CASE 413: INFANTILE HEMANGIOENDOTHELIAL of LIVER, Dr PHAN THANH HAI, Dr PHAM THI NGOC TUYET, Dr LE ANH TUAN, Dr LE QUANG THONG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

In  2008, a 5 months old  female baby with  abdomen distention and ultrasound scanning of her abdomen  detected  multiple echo poor  in her great liver ( US 1).

MRI of  liver  with gado  found out  multiple  white spots   with central  low enhancement, looked  like jack fruit appearance ( MRI 1, MRI 2).

CT of  liver non CE  also  found out multiple  black spot  inside her big liver ( CT1).

Blood test   with AFP = 76ng/mL.

Radiologist and hepatologist suggested that infantile hemangioendothelioma of liver,  no need of special treatment.

Reviewing of  this  case in  Jan  2017, now she is 9 year-old in well status, and  liver ultrasound  finds out only some small calcifications in her liver.

Conclusion: Multiple focal lesions of liver hemangioendothelial at neonate period now spontaneous regression for 9 years follow-up.

Update case 413 from Dr NGUYỄN ĐỨC TRÍ, CHILDREN N0 2 HOSPITAL

Today 18 Jan 2017, I see  an another case  looked  like the case 413 which is on a male 4 months old baby with abdomen distention.

Ultrasound and CT with CE  find out many round spots like jack fruit appearance.

Suspection of  a second case of liver infantile multiple hemangioendothelioma.

Wait and see  follow-up this case but how long to make sure the diagnosis?

REFERENCE:

CASE 412: SKIN PAPILLOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 65 yo  reported  this tumor at the  back of right  ear helix  that is  itching (see foto).

Seeing this tumor is superficial from skin with vegetation.

Ultrasound  with  high resolution  probe 12 MHz shows  this tumor is   superficial  of the derma layer,  no penetration to deep  cartilage  of  ear helix.  Color Doppler  detected  small vascular supply in tumor.

Biopsy  report is  papilloma.

CASE 411: ACCESSORY LIVER LOBE (ALL), Dr PHAN THANH HẢI - Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC VIETNAM

Boy 10 yo with  mass  at  RUQ. Ultrasound  detected  one mass size of 6cm at lower liver,  mobile and   its structure  as the liver tissue. Vascular supply from hepatic artery.

MSCT with CE showed  this mass is  in separation with liver,  hypervascular,  contrast enhance very fast  and artery supply come from  hepatic artery ( CT1,  CT 2, CT  3).

In operation, this mass  is  near the gallblader, connected with the liver by Glisson capsule, the structure surface  like liver.

Resection of this pedicule, macroscopic  structure  is looked  like liver tissue.

Microscopic  report it is normal liver tissue.

Conclusion: This liver mass  is  accessory liver lobe (ALL)​​.

REFERENCE:

CASE 410: SOLITARY PULMONARY NODULE (SPN), Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  66yo  diabetic, former smoking patient. Chest X-ray  is  nothing  abnormal detected.

CT total body  non CE   detected  one SPN which has size of  0.94 cm at  the left lung ( cT1, CT3).  CTCE  with dynamic scan  showed CE  rise from 14 HU to 74 HU.

Blood tests =  CYFRA 21-9,09  and  WAKO TEST  AFP=3.9;   AFP L3=19.3; DCP =25) another cancer markers  are normal.

What is your  suggestion for diagnostic and  therapy?
Operation thoracoscopy lobectomy, this tumor is hard and black central, tumor size  smaller than 1 cm.

Microscopic report is adenocarcinoma moderate differentiated.

REFERENCES:
NEjM 2006:355:1761.71

CASE 409: ECTOPIC FASCIOLIASIS, LÊ ĐÌNH VĨNH PHÚC, PHẠM CHÍ TOÀN, VÕ NGUYỄN THÀNH NHÂN MEDIC MEDICAL CENTER, HCMC, VIETNAM

31 year-old female patient,  accountant,  in Gia Lai province. Onset 2 months with scattered body itching, no skin lesions, no fever, no abdominal pain. A private clinic in Gia Lai, with blood tests, diagnosed Toxocara sp infection, and gave her albendazole 800mg/day x 21 days.  No itching she went down to an another private clinic in Quy Nhon province, and with another blood tests, she was diagnosed infected Cysticercosis, being treated with albendazole 800mg/day x 10 days. Then appearing right abdominal pain, ultrasound suspected liver damage caused by Fasciola spp. She went to Institute of  Parasitology and Entomology  in Quy Nhon province and then came to Medic Hoa Hao in Ho Chi Minh city.

Ultrasound detected right liver lesion with mixed echo, d = 5 cm, clear border, within a few of hypoechoic nodules, and no liver tissue edema around (Fig 1, 2). Further ultrasound detected colon wall thickness at liver region, hypoechoic,  not lumen narrowing (Fig 3).

Endoscopy showed transverse colitis.

Blood tests: WBC 14,500 cells/mm³ (Neutrophil 61.9%, Eosinophil 15.8%), hsCRP 14.53 mg/L. HBsAg (-), antiHCV (-), AFP (-), CEA (-), Fasciola sp IgG (+), stool exam (-).

Biopsy tissue in colon lesion was done and microscopic report was eosinophil mucosa colitis. 

MSCT CE presented liver lesion d = 4x6cm and transverse colon lesion with wall thickness d = 20mm (Fig 5, 6).

We diagnosed: liver abscess and pseudotumor colitis by Fasciola spp (Ectopic Fascioliasis) treated with Triclabendazol 10mg/kg/day x 2 days.

Re-examination 4 weeks later, WBC 8,800 cells/mm³ (Eosinophil 2.5%), hsCRP 1.3 mg/L.

Liver lesion in ultrasound and MSCT,  wall thickness d = 8mm in MSCT (Fig 8, 9).

We represented an ectopic  Fascioliasis with hepatic and transverse colon lesions and an undifferential serodiagnosis. Endoscopic biopsy result helped ruling out a colon tumor. But based on ultrasound findings of liver and colon lesions which were confirmed by MSCT we could chosed a concordant diagnosis for this case.

CASE 408 : DIFFUSE SKIN MACULAR MASTOCYTOSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Baby 6 month old, onset with fever and skin eruption for 3 months, starting in the legs and going to face and full body.  

Itching, in beginning lesion is red skin papula  and  progressing  to macular  shape (see foto of  face,  body).  Dermatologist  represented the lesion with crash and trap which  is  swelling  as  bullus (foto). Darier ‘s sign positive).

Blood tests  are normal .

Ultrasound  of this skin lesion detected  intra dermal hypoechoic infiltration, hypovascular pattern ( US 1, US 2).

Biopsy  of the  skin lesions and  microscopic report with histobiochemistry staining is  MASTOCYTOSIS. So this case is thought  Diffuse skin macular  mastocytosis.