CASE 390: PEDUNCULATED HCC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 56 YO REPORTED  HIS RUQ  SWOLLEN  SLOWLY FOR  6 MONTHS , NO DISTURB GI TRACK IN DIGESTION.

ULTRASOUND ABDOMEN:

US 1:ECHOGENEICITY OF LIVER  AND TUMOR  NEARBY  ARE DIFFERENT.

US 2:LONGITUDINAL SCAN,TUMOR AND LIVER BORDER ARE NOT CLEAR.

US 3: STRUCTURE OF THIS TUMOR IS SOLID, HYPOVASCULAR.

US 4: CROSS SECTION, TUMOR IS INTRA ABDOMEN, AT RIGHT  SITE OF AORTA.

MSCT WITH CE:

CT 1( 4 PICTURES): SAGITTAL VIEW, FRONTAL VIEW ,  CROSS-SECTION SHOWED VASCULAR SUPPLY OF THIS TUMOR IS FROM LIVER.

CT1:TUMOR IS  RELATED WITH  R/LIVER,   PEDUNCULATED, VASCULAR SUPPLY FROM LIVER.

CT2:MULTINODULAR, CONTRAST ENHANCE IS  IN BORDER OF TUMOR.

LAB BLOOD TESTS  =  HBV POSITIVE, AFP=651.8 ng/mL.

Operation  laparotomy  detected huge tumor connected with right liver border by
small area.

Microscopic report  is  undiffentiated  HCC 

( P-HCC; PEDUNCULATED HCC or  HANGING HCC..)

SUMMARY=   PRE OP IS SUSPECTED HCC, BUT IT  HAD PEDUNCLE  COME FROM RIGHT LIVER. LAPAROTOMY REMOVED BIG TUMOR  FROM THE RIGHT  LIVER.

REFERENCE:

PEDUNCULATED HCC

CASE 389: ECTOPIC APPENDICITIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 35yo, onset  epigastric pain  treated  as gastritis for one week, fever.

Ultrasound of   abdomen= pain  at  upper  left  abdomen quadrant (US 1  probe put over  pain point).

US  2= mass  rounding as  an abscess, CDI: no  more vascular  supply.

US 3 (with linear probe)  intra abscess the linear structure  look like  appendix).

US 4 =  cross section.

Emergency CT with CE=   mass  wall-off  by  small intestine and  great omentum  as an abscess  ( CT1, CT2).

Blood test  WBS = high 14k , with neutro 9.9,  CRP  38.3ng/dl.

Preoperative diagnostic is  intra abdomen abscess  due to ectopic appendicitis.

Laparoscopic view = the pus goes out  from this mass  and open operation removed appendiceal partial necrosis and  mobile coecum.

Conclusion=  appendiceal abscess in ectopic position at left abdomen site.

CASE 388: TESTIS TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Boy 11 yo with left  scrotum is bigger than right one, he went through an  operation for  left inguinal hernia  2 years before, now  no pain, no fever.

US of scrotum detected hydrovaginalis and a small focal intratestis, size  of 0,8 cm, cystic calcification  in septation ( US 1, 2, 3),  hypovascular 

and very hard  in elastography ( US 4).

MRI  reported  a cystic tumor with calcification with  size of 1 cm.

All  AFP, HCG, testosterone  or  corticoid of blood tests  are negative.

Operation  for biopsy: macroscopic tumor is intra testis,  not  invasion to tunica vaginalis; tumor is white structure  like caseum.

Microscopic report is mature teratoma.

REFERENCE

Epidermoid Cyst and Teratoma of the Testis - Journal of Ultrasound in Medicine

www.jultrasoundmed.org/content/24/10/1403.full.pdf

CASE 387: LIVER ABSCESS DUE TO FISHBONE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 52 yo with pain  in liver and history of treating  liver abscess by ultrasound  guided puncture and drainage for 1 month..

Ultrasound  scanning with linear probe=

 US 1:detecting  liver  abscess  in recovery phase with one  echo rich foreign body  came from duodenum. in the boder of liver.

US 2: CDI  no change of  vascular structure of liver.

US 3 : elastoscan  showed  this body having  very red code whicn means very hard.

CT liver  scanning  also detected  foreign body ( fb) intra liver and one site was intra duodenum wall.

Emergency  endoscopy  cannot detect  this fb.

Laparoscopy  removed the fish bone  with length of3.5 cm  (photo).

Conclusion: liver abscess  due to  fishbone  migrated from duodenum to liver.
Reference:

Fish Bone Penetration of the Duodenum: A Rare Cause of Liver Abscess

Fishbone_ Liver Abscess 

CASE 386: ADRENAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 44yo  high blood pressure. Ultrasound  screening of kidney detected one mass with size of  12 cm at upper pole of right kidney which was well bordered  and hyperechoic ( see  US 1)

US  2 and  US 3=  CDI  findings of  normal vascular kidney.

CT scan  with CE=  this mass is well bordered,  below liver  and pushed righ kidney down.

MRI  detected this mass more fatty structure  and  suggested that was a myelolipoma of right adrenal gland.

Blood tests detected nothing abnormal.

Do you make a diagnosis  of  myelolipoma for  adrenal gland?

OPERATION REMOVED  A ROUND TUMOR ( SEE MACRO).

Microscopic report   of this tumor is Myelolipoma  of adrenal gland.

REFERENCE

http://downloads.hindawi.com/journals/criu/2013/789481.pdf

CASE 385: PLANTAR, PALMAR KERATOSIS= HOWEL- EVANS SYNDROME, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 61 yo consulted  by  right and left plantar pain. He says  it happened more one year ago with skin in foot and hand  thickening (photo). 

Now he has got progressive dysphagia for one month.

Ultrasound at his neck detected  dilatation of cervical esophagus (US 1) and  one mass  intra  esophagus at  longitudinal scanning (US 2).  

Ultrasound suggestion is  tumor of cervical esophagus.

MSCT  with  oral contrast [CT 1, CT 2, CT 3] : cervical esophagus is  thickening of the wall by tumor  covered the lumen.

Endoscopy detected  exotic tumor intra esophagus lumen (endoscopic foto)  and  biosy is done.

Microscopic report is SCC (squamous cell carcinoma).

Do you see  another  case  having  relation  between  palma-plantar  keratosis and esophagus cancer ?

UPDATE= HOWEL-EVANS SYNDROME.