CASE 817: BOWEL VOLVULUS due to MESENTERIC LYMPHATIC TUMOR, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 15 year-old asthenic thin boy with crisii of nausea and colicky pain for ( 3 ? ) years. Failed in management of gastritis HP infected.

Ultrasound detected a malrotated mass with mesenteric vessels inside going to the clockwise.

Beside there was a hyperechoic mass in the pelvis with vessels in the mass.

MSCT confirmed the bowel malrotation and a lipoma in the pelvis.

Surgery was done to remove the #12,5x11mm pelvic mass which was a microcystic lymphatic malformation of the mesentery. It adhered the bowel and caused the bowel volvulus.

The boy gained 10 kilogram and had no pain nor nausea postop.

CASE 816 : PROSTATE CANCER RISK and Low Free PSA, Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 62 year-old man with  low PSA value which is in risk of prostate cancer.

But ultrasound and MRI detected only calcification of prostate.

 The patient belongs the high risk group of prostate cancer in our report 2011 although the normal results of diagnostic imaging.

CASE 815: ACUTE CHOLECYSTITIS and CHOLECYSTILOSIS, Dr PHAN THANH HẢI, Dr LÊ THANH TÙNG, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A  78 year-old diabetic man with a colicky pain at RUQ  and nausea in night. Coughing for one month he has been managed antibiotics in time.

Ultrasound detected  a #94x39 mm dilated gallbladder with an impacted biliary stone at the neck of GB and some 8-13 mm other stones in the inflammed GB (# 6mm thickening of the GB wall, anterior wall partial hypoechoic). It existed an amount of fluid around the inflammed gallbladder.

MSCT confirmed an impacted #14 mm GB stone at the neck of the GB.

Emergency endoscopic surgery was done after 8 hours entering the surgical ICU to remove the inflammed GB and peritoneal pseudomembranes.

REFERENCE:

CASE 814: COMPLICATED DIVERTICULITIS, Dr PHAN THANH HẢI, Dr PHAN THANH VIỆT BÌNH , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 65 year-old diabetic man with LLQ pain and lose stool for weeks.

Ultrasound detected some diverticula 7-9mm and a mass of sigmoid colon leading to an colo-colonic intussussception ?.

Colonoscopy noted some sigmoid diveticula and a  tumor caused narrowing 70% the lumen of the sigmoid colon.

MSCT confirmed an abscess of sigmoid colon maybe from an acute inflammation.

Surgery removed the sigmoid colon which had some diverticuls and a perforated diverticulum. It existed no tumoral mass of the sigmoid colon.

Microscopic result was  an acute sigmoid colitis having diverticula with a perforated abscess of a diverticulum.

Complicated diverticulitis : perforation, abscess are still rare conditions for MSCT and abdominal ultrasound (POCUS).

REFERENCE:

CASE 813: SPINE TUBERCULOSIS, Dr PHAN THANH HẢI, Dr PHÙ DUNG THÁI BIỂU, Dr TRẦN THỊ HỒNG VÂN, Dr TRẦN VĂN NAM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 44 year-old man with lumbago to the buttock for months, lumbar pain progressing in coughing and changing body position which failed in analgesics management. 

Ultrasound detected the #85x32mm left psoas muscle abscess with many hypoechoic foci in the upper of left psoas muscle maybe due to TB infection, and hypoechoic lesions in spinal thoracic and lumbar column.

MRI confirmed the vertebral lumbar column lesions from L2-S2 and the soft tissue inflammation of the left psoas muscle [L5-S1].

Lab data was only positive HCV. But positive with QuantiFERON-TB.

TB management of the spine has been done for 9 months. And treatment of HCV infection for 3 months. Lumbago reduced in the first month of treatment. HCV negative after 3 months. And at the 9th month, the spine lesions in recovery phase of TB treatment on Spine MRI.

QuantiFERON-TB in vitro, a ELISA technic (IGRAs) measures the adaptive immunity of T cell CD 4 and T CD 8 in releasing interferon gamma while in contact peptid of TB bacteria [sens 95.3%, spec 97.6%].

CASE 812: RENAL ARTERIAL STENOSIS, Dr PHAN THANH HẢI, Dr LƯƠNG THANH BỬU, Dr TRẦN THỊ THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 48 year-old diabetic woman with arterial hypertension for 6 years. BP: 211/116mmHg, HB: 89b/min

Lab data was still in normal values, but Doppler ultrasound detected stenosis 70% of the proximal part of the left renal artery and 30% of the right one due to atheroma.

MSCT Agio confirmed the stenosis of renal arteries due to atheromatous plaques.

Stenting successful of the left renal artery and the woman remains well, managed only Amlor per os 01c/day.

The arterial hypertension patient needs a Doppler ultrasound examination of the kidney and vessels to detect the stenosis of renal vessels.

CASE 811: ADOLESCENT PHYLLODES TUMOR (PT) and a REVIEW of P T in VMU, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, Dr TRƯƠNG THỊ MỸ HOÀNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 14 year-old female adolescent with a right breast tumor rapid progressing bigger for 4 months.

Breast ultrasound assessment was classified BI-RADS 4. Mixed tumor with cystic and solid parts, hypervascular, micro calcified, irregular border, spiculated margin. Biopsy result was benign phyllodes tumor.

But the result of histoimmunologicostaining was a malignant phyllodes tumor.

Phyllodes tumor is rare in adolescent. Only 20 cases were published in litterature. 

Two cases in adolescent [one 15 yo, another 14 yo] were published on our VMU.

In women, there were 11 cases of phyllodes tumor published on our VMU. Phyllodes tumor (1-3% breast tumor) comes from the fibrous tissue, 27 % malignant, growing rapidly with large size [ > 20 cm]. 

PTB is a very rare breast tumor in women aged 35 to 55 years. Our patient is younger but the progress of the tumor is the same in the literature: "unilateral, nodular, painless mass which has a history of the mass but that grows rapidly in the short term".

Phyllodes tumors (or phylloides tumors) are rare breast tumors that start in the connective (stromal) tissue of the breast, not the ducts or glands (which is where most breast cancers start). Most phyllodes tumors are benign and only a small number are malignant (cancer). American Cancer Society, July 2022.

REFERENCES:

1. REVIEW CASE 763 from Dr TRƯƠNG THỊ MỸ HOÀNG, MEDIC MEDICAL CENTER, HCMC.

2. CASE 292

3. REVIEW PT CASES 794-795 from Dr TRƯƠNG THỊ NGỌC TIẾN, MEDIC MEDICAL CENTER, HCMC.

4. CASE 654

5.

6. Phyllodes tumor: American Cancer Society.