CASE 715: INTRAHEPATIC CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 42 year-old woman without jaundice came to check-up. Her prior history noted managed thyroid cancer for 5 years and detected intrahepatic biliary dilatation 2 years before but the cause still unknown.

Ultrasound revealed  a hyperechoic mass at the hepatic hilus on normal hepatic bed.

MSCT  and MRI confirmed right intrahepatic dilatation and MRI noted cholangiocarcinoma.

Open surgery was done to remove gallbladder, V-VI subsegment of liver, connecting right hepatic duct to small  bowel [Roux-en-Y hepaticojejunostomy].

Microscopic result is cholangiocarcinoma invasive and chronic cholecystitis.

CASE 714: ENDOMETRIOSIS at Posterior Pouch, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ XUÂN HOA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 

A 48 year-old woman,  G2P2, with colicky pain of her colon is getting worse for one month. She has been managed for vaginitis and inflammed uterine cervix, and irritable bowel syndrome that was noted usually existing in her periods.

TVS and colposcopy showed  acute inflammed cervix and vaginitis. Colonoscopy denied colon disorders.

But in the second reexamination she has got menorrhagia for 7 days and there was continuous feelings of crapping with loose stool.

At that time colposcopy revealed some white spots at 13 and 16 o'clock of the cervix. These spots were swollen and getting in brownish color that lead to think about an endometriosis case.

MRI confirmed  the 38x17 mm [deep infiltrating endometriosis, DIE] endometrial mass at the posterior [rectouterine] pouch of the peritoneum and at the posterior cervix.

Understanding her condition, the patient accepts no further intervention.

CASE 713: CHORIOCARCINOMA and ECTOPIC PREGNANCY , Dr PHAN THANH HẢI, Dr PHAN NGOC NGOAN, BINH AN HOSPITAL - MEDIC MEDICAL CENTER, HCMC, VIETNAM

There are  03 cases in the topic of Choriocarcinoma that are noted a correlation to the corneal ectopic pregnancy. All of cases went through a laparoscopic resection of the angle of the uterus and monitoring the value of betaHCG for months to coming back of normal betaHCG  value. 

Case 01: A 34 yo female patient in hemorrhagic shock, painful abdomen due to ectopic pregnancy.  

TVS proved a corneal ectopic pregnancy and a laparoscopic resection of the angle of the uterus was done. But beta HCG raised continuously # 15,535 and a decision of hysterectomy was made. And chemotherapy later was managed. 

Case 02: A 37 yo female patient went through a laparoscopic resection of the angle of uterus as  left corneal ectopic pregnancy aged 7 weeks. 

Post-op the beta HCG was 15,055. So it was a choriocarcinoma with ectopic pregnancy. MTX chemotherapy was done and saved the female patient. 

Case 03: A 28 yo female patient with right corneal ectopic pregnancy and laparoscopic resection of the angle of uterus was done for the right corneal uterus. 

But beta HCG got down slowly  for 2 months and it was only a case of placental retention. 

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.