CASE 407: LIVER INFARCTION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 35 yo,  onset   epigatric pain and fever. Ultrasound  of abdomen detected  one mass  at left lobe of liver,  size 10cm,   structure looked like target..ring (US 1),  US 2:  color Doppler  shows  the left portal vein branch thrombosis; US 3=   normal flow  of hepatic vein.

Blood tests:    WBC = 16,9k with  neutro  12,9k, CRP= 243 ng/ml;   sero amibe is negative,   Wako test  triple negative, dDmer  is very high.

MSCT CE..presented the mass has  central necrosis   ( CT1), CT 2= thrombosis of  left  branch of portal vein  (CT3, CT 4).

What is your suggestion for diagnosis,based on clinical status of  US, LAB, CT.

Operation for left hepatectomy showed   big  liver tumor  not  changing the liver surface and peritoneum.

Microscopic report  is necrosis aseptic liver (liver infarction).

REFERENCE=

HEPATIC INFARCTION.pdf

CASE 406: NERVE TUMOR, Dr PHAN THANH HAI- Dr LE TU PHUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

Man 35 yo with  pain  at lateral of right leg.

In  examination detected   one  round  structure  along the  peroneal  bone which  is painful at palpation (photo).

Ultrasound  of right  leg revealed   this struture   hypoechoic, size of 1.2 cm in diameter and long # 10cm, lobulated ( US 1, US 2) and   rule out  venous thrombosis.

MRI  with  gado contrast...( MRI 1, MRI 2, MRI 3.)

Radiologist suggested  neuroma  tumor of peroneal  nerve.

Operation  removed this mass  wich is well bordered  like a snake ( foto)

Wait for microscopic report.
MICROSCOPIC  REPORT IS  SCHWANNOMA OF PERONEAL NERVE.

REF  CASE.

CASE 405: MATERNAL and INFATILE CHORIOCARCINOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Baby 01month-old with huge abdomen and having an abdominal wall bleeding ulcer. In hospital ND No2 this case was suspected bleeding metastasis of abdominal wall from liver tumor and thrombocytopenia.

In MEDIC,  ultrasound detected many liver nodules which was thought liver metastasis or diffuse primary liver tumors. AFP values in 2 times decreased in week after week. Meanwhile beta HCG raised over 200,000 UI. TOCE was done by French doctor for hemostasis for baby.

At that time her 41 yo mother  presented cough and chest pain with normal chest X-rays film, but chest CT and MRI revealed lung metastasis.

Blood beta HCG= 39,132 UI and urine beta HGC=40,000UI.

AFP= 2.5 UI, CEA 125= 20.3, CYFRA=7.57

Ultrasound of uterus and anexal detected no tumor.

CONCLUSION: Postpartum choriocarcinoma in infant and mother.

Update of case  405: Today, Feb 15, the baby came back to ND 2 hospital for continuing of chemotherapy; baby got weight well while the mother remains well also in Tu Du hospital post hysterectomy. 

It is the first case of maternal fetal choriocarcinoma published on internet from Vietnam that we taken part in helping baby and mother getting more healthy.
Reference:

 From Yale uni.

CASE 404: ECTOPIC TESTIS TUMOR, Dr PHAN THANH HẢI- Dr NGUYỄN PHÚ HỮU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 35 yo with  pain at RLQ. Ultrasound  of abdomen detected one hypoechoic mass retrocoecum ( US 1) which was  suspected an abscess.

Blood tests =  normal  WBC and CRP. MSCT reported  this ellypsoid  mass with   size of 5 cm,   retroperitoneum, pull up the coecum, and MSCT with CE for rule out an abscess. (CT1: cross section, CT 2 sagital. CT 3  scrotum  section  not detected right testis.

Pre operative  surgeon suggested right  ectopic testis tumor.

Endolaparoperation detected  the coecum  was pulled  up ( ope 1, 2 ).

Ope 3=tumor is retro peritoneum.

Macroscopic removing this tumor which is  ectopic testis.

Microscopic  report is seminoma.

COMMENT: For  men  once ultrasound detected a hypoechoic mass in  retroperitoneum  at pelvis that has to verify ectopic testis, and if it is hypoechoic  like the cyst, the nature of testis tumor may belong lymphoma or seminoma.

CASE 403: ECTOPIC ACCESSORY PANCREAS, Dr PHAN THANH HẢI - Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Female 19yo with headache and  abdominal peristaltic pain. In check- up of abdomen,  ultrasound detected one  subhepatic mass  moving  with respiration,  size of 6 cm,  hypoechoic, hypervascular, not  attached to any organ in abdomen ( US 1, US 2) .

Upon  MSCT with CE, this mass  is  very fast  CE enhanced,  same time with pancreas ( CT1, CT2).

Blood tests are normal. And gastro-colonoscopy is normal.

Discussion:  CT and ultrasound showed  this tumor  in abdomen near the liver border and duodenum while scanning  in  standing position  this mass moving to right iliac fossa. One surgeon said  may be GIST.
Endolaparoscopic operarion  detected this mass is covered by great omentum (see foto 1) with very long pedicule due to great vascular supply (foto 2).
Removed this mass and  macroscopic this tissue looked like pancreas tissue (foto 3, 4).

Microscopic report  is  adenoma  of pancreas.

CASE 402 : DOUBLE URINARY BLADDER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 62 yo, one month after robotic prostatectomy by prostatic carcinoma (PC)  stage I, pain in mictation.

US scan at pubis detected 2 cystic masses  look like  double urinary bladder (US 1, transverse scan ).

US 2:  scan at  left  cystic mass ,  size of 4 cm, thickening of  border and septation.

US 3:  longitudinal  scan at  central cystic mass,  it is  urinary bladder.

US 4: left pelvis mass and  iliac artery.

Report of sonologist  is double urinary bladder.

MSCT with CE of  urinary system= CT 1, CT 2 non CE showed  HU units  at  2 masses are  different  15.8   and 10.2 UI.

CT 3 =  contrast filling of  the central  mass is urinary bladder and  left mass is not enhanced.

CT4 : 3D C T of urinary system.

Puncture of this cyst  for removing fluid which is yellowish. Results of analysis of  its contence : urea 
4.8mmol/L,

creatinine 0.0741mmol/L.
 So it is lymphatic fluid. Now  operation for drainage.

Conclusion:  it is lymphocele  post prostatectomy and lymphoadenectomy.