CASE 331: MASS INSIDE STOMACH, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-331-mass-inside-stomach

Child 5 yo long history of epigastric pain and anorexia treated  as  HP  infected gastritis.

Ultrasound detected intragastric mass  with  large UMBRELLA SIGN  [showdown  like the  sunshine over the umbrella] which  covered  more  50%  of  lumen of stomach ( see US pictures 1, 2, 3).

MSCT of  abdomen revealed this mass  inside  stomach,  multilayer  structure, not  developmental from the wall of  stomach.

Based on ultrasound  and abdomen CT, suggestion  of radiologist  is  gastric trichobezoar.

What is your  suggestion, endoscopy  or  operation for removing the mass inside stomach?
Operation of gastrostomy removed the hair mass.

Reference:
Umbrella's sign of ultrasound.
https://www.google.com/?gfe_rd=cr&ei=g5_tU8msNeuJ8Qfjl4HADg&gws_rd=ssl#q=umbrella%27sign+ultrasound&imgrc=iff-XjzsO-ZxoM%3A

CASE 330 : SMALL HCC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-330-small-hcc-

Man  66 yo with history  no infected  HBV, HCV but  high values of liver enzymes for a long time.

Ultrasound of liver showed fatty infiltrating in liver.

Blood test of HCC RISK  positive  with AFP: 33.6 ng/ml; AFP-L3%: 62,4% and DCP: 21mAU/mL.

MRI of liver  with PRIMOVIST and DWI detected a  small focal lesion, size  of 0.8cm at the liver border in  segment 6,  very  bright  in DWI  and captured  and washed out  Primovist like a HCC.

Diagnosis  was made for a small HCC,  wait for operation.

DISCUSSION:

Biopsy or not for  the case:  hepatologist and  radiologist said no because worrying of sedding cancer cells.

RFA or  SURGERY? RFA  could  perform if ultrasound  can see the tumor. Yes,  WE CAN SEE  THIS  HCC ( see  2 US  pictures).

This case is  planning to do RFA in  next week and test HCC Risk (WAKO)  24 hours after this procedure.

After 48 hrs RFA [ 27-08-2015] 2nd Wako test repeated (AFP: 21.7 ng/ml, AFP-L3 : 60.5%, DCP: 21mAU/mL
Wako test  again  10 days after RFA [ 6-09-2015] 3rd Wako test ( AFP: 7.6ng/ml, AFP-L3: 42.1%,DCP: 20 mAU/mL)
Wako test  will be performed one month after RFA.

REFERENCE:
MayoClinics Report HCC_AFP_L3

CASE 329: MEDIASTINAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-329-mediastinal-tumor-

Man 28yo, one week ago getting of chest pain, fever and cough. Chest X-Rays (image 1)  showed a  mass  at  left  lung which was thought to be a left anterior mediastinal tumor.

Transthoracic  ultrasound reported  a solid mass, size of  6.7 cm, hypovascular, covered  left anterior mediastinum with  pericardial effusion (ultrasound images 1, 2, 3, 4).

MSCT with CE made diagnosis with a left anterior mediastinal tumor like thymoma.

Blood test made attention to  AFP very high value (lab report).

Clinical status  and  XRays film , US,  CT and  lab reports suggested a  teratocarcinoma (seminoma).

Core biopsy of  this tumor report was an  undifferentiated adenocarcinoma.

The  patient is  waiting for  operation.

CASE 328: DISSECTING SUPERIOR MESENTERIC ARTERY, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-328-dissecting-superior-mesenteric-artery-dr-l-vn-ti

Male patient  50yo, old patient of Medic Center with history HTA and prolonged epigastric pain , HP infected.

Epigastric pain was getting worse for one month, he was admitted by province hospital for 10 days and had been treated as gastritis, but continued gastric pain out of hospital for 20 days. So coming back to Medic Center.

Ultrasound at Medic Center revealed dissecting SMA at its origin, d=12mm, raising diameter and flapping moving inside in TM mode, aliasing in color mode,  and confirmed it later by MSCT.

REFERENCES:

CASE 327: INTRATHORACIC THYROID TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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 case-327-intrathoracic-thyroid-tumor-

Woman 37 yo with history of  sore throat and  changed  speaking.

Chest X-Ray detected  one  mass at upper pole of right lung (chest x-ray film).

Transthoracic ultrasound  of this mass revealed  a solid  hypovascular mass, size of 10 cm, no moving  with  respiration. Thyroid  ultrasound  scan  was normal  but the right lobe was  smaller  than left one.

MSCT  angio in  cervico-thoracic region showed mass in connecting with right  thyroid lobe.

Main vascular supplying for this mass was from branch of  inferior thyroid artery  (see CTA).

Operation for  removing of  one round mass connected with  right lobe of thyroid, its

structure was inhomogeneous  and pathology report was  colloidal  thyroid goiter.

Conclusion: this case  was  an intrathoracic goiter while on chest X-Ray film  looked like  lung tumor.
Reference:
Case from Mayo Clinics 

CASE 326: INTUSSUSCEPTION of COLON INDUCED by POLYP, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-326-intussusception-of-colon-induced-by-polyp-dr-l-t-phc

A 4 years-old boy presented to Medic Center with one year history of weakness, fatigue, lethargy, pale skin and less active. No recognition of other symptoms such as vomiting, abdominal pain or bloody stools. Patient was done blood test and abdominal ultrasound. 

Abdominal ultrasound detected colo-colonic intussusception in the right upper quadrant with concentric rings sign in transverse scan and "hay fork" sign in long axis scan. Located adjacent the intussusception show an isoechoic to hypoechoic solid mass, well defined oval, 30 mm in diameter, hypervascular in the hilus of the mass. Those blood vessels were continuing with the blood vessels from central portion of the intussusception. Sonologist suspected a intussusception of the ascending colon secondary to a  polyp. 

Laboratory investigations showed the reduction of Hemoglobin: 6.5 g / dl.

The patient was transferred to the hospital Nhi Dong 2. He had positive fecal occult blood test. Colonoscopy showed a polyp of ascending colon. 

A surgery was then obtained 2 weeks later.

 Surgical results confirmed polyp of the ascending colon which pathology result is tubular polyp.

CASE 325: STRETCH MARKS SKIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-325-

Boy 15 yo, history of  treated  high dosage  corticoid  due to uveitis;  2 years later  detected  many  scars  over  skin  at abdomen, leg, arm, back ( foto).

Ultrasound  of skin abdomen  shows  that  skin thin  and  hyperechoic, soft elasoscan ( see  US pictures 1,2,3,4).

Conclusion: It is  stretch marks skin due to  overuse  corticoid  which  destructed elastic fibers  in  derma layer of the skin.

REFERENCE:

Cases  of  skin stretch marks.