CASE 232: SORE THROAT AFTER COFFEE DRINKING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 50 yo more severe sore thoat after drinking black coffee cup, then she came to ENT hospital for endoscopy, CT of the neck: nothing detection while the neck was swelling, painful and fever. It is LEMIERRE's syndrome.

 MEDIC ultrasound of the neck detected on left lobe of thyroid one echo rich line, long of 3 cm, in an abscess and another abscess on right lobe of thyroid also.

Sonologist said it was a toothpick penetrating to the left thyroid gland.

 
WBC rising of 15k with 87% neutro and CRP was  high : 36mg/L.

MRI at the neck was done and detected a black line as the toothpick.

Emergency endoscopy detected the stuck toothpick in the throat and removing it out (see photo).

 This patient was treated with antibiotic and nasogastric feeding.

REFERENCES:

CASE 231: INTRALIVER TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 36 yo with long history of acute hypertension crisis.

Ultrasound of abdomen for check-up detected one mass at left lobe  of liver,  size of 11 cm-8,5 cm which had  round border  with central mass being thought  a scar necrosis( 2 pictures). Sonologist suggested a FNH or HCC.

Blood tests are normal AFP,  not infected HBV ,or HCV.

MSCT with CE of this tumor was well–bordered, blood supplying from liver tissue around, hypervascular with rapid washed-out contrast. This tumor had displaced liver vein. Radiologist diagnosis was a liver tumor as HCC.

Ultrasound guided biopsy was reported that a HCC.

Operation removed this tumor completely and it was not a liver tumor, but was one tumor outside liver .

Microscopic report was malignant pheochromocytoma.

Do you review if  those pictures  are correct with the end report or not?

CASE 230:CONTRALATERAL BREAST CANCER (CBC), Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 64 YO, 10 YEARS BEFORE SHE WENT THROUGH RIGHT MASTECTOMY BY BREAT CANCER [ T2N1MX ]. HISTOLOGY REPORT POST OP WAS DUCTAL CARCINOMA , NOS, ER, PR NEGATIVE. NO CHEMO NOR RADIOTHERAPY.

NOW SHE DETECTED BY HERSELF ONE MASS AT LEFT BREAST. ON ULTRASOUND IT WAS A TUMOR WITH CALCIFICATION, SIZE OF 4 CM AND BIG AXILLARY NODE (2 IMAGES).

MAMMOGRAPHY ALSO SUSPECTED MALIGNANT TUMOR.

MSCT OF THORAX : NO RECURRENT ON RIGHT SIDE, THE LEFT BREAST HAD TUMOR NEAR THE NIPPLE AND AXILLARY NODE. NOTHING DETECTED ANOTHER LESION OF OTHER ORGAN.

WHAT IS YOUR IDEA ? IT IS METASTASIS TO LEFT BREAST FROM THE FIRST BREAST CANCER OR SECOND CONTRALATERAL BREAST CANCER? 

POST OP  mastectomy and removing  10  lymph nodes. Microscopy reported  that  ductal carcinoma with  metastasis  axillary lymph nodes.  It had same  histology  with   cancer   right breast  10 years  before, so it was   second  breast  cancer,  a  contralateral  breast cancer  after  10 years.
Reference:

CASE 229: UMBILICAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Girl 7 yo detected umbilical foramen distention many years ago {see photo}. No clinical symptome.

On utrasound scanning it was well - bordered cystic tumor with septation. Color Doppler showed small vascularized intraseptal tumor(2 images).

MSCT with CE, tumor was not related with intra abdomen; its structure was very high contrast enhanced in late phase.( 3 images)

This case had been examined by many doctors. At first one sonologist suggested umbilical hernia, second senologist diagnosed as lymphangioma, another sonologist said hemo-lymphangioma. One radiologist said as dermoid cyst or fibroma. In operation removing this mass (see photos).

MICROSCOPIC REPORT IS HEMANGIO-LYMPHANGIOMA.

CASE 228: Thyroid Toxicosis Periodic Paralysis, Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM

Thyroid Toxicosis Periodic  Paralysis

Man 47 yo,  3 times  paralysis  at  get up in the  morning, he  came to hospital  for  emergency  perfusion  potassium and to  MEDIC  for check- up.

Ultrasound  of abdomen  no abnormal  detected,  no adrenal tumor, but  ultrasound  of thyroid gland is black , CDI hypervasular , typical of  hyperthyroidis .and  soft  with  elastoscan.

Blood test are very low TSH  , high T3, T4, TPO.

EMG was signal of  hypokalemia.

This case is TpP. Medical treatment of anti thyroidism  is requested.

REFERENCES:

CASE 227: Umbilical Tumor, Sister Mary Joseph Nodule, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 74 yo with chief complains of anorexia, colicky pain for one month. Ultrasound detected ascites and left pleural effusion, and at  periumbilical area, there was an umbilical tumor with size of 1.5cm, solid and low vascularity.

MSCT of abdomen also doesn’t find any intra-abdomen mass, but the umbilical tumor was very high CE enhancement.

Blood tests :   CRP= 806 ng/mL, albumine = 2.4 mg/mL,  CEA  normal, CA 125 = 611 UI/mL.
Ascites in puncture :  yellowish fluid.

Cytology analysis= 71% lymphocyte, ADA=16 ng/mL , Amylase=  109 UI/mL , CA 125 = very high more than 600 UI.
Biopsy of  umbilical tumor was done.

MICROSCOPIC REPORT WAS ADENOCARCINOMA METASTASES TO UMBILICUS. IT IS SMJN. (SISTER MARY JOSEPH NODULE ).

REFERENCES

CASE 226: UTERINE MASS: Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 45 yo,  nulliparous, vaginal bleeding.

Ultrasound  of pelvis showed  big uterus and  thickening of endometrium.

Elastoscan detected  the mass of  intrauterine cavity is soft and multiple white spots  in myometrium.

MRI  SUSPECTED  INTRAUTERINE  POLYP. 

Biopsy result was endometrium hyperplasia. Hysterectomy was done. See macroscopic photo in correlation with ultrasound and MRI appearances.

Microscopic report is adenomyosis with endometrium hyperplasia.

REFERENCE: ADENOMYOSIS