CASE 220:SMALL BOWEL G. I. S T.: Dr LÊ THANH LIÊM, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male 65 yo, occult blood stool  (+) in check-up,  then underwent  colonic endoscopy to confirm colon tumor, but only colonic polyp was detected.

Ultrasound pre endoscopy disclosed  a hypoechoic mass in LLQ, semilunar shape, with size of 28x25mm which  one part of contour was regularly round and another part close by lumen gas inside a loop of small bowel . There was vessels into this mass. 

The LLQ mass was thought to be a GIST of small bowel.

CEA rising of 5.38ng/mL

MSCT confirmed  the small bowel GIST later.

Surgery was done, macroscopic result was mural tumor of small bowel. 

Microscopy and immunohistostaining were proved for GIST tumor of small bowel.

CASE 219: RETROPERITONEAL TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN HỮU CHÍ, CHILDREN HOSPITAL 1 and MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Girl 6 yo, recurrent abdominal pain. Ultrasound detected one ovoid mass at the head of pancreas with size of 3x5cm, solid and well-bordered.

Image 1: this mass and IVC.

Image 2: CDI relation with right renal hilus.

Image 3: this mass expanding artery and renal vein.

Image 4:echo structure this mass is inhomogeneous, microcalcification and

hypovascular supplying.

MSCT  with CE: clear borders and  location of  this mass.

Blood tests were normal .

What is your suggestion based on  ultrasound and CT images?

PRE-OPERATION  THERE WERE  3  SUGGESTIONS OF DIAGNOSIS, AS  RETROPERITONEAL TUMOR, ADRENAL  GLAND TUMOR AND PANCREATIC TUMOR OF  PROCESSUS  UNCINATUS.

THIS CASE  WAS OPERATED REMOVING  THIS TUMOR EASILY.  IT  HAD APPEARANCE OF HEAD OF MEDUSA  (SEE  FOTO). THE STRUCTURE  INSIDE THE TUMOR WAS IN  RED COLOR  LIKED  BONE MARROW TISSUE.

MICROSCOPIC REPORT IS NEUROBLASTOMA.

CASE 218: LEFT SUPRACLAVICULAR MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 55 YO, LUMBAGO FOR 3 MONTHS.  MRI  SPINAL  SHOWED SOME  DESTRUCTIVE  SPINES SUSPECTING  METASTASIS  AND  A BIG  MASS  ON  LEFT  SUPRACLAVICULAR AREA.

ON ULTRASOUND  B MODE,  IT WAS A BILOBED MASS WHICH HAS DIFFERENT  ECHOSTRUCTURE . 

COLOR DOPPLER PRESENTED THIS HYPOVASCULAR MASS  LIKED SANDWICH SIGN.

ON ELASTOSCAN  ONE  PART OF THIS MAS WAS  SOFT  AND  ANOTHER ONE  WAS  HARD MASS.

WHERE DO YOU GUIDE  FOR  FNAC (HARD MASS OR  SOFT  MASS)?

WE DID PERFORM FNAC OF THIS SOFT MASS, REMOVING EASILY THE FLUID LIKED MILK;

FLUID ANALYSIS  : GRAM STAINING= NEGATIVE BACTERIA, BK NEGATIVE, BUT CELL BLOCK WAS ADENOCARCINOMA [SEE REPORT].

CASE 217: THYROID TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

WOMAN 41 YO, 5 YEARS AGO DETECTED SWOLLEN RIGHT SITE OF THE NECK.

ULTRASOUND DETECTED  A RIGHT LOBE OF THYROID, SOLID,  WELL- BORDERED, WITH SIZE OF 3 - 4 CM IN DIAMETER WHILE THE LEFT LOBE WAS ATROPHY. ON  COLOR DOPPLER  IT WAS NOT A  HYPERVASCULAR NODULE.

ELASTOSCAN WAS SOFT TUMOR.

NO CERVICAL LYMPH NODE DETECTABLE

BLOOD TESTS WERE NORMAL  VALUE OF TSH , T3, AND T4.

WHAT IS YOUR SUGGESTION,  FNAC OR NOT FOR THIS CASE.

Ultrasound guided for FNAC this mass and the result was colloidal goiter.

DISCUSSION:

B-mode ultrasound of thyroid is not full examination of the thyroid, only about the thyroid anatomy .Color Doppler explaines the vasculature, and ELASTOSCAN can guide for FNAC with high accuracy.

REFERENCE

 

CASE 216: MULTIPLE INTRAABDOMINAL NODULES, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 32 yo,abdominal pain, no fever. Emergency ultrasound of abdomen ruled out acute appendicitis, but there are ascites, and many small round nodules of  average of 2cm in diameter at great curvature of stomach, intra great epiploon, and at hilus of liver . All of them were  very poor echo like cyst (SEE 4 IMAGES= H.1: black nodule in hilus liver, H.2: cross section of abdomen and nodule intra great omentum, H.3:  echo poor nodule at great curvature of stomach, H4 : ascites at pelvis).

Blood test are normal. Punction of ascites fluid for analyse. PCR of tuberculosis is negative.

THIS CASE  UNDERWENT BIOPSY VIA LAPAROTOMY SHOWING  MULTIPLE WHITE SPOTS OVER PERITONEUM, LIKED CARCINOMATOSIS.

REMOVING ONE BIG MASS.AT GREAT CURVATURE OF STOMACH. CUTTING SURFACE SHOWED FLUID LIKED CASEUM.

SUGGESTION OF TUBERCULOSIS. WAIT FOR MICROSCOPY REPORT.

Microsopic  report  is  tuberculosis lymphadenitis (photo).

Discussions:

Why the result  of analysis of ascites fluid is negative  from TB PCR, ADA?
WHY TUBERCULOSIS LYMPH NODE  are VERY  BLACK in echogeneicity?
HOW to DIFFERENTIATE it WITH LYMPHOMA ?
 
REF

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CASE 215: PELVIS TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 50 yo amenorrhea 3 years ago, and hypogastric area distention like being of pregnancy for 6 months.

Ultrasound at the pelvis had a masss of 20 cm in diameter, cystic septation structure which cannot separate with cervis uterus by TVS ultrasound.

MRI of pelvis showed  that mass was cystic septation with very thick border (see MRI images).

DIFFICULTY FOR DIAGNOSING THIS CASE AS THIS MASS WAS TOO BIG, ULTRASOUND WAS LIMITED OF ANGLE OF FIELD OF VIEW.

MRI CANNOT STUDY THE MOTION OF THIS MASS, STRUCTURE WAS LOOKED LIKE OVARIAN CYSTIC TUMOR, BUT MRI  SHOWED  THE BORDER VERY THICK.

OPEN OPERATION FOR REMOVING THE UTERUS AS A SAME MASS.

SECTION OF THIS MASS WAS UTERINE FIBROMA IN NECROSIS, AND MICROSCOPY CONFIRMED.

IT IS A HUGE UTERINE FIBROMA NECROSIS LOOKED LIKE OVARIAN CYST.

Reference

DEGENERATED UTERINE FIBROID MIMICKING HYDROMETRA