CASE 710: Right Kidney Tumor, Dr PHAN THANH HẢI, Dr TRẦN MỘC HIỆP, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 50 year-old woman with right kidney tumor but it existed not any signs of hematuria or back pain. Laboratory findings noted only CA 19-9 value raised and normal urine tests. 

And normal EKG and chest X-ray findings.

Ultrasound confirmed a huge right kidney cystic tumor 97x93×88mm, hypovascularized  but there was cystic necrotizing inside with cloudy fluid. The capsule of tumor was intact while its content was inhomogeneous echogeneicity.

MSCT  represented later a #90×100×110 mm cystic tumor of upper pole of right kidney, classified BOSNIAK IV.

Open surgery explored and removed the right renal cystic tumor at upper part of kidney by scissor; some sludge fluid drained out from the bottom of the cystic tumor. And surgeons left a haft of right kidney in the renal bed after sewing it.

Microscopic result is adenocarcinoma of kidney.

CASE 709: LIPOMA of THYMUS and MYASTHENIA GRAVIS, Dr PHAN THANH HẢI, Dr CHÂU NGỌC MINH PHƯƠNG, Dr HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER, VIETNAM

A 52 year-old woman with her arm, face muscle weakness and slight ptosis for months in management with mestinon. She askes for knowing more about her disease and how to solve her illness.

MSCT detects multinodular blossom in the thymus and mediastinal lymph nodes. While brain MRI represents no brain tumor.

Ultrasound found out no cervical lymph node for biopsy.

Thoracic endosurgery removed the thymomal tumor and lymph nodes in mediastinum.

Microscopic result is lipoma of thymus, a case of the thymolipomatous myasthenia gravis.

CASE 708: GASTROINTESTINAL GIST, Dr SƠN THANH THINH. MEDIC CẦN THƠ, VIETNAM.

A 43 year-old woman with right upper abdominal pain for 3 months but failed with unknown treatments.

Ultrasound at Medic Can tho detected a 78×100 mm solid hypoechoic mass with Doppler signals inside and noted a mesenteric tumor. 

MSCT confirmed a # 98x76x91 mm mass in soft tissue density which adhered to stomach wall maybe an exophytic gastric GIST. 

Endoscopic surgery removed the tumor and microscopic result is a gastrointestinal GIST.

CASE 707: PSEUDOTUMORAL CYSTITIS, Dr VÕ THỊ THẢO VÂN, MEDIC CẦN THƠ, VIETNAM

A 15  15 year-old male child with dysuria and had been failed in treatment for urinary infections many times in history.

Ultrasound detected a # 4x5 cm solid mass at right anterior face of urinary bladder with a calcified spot inside.

MSCT  noted an urachal remnant adhesive to bladder or bladder tumor.

Bladder endoscopy removed the bladder tumor, and microscopic result is glandular cystitis.

CASE 706: CASTLEMAN DISEASE, Dr ĐÀO QUỐC TOÀN, Dr TRẦN LÊ DUNG, MEDIC CẦN THƠ, VIETNAM

 

A 40 year-old man in check-up was detected  a # 39x45 mm mass nearby the head of pancreas by ultrasound. Sonologist noted a mesenteric tumor or GIST. 

MSCT described a retroperitoneal tumor maybe neurofibroma.

MRI  confirmed a retroperitoneal tumor or mesenteric tumor.

Endoscopic surgery removed a # 4.5cm lymph node tumor. Gross specimen section is brownwhite and microscopic result is lymph node of Castleman disease.

CASE 705: PRIMARY HYPERPARATHYROIDISM with normal CALCEMIA (nHPT), Dr PHAN THANH HẢI, Dr HUỲNH TRÁC LUÂN , Dr JASMINE THANH XUÂN, Prof NGUYỄN THY KHUÊ, Dr PHẠM HUỲNH BẢO TRÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 64 year-old woman with fatigability in general check-up.

Neck ultrasound incidentally detects a right 16×11mm parathyroid tumor in right posteroinferior face of thyroid.

Laboratory findings note PTH value highly raised but not raised calcemia value. Osteogram notes her osteoporosis status with the bone fracture risk 6 times more.

Parathyroid Scan BIMI-99 Tc confirms a right parathyroid tumor.

Surgery removes  the right parathyroid tumor and PTH post-op value comes back to normal value. Histopathological result is a benign parathyroid tumor.

Summary

Normocalcemic hyperparathyroidism is a newly described variant of hyperparathyroidism. 

It is defined as persistently low or normal corrected or ionized serum calcium levels taken at least six months apart in the presence of elevated parathyroid hormone levels.

It may be primary or secondary. Normocalcemic secondary hyperparathyroidism is treated medically, while primary may need surgery.

….

The initial diagnostic approach for the patient is to rule out all secondary causes of hyperparathyroidism.

Normocalcemic primary hyperparathyroidism may be present in up to 17% of all cases of elevated PTH.

While usually asymptomatic, over one-third of nPHPT will progress to symptomatic bone disease or nephrolithiasis.

Familial hypocalciuric hypercalcemia needs to be ruled out. This can generally be done via a low calcium/creatinine clearance ratio. 

CASE 703-704: STROKE due to CEREBRAL ISCHEMIA, Dr PHAN THANH HẢI, Dr NGUYỄN THỊ ÁNH HỒNG, Dr TRẦN THỊ THANH NGA, Dr PHAN THANH HẢI PHƯỢNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Cerebral ischemic diagnosing bases on spontaneity of  decreasing and loss memory and vision. And Face  Arm Speech Time [FAST] scale. Roles of diagnostic imaging in cerebral ischemia are exactly detecting and rapidly in time (less than one hour).

CASE 01:

A male patient 55 year-old with left eye blurred vision and left dull headache for 2 days. 8 months ago his right arm was in weakness in 2 hours. History notes no FAST, without HTA, DM, except smoking for 30 years.

Brain MRI notes left brain ischemia at occipital region in small area and leukoaraiosis.

Vascular ultrasound notes plaque of the left ICA from its origin to occlude all its length and cause no ICA flow;  and the left central retinal artery flow decreases.

Because of the ipsilateral ICA occlusion,  the left ECA flow becomes internalization.

CTA notes the left ICA occlusion and the left middle cerebral artery is enhanced from the left anterior cerebral artery.

CASE 2:

A HTA male patient 63 year-old with spontaneous loss memory after a critical headache for 6 days. His history is smoking and alcohol beverage for 40 years. No FAST. No loss vision.

Vascular ultrasound notes plaque at the right ICA origin which narrows up 90% lumen and total left ICA occlusion (NASCET), ICA/CCA ratio> 2.

Brain MRI shows large cerebral ischemia,  occlusion of the left middle cerebral artery and the left ICA.

FAST scale and types of diagnostic neuroimaging (vascular ultrasound, CTA and MRI) take  theirs roles in cerebral ischemia and stroke.

REFERENCES: [for vascular ultrasound]