CASE 465: LUNG with LOFFLER SYNDROME, Dr PHAN THANH HAI. MEDIC MEDICAL CENTER, HCMC VIETNAM

Woman  45 yo with  fever and cough. Chest XRays detected many  white spots  like balloon both site the lung.

Radiologist suggested diffuse lung metastasis.

Blood tests=  WBC rise 11.27 k, eosi 20,7%,  IgE 1779 UI/mL.

Toxocara sp  positive  with od 1,809 and  all cancer marker are negative.

CT scan  with CE many opacification of  peripheral lung  booth site( CT1a/b)

CT scan the lung  with CE   the  lesion is small  regression.

Ultrasound of thorax  with small light 

After one week treatment  no fever  no cough.   Chest  Xrays  is clear.

Summary:   By the clinical, blood tests, chest XRays,  diagnosis  as  Loffler syndrome  of the lung  was made for the case.
REFERENCE

AFTER ONE MONTH  CHEST XRAY IS NORMAL  AND BLOOD TEST  STILL HIGHT EOSINOPHILE 13%  

CASE 464: ANTERIOR MEDIASTINAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Female patient 62 yo, cardiologist send to CT scan for coronary artery  but in same time CT scanning detected one 3 cm mass  at the superior anterior madiastinal area.., well bordered.

CT1:  crossed section  non CE this mass has HU  = 54.

CT 2 :  after CE late phase HU  = 73.

CT 3 :  sagittal section, this mass is  ovoid  form at the  anterior mediastinal area.

CT 4 :  frontal view,  this mass is near aortic ascending.

CT 5 :  CE  arterial  phase,  this mass is late enhanced  and cystic formation.

Blood test is normal, and negative all cancer markers.

Radiologist suggested  thymom
Endoscopy operation of thoracotomy  removed this tumor  and  microscopic report is normal thymus tissue.

Conclusion:  it is  thymus resting.

CASE 463: MADURA FOOT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 25 yo, with  right  swollen foot   and  bleeding  after  small  trauma for  5 years.  Being treated  in many hospital  this foot  but  not better.  Biopsy 3 times in Cancer Center  with  report is chronic inflamation. (see foto 1,2).

Xray   shows  the  erosion of metatarsal bones ( xray)

Ultrasound  reported   edema with  hypervascular  soft tissue of the foot 

Biopsy of this  tumor again

Biopsy report is mycetoma.
REFERENCE:
Mycetoma

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.