CASE 354: RIGHT KIDNEY TUMOR, Dr PHAN THANH HẢI-Dr TRẦN LÃM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man  37 yo, screening by  MSCT total body  non CE  detected  abnormal  border of upper pole of right kidney (images CT 1, CT 2).

Phased  CT CE find out  this mass being tumor of upper pole of right kidney, size  of3,5 cm with the rim border but non fatty tissue in structure (CT 3, CT4).

Ultrasound for verifying of this mass is mixed echoic, hypovascular supplying, not invasion to hilus of right kidney (US 1, US 2( longitudinal scanning), US 3 (cross-section).

What is your  suggestion of diagnosis, and biopsy or not?

Urologist  says no biopsy, clinical  imaging  looks like  RCC. Planning to surgery, partial nephrectomy (see macro).

MICROSCOPIC REPORT  IS  RCC (RENAL CELL CARCINOMA).

CASE 353: SCALP SKIN TUMOR, Dr PHAN THANH HẢI, Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN  37 YO. HISTORY:  KNOWN THAT SMALL TUMOR  AT OCCIPUS  AREA.OF SCALP FOR 20 YEARS . BUT THIS  YEAR  THIS TUMOR IS GETTING BIG  SIZE  OF10CM, NO PAIN.

ON CLINICAL EXAMINATION THIS TUMOR IS HARD IN PALPATION ( FOTO).

ULTRASOUND  OF THIS TUMOR  BY LINEAR PROBE 10MHz : THIS TUMOR IS SOLID, THICKENING ABOUT 1- 2 CM, HYPOECHOIC, HYPOVASCULAR.

 ELASTOSCAN US   IS HARD  OF 22kPa.  NO EROSION IN  BONE  BELOW  ( SEE US 1, US 2, US3, US 4).

ONE DERMATOLOGIST   SUGGESTED  SEBACEOUS NEAVUS.

OPERATION REMOVED THIS TUMOR ( SEE  MACRO).

Microscopic result is syringoma.

Report of  another case ( Dr Le thong Luu) soft  tumor of the thigh ( foto). 

Ultrasound is  cystic  tumor, but  macro and  microscopic report post op is  syringoma.

CASE 352: PROSTATE TUBERCULOSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man  49yo, dysuria, clicinal examination  detected  big lymph node on his left neck ( foto).

Ultrasound  examination of  the neck: normal thyroid  gland, size of  lymph node of  2cm,  hypoechoic  without hilus  on color doppler ( US 1).

On elastoscan, center of this  lymph node is hard  22kPa.

Ultrasound  scanning of pelvis  detected prostate having  one hypoechoic mass   at  right lobe ( US 3).

 US scanning  at epigatric area detected one mass ellypsoid of  3 cm lying over aorta (US 4).

Sonologist suggested a prostate cancer with metastasis to  lymph node.

CT scan with  CE revealed the mass in prostate  hypovascular, no contrast enhancement. looked like  necrosis or abscess.

Biopsy of  this cervical lymph node is tuberculosis lymphadenitis  (photo )

Punction of  prostate mass  removed pus specimen, and  examination this pus with PCR is TB positive and  high ADA.

Blood test  PSA is 2.05 ng/mL.

CONCLUSION:  this case is  tuberculosis prostate and lymph node looked like  prostate cancer metastasis to cervical lymph node.

CASE 351:A CASE of FITZ-HUGH-CURTIS SYNDROME , Dr PHAN THANH HAI - Dr VO NGUYEN THANH NHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 24 yo post partum,  pain at right pelvis and fever. But one day after, pain  at  liver region, palpation is very painful  at Murphy point liked  cholecystitis.

Ultrasound of abdomen  cannot  detect   cause of pain, no stone in gallbladder , no thickening of the wall of gallbladder, no free air or free fluid at  Morrison space (see US pictures 1,  2).

Ultrasound at pelvis  revealed  thickening  of pelvic  peritoneum and hypervacular  at right  uterine tube ( US 3).

MSCT of  abdomen without  CE cannot detect  abnormal ( CT 1);  with CE  injection, in delay  phase  radiologist  reported  abnormal perihepatic contrast  enhanced.

Blood tests :  high CRP of 104.89ng/ml, WBC normal.

Suggestion for this case : perihepatitis and PID [pelvic inflammatory disease] means   FITZ-HUGH-CURTIS SYNDROME.

THIS PATIENT HAD BEEN TREATED BY ANTIBIOTICS,  CLINICAL STATUS RESPONSED VERY WELL, NO MORE PAIN AND  NO FEVER, AND  DISCHARGED  HOSPITAL AFTER  3 DAYS.

REFERENCE: FHC SYNDROME.

CASE 350: SKIN TUMOR, Dr PHAN THANH HAI - Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 78 yo, presented small nodule of upper lip, slow growing for 1 year, no pain, no itching. Palpation of this tumor was hard,  size around 2 cm ( see  foto).

Ultrasound examination of this tumor from the skin of upper lip; no invasion to fatty layer but  hypervascular.

OPERATION REMOVED THIS TUMOR EASILY WITH WELL BORDERED ( SEE FOTO MACRO)

MICROSCOPIC IS BASAL CELL CARCINOMA [BCC]  WITH  IMMUNO HISTO STAINNING.

CASE 349: TESTIS TUMOR, Dr PHAN THANH HAI- Dr LE THONG NHAT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 42 YO, ONE MONTH AGO, PAIN IN ORAL SINUS, DIFFICULT EATING AND 2 DAYS  PAIN AT LEFT TESTIS [FOTO IN ORAL TUMOR AT PALATINE].

ULTRASOUND OF LEFT TESTIS PRESENTED   BIG  AND  HOT  (US 1, B MODE B&W,  CROSS SECTION OF  LEFT TESTIS HYPOECHOIC  INFILTRATION; US2, COLOR DOPPLER  IS  HYPERVASCULAR OF ONE PORTION OF TESTIS; US3, LONGITUDINAL  SECTION OF LEFT TESTIS; 

US4 ELASTOSCAN   THIS  HYPOECHOIC IS 10,5 kPA).

FNAC OF THIS MASS OF  LEFT TESTIS  HAVING   ABNORMAL CELLS.

  

BIOPSY  OF THIS TUMOR IN ORAL IS  B CELL LYMPHOMA.

MY DIAGNOSIS IS LARGE B CELL LYMPHOMA  STAGE 4.