CASE 695: Fasciola sp, UNUSUAL CAUSE of THICKENING of G I TRACT, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

  

Two cases of infected Fasciola sp whose larva migrants having in the same time some hepatic lesions and thickening of duodenum (2023) and right colon wall (2017) that are noted at Medic Center. 

CASE ONE:  A male patient 45 year-old, with history of thyroid cancer in 2013, enters a hospital as nausea, abdominal pain without fever after a ceremony buffet one day before.  Ultrasound detects hepatic lesions, and MRI  later reveals lesions in caudate lobe of liver and duodenum D3 wall thickening that is thought a case of infiltration of lymphoma on GI tract and liver.

But lab data notes raised highly the eosinophil proportion (48%) and positive Elisa tests for Fasciola sp and Gnathostoma.

Ultrasound of Medic Center confirmes liver lesions  and  duodenum D3 wall thickening  that maybe concludes due to infected parasites.

After 6 weeks managed by medical parasite drugs for Fasciola sp the male patient remains well; liver lesions reduce its sizes and duodenum wall gets normal on ultrasound and abdominal MSCT , and getting downed the eosinophil proportion.

CASE TWO: 

A female patient with Fascioliasis lesions in her liver and her right colon wall thickening in the same time which were detected by ultrasound and MSCT. 

Endoscopic biopsy of colon result was epithelial inflammation with eosinophil white blood cells.

She was managed successfully as Fasciola visceral larva migrants.

Larva migrants, especially for Fasciola sp, have a classic site in liver and biliary tree in acute phase and chronic phase. 

It exists two cases of larva migrants going outside the liver and biliary tree, to GI tract. If having lesions of it in liver or biliary tree one should not forget to find out larva migrants in another place.

REFERENCES:

https://www.nguyenthienhung.com/2008/10/c-im-siu-m-tn-thng-gan-do-sn-l-gan-ln.html?m=1

Ultrasound and Fascioliasis at MEDIC CENTER, Vietnam (slideshare.net) Oct, 21, 2013

CASE 694: SPONTANEOUS SPLEEN LACERATION, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A male patient 56 year-old  with one day of pain at left side of abdomen, obesity, and five-year chronic leukemia.  His history is noted splenohepatomegaly and cirrhosis and controlled type 2 diabetes. 

At Medic Center ultrasound detects free fluid in abdomen and big spleen with hematoma inside which makes thought about a spontaneous spleen laceration without any injured causes in spite of spleen infarction.

MSCT  with CE confirmes a spleen rupture with subcapsular hematoma and free fluid in the abdomen.

Surgery in emergency is done to remove the # 180x120x80 mm spleen and hemostasis procedure.

At the middle of anteromedial face of spleen it exists a #50 mm long  and 30 mm deep laceration line. Bloody fluid in abdominal cavity is an amount of 1.8 liter.

The patient goes through successfully the operation  but comes back with an 80x89 mm spleen bed abscess which is solved by medical management.

 

Chronic leukemia and obesity and DM may induce a spontaneous spleen laceration.

CASE 693: ADVANCED MALIGNANT MESENCHYMAL CELLS of PROSTATIC TUMOR, Dr PHAN THANH HAI, Dr NGUYEN MINH THIEN, MEDIC MEDICAL CENTER. HCMC, VIETNAM.

 A 66 year-old male patient with weight loss and asthenia. Some 15-30 mm metastasized necrotic periaortic lymph nodes and prostate hypertrophy are noted on abdominal ultrasound.  Chest X-ray is normal and abdominal MSCT confirmes retroperitoneal lymph nodes and prostate tumor. PSA value is 1.38 ng/mL but with microscopic blood urine that transfers him to Medic Center for a prostate biopsy.

By via TRUS it exists a #55x43x62 mm big prostate, loss its capsule and distorsion of prostatic structure. The prostate tumor is noted having of many hard sites on shear wave ultrasound elastography.

Performed 12 specimen prostate biopsy and 16 items histoimmunopathologic report concludes a non- specialized mesenchymal cell of prostate tumor (PCa) on a chronic TB inflamed based structure.

This is a rare PCa malignant mesenchymal cell  of prostate tumor may happen on 1/1000 cases. The patient is waiting for an appropriate management due to his advanced status of the tumoral progress.

CASE 692: Five Year HCC post-op, Dr PHAN THANH HẢI, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, HCMC , VIETNAM.

 A 71 year-old female patient with her history of a liver tumor which was quite difficult diagnosed 5 years before.

She had been go through ultrasound, MSCT  and liver biopsy 2 times in 2 other hospitals, but the results were benign hepatic tumor and no clue of infected HCV and HBV.

In Medic Center, ultrasound noted a 50 milimeter right liver hemangioma and MRI  with gado was an AML but not ruling out HCC.

But HCC risk tests with WAKO test were positive and positive antiHBe in that time.

After 2 months of the five year before to examine the liver tumor, the HCC  diagnosis was made and the tumor was removed surgically when the patient aged 66.

Histopathological report was a poor differentiazed carcinoma of liver with fatty degeneration  and hepatic chronic inflammation.

And 5 years went by the female patient remains well. The right lobe of liver exists a fibrosis scar.

The prognosis of HCC patient will be well if an effective management performs successfully in time for the female patient [Acceptable 5-year survival].

CASE 691: LEFT ADRENAL TUMOR, Dr PHAN THANH HẢI, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 48 year-old female patient without arterial hypertension signs is incidentally detected a tumor of adrenal gland #20×22 mm by ultrasound.

MSCT confirmes  a 16x22 mm left adrenal benign tumor  which HU before CE is 69 and HU post CE =26. CE discharge is over 50% that may proove the benignity of the tumor.

4 months after the left adrenal tumor is removed by endoscopic surgery.

Result of pathology is a benign adrenal tumor with thin fibrous capsule.

CASE 690: APPENDICULAR ABSCESS, Dr PHAN THANH HAI, Dr NGUYEN NGOC XUÂN GIANG, MEDIC MEDICAL CENTER - BINH AN HOSPITAL KIÊN GIANG, VIETNAM

A 56 year-old female patient with umbilical pain for one week, comes to Binh an hospital after 4 days in constipation.

Ultrasound detects an abscess in RLQ but could not rule out a PID. Although sonologist notes an appendicular abscess but could not reveal the inflammed appendix into the pelvic abscess.

MSCT confirms a 60x80 mm  right pelvic abscess contrast captured and edema of the wall of terminal jejunum. The report is pelvic abscess maybe an appendicular abscess.

Endoscopic surgery drained the pelvic abscess and the patient remains well.

CASE 689: RECTUM WALL GIST, Dr PHAN THANH HẢI, Dr LÊ TUẤN KHUÊ, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 56 year-old female patient with 6 month constipation and bleeding from her anus  for 2 weeks.

Rectal endoscopic result is a hemorrhagic rectal tumor which is far from anal orifice 20 millimeters.

MRI confirms a 53x41 mm tumor of the rectal canal.

A transperineal biopsy with ultrasound-based guiding is done for a 42x48x44mm vascularised solid mixed tumor.

Result of histoimmunology is a GIST tumor of  rectum wall.

The female patient is planned for a surgery and chemotherapy.