CASE 601= MALIGNANT LIVER TUMOR BUT WAKO TEST NEGATIVE, Dr PHAN THANH HẢI, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

Male patient 43yo with HBV infection for years but only follow-up now detected right lobe indeterminated tumor #30x23mm at subsegment VIII on ultrasound. Doctors thought benign tumor because of WAKO test negative.

MSCT confirmed a focal fatty infiltration on right lobe in different diagnostic of a liver tumor.

One month later, MRI with Primovist detected  liver tumor at VIII segment, T1 low  tumor signal than mesenchymal signal, but T2 higher than liver. Wash-out is typically same HCC  (7sec, 7min and 30min).

The tumor is close to IVC and between right and middle  hepatic veins that will invade vessels if delayed management.

Open surgery to remove tumor in anterior lobe of liver. Histopathologic report is liver cell carcinoma, trabeculated pattern.

CONCLUSION: MRI with Primovist is best choice for small liver HCC with negative WAKO test.

CASE 600: MIRIZZI SYNDROME, Dr PHAN THANH HẢI, Dr PHAN NGUYỄN THIỆN CHÂU, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Male patient 62yo with RUQ pain for 1 month failed  managed as gastritis. Ultrasound at local hospital detected GB stone so the patient came to MEDIC to reexamination.

Ultrasound at Medic Center detected big GB stone # 24mm and CHB dilatation, thought about GB stone and Mirizzi syndrome.

MSCT confirmed later GB stone in cystic duct and Mirizzi syndrome.

Lab tests CA 19-9=145.5U/mL, Bilirubin raising esp direct bilirubin.

Patient was sent to Binh dan hospital to manage the GB stone.

Bình dan MRI confirmed GB stone and Mirizzi syndrome.

Surgery was done to remove GB stone, cholecystectomy and Kerh drainage for C H D.

CASE 599: TESTICULAR CANCER MIMICKING TESTIS TORSION , Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, Dr MAI BÁ TIẾN DŨNG, MEDIC MEDICAL CENTER, HCMC VIETNAM

Male patient 31 yo, with sudden pain at left scrotum for 2 months had been treated as epidydimitis but treatment failed. He came to Medic for reexamination because swollen scrotum and testicular pain.

Ultrasound at Medic Center detected swollen left testis  with edema of epidydimis and hypervacularization. Testicular axis turned horizontally and left testis was inhomogenous with cystic necrosis and no vascular signal mimicking a left testicular torsion.

MRI of left testis #  60x85mm, inhomogenous signals that existed fluid and blood inside but captured a few of contrast. Edema of epidydimis and spermatic cord. No spermatocele.

Lab results showed no sign of inflammation, beta HCG, AFP, LDH raising that lead to think about a testicular  tumor non seminoma.

Operation removed left testis. It looks like tumor on macroscopic view. Histopathologic result is testicular embryonic carcinoma.

Post surgery one day,  blood tests dropped=  AFP, Beta HCG and LDH   ( AFP= 62, beta HCG= 8.9, LDH= 419). Normal. Chest XRray .  

DISCUSSION= Diagnosis of left testicular tumor based on patient history, age, beta HCG, LDH and AFP raising. No hypervascularizing of left testicular tumor maybe due to thrombosis of vessels in spermatic cord that could make mistake for ultrasound and MRI.

CASE 598: COLONOGASTRIC FISTULA DUE TO LEFT COLON TUMOR, Dr PHAN THANH HẢI- Dr VÕ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

Female patient 39yo, thin, pale, anemia with crises of epigastric and left flank pain without fever and lost weight for 2 weeks.

Ultrasound detected one mass in LUQ nearby gastric greater curvature that made thought about stomach tumor. But in swallowing water to examine, ultrasound revealed gas in the mass which adhered stomach so it may exist a fistula that connected gas in the mass and stomach.

Gastric endoscopy confirmed stool inside stomach and a fistula, d#10mm on gastric wall. Then a colonoscopy showed left colon tumor at splenic angle.

MSCT proved left colon tumor invaded stomach with fistula that adhered to gastric corpus. Lesion of thickening colon wall #25mm, degraded surrounding fatty tissue and captured mildly contrast.

Surgery was done to remove left colon tumor that seeding peritoneum, posterior uterus and lymph nodes. Tumor invaded stomach, tail of pancreas and lower pole of spleen.

Histopathological result post op is a colon adenocarcinoma grade 2 invasing serosa and metastasing nodes and peritoneum.

CASE 597: RECTUM CANCER, Dr PHAN THANH HẢI, Dr PHAN ANH TUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Male patient 60yo with lower GI tract hemorrhagia for months. At local hospital rectal endoscopy noted rectal wall rigid invasion. Biopsy results showed rectal ulcerative inflammation with anaplastic inversion. 

At Medic Center, colon enema with barium revealed contrast lacunae and rigid wall of rectal   tumor.        

Abdominal MSCT= Rectal wall lesion thickening #18mm captured contrast in medium intensity and degraded fatty tissue around . Some mesenteric  nodes 5-10mm. Being thought about rectal tumor invading tissue around and metastasing to nodes.

-                    

-                   Pelvic MRI= Invaded pattern tumor  is inside rectum # 82mm  which made narrowing rectal  lumen that is far from anus #46mm and invaded muscular layer toward posterior wall of rectum and presacral area from S2 to coccyx and adhered  posterior prostatic urethra wall. Gado captured non similarly with high signal intensity on T2W1, medium signal intensity on T1W1. Some 10-16mm nodes existed around rectum.

-                   Intraluminal rectal ultrasound with probe ASU-67, 7.5-10MHz,  views 360 degree detects rectal tumor far from anus 30-40mm. Tumor takes place entirely rectum and outside = invaded anterior sacrum posteriorly and adhered prostate and prostatic urethra anteriorly. Existing some 5-7mm nodes nearby tumor.

-                   Endoscopy of rectum revealed rectal ulcerative invasive lesions that made narrowing rectal lumen. Biopsy results is poor differentiated adenocarcinoma, type ring cell of rectum.

Chemotherapy is on going for patient at Binh dan hospital.                     

 CONCLUSION=

Intraluminal rectal ultrasound by probe view 360 degree is useful to assess rectal wall lesion and around rectum tissue,  taking part to detect rectum and rectal canal disorders.