CASE 784: SKIN ULTRASOUND for PACHYDERMOPERIOSTOSIS [PDP], Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 26 year-old man with lion- like face [dermatological face]  and drumstick- like fingers [digital clubbing](hypertrophic osteoarthropathy) for 6 years.

X-rays films show thickening of the periosteum of ribs, upper and lower limb bones.

  

Skin ultrasound with 23 MHz probe reveales thickening of subcutanous layer and skin of forehead # 5mm, neck #1mm, cheek #3 mm. It exists  distorted structures as hyperechoic and hypoechoic layers in appearance without vascularisation.

             Cheek (L) and  neck (R) skin.
 

      

        Forehead skin # 5 mm of the patient (L) and                evidence # 2mm (R).

Skin biopsy result is related to Tourain-Solente-Gole syndrome (pachydermoperiostosis) which is a rare hereditary disorder affecting to bone and skin.

Pachydermoperiostosis (PDP) is a form of primary hypertrophic osteoarthropathy (see this term), a rare hereditary disorder, and is characterized by digital clubbing, pachydermia and subperiosteal new bone formation associated with pain, polyarthritis, cutis verticis gyrata, seborrhea and hyperhidrosis (from Orphanet).

REFERENCES:

CASE 783: CECUM CANCER in a Young Woman, Dr PHAN THANH HẢI, Dr TRƯƠNG CÔNG THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 31 year-old woman with loose stool but no blood nor glue secretion 1-2 times/day for two months. She lost of her weight # 1 kilogram and has some cramps at her right flank. Her past history noted a gastritis management and her familial history denies any tumoral diseases.

Abdominal ultrasound at Medic Center detected a thickening wall of the terminal ileum, the cecum and the ascending colon which were thought maybe due to an GI inflammation.

But CEA elevated # 5.04 ng/mL. FOBT positive and calprotectin raised# 240 microgram/gr.

Colonoscopy revealed an ulcer with hard border of the cecal tumor; and MSCT confirmed a tumor of the cecum and metastase lymph nodes and a  metastase node in the right lobe of the liver, T3 N2 M1.

Result of microscopic biopsy was a  well differentiated adenocarcinoma of the colon.

She went through a chemotherapy before the right colonoectomy.

CEA came back normally: 2.73 ng/mL post of therapy. 

5 months later the treated liver node shows no a relapse on abdominal MSCT.

Cancer of the colon is taken the 5th place of tumor diseases in Vietnam, and seems to be appeared more early in the young patient without any symptome.

REFERENCE:

CASE 782: TOOTHPICK PENETRATING TO ABDOMINAL WALL, Dr PHAN THANH HẢI, Dr NGUYỄN NGỌC XUÂN GIANG, BÌNH AN HOSPITAL KIÊN GIANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 49 year-old man with an abscess at the left flank of the abdomen for one week and WBC = 14,000.

Ultrasound detected a # 6cm foreign body in the wall of the abdomen lead to the descending colon wall.

MSCT confirmed a toothpick penetrating the abdominal wall from the left colon, and stone of pancreatic duct.

Operation removed the # 6cm toothpick and drained out the chocolate pus from the abdominal wall abscess.

CASE 781: ELEVATED PSA VALUE and SMALL NODE of PROSTATE CANCER, Dr PHAN THANH HẢI , Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 69 year-old male with high PSA value wants to examine his prostate.

MRI prostate noted an enlarged prostate PI-RADS 3.

But TRUS, transrectal ultrasound, revealed a malignant small lesion #9×5 mm in left peripheral zone of the prostate, and performing 12 point-biopsy.

Histoanatopathologic result was a prostatic adenocarcinoma, Gleason score 6 (3+3) and ISUP Gleason group 1.

Robot endoscopy surgery removed the prostate cancer small node. And PSA value reduced from 6.4 ng/mL to 0.68ng/mL post-op.

Ultrasound post-op showed no prostate only an small amount of collected fluid.

Microscopic result was prostatic adenocarcinoma, intact capsule, Gleason 6.

 

CASE 780: UROEPITHELIAL PAPILLOMA and IBS, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 69 year-old man with IBS syndrome and dysuria. But he concerned more his colon for 3 months which went through a polypectomy in the past. And the dysuria maybe due to an enlarged prostate of the elderly as in his thought.

Ultrasound revealed a papilloma in the full of urine of the bladder which was not rule out a malignant tumor. And it existed nothing about enlarged prostate also the colon tumor.

Bladder endoscopy was done and confirmed a bladder tumor with its stalk at the bladder neck.

A cauterised endoscopy was performed to remove the 2x3 cm bladder tumor.

Histoanapathological result was an uroepithelial papilloma.

CASE 779: VIRTUAL COLONOSCOPY for SIGMOID COLON CANCER, Dr PHAN THANH HẢI, Dr LÂM CẨM TÚ, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 66 year-old man post cerebral ischemic disorder with constipation for 2 months. Sometimes he notes a bloody stool. His doctor would like a diagnosis for his client before the day of  September 2nd, so sending him to Medic Center on August 31. Because all of the hospitals will be in the day off from September 1 to 3 to celebrate the day of the National Independence of Vietnam.

Abdominal ultrasound detected nothing but a virtual CT colonoscopy revealed rapidly a sigmoid colon tumor and some colonic polyps.

Later a conventional colonoscopy was performed and biopsy of a # 2cm tumor of sigmoid colon which is far from the anus about 20 cm, and some polyps.

The  imaging diagnostic results last in some hours in one day of the August 31, for a sigmoid colon tumor. And waiting for the histoanapathologic result will be reply on the September 5.

The result is moderately diferentiazed adenocarcinoma of colon.

REFERENCE:

Computed tomographic (CT) colonography, also called CTC, virtual colonoscopy (VC) or CT pneumocolon, is a powerful minimally invasive technique for colorectal cancer screening [from Radiopaedia.org].