CASE 671: BetaHCG SECRETION by a PULMONARY CARCINOMA, Dr PHAN THANH HẢI, Dr NEANG SI PHATS, Dr HUỲNH TRÁC LUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A  42 year-old female patient,  TPAL 1001 with critical menorrhegia for one month  and weight loss and anemia. HTA:100/70 mmHg, PA:110 bpm. W = 40 kg H: 155mm, BMI: 16.6.

TVS ultrasound detects only uterine fibroma, but beta HCG highly rising= 69,474 mlU/mL.

Total body MRI detects a 98 mm right lung tumor and a 25 mm uterine fibroma.

Chest X-Ray film represents tumor of the right lung which is thought a beta HCG secretion tumor.

Lung biopsy result is a non small cell adenocarcinoma, stage IIIc, invasive at lung.

As the poor status of the patient, the current clinical management is blood transfusion to improve her life in waiting for a reexamination in a cancer hospital.

REFERENCE:

CASE 670: CHRONIC AORTIC DISSECTION, Dr PHAN THANH HẢI, Dr TRẦN THANH NGA, Dr VÕ NG THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 62 year-old HTA female patient with asthenia, impermanent chest pain for one month, is diagnosed aortic dissection by color Doppler ultrasound. She has got slightly leg edema for one week before ultrasound examination.

HTA: 150/80 mmHg, HR : 115 b/min.

Chest X-ray shows pneumonia of upper lobe of the right lung without pleural effusion.

Ultrasound detects a thick flap inside the abdominal aortic lumen which separates the 22 milimeter aorta into 2 colored Doppler code lumens. The aortic dissection represents from thorax to right iliac artery. Bloodstreams in two lumens of the aorta are different with one velocity of 66 cm/s lower than the other, 166 cm/s. 

AngioMSCT confirmes aortic dissection from aortic arc in the chest to iliac artery in thr abdomen. The diameters of aorta are ascending 35mm, aortic arc, 33mm, abdominal, 30 mm respectively. The left kidney artery comes from the lower velocity lumen.

Stenting the aortic dissection is the appropriate management for the chronic aortic dissection w

and antihypertensive treatment.

REFERENCE

CASE 669: PROSTATIC CYST or A-V FISTULA, Dr PHAN THANH HẢI, Dr LÝ THANH LÃM, Dr LÊ THANH LIÊM, Dr VÕ NG THÀNH NHÂN, Dr HỒ KHÁNH ÐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 62 year-old male HTA patient with an aliasing cystic lesion close by his prostate without urogenic symptom was revealed by Doppler technique. A note of an pseudoaneurysm of the right internal iliac artery due to A-V fistula is written down, but it has been missed out on it in 3 other examinations in the past.

MSCT and Angio confirm the pseudoaneurysm of right internal iliac artery.

After a vascular collation via pelvic angiography the pseudoaneurysm disappeares.

Without Doppler technique we could be in error or misdiagnose some cystic lesion.

CASE 668: THYROID TUMOR, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, VIETNAM.

A 64 year-old male diabetic patient with right painfull swollen neck for 2 weeks, he has also got impermanent tinnitus and hoarse voice due to right vocal cord paralysis.

Ultrasound of his neck shows a 29x33 mm big right lobe of thyroid, hypoechoic mixed pattern, poor-limited while the left lobe is intact with its slightly small size #15x17mm. It exists many round and ovale, hypoechoic lymph nodes on both 2 sides of his neck maybe due to metastase or infiltrated lymphoma.

Result of lymph node biopsy is poorly differentiated carcinoma metastase node.

MSCT of neck and chest detect lymph nodes in mediastinum, and on 2 sides of neck that are thought due to metastasis from unknown origin. The  right lobe of thyroid represents undetermined lesion and low captured CE. 

As a poorly differentiated carcinoma of thyroid is a rare entity, a FNAC of right thyroid lobe is performed.

And the result of FNAC of right lobe of thyroid is poorly differentiated thyroid carcinoma.

As the poor status the patient just only undergoes a chemotherapy.

CASE 667: LEFT KIDNEY UTUC, Dr PHAN THANH HẢI, Dr TRẦN THANH NGA, MEDIC MEDICAL CENTER, VIETNAM

 

A 51 year-old male patient with hematuria for 6 months but since last month he suffered from a full hematuria. Ultrasound detected a hypoechoic mass nearby left inferior renal pole. SMI showed hypervascular pattern inside the mass.

MSCT later confirmed a left renal tumor RCC or oncocytoma and a proximal upper left ureter tumor.

Surgery removed the left kidney, left ureter and a part of bladder as high malignant upper tract urothelial cancer (UTUC).

CASE 666: GIANT HYDRONEPHROSIS, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 53 year-old male patient with a painless big abdomen was accidentally detected having a right giant hydronephrosis via ultrasound examination. 

As the right dilated kidney was in large size that could not use any classic section to find out the clue of the renal obstruction. But in going down  from the left pelvis and toward right side, ultrasound revealed an evident ureteral stone # 20 milimeter.

Later, MSCT confirmed easier than ultrasound the 20 mm right ureteral stone which caused the right giant hydronephrosis.

The patient went through a right nephrostomy in emergency situation. About 4.5 liters of urine was drained out and then his abdomen getting flatten.

Two weeks later was done an evaluation of the right kidney function via Tc-99m DTPA scan. Ultrasound re-examination noted a distortion of right kidney structure: thickness of renal cortex thinner than 6 millimeter and nonexistent differentiation of renal medulla from cortex of renal parenchyma.

Via endoscopy  right nephrectomy was performed as the right disfunction kidney. 

6 months later value of eGFR rised from 64 to 75 mL/min/1.73m2 , and the patient remains well.

CASE 665: INTESTINAL GIST, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 55 year-old female patient suffers from a painful epigastric mass for one week. As gastritis management failed, ultrasound reexamines her abdomen.

A 117x67 milimeter mass is detected between liver and right kidney. Its structure is poor with some cystic lesions and central part more rich echogeneicity that is thought to be an intestinal GIST. 

Her uterus gets having some fibroma lesions also which have the same echogeneicity.

MSCT later confirmes the intestinal GIST and uterine fibroma.

Surgery removes the intestinal GIST [left specimen] and an uterine fibroma with stalk (right specimen).

The histopathologic and chemohistoimmuno- staining results are intestinal GIST, and uterine leiomyoma.