CASES 742-743: 2 CASES of BREAST TUMOR with NEGATIVE MAMMOGRAPHY, Dr PHAN THANH HẢI, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2 CASES of BREAST TUMOR with UNCLEAR MAMMOGRAPHY

Case 742:

A woman 64 year-old in check-up.

Mammography findings noted breast in B group, nearly a doubtful breast mass on right side.

Ultrasound revealed a small # 7 mm spidicular mass in right breast. Elastography was a hard tumor. BI-RADS 5. Axillary nodes were metastases 

Core biopsy and chemoimmunologic staining resulted a small invasive carcinoma of the breast. A mastectomy was done and microscopic result was  carcinoma.

Case 743:

 

A woman 34 year-old with right lung cancer, positive EGFR and right pleural effusion has bee managed for 4 months. She herself found her right breast harder.

On mammography her right breast belonged type D (dense) which could not detect the tumor.

But ultrasound detected easily a big 37×19 mm tumor in BI-RADS 5 with cervical metastasized nodes.

The poor young woman with 2 kinds of cancer at the same time. 

Core biopsy resulted invasive breast carcinoma metastasized cervical nodes. And rib bones

and left pelvic bone on scintigraphy.

CASE 741: HEMORRHAGIC MESENTERIC HEMANGIOMA, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A woman 49 year-old  with a critical left flank pain for 1 day which was progressed continously. It made the woman in rigidity of her body to against her abdominal pain and to defecate many times.

Ultrasound detected a #58 mm well-limited mass containing sludgy fluid full-filled at left side of abdomen nearby her left kidney, and abdominal wall. And a renal cystic  and a kidney stone also existed.

MSCT confirmed a # 50x60 mm mesenteric cystic tumor as it was non captured CE,  HU 51.0 maybe a mesenteric cyst including hemangioma that adhered to left colon, left kidney  and abdominal wall.

Endoscopic surgery revealed the mass adhered the mesentery and the left colon, and the abdominal wall, then an open surgery was done.  

Microscopic result was a hemorrhagic hemangioma of the mesentery. 

Hemangioma in hemorrhagia of the mesentery is a rare entity. The scenario is too complex for exactly diagnosing pre-op.

CASE 740: DIFFUSE SCLEROSING VARIANT of PTC, Dr PHAN THANH HẢI, Dr NGUYỄN KIM HIẾU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

  

A woman 42 year-old with swollen neck on right side and hoarseness.

Neck ultrasound detected a hypoechoic thyroid, hypovascularized and diffuse microcalcification. It exists lymph nodes both 2 sides of her neck.

FNAC result was  a papilary thyroid carcinoma [PTC] with lymph nodes metastases, Bethesda classification group VI.

A thyroid total  and metastasized lymph nodes removed  and radiotherapy was done later.

Reference:

CASE 738-739: OCCULT B INFECTION (OBI) and CIRRHOSIS and HCC, Dr PHAN THANH HẢI, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Case 738:

A man 54 year-old with fever for 4 days and epigastric pain.

Abdominal ultrasound detected a right lobe hepatic tumor # 12cm, but with negative infected HBV except value of AFP of 51.40 ng/mL. MSCT confirmed liver tumor.

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Case 739:

A female nurse 56 year-old  with unknown cause of rising liver enzymes and HBsAg negative for 3 years. But HBV DNA positive  and AntiHBc total  positive at this time. Liver FibroScan F 3. Obstruction of branch of portal vein on MRI Primovist. Only cirrhosis and no sign of liver cancer. 

REFERENCE

CASES 735-736-737: ENHANCED MYOMETRIAL VASCULARITY [EMV], Dr PHAN THANH HẢI, Dr DƯƠNG ĐĂNG NGỌC PHƯƠNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

3 cases of EMV post partum were discovered by Doppler ultrasound and were managed successfully in ceasing the menorrhagia by curettage.

Case 01:

After 3 months delivery without menorrhagia and beta HCG negative but EMV on transvaginal sonography (TVS). Doubtful placental retention.

Case 02:

Menorrhagia for 20 days after miscarriage, blood beta HCG = 19.25mUI/mL, TVS detected EMV.

Case 03: 

Menorrhagia in small amount for each batch every 2-3 days with  beta HCG highly rising = 66.975  mUI/mL, TVS detected uterine bloody retention, noted placental retention and EMV.

Microscopic specimen was placental villous structure.

BetaHCG = 2.1mUI/mL after curettage procedure.

REFERENCE

EMV Ultrasound findings ( from Radiopaeda)

It is impossible to distinguish enhanced myometrial vascularity from a true arteriovenous malformation on ultrasound 5. 

On greyscale ultrasound, there are anechoic, tortuous, tubular structures within the myometrium that may involve the endometrium. Echogenic intrauterine material in keeping with concurrent retained products of conception is commonly seen.

On color Doppler ultrasound, there is a mosaic turbulent pattern with multiple flow reversals. This demonstrates low impedance flow with a high peak systolic velocity (PSV) ≥20 cm/s and low arterial waveform pulsatility. It should be noted that while some authors consider a PSV >60 cm/s to be high risk 4,9,10, studies have shown that higher PSV values do not necessarily confer a greater hemorrhagic risk 1. 

CASES 732-733-734: SUBCLAVIAN ARTERY ANEURYSM, Dr PHAN THANH HẢI, Dr ĐINH MINH TUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

03 cases of SUBCLAVIAN ARTERY ANEURYSM [ 2 right, 1 left side] from 3 males 34-32-44 year-old revealed by chest X-Ray, vascular ultrasoud and MSCT. Patients complaint weakness upper limb, numbness and right chess pain or  just only for a check-up without symptoms.

Chest X-Rays noted a blurred node close by the clavicle which could not differentiate from anterior mediastinal tumor or lung tumor. Vascular ultrasound could detect a yin-yang sign of a round mass with thrombus of the wall and MSCT could determine exactly the size, location, and reconstruct in 3D view.

CASE  01

Male patient 34 year-old for check-up. A 69 round mass was on the left clavicle. Yin-yang sign positive and thickening wall due to thrombus on ultrasound. The left brachial artery was intact.

CASE 2

Male patient 34 year-old with cough and chest pain. The subclavian aneurysm size was # 49x52 mm with calcified its wall on chest X-ray. Thrombus of the aneurysmal wall on ultrasound and MSCT. Turbulent flow on Doppler vascular ultrasound. 

CASE  3

Male patient 44 year-old weakness right upper limb, hoarseness and chest pain. The subclavian aneurysm was # 10×8 mm with turbulent flow, and thrombus filled up nearly the lumen. 3D view of MSCT reconstruction was not seen the aneurysmal lumen.

Surgery repaired the subclavian aneurysm with Y unigraft and the patient remains well. The aneurysm with its calcified contour was seen on the post-op chest X-ray.

CASES 730-731: SECONDARY APPENDICITIS in ELDERLY PATIENTS, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

There are two instances of secondary inflamed appendices in senior patients that might make for intriguing clinical notes.

Case 01.

A 78 year-old man with RLQ colicky pain for one month and loose stool. Ultrasound detected an appendiceal lump with a big appendix which was #69x17mm containing mixed fluid. The cecum was uncertainty a tumoral mass #72×48mm with air inside. Sonologist noted a rupture of appendiceal mucocele which made an appendiceal lump unveiled the cecum. 

But MSCT noted an inflamed cecum as edema of the cecum wall and a fluid-filled appendix as appendiceal mucocele.

Report of surgery was cecum cancer and a dilated acute appendicitis.

Case 02:

A 78 year-old  man with acute RLQ pain.

Ultrasound detected a #38mm cecum cancer which caused dilated appendicitis. Later MSCT confirmed the cecum cancer and the appendicitis which was compressed by the colon tumor.

The right colon tumor and the nearby appendix filled with fluid were discovered during surgery.

DISCUSSION 

Appendicitis seldom develops in senior patients above the age of 70. This might be because the appendix's tip and the colon's lymph tissue were underdeveloped.

The issue of appendix blockage brought on by colon tumor compression may be explained by the two appendicitis instances with colon cancer mentioned above.

Given that the etiology of appendicitis remains uncertain, it is important to reveal the presence of colon cancer in older patients.