CASE 803: GERMINOMA METASTASE, Dr PHAN THANH HẢI, Dr PHẠM HUỲNH BẢO TRÂN, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 42 year-old man with LLQ pain and  defecation troubles and some left neck lymph nodes for one week. He lost # 2kg. He denied to ask doctor his swollen right scrotum as ashamed of it.

Abdominal  and neck ultrasound detected some lymph nodes ( most big size # 51mm) into abdomen and retroperitoneum which were hypoechoic pattern maybe due to lymphoma infiltration.

Some 9-21 mm lymph nodes at left posterior triangular neck.

Lab data result has beta2 microglobulin elevated.

Histopathological biopsy result of the subclavian  node was lymphoma big cell. But histoimmunochemostaining was a germinoma metastase to lymph node.

Fuĺl body MSCT performed to evaluate the lymph nodes

But MSCT detected a # 46x58 mm right testicular tumor with metastase lymph nodes in the abdomen and retroperitoneum, at the groins and the subclavian region and left neck.

Scrotal ultrasound later confirmed a # 76x66x36 mm right testicular tumor and inguinal and pelvic lymph nodes metastase.

Surgery removed the right testicular tumor and 

planning of chemotherapy management. The patient remains well and ceases GI tract trouble.

Germinoma in elderly patient is rare entity and the ashamed feeling of his big scrotum was one dramatic cause for a difficult diagnosis.

CASES 801-802: WARTHIN TUMOR, Dr PHAN THANH HẢI, Dr PHẠM THỊ CẨM VÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases of Warthin tumor were detected by ultrasound Medic and removed successfully.

CASE 1:

A 48 year-old man was diagnosed Warthin tumor of his left parotid which was #19×37 millimiter hypervascular hypoechoic pattern with some small cystic lesions inside. Microscopic result was a Warthin tumor and removed later.

CASE 2:

A 68 year-old with managed liver tumor was detected Warthin tumor in the left parotid in period check-up by ultrasound.

A  # 16x10x21 milimeter hypoechoic cystic mass inside the left parotid was vascularised in low flow.

Microscopic and macrospecimen results were  the Warthin tumor.

REFERENCE:

CASE 800: SMALL BREAST CANCER INCIDENTALLY DETECTION, Dr PHAN THANH HAI, Dr JASMINE THANH XUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 66 year-old woman with a #10x7 millimeter spicular hypoechoic mass which invaded the skin above,  and a # 3.8 millimeter small node satellite, both of two lesions were nearby the nipple of the right breast. They were incidentally detected by ultrasound as small carcinoma, BI-RADS 4C. Strain elasticity was hard code. Axillary lymph nodes were inflamed nodes, LN-RADS 2.

Mammogram showed one right breast lesion beside the nipple, BI-RADS 4.

MRI confirmed the #11x9x10 millimeter tumor of the right breast, BI-RADS 5. Right axillary nodes still exist the hilus.

Results of core biopsy was an invasive breast carcinoma of no typical type, grade 2.

Histoimmunostaining result was an invasive carcinoma of the right breast.

CASE 799: ENDOCRINOLOGICAL PANCREAS TUMOR METASTASIZED LIVER, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THỤC QUYÊN, MEDIC MEDICAL CENTER, VIETNAM.

 A 65 year-old man with anorexia, epigastric pain and weight loss # 2kilogram for one month but without nausea nor jaundice.

Abdomen ultrasound detected some metastase nodes in the liver that may come from the tail of the pancreas tumor. 

A hypoechoic mass with peripheric Doppler signals at the spleen hilus # 35x29mm was revealed through the spleen window at the LUQ that leads to think about a pancreatic tail tumor.

Lab data was not any interesting clue for diagnosis.

MSCT confirmed a #30x40mm pancreas tumor of the pancreatic tail which captured CE irregularly,  hypodensity lower than pancreatic tisue and metastase liver nodes #10-45mm.

Biopsy of metastases liver nodule was done. The result of the liver biopsy was a poor differentialized adenocarcinoma ; and immunohistostaining was an endocrinological pancreatic tumor.

Endocrinological pancreatic tumor is still a rare entity and hardly to diagnose as it could appear anywhere. It has to combine some  modalities of the diagnostic imaging as the diversity and complexities of the endocrinological pancreatic tumor.

A chemotherapy had been planned for the patient.

CASE 798: GASTRIC GIST, Dr PHAN THANH HẢI, Dr LÊ ĐÌNH TÍN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 42 year-old man with gastric pain and has been managed iron deficiency anemia.

Ultrasound of abdomen detected a # 6x3x3.8 cm tumoral necrotic mass at lesser curvature of the stomach.

But GI endoscopy result was only gastritis.

MSCT performed and represented a # 3X5x6 cm gastric GIST.

Gastric endoscopy in the second exam concluded a submucosal tumor.

 Surgery removed the gastric tumor. 

and anapath and immunohistostaining results were gastric GIST with high index of cellular division.

CASE 797: PELVIC ABSCESS and DIVERTICULITIS, Dr PHAN THANH HẢI, Dr PHAN NGUYỄN THIỆN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 54 year-old  diabetic woman with left lower quadrand pain for one year.  About one week before entering Medic Center, she got fever, cold and shivering and LLQ pain more and increasing CRP.

Abdominal ultrasound detected one left pelvic #46x56x64mm septated mass beside the sigmoid colon cannot ruling out an ovarian tumor.

MSCT confirmed a pelvic abscess with a high density foreign body inside # 2 mm.

Endoscopic surgery revealed an abscess due to colonobladder fistula. Then an open surgery performed to remove the pelvic abscess which was from an inflammed diverticulum and penetrated the urinary bladder,  and to create an artificial anus at the LLQ and cystostomy. The foreign body could not find out.

Post-op the patient was getting better but still in urinary infection.

It was a rare of case of complicated diverticulitis.