CASE 393: SPLEEN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 26 yo with no clinical symptom. Ultrasound screening detected a spleen mass

US 1= longitudinal scan of this mass size of 6.0cm at lower pole of spleen, hypoechoic, well bordered.

US 2=cross-sectional view of mass.

US 3=CDI of this mass with vascular bending sign and, ( US 4) structure inside hypervascular.

Blood tests are normal.

CT with CE:CT 1 non CE , CT2 CE, delay phase with central mass lower perfusion.

MRI with gado: this tumor is well bordered, peripheral enhanced and central hypoperfusion at the late phase.

LAPAROSCOPY  FOR  SPLENECTOMY  . SURGEON REPORTED  THIS TUMOR IS INTRA SPLEEN AND ITS COLOR  LOOKS LIKE SPLEEN TISSUE ( SEE  SPECIMEN).HE SAID IT MAY BE  HEMANGIOMA.

MICROSCOPIC REPORT  IS CAVERNEOUS HEMANGIOMA.

CASE 392: PERFORATED SEAL-OFF DUODENUM, Dr LÊ TỰ PHÚC-Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM.

"A 37-year-old male presented in our hospital with moderate epigastric pain for three months. Around one week before examination, the pain became more severe, but he didn’t recognize a suddenly pain. Clinical examination revealed no muscle guarding and rebound tenderness.

Abdominal ultrasound images showed unconcentric wall thickening of the gallbladder. Beside the more thickening wall of gallbladder, a hyperechoic of air collection was found. This air collection was continuous with small hyperechoic air spots inside duodenum. A perforated duodenal ulcer with air leakage was suspected.

CT-Scan confirmed air collection beside a thickening gallbladder wall.

Blood test indicated and raised of white blood cells (10,350 / mL) with low level of CRP (0.9 mg/L) and possitive Helicobacter Pylori test.

Without surgery, the patient pain released and the air collection was disappear in ultrasound and CT-Scan images for one month follow-up. Gastroduodenal endoscopy showed a healing ulcer in the anterial wall of duodenum. White blood cell count returned to normal."

This is a case of perforated seal-off duodenum revealed by ultrasound and confirmed by CT-scan later and successfully management without surgery.

CASE 391: DOUBLE BREAST TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 53 yo, for one month  detected  her breast distention both 2 sites and  pain. In clinical examination 2 breast are hot and hard.

Ultrasound  (US 1), right breast had some echo poor focal lesions, 2-3 cm, non compressible.

US 2: same  structure at the left  breast.

US 3=

US 4: color Doppler  hypovascular.

Mammo Xray  =  very dense breast (MM1, 2).

MRI with gado=  breast are filling by  hyperintense mass  with gado enhancement.

Bood tests= WBC  normal, beta microglobuline raised 2,200 UI (n=2,100 UI)

Biopsy was done  by core biopsy  and  IHC staining  report is  lymphoma large B cell.

Conclusion= Lymphoma is most common appearance of  2 breast simultaneous infiltration.

REFERENCE

DOWNLOAD PRIMARY BREAST LYMPHOMA

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.