CASE 457: AML KIDNEY TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN HOÀNG ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 45 yo, ultrasound screening  detected left kidney tumor.

US 1: tumor of lover pole of left  kidney,  size 4 cm,  hypoechoic pattern.

US 2:  CDI, hypovascular mass. 

US 3:  crossed section  of this left kidney tumor.

US 4:  elastoscan of this tumor is 12kPa.

MSCT with CE

CT 1:  crossed section  this tumor is low CE.

CT 2: CT density HU  is low  

CT 3:  well limited bordered tumor.

MRI  showed  the intratumoral  fatty tissue and radiologist  suggesting AML kidney tumor.

Laparoscopic operation of web resection of this tumor ( see macro1).

Microscopic result  is  AML kidney tumor.

REFERENCE:

CASE 456 : LEG GAS GANGRENE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 41 yo,with  history of liver cirhosis and ascites. 3 days fever and pain at left swollen leg.       [Foto1].      Clinical suspected lower limb DVT Ultrasound  ruled out DVT ( US 1=artery and vein at left inguinal), US 2   fluid collecting         between muscle quadriceps; US 3  scanning at calf  detected intramuscular  air         US 4 air and  level. MSCT non CE detected   air in calf muscles CT 1  crossed section;  CT 2  sagittal scanning    Blood test, WBC  no rising;    blood culture  detected  gram  negative bacillus,   For 24 hours after  hospital admission  patient was dead with  bullous legs [Foto2]. Blood culture identifies Aeromonas caviae.

REFERENCE :

http://www.ajemjournal.com/article/S0735-6757(08)00139-3/pdf

CASE 455: FINGER TUMOR, Dr PHAN THANH HAI, Dr TRUONG TRI HUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 54 yo,  4 months  ago  detected  one mass, at 4th finger of right hand,  slow growth,  no pain,  no disturbing movement.of this finger  (see  photo1, 2).

X-Rays  of AP and lateral views of 4th finger  = bone is  normal but  periosteum changing this mass to a soft tissue tumor ( xrays 1, 2).

Ultrasound   scan of this mass is hypoechoic like a cyst of lateral finger, from the tendon,  size 3 cm of length (US 1).

US 2  CDI of  vascular supplying arround this tumor means  a solid tumor

US 3  crossed section  of the arround vascular tumor.

US 4 mass is soft  on elastoscanning , arround 30 kPa.

OPERATION REMOVED TOTAL TUMOR.

MACROSCOPIC  REPORT BY SURGEON LOOKED LIKE  XANTHOMA, BUT  MICROSCOPIC REPORT IS  GEANT CELL TUMOR of TENDON SHEATH.

CASE 454: IVC STENOSIS, Dr PHAN THANH HẢI, Dr TRỊNH DUY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 30 yo with 3 times of miscarriage, she came to MEDIC for a check- up (foto  subcutaneous veins).

Ultrasound of abdomen and pelvis:  normal uterus size.

US 1 = big liver caudate lobe 

US 2 = IVC  stenosis at  upper portion of liver
US 3 = crossed section of IVC no flow with hepatic vein.

MSCE with CE:

CT 1=  normal uterus structure.  CT2  = IVC  contrast filling  short portion cannot go upper to liver portion.  CT3 =  crossed section of  dilated subcutaneous abdominal veins. CT4 = crossed section= IVC no contrast in liver portion and abnormal late phase of liver vein, 

CT 5  = surface abdomen skin.

TREATMENT  ANGIOINTERVENTION;   DILATATION of STENOSIS AND STENTING.

Summary  =  IVC abnormal  stenosis near  diaphragm and  many venous collateral returning ways. 

REFERENCE:

CASE 453: SMALL BOWEL MELANOMA, Dr PHAN THANH HẢI, Dr TRẦN MINH ĐÚNG, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, TÂM TRÍ GENERAL HOSPITAL, HCMC, VIETNAM

Man 56 yo with acute abdomen pain,  vomitting, and dark stool [melaena]. Clinical examination was oriented to 4th day bowel occlusion.

https://suckhoe.vnexpress.net/tin-tuc/cac-benh/ung-thu/khoi-u-hiem-gap-khien-nguoi-dan-ong-bi-tac-ruot-suot-ba-ngay-3646138.html

Abdomen US scan in emergency  detected  dilated bowel  with  crossed sectional view  presented typical oignon sign  of intussusception  ( US 1,   crossed section;  US 2,  longitudinal  scan.    With linear probe, US 3, CDI examination;  US 4,  multilayer of  intussuscipiens [boudin].

MSCT  with CE of abdomen =   

CT 1: bowel dilatation  due to  bowel obstruction

CT 2 : mass  with  multilayer of small bowel wall.

CT 3 :  intussusception with target sign or pseudokidney sign

CT4 :  sagittal view of the abdomen

Lab test is normal.

Emergency  operation  via laparotomy  with diagnosis  intussusception by small bowel tumor. Surgeon reported that  tumor is black color, intra jejunum, size 5 cm. Microscopic report  with immunohisto chemistry is  malignant melanoma.

UPDATE:

For DISCUSSION  whatever PRIMARY OR SECONDARY MENALOMA?

                       CAREFUL EXAMINATION FULL BODY  DETECTED  ONE SCAR AT THE  LEFT PLANTAR FOOT DUE TO OPERATION 6 YEARS BEFORE AT CANCER CENTER.

BUT PATIENT DID NOT REPORT THIS ISSUE and HAS NOT REPORT FROM THIS OPERATION.

THIS CASE  MAY BE CASE of SECONDARY MELANOMA METASTASIZING TO SMALL BOWEL ( SEE FOTO).

REFERENCE:   SMALL BOWEL MELANOMA