CASE 379: ECTOPIC PANCREAS TISSUE in JEJUNUM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNA

Man 41 yo, headache, high BP, clinical looked like  pheochromocytoma.

Ultrasound detected nothing abnormal in abdomen.

CT scan of  abdomen  with CE detected small tumor in jejunum wall size of 2.5 cm, very high contrast enhancement (see CT1).

Blood test  is not  clear diagnosis.

2 weeks after CT with C E  again also detected  this tumor in same size (see CT2).

Gastro-colono endoscopy  is normal,  report  no polyp detected. Laparoendoscopy detected  this tumor is  in jejunum wall..( lap1, lap 2 , ope.. ) 

and resection  this tumor (see macro 1,2)

Surgery report is small intramural tumor of jejunum, 20 cm far from  D3, well bordered looked like ectopic pancreatic tissue. Microscopic report is  ectopic intramural jejunum pancreas tissue. 

DISCUSSION: Ectopic pancreas in jejunum is very rare, reviewing of  CT with CE  made sure  pancreas  in  normal size and structure  CT number ( HU) is 126. Comparison with  HU of  ECTOPIC  PANCREAS is 120. It  is criteria for diagnosis in suspection of  ECTOPIC PANCREAS

REFERENCE:

CASE 378: BLACK SKIN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 44 yo,  3 years ago after removing a small skin tumor [2005] at the  left back  with the result of skin hemangioma, this site is growing another black tumor foto), size  arround 3 cm.

 Ultrasound of skin tumor= US 1: solid tumor, inhomogenous structure,  located subcutaneous to superficial muscular  fascia.

US 2: very high vascular structure of this tumor  on color Doppler.

US 3: Power Doppler  very high flow, lower RI of  artery  in tumor.

US 4: PW Doppler of  the main artery supply of this tumor= very high flow, high PI. 

What is your  diagnosis for this cases?  It is a recurrent black tumor.

CASE 377: OMENTUM PSEUDOTUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 44 yo  pain  at  RLQ   and fever for  2 weeks, being treated  ambulatory with antibiotics. In clinical examination of  abdomen wall at RLQ is edema,  induration and pain in compression.

Ultrasound  shows the abdomen wall  thickening with edema and fluid in muscle

(us 1);  no  air or  blood supply of this  site  (us 2), us 3: the great omentum  is  thickening  and adherent to  abdominal wall; us 4=  small intestine  walled-off.

MSCT with CE= the  wall of abdomen is edema  and great omentum is  covered RLQ site (CT1);   CT2: edema of abdomen wall; CT3: sagittal view.

Blood tests: WBC rised to 20k;  high CRP =  30ng/mL.

Clinical  diagnosis is  suspected  plastron appendiculaire .

Normal coecum is looking in colono-endoscopy.

Operation for removing a very big hard mass of great omentum, (see macro1, 2)

and report of surgeon is  looked like  tumor.

MICROSCOPIC REPORT IS  INFLAMATION, NO TUMOR CELL.

CONCLUSION: INFLAMATION of PSEUDOTUMOR from GREAT OMENTUM.

Reference:

CASE 376: UREMIC ASCITES, Dr PHAN THANH HẢI- Dr VĨNH PHÚC- Dr JASMINE THANH XUÂN

Woman 30 yo with  total colectomy by  colon poliposis for   2 years ; one month ago  she  detected  ascites unknown origine at MEDIC [19, April]. Ultrasound   showed that high volume ascites, normal liver and.kidney (see 4 pictures ultrasound).

CT of abdomen with CE also cannot detected the cause of ascites;  she underwent laparoscopic biopsy of  peritoneum and report was non specific chronic inflamation.

One week  later  [ 25,April, 2016] she got acute abdomen pain..and  came to MEDIC again.

CT of abdomen with CE detected  left kidney  hydronephrosis 2nd degree and one mass  of 5 cm in retroperitoneum  near  abdominal aorta bifurcation obstructed left ureter loodk like   urinoma (see  CT 1 and  ultrasound images of this mass(see US 2).

Abdominal tap removed  pink  ascites fluid and analysis report= ADA negative,  high protein, normal amylase, urea= 36.04mg/dL, creatinine  3.2 mg/mL (normal <1mg/ml).

Summary of this case:  ascites  with CT and ultrasound detected  urinoma and high creatinin in ascites that proved an uremic ascites.
Reference:

CASE 375: UTERUS MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 33 yo PARA 1011  underwent C-section 3 years [ 2013]  now  ultrasound detected  in 6 week pregnancy.  But  she would like to  evacuate the embryonic sac  by curettage . Then 3 weeks later  she  get pain at her pelvis.

Ultrasound  again  detected one hypervascular  mass  at the neck of uterus ( see 3 US images).

And beta HCG of  blood test is  high.

MRI  uterus of this mass  suspected  gestation at neck  uterus  in the scar of cesarian section before.

Open operation  for hysterectomy confirmed  cervical pregnancy  in  C-section scar.

CASE 374: MALIGNANT PHEOCHROMOCYTOMA and CUSHING SYNDROME, Dr LÊ TUẤN KHUÊ, Dr NGUYỄN MINH THIỀN, Dr PHẠM THẾ ANH, Dr PHAN THANH HẢI, MEDIC MEDICAL CETER, HCMC, VIETNAM

Woman, 20 yo, discovered HTA  in pregnant at 16 weeks

 5-months before this hospitalization: pregnant  in 28ws, sudden obstetrical  seizures in Ca Mau hospital.  Diagnosis of eclampsia / hypertension / 28w pregnant. Treatment: cesarean section.

 After surgery , patients changed  body shape, round, fat face, neck, stretching skin, increasing weight gain, examination findings adrenal gland tumor  in Can Tho General Hospital, then transferred to Binh Dan hospital.

In clinic examination, obesity, Cushing syndrome,  other organs detect no abnormalities. HTA being treated.

Blood and urine catecholamine increasing, blood and urine cortisol increasing, ACTH reducing.

MSCT: right adrenal tumor.

CONCLUSION=  Female patient 20 yo, hospitalized for weight gain and  HTA, Cushing syndrome. Reducing of  blood ACTH and metanephrine; catecholamine and cortisol secretion increasing in blood, and urine.

Surgery removed right adrenal tumor. Pathological result is malignant pheochromocytoma.

 Secreted adrenal neoplasms - suppression of axis of  adrenal pituitary.