CASE 459 : CERVICAL LYMPH NODES, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 63 yo   detected  cervical  nodules  at right neck, that were in slow growth, no pain,  no fever,   no sore throat.

Clinical palpation this  lateral nodule of the neck  from SCM chain  continuous with subclavicular group

US scan  with 12 MHz probe= thyroid gland is normal

US1: many  small 1-2 cm hypoechoic nodes ,  round border.

US2:   big node =  round,  echo very poor ,  nonvascular inside.

US3:  small node = very high vascular supply.

US4  elastoscan = very soft structure

And  the left neck is normal.

MICROSCOPIC REPORT WITH IMMUNOHISTOCHEMISTRY IS   LYMPHOMA.

CASE 458: PERIAORTIC LYMPHOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 77 yo with  renal  hydronephrosis  and  insufficiency, EGFR= 11 ml/mn.

US scanning of abdomen:

US 1, US 2=2 kidneys hydronephrosis  no stone.

US 3  crossed section of aorta: Periaortic  thickening  by  hypoechoic ring.

US 4  longitudinal  scan of  abdominal aorta.

US 5: CDI.

US  6 :  scan at aorta bifurcation, CDI   longitudinal  scanning of  aorta.

CT of abdomen non CE=

CT 1=2 kidneys  hydronephrosis.

CT 2  = frontal view,   aorta is covered by the mass.

CT 3 =sagittal view.

Blood test =  betamicroglobulin 12,577UI (n=2,164)  ferritin  621ng (n =400) 

SUMMARY: 

Suspected  periaortic retroperitoneum  lymphoma in  compression of ureter  to make renal insufficiency. Wait for biopsy of  the inguinal nodes for  histo immuno stainning.

Ultrasound scanning at left inguinal region  detected many hypoechoic, hypervascular lymph nodes  that were removed for biopsy.

THE  FINAL REPORT IS FOLLICULAR LYMPHOMA WITH HISTOIMMUNO STAINING.

REFERENCE : Xin xem ca 318.

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.