CASE 249: RLAQ MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 56 yo, pain in RLAQ for 2 weeks, fever and GI tract trouble with diarrhea was treated  by  antibiotics.

Ultrasound detected one mass at RLAQ, suspected appendicular abscess or coecum tumor (see 4 US pictures).

Blood test  WBC= 17K with 17% neutro.

MSCT with CE  shows  this mass  being wall-off  by  instestine,  central part is  liquide as pus collection (see 3 CT pictures).

What is your suggestion of diagnosis and what is  the another test needed for make sure diagnosis?.
Open operation  detected  this mass at  RLAQ  is abscess due to appendicular necrosis.

DISCUSSION: TRIPLE TEST  of appendicitis is blood tests  for diagnosis of acute or   appendicula abscess including 3 criteria: WBC, NEUTRO%  and CRP.

REFERENCE:

CASE 248: GASTRIC WALL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 75 yo vomiting, endoscopy detected  an extragastric fundus tumor (see  pictures).

Ultrasound of abdomen showed one hypoechoic mass with size of 4 cm, well-bordered at the hilus of  spleen ( see 2 ultrasound pictures).

MSCT with CE  found out this mass bending the wall of great curvature of stomach, very slow CE enhancement (see 3 CT pictures).

Blood tests of all  markers are normal.

What is your suggestion of diagnosis?

Open surgery removed the tumor easily. It grew from gastric fundus wall, its structure was hard.

MICROSCOPIC  REPORT  WITH  IMMUNOHISTO CHEMISTRY  is  GIST OF  STOMACH WALL.

REFERENCE:

CASE 247: INTRAHEPATIC AVM, Dr PHAN THANH HAI, Dr NGUYEN CAO CUONG, Dr TRAN NGAN CHAU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 31-year-old male patient complained about 3-day mild fever, right subcostal abdominal pain. He did not have any other symtomps such as voimiting, diarrhea and no history of abdominal surgery, trauma, liver biopsy or alcohol abuse. On physical examination, no mass in the right subcostal. B-mode ultrasound (US) findings showed a cystic structure (21x21mm) in the sixth segment, it communicated with 2 parallel –dilated - tubular - structure (d = 8 and 9mm) originated from the right portal vein and right hepatic vein.

Doppler US showed yin-yang sign, right portal vein flow and right portal vein flow in the cystic structure.

MSCT Angio comfirmed the AVM in right lobe of liver.

The patient underwent an abdominal laparoscopic surgery for resection the AVM.  In the course of operation, surgeon saw the sac pulsating.

The patient remains well post-op.

Microscopic result is concordant with hepatic AVM.

CASE 246: PANCREAS TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

14yo girl  for  a long time epigastric pain  like gastric syndrome.

But ultrasound detected one round mass of 4 cm at the head of pancreas, without dilated CBD or Wirsung duct. CDI no detection vascular intratumor and echostructure was inhomogeneous (see 3 US pictures).

MSCT with CE showed  this mass well bordered at the head of pancreas, slow enhancement of contrast.

Blood tests no abnormal.

Based on clinical status and  ultrasound and MSCT imaging,  what is your suggestion of diagnosis and what is your plan for treatment ?

Discussion: young girl with chronic pain.

US and MSCT cannot make sure diagnosis.

Operation for biopsy this tumor; the tumor is fixed to deep structure, thickening of the wall.After opening  the wall, the black fluid came out and red blood following. Biopsy the wall of this tumor and one lymph node nearby.

Microscopic report is  pseudocyst of  pancreas and  lymphadenitis.

Plan to treat  is waiting  and seeing  the evolution  of  this cyst.

REFERENCE
 pdf..  Management  cystic structure of pancreas.

 

CASE 245: CERVICAL VAGUS NERVE SCHWANNOMA, Dr PHAN THANH HAI - Dr LAM CAM TU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 51yo detected lateral left neck mass, no pain (see foto ).

ENT doctor did endoscopy for rule out a cavum cancer, and FNAC did not detect cancer cell metastasis to this mass.

Ultrasound report was an ellipse mass of 3 x 5 cm,  well-bordered,  hypoechoic, hypovascular with small cystic formation which deplaced the CCA and internal jugular vein (IJV) that well confirmed by 3D vascular CT angio (see 4 CT pictures).

Discussion:  This 51 yo woman with the mass in upper portion of left lateral neck, painless for a long time suggesting malignancy.
Ultrasound is the fist choice for diagnosis after consultation of ENT doctor. Ultrasound picture is like a cystic mass, hypovascular supplied which situated  between CCA and  internal jugular vein. The tumor developed in the sheath of carotid artery and expansion. MSCT 3D angio shows very well  the  displacement of  CCA and IJV,  that is the key for  diagnosis;  this tumor developed from carotid sheath like schwannoma (neurilemnoma).  

Operation for  removing  this  tumor easily;  macroscopic view shows capsule thickening  tissue that is  soft,  like brain tissue.

Microscopic report is a schwannoma of vagus nerve.

REFERENCE:

Case report pdf