CASE 622: RECTUM CARCINOMA, Dr ĐẶNG NGUYÊN KHÔI, Dr PHẠM CHÍ TOÀN, Dr VÕ NGUYỄN THÀNH NHÂN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Male patient 64yo, revealed  himself blood in stool. 

Virtual Colonoscopy MSCT detected in left pelvis a vegetative tumor of colon that narrowed 50% lumen of colon and blurred fatty tissue around.

Colonoscopy confirmed a vegetative colonic tumor which was 15 cm far from anus that made narrow lumen #50%.

Endorectal ultrasound 360 degree [EUS] detected the tumor, T3 N1 Mx. Tumor # 29x16 mm of mucosa of posterior wall invaded epithelial layer to posterior fatty tissue of rectum.

Biopsy report of the tumor is colon cancer. Differentiated carcinoma of rectum (C 18.9).

Colon rectum removed, See macro specimen.

CASE 621: INCIDENTAL THYROID SMALL TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female patient 48 yo came to Medic Center for a check-up .

Ultrasound for thyroid incidentally detects a small nodule in left lobe that belongs TI-RADS 5 classification. Solid nodule, not well limited border,  hypoechoic, non hypervascularized without calcification. 

Lab data  TSH usensitive 1.4ulU/mL, free T4 1.13ug/dL, Antithyroglobulin 498UI/mL, Anti Microsomal [TPOAb] 37.47UI/mL.

Although there is guidelines of no need to biopsy for thyroid nodule under 1 cm of diameter, a FNAC was performed. 

And  histopathological report is a follicular lesion, BETHESDA System Group III that means a follow-up planning must be made and in some day removing small tumor will be done.

CASE 620: RECURRENT TONGUE CANCER, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THỤC QUYÊN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female patient 48 yo suffers from a tumor of her tongue for 2 months. The tongue tumor maybe is recurrent from the small tongue tumor  3 years before and now is still a scar on right border of tongue, she said. Some lymph nodes were removed and she underwent radiation therapy on neck region.

Ultrasound detects a hypoechoic mass at right border of tongue, but is more deeper and larger than its surface. # 41x40mm. 

Later MRI confirmed the tongue tumor at right border but it is still one side and not comes to over the midline of the tongue.

Partial tongue was removed and reconstructed to keep her normal voice. Report of histopathology is squamous cell carcinoma, grade II.

CASE 619 : ABDOMINAL AORTIC DILATATION, Dr PHAN THANH HẢI, Dr TRẦN THỊ THANH NGA, Dr VÕ NGUYỄN THÀNH NHÂN, Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Old male patient 70 yo, with  AAA suspected came to Medic for reexamination.

Abdominal CT with contrast thought about subrenal non dissection AAA, diameter # 29x32mm, with intramural aortic thrombus and  aortic wall plaques. Left iliac artery in dilatation with plaque and ulcer of vascular wall.

But Doppler color ultrasound showed a dilatation of subrenal abdominal aorta  # 60x18mm with thombus that narrows 30% of  lumen and aliasing artifacts into.

Later MRI of abdomen without Gadolinium confirmed a dilatation of abdominal aorta in 2 sections, the last one with plaques in subrenal part of aorta . Left commun iliac artery with plaques is also in dilatation.

MRI of Medic Center could perform vascular imaging without Gadolinium enhancement.

CASE 618: SMALL UTERUS LEADS TO SUSPICION TO CEREBRAL TUMOR, Dr LE DINH VINH PHUC, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female tennager 13 yo from midland region of middle Vietnam go to Medic for a checkup. 

In general ultrasound  a small uterus was detected so inducing a endocrinological problem but therer is no clue about. 

For year got pain of her right leg and foot at gym without abnormal on X-ray films. From 6 months till now 3 right hand fingers, foot and fingers are involuntary in flexion and weakness feelings. Then for later 3 months her chief complaints are plenty drinking, polyuria, headache, space out, more sleeping and drowsiness. But she got no fever nor blurred vision.

MRI brain was performed and a germinoma tumor was detected above hypophysis,hypophysis and basal ganglion on right side.

CASE 617: PROSTATE on SWE TRUS with BIPLAN PROBE, Dr NGUYEN MINH THIEN, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 64yo with fever and voiding discomfort for month.

Digital rectal examination detected a big prostate with a hard nodule on right side.

On MRI there were a 22x15mm hard node of right lobe and another one, 12x16mm, on the left of prostate which concern neoplastic foci , but  PSA=1.75 ng/mL;  F/T=20%

At Medic, an SWE elastography TRUS with biplane probe was done

On TRUS B-mode,  peripheral area of right lobe exists a 16x18 mm hypoechoic nodule, not well-limited,  hypervascular and irregular capsule of right lobe.

On strain elastography, nodule is harder than transitional area while surrounded area of right lobe is softer than the nodule.

On 2D SWE, stiffness of nodule on right side has got a value of 50 kPa [mild hard] while lesion of transitional area of left lobe of 47 kPa.

By via  transperineal a biopsy of prostate was perfomed and histopathological result is TB of prostate and subacute prostatitis.

Conclusion: 

SWE TRUS with biplan probe helps imaging lesions of prostate with more  information to plan for treatment better.

CASE 616: INFECTED SCROTAL SKIN, Dr LE TU PHUC, Dr LE VAN TAI, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 74-year-old male patient presented to our clinic because of pain and swelling in the right scrotum for 10 days. The scrotum became larger, harder and pus drained out of the scrotum about 3 days before the ultrasound examination.

About 3 months ago, he underwent transurethral resection of the prostate (TURP) and was infected with COVID-19 in the postoperative period. After the COVID isolation, the patient did not show any symptoms of infection.

On ultrasound of the scrotum, we found scrotal edema, thickening, interstitial fluid and gas between the scrotal skin layers. Gas spreads anteriorly to the right pubic tubercle and posteriorly to the base of the penis near the anus.

Gas was not seen in the left scrotum, in the spermatic cord, in the skin of the abdomen and on the buttocks and thighs. No fistula from the rectum was found.

Due to the patient's recent urinary tract surgery, urinary catheterization, history of diabetes, gas and fluid in the right scrotal skin. We therefore assumed diagnosis of Fournier's gangrene.

The paitent was transferred to surgery department after and treated with debridement surgery in combination with antibacterial and detoxification therapy. He improve well till now.

Getting well at hospital discharge.