CASE 702: SMALL INTESTINE GIST INCIDENTALOMA, Dr PHAN THANH HẢI, Dr PHAN THANH HẢI PHƯỢNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A HTA 65 year-old female with chest pain, mild apsnea and without gastroenterological symptom.

Ultrasound incidentally detects a 37x29 mm hypervascular hypoechoic mass which seems to be from the small bowel at her left abdomen.

Because of the rare incidence of small intestine (SI) tumor and in SI GIST, sonologists choose a SI polyp in differentiaziting a SI GIST.

MSCT confirms a 30x40 mm non invasive bowel wall tumor of GIST, strongly captures CE.

Endoscopic examination notes an exophytic jejunum tumor and open surgery removes  a small intestine loop which is an adequate clearance of 5 cm upper and lower of the tumor, and performs an end-to-end anastomosis. 

Gross specimen is a 5cm bowel intestine that exists at submucosa layer. The tumor section surface is solid, whitish with hemorrhagic ulceronecrosis.

Microscopic studies reveales spindle cells type of GIST with low mitose index.

CASE 701: BREAST TUMOR CASE, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr NGUYỄN KIM HIẾU, Dr VÕ KIM LOAN, Dr NẠI THỊ HƯƠNG NG THOANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 30 year-old female patient with a 13x17 mm right breast tumor goes through breast ultrasound 3 times.

In the first time, results are tumor BI-RADS 4A, FNAC : Fibrocystic changes.

Second time breast examnination, 14x19 mm tumor

BI-RADS 4A, FNAC , Fibroadenoma.

The third exam results are 12×20 mm,BI-RADS 4C, inhomogeneous hypoechoic with microcalcification, malignant doutfully elastography.

Core biopsy result is invasive breast carcinoma of no special type, grade 2.

Mammography BI-RADS 4 with multiformal collective microcalcification at 11o'clock 3 cm far from nipple.

Lame consultation is Atypical ductal hyperplasia with chemohistoimmunological staining results are P63+, ER + 50%, CK5/6 +.

But Breast MRI thinks about breast tumor BI-RADS 5.

In cancer hospital, guided ultrasound biopsy by VABB removes the 20×24 mm hole tumor.

The last result is Intraductal Papilloma.

The patient remains well after 2 months reexamination.

Conclusion: 

A right breast tumor of the 30 year-old patient raises gradually its size which ultrasound scoring from BI-RADS 4A to 4C. 

MRI BI-RADS 5. Mammography BI-RADS 4. 

FNAC, Core biopsy results are different.

And the last result due to VABB and Chemohistoimmunological staining is Intraductal Papilloma.

CASE 700: RIGHT THORACIC WALL TB ABSCESS, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr HỒ CHÍ TRUNG, Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 45 year-old  female patient with right thoracic painful swollen area for 5 months.

Ultrasound detects right pleural effusion, thoracic wall mass which contains rib cartilage destruction, close by pleural wall thickening at 4 th intercostal space, and local lymph nodes.

Chest X-RAY  shows right pleural effusion and nothing about thoracic wall. 

MSCT  confirms a right thoracic wall lesion and right lung NAD.

FNAC and core biopsy of right thoracic wall results  think  about TB inflammed lesion with ADA raises slightly in right pleural fluid.

So it exists a painful right thoracic wall for 5 months and evidents belongs to a TB infection without primary lung lesion.

Histoimmumologic staining results are TB inflammed cartilage and soft tissue which exists granular cells and lymphocytes.

It will be planned for a TB regimen in TB and Lung hospital.

CASE 699: DIFFUSE LARGE B CELL LYMPHOMA and WALDEYER'S RING, Dr PHAN THANH HẢI, Dr DƯƠNG XUÂN TÙNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM

A male patient 41 year-old with multiple cervical nodes and sore throat as tonsillitis.

Chest X-RAY notes left lung lesion.

Ultrasound detects many lymph nodes  # 17-15-13 mm without nodal hilus, solid, hypoechoic on his neck and in the abdomen : at liver hilus :27mm, mesenteric,  pelvic: 17-21 mm and a splenomegaly :141mm. Results of ultrasound notes a multiple lymph nodes in cervical, supraclavicular and abdominal region that leads to a diffuse lymphoma. 

Biopsies of tonsils and pharyngeal cavum results are lymphoma infiltration without immunohistochemical staining.

ENT examinations results are many lesions of tonsils and oral cavity and Waldayer's ring.

Biopsy of right tonsil ulcer for ruling out cancer and immuohistochemical staining result is diffuse lymphoma type large B cell.

Patient goes through a chemotherapy planning for lymphoma. Cervical nodes reduce their sizes with effective management. 

REFERENCES:

CASE 698: HTA YOUNG PATIENT with 2 RENAL ARTERIES each side, Dr PHAN THANH HẢI, Dr PHAN THANH HẢI PHƯỢNG, Dr HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 47 year-old HTA male patient with feelings of his heavy chest. His history notes 2 times of syncope and suffering from HTA since his ages of seventeen.

Ultrasound feels uncertainly about a  50% stenosis of renal artery which its diameter is # 7.5 milimeter.

Renal structures and sizes seem being in normal limits.

Chest X-RAY film is normal and his EKG results ischemic heart disease.

Lab data shows renal insufficiency: eGFR 37mL/min/1.73m2; creatinin 2.2mg/dL;  and hyperuricemia with serum urea 65.84mg/dL

At last, DSA detects 2 renal arteries each side that belongs to a renal artery malformation (bilateral duplication of renal artery).

So the male patient with renal duplicated arteries might be suffering from parenchymal nephropathy /and due to gout.

REFERENCE

Renal arteries are a pair of lateral branches from abdominal aorta. Normally each kidney receives one renal artery. However, accessory renal arteries can also exist. The normal renal arteries enter the kidney through its hilum where as the accessory renal arteries might enter the renal artery through the hilum or through the surfaces of the kidney. Knowledge of the variations in the renal arteries is important for urologists, radiologists and surgeons in general.

Accessory renal arteries are common in 20–30% of individuals, usually arising from the aorta above or below the main renal artery. The variation in the number of arteries is because of persistence of lateral splanchnic arteries or due to the persistence of blood supply from lower level than normal.