CASE 778: GASTRIC YOLK SAC TUMOR, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 84 year-old myocardial ischemia man with stenting cononary artery in annual check-up.

Since September 2023, AFP value was 6,015 ng/mL, and April 2024, ultrasound and MSCT detected an exophytic cardia gastric wall tumor # 69x90x30mm and metastatic lymph nodes.

But gastric endoscopy was negative. 

While AFP value elevated highly  3,667 ng/mL ultrasound and MSCT detected no liver tumor.

Later in May 2024, the cardia gastric wal tumor # 82x83mm, and lymph nodes were getting bigger on ultrasound and MSCT . 

A higher AFP value =5,685 ng/mL noted again. And at that time, it appeared some liver nodules in the right and left lobe =73-61-46-20-14mm on ultrasound. The echogenic structure of these nodules were complex, one hyperechoic, another mixed echoic that might come from the gastric tumor instead a multiple HCC.

No surgery was performed for the elderly patient and he died some days in this week.

But in the literature there were only 6 cases of the gastric tumor with high value of AFP . These cases belong to the primary gastric yolk sac tumor with immunohistochemistry stain results.

The primary gastric yolk sac tumor with high value of AFP is still a very rare malignant entity.

REFEẺENCE:

PRIMARY GASTRIC YOLK SAC TUMOR

CASE 777: BREAST LYMPHOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ LOAN, MEDIC MEDICAL CENTER, VIETNAM

 A 33 year-old woman in annual check-up.

Breast Ultrasound, AVBS detected 2 phyllodes tumors, mixed echogenic, hypervascular without axilarry node.

An Automated Volume Breast Sonography [AVBS] video clip:

Mammography revealed 2 blurred masses # 5 cm, BI-RADS 4.

Breast MSCT confirmed right breast mass 7x5 cm and left one 4x3 cm.

2 breasts were getting bigger and painful in 3 weeks later and the breasts becoming more reddish skin appearance.

Core biopsy and histoimmunostaining result was Lymphoma B high malignancy.

REFERENCE:

VMU CASE 391

CASE 776: RUPTURED LEFT LIVER ABSCESS, Dr PHAN THANH HAI, Dr LE VAN TAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 52 year-old man with LUQ pain for 4 days in body bending walking. History noted he got liver abscess in one year before which was successfully in medical management.

Ultrasound detected a left liver abscess with fluid collection close by the inferior border of the left lobe of liver.

Chest Xray film was normal and the heart was nothing abnormal detected.

MSCT confirmed a 104× 56 mm left liver abscess in rupture with abdominal fluid collection close by the left lobe, the stomach and the spleen.

The left liver abscess was drained out  4 hours

 later by via endoscopic surgery.

CASE 775: ECTOPIC TESTICULAR SEMINOMA, Dr PHAN THANH HAI, Dr TRAN THI BAO CHAU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 52 year-old monk with LUQ pain for days.

Ultrasound revealed 2 left kidney stones # 6 mm. And a RLQ mass#40x37 maybe GIST beside the cecum. His scrotum were empty both 2 sides.

MSCT detected right testicle at RLQ and left one inside the left inguinal canal. And a left renal stone.

Surgery removed the right testicular tumor and reconstructed the left inguinal canal in bringing back the left undescended testicle to the left scrotum.

Result of histoanapathogy of the right testicular tumor was seminoma.

So the monk got a testicular tumor that maybe due to be misplaced into the abdominal cavity; and an undescended testicle in the left inguinal canal which is called a cryptochism.

CASE 774: THORACIC AORTIC PENETRATION DUE TO A FISH BONE, Dr PHAN THANH HẢI, Dr PHAN THANH VIỆT BÌNH , and FELLOW DOCTORS from BINH DAN HOSPITAL, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 

A 35 year-old woman with chest pain for 5 days who failed in gastritis management.

Abdominal ultrasound was nothing, but GI endoscopy detected 1/3 midle of esophagus in edema and narrowing of the lumen that may be perforated by a foreign body. The endoscopic examination must be stopped in waiting for a MSCT.

MSCT revealed a #34×2 mm fish bone which penetrated the esophageal wall to the thoracic aorta that made a critical pseudoaneurysm of the thoracic aorta.

The female patient was transmitted rapidly to Binh dan hospital. A planed management was conducted in emergency for reconstructing the thoracic aorta, sewing the hole of  the thoracic esophageal perforation and removing the fish bone.

Thoracic surgery was done successfully for reconstructing the thoracic pseudoaneurysm,

sewing the penetrated esophageal wall

and removed the fish bone with 2 sharp ends.

The woman remains well post op.

REFERENCE:

CASE 773: PCC MIMICKING RENAL CYSTIC TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 61 year-old diabetic man in  annual check-up with a #15-17mm left renal cyst known by non CE MSCT for years.

MSCT of full body detected a #21x16mm left adenal tumor, a thyroid cyst, some renal cysts and a #17mm renal  tùm or  which moderately captured CE that cannot rule out a renal tumor.

He has got a thyroid tumor#19mm and a colon polyp.

Coronary arteries were slightly stenosis.

Lab data were not interested except an endocrinal adrenal tumor.

Endoscopic surgery removed the left papillary cell carcinoma PCC and a hafl of the left kidney.

and the left adrenal tumor.

Histopathological results were the PCC of the left kidney and the left endocrine cortical adrenal tumor.

CASE 772: THYROID CANCER METASTATIC to ESOPHAGUS ?, Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A  47 year-old diabetic man, hoarsening, with thyroid tumor on the left lobe.

Ultrasound represented a # 49x34 mm solid mass, blurred contour, strong posterior shadowing, close to cervical esophagus with thickening wall.

He had got the lefl vocal paralysis.

MSCT and endoscopy detected  an esophageal tumor at 1/3 middle part, invading the left lobe of thyroid.

Histopathogical results were an esophageal cancer, poor differentiazed squamous cell carcinoma.

Patient died some weeks later in chemotherapy management.