CASE 361: TUMOR of MUSCLE RECTUS ABDOMINIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 33yo, 4 months after cesarian operation  detected a  mass near umbilicus on right side, fixed  palpation, 

Ultrasound.scanning of   this mass revealed  intra abdominal wall mass, from lower part of  rectus abdominis muscle. ( US 1, US 2, US 3 ( linear probe), video) . Video clip  shows this tumor  from anterior abdominal wall ).

On MRI, this tumor is solid, size of 12 cm, structure looked like  uterine  myoma.

( MRI1, MRI2, MRI3).

Discussion:

At first,  diagnosis from one  OBGY  doctor is endometriosis  post c-section. But  another  sonologist  from  Obgy hospital is pediculate fibroma of uterus. One  radiologist  looking  MRI  says tumor of rectus abdominis muscle  same as  fibromuscular mass.
Operation for remove this tumor; operator reported  this tumor was well bordered,  hard,
and developered from  rectus muscle, not  from the middle line if c-section.
Macroscopic view of  section surface look like  fibroma.

Discussion 2: In past history she had been first c-section for first delivery 3 years ago. During second pregnancy, this patient known having fibroma of uterus from doctor ObGyn. It is mistaken prenatal diagnosis. Her past history is very important issue for diagnosing today.

Discussion 3 from pathologist: based on HE staining slices, 3  pathologist professors say  surely that not  endometriosis, 2 prof say  maybe  a desmoid tumor  but one  is  say  fibroma. 

Microscopic result with imunohistochemistry  staining is desmoid tumor.

Reference: Desmoid tumor of abdominal wall.

CASE 360: RIGHT KIDNEY TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 38yo 2 years ago  intermittent  hematuria, today  acute right renal colicky pain. 

Ultrasound in emergency detected big right kidney and fluid collection arround  kidney.

Pelvic kidney  has a collected  hyperechoic mass which made  dilated ureter.

CDI ultrasound detected  no Doppler signal in  vascular renal cortex ( US 2)

MSCT with CE=CT1: frontal view=  right kidney  too big without contrast  supplying.

CT 2: frontal view, pelvis of right kidney  is covered by enhanced contrast mass  just to dilated ureter. 

CT3, CT 4: cross- sectional view: pelvis and ureter detected  intralumen  one enhanced  contrast structure  liked  a tumor.

CT 6: 3D vascular view= no vascular supplying to right kidney.

Report  by radiologist  is  bleeding intra  right urinary system with  ureter obstruction  by  tumor, suspected  TCC.(TRANSITIONAL CELL CARCINOMA)

Emergency operation  of right nephrectomy and  ureterectomy.

Macroscopic specimen showed  tumor in obstruction of distal ureter.

Microscopic report TCC  ( transitional cell carcinoma hight grade malignancy.

CASE 359: RIGHT HIP PAIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Women 72 yo, pain at right hip  in walking for 2 months , no trauma, no fever.

Ultrasound of right hip joint ( us 1 scan,  us2, us 3  cross- section).

Plain XRay in AP view  for comparison of right to left hip joint ( XRay image)  no abnormal detected.

CT scanning  ( CT 1 : cross section of  head of  femoral  bone deformation  at right side, CT 2: frontal view,  CT3  3D view).

MRI  of hip joint  in comparison of  right to left  femoral head bone.

Final diagnosis is AVN ( avascular necrosis of femoral head)

Reference  case: http://radsource.us/avn-of-the-hip/ 

CASE 358: LESSER OMENTUM TUMOR, Dr PHAN THANH HAI , Dr VAN UYEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Women 30yo, general check- up .

Ultrasound detected a tumor on border of liver near gallblader which deplaces left gastric curvature and is from retroperitoneal space. Its structure are solid and cystic parts,  size arround 10cm ( see ultrasound  us1.. cystic part tumor  in border  liver; us 2..near gallblader;  us 3..long scan  left lobe liver and tumor.). Sonologist cannot  diagnose this tumor  from lesser omentum.

MSCT with CE of this tumor  is mixed structure, cystic, fatty, and calcification [ CT1..section, CT 2  frontal section , CT3  sagital ). Suggession from radiologist  is teratoma tumor or  lipoma necrosis.

MRI   with gado ( MRI 1..struture is more fat tissue., MRI 2..with  fat suppression ,  MRI  3 frontal view).  Radiologist  says  teratoma of retroperitoneum, in lesser omentum area.

Blood test  of all  cancer markers are normal.

Laparo-operation= 

picture 1( retrogastric tumor well bordered)

picture   2macro

picture  macro 3, opened specimen,   solid and cystic tumorand  fluid inside  like milk)

Microscopic report of this tumor is teratoma maturation.

CASE 357: PELVIC MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Female  15 yo, pain at pelvis, no mentrial cycle.

Ultrasound of  pelvis   one  sonologist  suggested  ovarian tumor.

Review of  ultrasound:

US1:   cystic structure in pelvis, long 20cm, morphology like a  hourglass, upper portion  near  bifurcation of abdominal aorta.

US2:  cross-section..of the mass :  fluid and debris inside.

US3.  Cross- section,  the wall of the upper part  is thiskening.

US4 with linear  probe:  wall is   thickening  in comparison to  the lower part.

Ultrasound   report suggested  a  hematometriocolpos.

MRI of pelvis detected  this mass with  old blood  inside.

Diagnosis is  imperforated hymen  and  hematometriocolpos.

ObGyn doctor resolved it by  incision of hymen to drainage  this old blood.

CASE 356 : COLO-COLIC INTUSSUSCEPTION, Dr PHAN THANH HẢI, Dr VÕ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 56 yo, acute  colic pain at  right  upper quadrant of  abdomen,  crisis and  vomitting 3 days ago.

Ultrasound  scanning of liver: 

US1: Ultrasound detects big mass  near gallblader liked a bowel loop dilated.

US 2: Right colon dilated  with  multiple layers  which is oignon sign.

US3. Coecum moved  up near liver  connected with one cystic mass.

US 4  Cystic mass  with  multiple  rings  [oignon sign],  typical of  mucineous cyst  of appendix.

CT scan abdomen detected  right colon  moving up  with  coecum  intussusception (CT1 frontal  section;, CT2, sagital section; CT3, frontal section).

Emergency  operation with diagnosis  colo-colic intussusception  by  appendicular mucocele.

See specimen of operation by right colectomy.

Microscopic report  is appendicular mucocele. 

Reference:

Case 181:  Carcinoma of Appendicular Mucocele of  Medic Center