CASE 324: BREAST PSEUDOTUMOR, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-324-breast-pseudotumor-

Woman 52 yo, history of hypertrophy of bilateral mammar gland. She had been in operation  for reduction of breast  size   10 years before. After operation she  detected  the  mass at the  site operation,  6- hour  position  at  2 breasts more and  more hard and no painful.

Ultrasound  check-up detected  at 2 breast,  masses  size  arround 5cm under  the skin incision at 6-hr position  of the breast,  hypoechoic  with  lateral shadowing.  At the left  breat mass  had  calcification,  soft elasto Q-score (see 5 ultrasound scan).

Mammography  cannot detected this mass.

MRI of breast without  gado, T1 ,T2 and fat subtraction, showed  fat  tissue with fibrosis  around and no axillary  lymph node.

Core biopsy of  this mass  and  reported  that  fatty tissue with  fibrosis, the border

was  fibrosis of scar  after operation  looked like a tumor. 

CASE 323: ELEPHANTIASIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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/case-323-

BOY 16 YO, HISTORY OF    ABNORMAL DETECTION OF HAND AND LEG IN THE CHILDHOOD, SLOW GROWTH ( FOTO).

2 HANDS  AND RIGHT LEG ARE ABNORMAL. PALPATION OF THE SKIN FEELS  EDEMA AND COMPRESSIBLE, NO PAINFUL.

ULTRASOUND  of  RIGHT LEG  REVEALED  SKIN AND SUBCUTANEOUS  LAYER THICKENING  TO 1,9CM, NO RAISED  VASCULAR STRUCTURE.

MSCT  NON CE SHOWS  SKIN AND  SUBCUTANOUS   FATTY EDEMA, LOCATED THE  2 HANDS AND  FOREARM, RIGHT  HALF BODY, AND RIGHT LEG WHILE   BONES AND MUSCLES ARE NORMAL.

WHAT IS  YOUR  DIAGNOSIS?.

CASE 322: OVARY TWISTING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-322-ovary-twisting-

WOMAN 36 YO, 3 DAYS  AGO PAIN AT  SUPRAPUBIS, AND POLYKYURIA.

ULTRASOUND  OF  PELVIS WAS NORMAL.

PAIN CONTINUING  AND  RISING  AND SHE  WAS IN ADMISSION  OF ONE  EMERGENCY HOSPITAL,   IN CLINICAL SUSPECTED  RENAL COLICKY PAIN.

ULTRASOUND  AGAIN   DETECTED  ONE SUPRAPUBIS MASS,  SIZE OF10CM,  CYSTIC WITH  CLOUDY  FLUID INSIDE (US 1).

CDI  REPORT  WAS SMALL UTERUS, CANNOT  DETECT VASCULAR  AT  RIGHT UTERUS CORNER (US 2).

THIS CYSTIC MASS  WITH  MASS INTRA CYST  LIKED  SEBUM THAT  SUSGESTED  RIGHT OVARY TERATOMA  IN TORSION.

NO STONE  INTRA URINARY SYSTEM.

MSCT  NON CE   PRESENTED  OVARY MASS  LOOK LIKED TORSION OF TERATOMA.

EMERGENT OPERATION BY LAPAROTOMY DETECTED THIS MASS BEING AN OVARIAN CYST   BLACK IN  COLOR DUE TO TORSION ( SEE FOTO)

OPEN  SURGERY  REMOVED  RIGHT  OVARY MASS  ISCHEMIA AND BLEEDING INSIDE OF A  TERATOMA TUMOR.

Discussion : Why the first ultrasound examination was  normal?  Looking  the first picture ultrasound of the uterus that was  clear view and  the fluid  over  look liked urinary bladder.

But  you can see the small urinary bladder  in the lower corner of the first ultrasound picture.

The mistake  was due to ultrasound  scanning  with  the urinary bladder  not full filling , the ovary cyst  was not  septation because scanning view in small window.

The ultrasound examination is better  view  with  lateral decubitus position, but in some cases cannot see well in decubitus position.

Pathology report was an ovarian teratoma.

CASE 321: MALE BREAST TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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/case-321-male-breast-tumor

Male 58 yo  history of sefl  detected  right  breast tumor  slowly growing for 10 years [see FOTO],  its size of  6 cm and  changing color of covered skin.

On ultrasound   it was a solid tumor  with cystic formation, hypovascular, no  adherence to deep  muscle layer and small  axillary nodes ( US 1, US 2, US 3).

Mammography  showed well- bordered  round tumor,   no calcification ( mammo1, 2).

MSCT  with CE of this  tumor was  low CE enhanced,  very clear border (CT 1,2,3).

FNAC report  was  blood cell only and no tumor cell.

Operation  removed this tumor ( 2 specemen )

Pathology report  was  caverneous  hemangioma.

CASE 320: VENA PORTA THROMBOSIS BY HCC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-320-portal-vein-thrombosis

Woman 58yo, history of  infected  HBV  and diabetes. One week ago  she was very  painful  in  liver region.

Chest x-ray showed elevated  right diaphragm ( see Xray chest film).

Ultrasound  reported that  no pleural effusion..but  liver  had  many tumors with  portal vein thrombosis  completly..( us1, us 2, us 3, us4 and video).

Blood tests = HBsAg  positive  with  AFP = 9.3 ng/mL.

Blood tests  again  with   HCC risk  on Wako machine resulted  very high  level of DCP, this test made thinking  portal vein  thrombosis  by HCC.

Discussion : History of  infected  chronic HBV,  and normal..AFP,  but  ultrasound suggested   VP THROMBOSIS due to HCC  that based on  WAKO  compiling  3 tests  AFP, AFP-L3%, DCP which confirmed  HCC.