEN OF GALLBLADDER MORE HYPERVACULAR LOOK LIKE
A-V MALFORMATION.

MSCT with CE,  hypervascular gallbladder is supplied by cystic artery, and the central portion of gallbladder is very high enhancement.

The GB returned vein is drained to hepatic vein.

Radiologist proposes a hemangioma for her gallbladder.

Gallbladder being removed, and microscopy says it cancer.

Discussion: Why the gallbladder cancer enhances like that (more central than peripheral part)?. 

CASE 147: LIVER TUMOR MIMICKING HEPATIC ABSCESS , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 35 YO, PAIN AT RIGHT SUBCOSTAL AREA, CLINICAL POSITIVE MURPHY'S SIGN.

ULTRASOUND DETECTED  A FOCAL LESION NEARBY GALLBLADDER, SIZE OF 4,9 CM, HYPOECHOIC  WITH CENTRAL WHITE SPOT, THEN SUSPECTED LIVER ABSCESS.

MSCT OF LIVER WITH CE ALSO SUGGESTED A LIVER ABSCESS.

Blood tests  showed that patient infected HBV with AFP L3  high risk.

Laparotomy was done for resection the liver tumor and gallbladder.

In macroscopy, it is an invasion to gallbladder of a very hard liver tumor.



MICROSCOPIC REPORT IS  LIVER CANCER .

 

 

 

BUT SOME QUESTIONS: IN THIS CASE, WHY   THE CENTRAL PART OF TUMOR  IS VERY HYPODENSE ON  CT  SCAN WHILE ITS  VERY  HYPERECHOIC ON  ULTRASOUND, AND IN COMPARISON TO THE MACROSCOPIC SPECIMEN,   AND WHAT IS THE REASON ?

CASE 146: JACK-FRUIT LIVER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN, EPIGASTRIC PAIN FOR 6 MONTHS.

ULTRASOUND DETECTED MANY HYPERECHOIC NODULES IN LIVER, SIZE OF 1-2 CM.  THE LIVER LOOKS LIKE JACK-FRUIT ON ULTRASOUND IMAGE.

MSCT LIVER WITH 3 PHASES, ARTERIAL, VENOUS, AND LATE.

DO YOU THING LIVER METASTASIS WHICH COMES FROM...

ON CT SCANNING THE GASTRIC WALL WAS THICKENED.

GASTROSCOPY WAS DONE WITH BIOPSY SHOWING A TUMOR OF ANTRUM BLEEDING.

MICROSCOPIC REPORT OF BIOPSY AT ANTRUM GASTRIC TUMOR IS DIFFERENTIATED  MODERATELY  ADENOCARCINOMA.

CASE 145: MALIGNANT OVARIAN TUMOR ?, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 26YO, SINGLE, HYPOGASTRIC DISTENTION.

ABDOMEN ULTRASOUND SCAN OVER HER PELVIS DETECTED ONE 20CM MASS FROM PUBIS TO UMBILICAL REGION, BIG, CYSTIC, MULTILOCULATED WITH SEPTATION. IT DEPLACED UTERUS TO LEFT SIDE.

IMAGE 1: LONGITUDINAL SCAN OVER PELVIS FROM UMBILICUS TO PUBIS, THE MASS WAS MULTILOCULATED CYSTIC PATTERN.

 

 

 

IMAGE 002: COLOR DOPPLER SHOWED LOW VASCULAR SUPPLY, AND NO VEGETATION ON THE SEPTATION .

 

 

IMAGE 003:  STRUCTURE OF CENTRAL PART OF THIS MASS WAS  SOLID, HYPERECHOIC,  LIKE FATTY TISSUE.
 

 

 

 

THE MASS WAS SUSPECTED OVARY TUMOR ...

BLOOD TESTS=  AFP, BETA HCG WERE NORMAL, CA125=175UI [ N<35]UI. ROMA TEST WAS IN HIGHT RISK VALUE.

FOR MORE INFORMATION, MRI  WAS DONE WITH GADO CE. IT SHOWED THIS TUMOR CYSTIC MULTILOCATED CONTAINING  HYPERPROTEIN FLUID  AND FATTY TISSUE WITHOUT CALCIFICATION.

WITH MRI RADIOLOGIST SUSPECTED  TERATOMA OF OVARY.

LAPAROTOMY OPERATION WAS DONE AT HUNG VUONG HOSPITAL TO REMOVE  HUGE OVARIAN TUMOR, WITH  HAIR AND POLYMORPHIC TISSUES .

 

MICROSCOPIC REPORT IS MATURE TERATOMA.

 

CASE 144: ABNORMAL GALL BLADDER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 36 yo, recurrent epigatric pain. Abdomen ultrasound detected the abnormal gall bladder which was  big and changing the shape,  look like a bottle with two parts, one contained bile and the fundus was solid and very small lumen. With CDI the fundus of gallbladder was full of many Doppler artefacts due to cholesterol crystal ( image 1 and 2 viewing with the probe 3,5 MHz,  image 3, probe 12 MHz).

 

 

 

 

MSCT ABDOMEN WITH CE ALSO SUSPECTED OF ADENOMYOMATOSIS OR GALL BALDDER TUMOR.

 

 

THIS CASE HAD BEEN UNDERGOING  ENDOSCOPY OPERATION FOR REMOVING  GALL BLADDER. MACROSCOPIC SPECIMEN  LOOKS LIKE HOURGLASS SHAPE, WITH  VERY THICKENED WALL OF THE GALL BLADDER FUNDUS.

 

 

MICROSCOPIC REPORT IS ADENOMYOMATOSIS of GALLBLADDER

 

REFERENCE : AJR:189, July 2007.

 

CASE 143: INTUSSUSCEPTION of COLON due to POLYP, Dr PHAN THANH HẢI, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female patient 23yo, pain at right flank, came to MEDIC for ultrasound of abdomen.
Ultrasound detected an uncomplicated intussusception of right colon, maybe due to a polyp of colon.

 

MDCT 64 disclosed a polyp of colon inducing an intussusception of ileum into right colon.

Operation was done for hemicolectomy. Gross specimen proved a polyp of colon and microscopic result was a benign polyp.

CASE 142: MULTIFOCAL LIVER and VOMITTING at POST PRANDIAL, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 59 yo,  EPIGATRIC PAIN AND VOMITTING  HAVING MEAL.

ULTRASOUND SCAN OF LIVER DETECTED MANY FOCAL LESIONS WHICH HAD  DIFFERENT ECHOSTRUCTURES : SOLID  HYPERECHOIC, HYPOECHOIC AND CYSTIC, with SIZE  IN AVERAGE OF 1-2 CM OVER THE LIVER.

  

  

THIS PATIENT HAD NO HISTORY OF INFECTED HBV OR HCV, BLOOD TESTS SHOWED    RAISING OF WBC  WITH PLATELET COUNTS IN  HIGH VALUE.

This case based on ultrasound images and one sonologist suggested that was to be microabscesses of liver due to parasites, but blood tests ruling out.

For making clear the symptom of vomitting, an esophago-gastric x-ray was done, and it suggested that a cancer of middle portion of esophagus.
Biopsy confirmed a squamous cell carcinoma of esophagus, causing multifocal nodule metastasis in liver.

  

Do you thing this liver images by ultrasound are metastasis from the esophagus cancer ?.

What is the most different diagnosis for this case ?

Ref. 2 PDF.