CASE 712: GERMINOMA METASTASIS, Dr PHAN THANH HẢI, Dr LÝ VĂN PHÁI, Dr HUỲNH TRÁC LUÂN, Dr PHẠM HUỲNH BẢO TRÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 42 year-old man with continuing pain in LLQ for one week and complained a light diarrhea and one lymph node at his left neck. He had no fever.

Laboratory findings noted raised beta 2 microglobulin.

Ultrasound detected hepatosplenomegaly and many lymph nodes in the abdomen, groins and neck that lead to think about an infiltration of lymphoma stage IV.

Full body MSCT detected a metastasized seminoma in right scrotum to the abdomen and mediastinum.

Chest X-RAY  noted nothing remarkable.

Microscopic and chemoimmunologic staining results of the left neck node were germinoma.

Based on evidences of  neck core biopsy and full body MSCT,  a scrotum ultrasound was done in revealing a tumor of the right testis, which was of size #74×36×66mm, vascularised , hypoechoic. The testis tumor metastasized pelvic and 2 groin lymph nodes and in the abdomen and mediastinum and the leftsideof the neck.

So at last it was a case of the germinoma tumor of the right testis that metastasized largely to the abdomen, groin, mediastinum and left neck lymph nodes. The clue of diagnosing for the case is performance of core biopsy of the neck lymph node.

Ultrasound could detect the case if taking notice of the scrotum of the patient.

CASE 711: TENOSYNOVIAL GIANT CELL TUMOR, Dr PHAN THANH HẢI, Dr MÃ NGUYỄN MINH TÙNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 37 year-old man complained the pain of his knee and lower part of right thigh and first digit of right foot for one year. His prior history noted no trauma at the area.

Ultrasound detected an inhomogeneous hyperechoic mass #49×27mm at upper part of the knee that could not describe clearly the tendon and the periosteum of femur bone beneath.

Laboratory findings were nothing remarkable, except diabetes and lipid metabolic disorders.

MRI described  a synovial giant cell tumor.

Core biopsy resulted a TENOSYNOVIAL GIANT CELL TUMOR.

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.