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Monday, 14 April 2014

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


Woman 75 yo vomiting, endoscopy detected  tumor extragastric fundus (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  SAYS  GIST OF  STOMACH WALL.

REFERENCE:

Friday, 11 April 2014

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.



Wednesday, 9 April 2014

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.

 

Saturday, 5 April 2014

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

Sunday, 23 March 2014

CASE 244: AVM and MESENTERIC PANNICULATIS, Dr PHAN THANH HAI, Dr LY VAN PHAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Man 31 yo, one week ago complained  of epigastric pain and vomiting.
Clinical examination he had red skin on the right thorax and atrophied muscles of right arm.


Emergent abdominal ultrasound scan showed  one mass of 4cm located near the head of pancreas, at processus uncinatus which  compressed duodenum..
(see 3 ultrasound pictures.. P1.color doppler at right subclavicule suspected A-V-M) , P4 .P5..cross scan and long scan this mass at the head of pancreas.)





Gastroendoscopy went down just to duodenum but nothing detected.
MSCT with CE: this mass was in retroperitoneum compressing duodenum D2,
contrast injection was slowly enhancement , but it had air in the  mass ( see 4 CT  with CE pictures CT1, is angiogram of right axillary artery, CT2. this mass with air inside, CT3, relation with right kidney and aorta, CT4 vascular SMA and mass).





Blood tests were no abnormal.
What is your suggestion for diagnosis ?.

Operation laparotomy for  biopsy this tumor  and  bypass anatomosis ; this tumor was  covered SMA then  cannot remove.
Microscopy is  fibrosis, no  cancer cell detection.

It is a fibrosis mesenteric case.
 
Discussion: this 31 yo patient, vomitting at the clinical onset,     due to  obstruction  of upper  GI tract . Ultrasound and  CT showed  the mass  near  the processus uncinatus of  pancreas  and   SMA encasement .
Operation cannot  remove  this tumor   because  it  fixed  to superior  mesenteric artery, biopsy  this mass  with report   no cancer cell,only  fibrosis  tissue suggesting a  pseudotumor like  mesenteric  panniculatis. It is  rare case   response with  corticoid  treatment   or  with  colchicine.
REFERENCE
case  of mesenteric panniculatis.