CASE 452: MESENTERIC CASTLEMAN DISEASE, Dr PHAN THANH HẢI, Dr NGUYỄN PHÚ HUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 65 yo with  anorexia,  weigh loss # 5 kg in 3 months.

Ultrasound of abdomen for general check-up detected  one round mass, mobile  at  RLQ.

US 1 :  hypoechoic homogeneous  mass looked like a cyst,  size 3 cm, round border  with  low posterior enhancement,  intra mesenteric situation.

US 2 : CDI   vascular  around this mass not branching inside this mass   

US 3: CDI with another section, no vascular in the mass

US 4 scanning by linear 14 MHz  probe:  this mas  like a cyst.

US 5 :  elastoscan of this mass  mean  9 kPascal.

MSCT with CE=

CT 1:  crossed section of this mass very quick and  high contrast enhanced,  

CT 2:  frontal section of  this mass = intra mesentery

CT 3:  sagittal section of this mass:  near  anterior wall of abdomen  

Blood tests= normal  CBC, negative all cancer markers.

DISCUSSIONS=

 1. This mass is  intra mesenteric area not related with GI TRACT

 2. THIS MASS IS VERY  HYPOECHOIC AND HOMOGENEOUS  LOOKED LIKE A CYST  BUT IT IS SOLID MASS

 3. THIS MASS IS VERY QUICK AND HIGH CONTRAST ENHANCEMENT, HOMOGENEOUS STRUCTURE.

 4.  BLOOD TESTS   BETA 2  MICROGLOBULINE and FERRITIN , LDH NOT RISING

THE FIRST CHOICE OF  THIS MASS IS LYMPHOMA.

Laparoscopic operation  detected the mass intra mesenteric  jejunum; open surgery removed this mass out the abdomen cavity and web resection.

Microscopic report with  immunohisto-staining is  CASTLEMAN DISEASE.

REFERENCES: With 2 VMU Cases in the past.

CASE 451: CARDIAC MYXOMA, Dr PHAN THANH HẢI Dr NGUYỄN TUẤN VŨ, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 33 yo, with  dypsnea progressing for one year but being normal chest X-Rays , EKG and abdomen ultrasound.   

  

Cardiac ultrasound  detected  one mass 5 cm intra left atrium  covering  near all cavity space ( US 1, US 2, US 3). 

And  echocardiologist says  cardiac myxoma.

CTA  of cardiology  non CE showed  this round mass  related to  left atrium, and radiologist confirmed  myxoma in left atrium.

Emergency heart operation was done.
OPERATION  REMOVED BIG TUMOR 5 CM  WITH  STRUCTURE LIKE  MYXOMA.

MICROSCOPIC REPORT IS MYXOMA.

Reference:

CASE 450: PID with PELVIC MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  34 yo with  onset 2 weeks ago,  fever  and pain at pelvic region.

Ultrasound  first at an obgyn hospital  says  ovary cyst or endometriosis. But medical  management  with antibiotis failed in clearing fever.

(US 1: scanning  after 2wks,  uterus and cystic mass # 10cm with very thickening wall; US 2 : on CDI;  US 3:  intracystic mass detecting one structure like a bridge: US 4:  ascites intra RLAQ;  US 5:  this mass was scanned with linear 12 MHz probe. 

MRI of pelvis with gado=   this cystic mass is  in left ovary  with  the wall very thick, and  black spot intra mass  unknown  original,   but radiologist  suspected an ovary cancer.

   

Blood tests=   WBC  12k with 70% neutron,  Plt= 515,  CA 125  rising  100 UI.

 18 DAY FEVER AGO CANNOT STOP BY ANTIBIOTICS.  OPERATION BY LAPAROENDOSCOPY WITH DIAGNOSIS  OF P I D.
Picture OPE1: LEFT OVARY IS VERY BIG MASS AND FALLOPEAN TUBE IS BIG ALSO.  

Picture OPE 2: INCISION OF THE WALL OF CYSTIC MASS SHOWING VERY THICK AND an AMOUNT of PUS  GOES OUT.

Picture OP 3: VASCULAR THROMBOSIS INTRACYSTIC MASS.

BACTERIOLOGY  REPORT  of THE PUS from STREPTOCOCCUS  and  MICROSCOPIC REPORT of THE WALL of CYST IS  ABSCESS WALL.

Reference:

CASE 449: LIVER TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 77yo, in  general check up  by ultrasound  detected  one round mass 5 cm in  segment 6 of liver with Left  kidney cyst and big prostate  (US 1, US 2, US 3, US 4).

MSCT of liver with CE=   showed this liver tumor  well bordered, quick CE   and  delay wash out CE that looked like HCC by radiologist  (CT1, CT 2, CT 3, CT 4).

Blood tests = HCV , HBV non detected. Wako test =  3 negative.

In MSCTA, vascular supply of the tumor comes from left gastric artery.

Operation laparotomy  removed this tumor  that macroscopic feature likes liver normal tissue of liver.

Microscopic report  is hepatic adenoma.