CASE 654: PHYLLODES TUMOR of the BREAST, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr TRẦN THỊ HỒNG VÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 21 year-old female patient herself detects a small mass of right breast from years, but it is getting bigger recently for some months, hard feeling when palpation and painless. The skin of right breast is still normal and no axillary lymph node.

Thermography of breast tumor exists on right thoracic wall in highest hot 36.8 C degree.

On ultrasound, the right breast tumor # 60x70 mm is in central, ovoid, macrolobulated, well  capsulated, hypoechoic with many echo poor bands / clefts from central to peripheral tumor, medium vascularized. 

MRI detects medium signal on T1W1, high on T2 STIR, contrast well captured, categoried type 2.

Result of core biopsy is a benign phyllodes tumor of the breast (PTB).

On the surface the tumor is nodular, while on section tumor  is lobulated, solid in gray and gray-yellow color.

PTB is a very rare breast tumor in women aged 35 to 55 years. Our patient is younger but the progress of the tumor is the same in the literature: "unilateral, nodular, painless mass which has a history of the mass but that grows rapidly in the short term".

 

CASE 653: PRIMARY MUSCLE LYMPHOMA, Dr PHẠM THỊ THANH XUÂN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 68 year-old male patient with a mass at right neck  in  lung TB regimen for 4 months but still weight loss and sudation. The painful mass existed for 1 month and getting bigger with skin redness.

Soft tissue ultrasound detected a complexe mass #57x43 mm in muscle at right neck from angula of lower maxillary region which distorsed structure, with intramuscular fluid beside cervical vertebral column C4. It existed not any neck lymph node.

MRI  confirmed a right neck tumor invasive to muscle.

Chest CT = no lung invasive, no mediastinal lymph node nor axillary node. Bone marrow biopsy  exist not any malignant cell.

In surgical biopsy for chemohistopathology of the tumor resulted small cell lymphoma (C83).

The patient was  treated TB lung completely and then continued lymphoma chemotherapy. Now the muscular tumor was  smaller 80% and the patient remains well.

Primary muscle lymphoma is very rare entity without characteristic imaging findings but diagnostic imaging keeps a role.

REFERENCES:

Cancer Imaging (2013) 13(4), 448457 DOI: 10.1102/1470-7330.2013.0036
Imaging of musculoskeletal lymphoma
https://www.leukaemia.org.au/blood-cancer-information/types-of-bloodcancer/lymphoma/non- hodgkin-lymphoma/small-lymphocytic-lymphoma/
https://www.cancersupportcommunity.org/chronic-lymphocytic leukemiasmalllymphocytic-lymphoma
https://patientpower.info/the-curious-case-of-cll-and-sll-leukemia-lymphoma-orboth/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400341/
https://ashpublications.org/blood/article/131/25/2745/37141/iwCLL-guidelines-fordiagnosis- indications-for
Muscle lymphoma | Radiology Reference Article | Radiopaedia.org
Hindawi Case Reports in Radiology Volume 2017, Article ID 2068957, 7 pages
https://doi.org/10.1155/2017/2068957
Diagnostic challenge of soft tissue extranodal Hodgkin lymphoma in core-needle
biopsy: case report

CASE 652: MILIA, Dr PHAN THANH HAI, Dr LE THANH LIEM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 70 yo male patient got a small white spot # 5 mm without pain on left side of his mouth for 3 months

Dermatologist thought about a milia.

Skin ultrasound wih 24MHz probe detected an intradermic layer, well-border, inhomogenous  content, no vessels in and around the lesion. 

On 33MHz probe lesion could be seen more clearly its structure inside.

Removed the milia by puncture and FNAC.

Photo after 24 hours.

 

CASE 651: PERITONEAL ABSCESS DUE TO FOREIGN OBJECT (FISH BONE), Dr PHAN THANH HẢI, Dr CHÂU NGỌC MINH PHƯƠNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 67 year-old male patient, presented with periumbilical and left lumbar pain for one month that was not response to treatment.

Abdominal ultrasound detected one mixed echogenic mass in the left lumbar mesentery with the diameter of 84 x 47mm. The conclusion was: Suspected mesenteric infarction (Differential diagnosis: Intra-abdominal Abscess) – Hepatic Steatosis – Abdominal Aortic Atherosclerosis.

MSCT of the abdomen showed a foreign object similar to a toothpick near the abdominal wall, right above the umbilicus, with a lenghth of 21 mm. The greater omentum surrounded the foreign object forming a mass with the diameters of 60 x 45 mm.

During operation, surgeons removed a foreign object which was highly suspected as a fish bone after dissecting the abscess in the greater omentum. The two adhering loops of small intestines were separated and reinforced with stitches.

 

  

 

Conclusion: Physicians should be on high alert when patients with abdominal pain not responding to the treatment. Abdominal ultrasound and MSCT help guiding the appropriate diagnosis for the case.

CASE 650: SOFT TISSUE TUMOR, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 52 year-old patient with a mass at her right frontal region, no pain, no changed skin color.

Ultrasound detected a subcutaneous hypoechoic with vascular signals which was noted a vascular tumor but not invasive frontal  bone. Elastography was medium hard than other tissue around.

Histoanapathologic result was benign cystic hemangioma.

CASE 649: CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ THANH THẢO, Dr TRẦN CHÍ ĐỦ, Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIET NAM.

 A  68 year-old male patient with jaundice in ruling out of head of pancreas tumor from Tra vinh province went to Medic Center for an exact diagnosis before a surgical treatment.

Ultrasound ruled out pancreatic tumor and noted intrahepatic bile duct dilatation and 2 sides pleuresia. Gallbladder was not big with some sludge.  Wall of bile duct thickening # 6-7mm, hyperechoic, CBD diameter 1.24mm existed 0.66--1.2 mm bile sludge at the beginning of CBD. Sign of bile duct tumor was unclear.

Later biliary MRI performed and the result was a tumoral infiltration in bile duct  that made collapse biled duct at the hepatic umbilicus leading to dilatation of intrahepatic bile ducts. Maybe there was an other thought about of stricture of bile duct due to cholangitis.

Surgery was done that detected bile duct tumor #1x2 cm.  Removed bile duct tumor, GB,  and  connecting hepatic duct  to jejunum by Roux-en-Y. Anapath was CholangioCarcinoma grade 2 invasive.

CASE 648 : SKIN ULTRASOUND, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC , VIETNAM

 A 90 year-old male patient with a painless node at right angle of his mouth. His past history was a left kidney cancer that had been cured for 5 years.

Skin utrasound  by VINNO M86 system with linear probe 16MHz and 23MHz. 

Focal cystic lesion # 9x4mm,  represented mixed structure in subcutaneous layer, with fluid, non vascular, well limitted capsule. Elastography was green code that means a medium hardness. A benign mucous cyst was noted.