CASE 470: TROISIER-VIRCHOW NODES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 70 YO  COUGH . NO FEVER. CHEST CT   DETECTION  IS LEFT LUNG  LESION  WITH WIDERING OF MEDIASTINUM.
(CT1/ CT2:   SUPRA LEFT CLAVICULAR  MASS SUSPECTED LYMPH NODES.

ULTRASOUND  of SUPRA LEFT CLAVICULAR  AREA IS  MULTIPLE LYMPH NODES.

US1=LYMPH NODES ROUND 2CM, LOSS HILUS, HYPOECHOIC,  HYPOVASCULAR.

US 2 =THE VASCULAR SUPPLY IS  INTER-NODES  LIKE A RING.

US 3= ELASTOSCAN of THIS NODES WITH CENTRAL 23 kPa.

ULTRASOUND EXAMINATION REPORT IS METASTASIS  LYMPH NODES   THAT WERE TROISIER-VIRCHOW NODES.

WAIT FOR  BIOPSY.
MICROPATHOLOGY REPORT WITH  IMMUNOHISTOCHEMISTRY  IS   NEURO ENDOCRINO-

CARCINOMA METASTASIS TO  TROISIER -VIRCHOW NODE.

REFERENCE :  ANATOMY TROISIER NODE

                         PICTURE OF  DR TROISIER --PROF VIRCHOW.

CASE 469: T CELL LYMPHOMA OF SUBMANDIBULAR NODES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC

Man 30 yo, detected 3 months ago submandibular nodules, subcutaneous neck , no fever.

Ultrasound of the neck

US 1: normal thyroid , and subcutaneous nodule is round, black like a cyst .

US 2:  Lymph nodes have the hilus.

US 3:  CDI  Hypervascular with the vascular tree.

  

US 4: MP4  VIDEO

US 5:  PW DOPPLER  RI  0.56,  PSV  46cm/S 

US 6:  ELASTOSCAN  = 2 kPa

Clinical suspected  lymph node lymphoma.

Blood test   EBV IgG positive   118.5 UI/mL,  IgM  negative.

BETAMICROGLOBULINE IN BLOOD TEST IS  LOWER  = 1412   (  NORMAL CUT- OFF=  2164)    

HISTOBIOCHEMYSTRY  REPORT  IS  T-CELL LYMPHOMA

DISCUSSION= THE  NODULE IS LYMPH NODE  HAVING HILUS  AND  HYPOECHOIC  LIKE CYST ;  ELASTOSCAN IS VERY SOFT = 2 kPa   LOOKED LIKE LYMPHOMA.

Structure of lymph node.

CASE 468: ADRENAL GLAND TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN PHỨƠC TÒAN, Dr VĨNH TUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 26yo,  ultrasound of abdomen for screening  incidentally detected  one mass of 5 cm at the right adrenal gland area.

US1= longitudinal scanning of  this tumor at upper area of right kidney, well bordered.

  

US2=  CDI of  this mass pulled down right kidney.

US3=  crossed section  of this mass is well bordered  under liver near IVC.

US4=  very  small vascular signals  in mass.

• US5=   elastoscanning of this mass: very hard  32 kPa in comparison to  liver = 9.3 kPa.

Sonologist reported solid adrenal tumor for this mass.

MSCT revealed:

CT 1= this mass is  hypodense like a cyst.

MSCT with CE, CT 2=  this mass is very low enhancement.

CT 3=  crossed section and sagittal scanning like a cyst of adrenal tumor.

Blood tests :  no abnornal  of cortico-medullary  adrenal function.

Pre-op   suggestion of surgeon is cyst of adrenal gland.

OPERATION REMOVED THIS TUMOR COMPLETLY.  MACROSCOPIC SPECIMEN WAS  WHITE AND HARD STRUCTURE, SECTION SURFACE SWELLED UP.

MICROSPIC REPORT IS  PARAGANGLION NEUROMA, BENIGN TUMOR.

REFERENCE:

https://journals.viamedica.pl/endokrynologia_polska/article/view/EP.2014.0017/32252

CASE 467: SUBMANDIBULAR MASS, Dr PHẠM THỊ THANH XUÂN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

Man 41 yo,   5 years ago  detected one mass at submandibular region, slow growth. Clinical palpation no pain,  soft, and without  trouble of  eating.

Ultrasound:

US 1=  longitudinal  scan with  curve probe 3.5 MHz :   ovoid mass clear border, hypoechoic with  no vascular signals inside.

US 2 = scanning with linear probe 12MHz=   inhomogeneous structure with many  black spots,    size # 0.5 cm.

US 3 =  elastoscanning of   this mass disclosed a cyst  with  many spots  hardening;  like pomegranate fruit.

CT scan with CE=   it is a cyst,  well bordered, .CT1, 2 , 3 with 3 sections of  this mass,    radiologist said  teratoma.

Operation for  remove this cyst with  content like  yellow milk   typical of  sebaceous cyst  (epidermoid cyst).

 MICROSCOPIC REPORT  IS EPIDERMOID CYST,   BENIGN TUMOR.

REFERENCE: IT IS RICE BODIES.

CASE 466:CHILDREN HEEL PAIN : A SEVER'S DISEASE CASE , Dr PHAN THANH HẢI PHƯỢNG, MEDIC MEDICAL CENTER, HMC, VIETNAM

9 years old male patient,  with chief complain of pain in both heels, which worsen by physical activities such as walking, running.

Physical examination: generally normal, Squeeze test (+) on right side.

 X-ray examination and ultrasound were performed.

On ultrasound plantar fascia is normal. Note: the anechoic region between calcaneous is not fluid (which can indirectly suggest fascilitis in case of adult) but in fact the normal apophysis (growth plate). 

Achilles tendon is normal and remains continous fibrous echotexture (US 2), again, the rough bone surface with anechoic shown normal apophysis.

Normal distance to apophysis in both sides, no dislocation, no avulsion.

X-rays examination of both 2 heel  are normal.

Physician suggests Sever's disease, and patient was told to take some time to
rest, proper physical activity and shoes fitting.

Conclusion:

Sever's disease, the most common cause of children heel pain, known as calcaneal apophysitis is an inflammation of growth plate in heel of growing children.  Diagnosis usually bases on clinical,  and X-rays is normal. Ultrasound is suitable diagnostic tool while X-ray examination is only helpful when an ossification center of apophysis exist. Ultrasound  helps ruling out muscle strain, detect edema, lytic and avulsion.