CASE 397: NERVE TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Boy 17yo with pain at anterior brachial region both 2 sides. Clinical palpation revealed many small subcutaneous nodules, size as a pepper nut, painful at palpation ; and swelling neck (see chest XRays).

Ultrasound scanning of the antebrachial areas detected many small ellypsoid nodules along the arterial way looked like the nerve ( US 1, US 2: longitudinal scan and cross-section).

US 3, US 4 scan at the carotid detected hypoechoic mass along the carotid sites  which belong to vagus nerves 2 sites.

US 5, US 6 scan at left carotid= big size vagus nerve, hypoechoic #1.5 cm in diameter at cross section.

MRI of the neck and thorax= MRI 1, MRI 2: hypertrophic nodular vagus nervi go to  mediastinum.

MRI 3: lateral view of the neck; MRI 4 = cross section of vagus nerve at the neck in relation with carotid artery.

MRI 5: hypertrophic intercostal nerve at thorax.

Biopsy of  the subcutaneous nodule at forearm  reported  neurofibroma in microscopic result.

CASE 396: PARATHYROID CYST, Dr PHAN THANH HẢI, Dr NẠI HƯƠNG THOANG, Dr VŨ TU THÂN

Woman 43 yo with  sorethroat  and cough, sputum bleeding.

Chest X-Rays for  screening: no  chest lesion ( see foto chest X-Rays).

Ultrasound of  the neck: normal thyroid  but detected a cyst at lower pole of thyroid gland, size of 5-6 cm, monocystic  prolonged to retrosternum.

US 1,US 2 ( CDI),   US 3    pretrachea longitudinal scanning.

MSCT CE of  the neck: CT 1=frontal viewing,  well bordered cyst, CT 2: sagittal view..

C T 3. Cross-section= retrosternum tumor.

Ultrasound guide punction  of this cyst removing 10ml clear fluid.

What do you need to study in this fluid?

Fluid analysis report: high PTH  78.69pg/ml  and in the blood PTH is 47pg/mL.

The final diagnosis is  non functional PARATHYROID  CYST.

  

Reference

CASE 395: MAJOR LABIA TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 45 YO, SAYS  THIS VULVA MASS  IN  SLOW GROWING 6 MONTHS AGO, WITHOUT  PAIN ( FOTO).

ULTRASOUND OF THIS TUMOR REVEALED SOLID, FIRM,   SIZE OF 10CM.

 US 1:WITH  B MODE,    US 2 WITH  CDI : HYPOVASCULAR SOLID TUMOR /  US 3=ELASTOULTRASOUND OF THIS TUMOR IS HARD STRUCTURE.

MRI 1 SCAN = SAGITTAL SECTION OF THIS TUMOR

MRI 2 WITH  GADO  CE= IN LATE PHASE, LOOK LIKE  A CYSTIC DEGENERATION.

 MRI 3 = FRONTAL  SECTION OF THIS MASS  FROM LEFT MAJOR LABIA,  PEDUNCULATED  LOOK  LIKE SCROTUM IN MALE PATIENT.

Core  biopsy reported  microscopic with  immmunochemistry staining is  glomus tumor.

Operation remove this tumor (see macro)

.

Reference:

https://www.scitechnol.com/glomus-tumor-in-vulva-with-uncertain-malignant-potential-1Mbz.pdf

CASE 394: COLON TUBERCULOSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 43 yo with epigastric pain  crisis and  gastroendoscopy showed  gastritis.

Ultrasound  detected  one mass  like target  with  thickening of the  wall of colon (see  US 1=csoss-section  colon over  right kidney);   US  2  with linear  probe= colon wall is thickening; US 3, US 4 =  longitudinal scan).

MSCT of abdomen with CE revealed  thickening of  ascending colon wall  (CT1,  CT2).

Chest X-rays  before endoscopy  detected  infiltration of  left upper lung.

Colonoscopy reported the mass in right colon, nodular ( see foto) biopsy. 

Report of endoscopist is colon cancer.
Microscopic report  is colon tuberculosis.

Conclusion = this  case  represented colicky pain at epigastric region but  ultrasound and CT  suggested  colon cancer, same as colonoscopy, but  microscopic is tuberculosis.of colon and left lung.

REFERENCE:

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.