CASE 282: SUPRAPUBIC MASS, Dr PHAN THANH HẢI-Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 45 yo, 3 months after operation  for repairing left  inguinal  hernia,  pain in micturition and  polykiuria; clinical palpation  detected one mass  at suprapubic area.

Ultrasound  detected  this mass being a cyst, size of 10cm with many  bodies hyperechoic  intra cystic, which were looked like  foreign  bodies  ( see 4  US pictures). This  mass was  intra  abdominal  wall in  compression to urinary bladder.

MRI  of pelvis with gado reported  a  mass which was liked an abscess with  viscous fluid content  and cannot see  intracystic structure.

What is your suggestion for diagnosis of the suprapubic mass?

CASE 281: INSULINOMA, Dr PHAN THANH HẢI-Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 39yo  after  delivering her  second  baby, she  had  hypoglycemia  repeatedly  and  more  frequently.  But ultrasound  of pancreas  many time with many sonologists  cannot detect  abnormal in pancreas (see 3  ultrasound pictures  at Medic).

MRI  with gado detected  a small mass  of 1 cm in diameter  at the  head  of  pancreas ( see 3 MRI pictures)

Operation was done  for removing  this mass  and for  microscopic report.

After  removing  the mass of  pancreas,  the  sugar blood was getting  stable and returning to norma value.

Microscopic report was an insulinoma. 

TODAY PATIENT  DISCHARGED FROM HOSPITAL.

IN FASTING  INSULIN WAS  8.1 UI/ML  IN COMPARISON TO PRE-OP VALUE OF 50.9UI/ML.

CASE 280: FETUS ONE KIDNEY in HYDRONEPHROSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman in pregnancy  31 yo  PARA 2002. First time cesarian delivery, but  now  check for the second delivery. Prenatal ultrasound that  detected  oligoamniotic  and  but fetus having only one right hydronephrosis [see image US 1, US 2 ].

Urinary bladder was  normal and cannot find out the left fetal kidney (US 3 video  showed the facial fetus and  his nose and mouth  in normal respiration).

Fetal MRI  made sure that  only one abnormal  right fetal kidney, small and cannot find out the left fetal kidney [see MRI 1, frontal section  MRI 2  section, MRI 3, sagital section, MRI 4.)

Prenatal 36 weeks  detected  renal  malformation  with agenesis of kidney.

DISCUSSION:

In this case,  fetus has only one  kidney  in  hydronephrosis.

The mother  has to undergo a cesarian deliverying  and  strict  survey the neonate, and if  the  hydronephrosis is  still progressing, an emergency  endostent by JJ is method for  reduction of intrarenal pressure.

It is  look like  POTT SYNDROME, this  baby needs   DNA gene examination.

CASE 279: RETROPERITONEAL PELVIC SCHWANNOMA, Dr PHAN THANH HẢI- Dr LÊ TUẤN KHUÊ. MEDIC MEDICAL CENTER, HCMC, VIETNAM

MALE PATIENT 42 yo, from CA MAU PROVINCE, GETTING  HIS LOWER ABDOMEN BIGGER  AS 3 MONTH WITHOUT ANY SYMPTOM.

HE WAS TRANSMITTED TO CANCER HOSPITAL AND BINH DAN HOSPITAL.

ON CYSTOSCOPY HIS URINARY BLADDER WAS PRESSED FROM OUTSIDE.

ULTRASOUND AT MEDIC DETECTED A HUGE MASS IN PELVIS, CENTRAL NECROSIS.

AT BINH DAN HOSPITAL, COLONOSCOPY WAS PERFORMED AND THE RESULT WAS SIGMOID COLITIS.

AND CT of BINH DAN HOSPITAL REVEALED A HUGE RETROPERITONEAL MASS IN PELVIC REGION.

OPERATION  WAS DONE TO REMOVE THE TUMOR WHICH WAS of 15X20cm IN SIZE FROM ANTERIOR OF URINARY BLADDER TO PROMONTORY of SACRUM.

THE RESULT of HISTOPATHOLOGY AND HISTOIMMUNOLOGIC STAINING WAS A SCHWANNOMA.

REFERENCE:

CASE 278: UNKNOWN ASCITES, Dr PHAN THANH HẢI-Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 30 YO   ABDOMINAL PAIN  SOME MONTHS AGO,   ABDOMEN WAS DISTENTION AND  CANNOT EATING, NO FEVER  NO TRAUMA OR TUBERCULOSIS IN  HISTORY.
ABDOMEN ULTRASOUND  DETECTED ASCITES  WITH  BOWEL  ADHERENCE IN MASS, LIKE COCOON  SIGN ( 2 VIDEO).

MSCT of ABDOMEN WITH  CE REVEALED  NORMAL LIVER  WITHOUT TUMOR ( SEE  CT  3 PICTURES).

PUNCTURE of ASCITES SHOWED OLD  BLOODY  FLUID. ANALYSIS RESULTED NORMAL AMYLASE,  ADA, AND  CA 125.

PATIENT WAS ADMITTED HOSPITAL IN  EMERGENCY FOR  BOWEL  SUB-OBSTRUCTION.

LAPAROSCOPIC OPERATION   DETECTED  OLD BLOOD  WITH  ADHERENT FIBRIN  WHICH MADE BOWEL  AS A BALL (COCOON),  CANNOT FIND OUT THE BLEEDING SITE. NO TUMOR DETECTABLE, AND BIOPSY OF  ONE  OF PARIETAL PERITONEAL AREA THICKNESS.

MICROSCOPIC REPORT WAS  HEMORRHAGIC PERITONITIS.

WHAT IS THE  PLAN OF TREATMENT FOR THIS PATIENT ?.

CASE 277: CLOSE BY KNEE JOINT TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 21 YO   PAIN  NEAR  THE  LEFT   KNEE  AFTER  PLAYING  FOOTBALL.
 X-RAY FIRST OF LEFT KNEE AREA D ETECTED ONE MASS  INTRA
MUSCLE WITH  CALCIFICATION  AND ADHERENT TO FEMUR BONE  WITH SIGN OF PERIOSTEAL  EROSION.

ULTRASOUND OF THIS MASS  REVEALED  HYPOECHOIC PATTERN WITH CALCIFICATION INTRA MASS,
HYPOVASCULAR,  SIZE  ARROUND 4 CM.

ELASTOGRAM  SHOWED THAT MASS WAS HARD AND CENTRAL NECROSIS.

MRI  OF THIS MAS PROVED COMING FROM THE FEMUR BONE AND IN   EXTENSION OUT  TO
MUSCLE, LOOKED LIKE  BONE TUMOR (SEE  MRI 1, 2, 3 ).

PET CT   MADE STAGING  THIS TUMOR WAS  LOCAL  INVASION   HIGH
UPTAKED  18 FDG, SUSPECTED OSTEOSARCOMA.

OPEN  SURGERY  BIOPSY FOR  MAKING SURE  DIAGNOSIS.

WAIT FOR MICROSCOPY REPORT.

MICROSCOPIC REPORT WAS  PERIOSTEAL SARCOMA.

WHAT IS  PLAN of TREATMENT FOR THE  21 YO YOUNG PATIENT?  

CASE 276: PTC, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female 29 yo,  getting big neck  faster.

 Last  year she got some  small colloidal  cyst on right lobe. But at this time ultrasound detected hypoechoic mass on right lobe,  #34x60x24mm with many small cysts inside, calcified and hyperechoic nodules and  vascular network between cysts which was thought to be colloidal cysts.  

With elastoultrasound ARFI, lesion was harder than the surrounding, black color on VTI and blue code on Esie Touch. Elastographic velocity was higher , V=2.7à 3.14 m/s than the surrounding, v=1.28m/s. It suggested a malignant lesion on elastographic US.

Microscopic result of FNAC was PTC.

Discussion: An interesting  case of PTC with appearance of many small cysts which make confusion to colloidal cysts. Clinical findings which helped to diagnose are tumor getting bigger faster on one lobe of thyroid. And ARFI elastoUS  keeps the predictive role in diagnosing exactly for this case.