CASE 462: LIVER ABSCESS POST ENDOSCOPIC CHOLECYSTECTOMY, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 67 y o, emergency operation by acute necrosis of  gallbladder by stone one week ago, still pain at  Murphy area. WBC = 12k with neutro 90%,  CRP= 100ng/mL.

Abdomen ultrasound detected one mass # 5 cm  at the bed of gallbladder. Mass has got fluid content  and  white structures inside with very strong  shadowing and air in formatting an abscess.

No dilatation of the biliary system.

US 1: subhepatic abscess  with strong shadowing in abscess.

US  2: umbrella sign of  the shadowing.

US 3:  elatoscan  shows  this structure is very hard.

MSCT:   CT 1:  abscess with  air and fluid filling at the bed of gall bladder which had been  removed of GB.

              CT 2:  crossed-section view of this abscess:  inhomogenous structure  and air

              CT 3:   frontal view of the abscess.

   

Radiologist reported  textilloma in suspection.

Laparoendoscopy detected an abscess in liver at the bed of gallbladder necrosis and no textilloma.

CASE 461: AXILLARY MAMMARY GLAND, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  35 yo detected  at  right axiilary  a soft  and bigger mass. Clinical looked  like a lipoma.

Ultrasound  scan of this mass :  

US 1:  longitudinal scan=  subcutaneous hypoechoic mass,  size  4cm,  well bordered.   

US 2: CDI  hypovascular  pattern.

US 3:  elastoscan of this mass = 4.3 kPa,  like fatty tissue.

MSCT  non CE:

CT 1:  frontal view of  this mass  = subcutaneous, same density of fatty tissue.

CT 2 :  zooming of this mass  showed  structure  looked like a nipple of breast.

CT 3:   crossed-sectional view of  this mass = well bodered, not connected to the right breast.

CT 4:   sagittal view of  this mass=  separation to the right breast.

Radiologist reported  an axillary  mammary gland.

Operation  for removing  this mass     (see foto  specimen),  

surgeon reported it having  fatty  and hard tissue. Microscopic report is tissue of mammary gland.

Summary of  this case:    axiilary mammary gland  mimicking as a lipoma mass.

CASE 460: CALCIFIED THYROID TUMOR , Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 52 yo, voice tone changes for  2 months, and  ENT doctor said vocal paralysis by endoscopy.

Ultrasound of the neck    

US1  left thyroid lobe normal

US2  right  lobe   covered by a big mass  4 cm  with strong  posterior shadowing  cannot see structure inside.

US3  near R/ CCA  small nodes with calcification #1cm.

US4  with convex probe ultrasound cannot se intra tumor by very strong calcification.

MTSC  non CE   

CT1: cross- section of the neck = mass is  very high calcification 

CT2 : cross- section=  calcification some lymph nodes near R/  CCA.

CT3 : frontal view  with CE=HU of this mass is  1,319 UI

CT4:   lymph node also has HU  1326UI.

CT5:  sagittal view   this mass  is  covered near the righ lobe of thyroid gland.

Blood test   TSH  is  0,041  T4  1,2   TG  97,42 (  n 3, 5-77)

 Pre-op diagnosis is thyroid cancer  metastasis neck lymph nodes.
OPERATION REMOVED RIGHT THYROID GLAND AND LYMPHADENECTOMY.

SEE  SPECEMEN 
 FOTO1    FOTO2  THYROID TUMOR CALCIFICATION

 FOTO3  LYMPH NODE

 For this case  clinical  ultrasound and CT , blood tests suggested   thyroid carcinoma   but report  of FNA  cytology is negative.

CALCITONINE = 2PG/ML   (M <18.2PG/ML)..RULES OUT MTC ( MEDULLARY THYROID CARCINOMA)

MICROSCOPIC REPORT OF SURGICAL SPECIMEN IS PAPILLARY CARCINOMA ( PTC)  METASTASIS TO SOME LYMPH NODES.

SUMMARY = PTC  WITH  HUGE CALCIFICATION  UNKNOWN.

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.