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Tuesday, 23 January 2018

CASE 473: SCIATIC NERVE TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Woman 59yo  detected  one mass  at right buttock that is in slow growth and no painfull.
Ultrasound scan
US 1= longitudinal scan of  this mass with size 6.7 cm,  ovoid, hypoechoic  in gluteus maximus muscle   near sciatic nerve  like a size of a mango.



US 2 = crossed section of this tumor is well bordered and hypovascular pattern. 

US 3 = elasoscanning of  this mass is inhomogeneous  structure.




MRI scan




MRI 1   crossed section   this mass is   well bordered  in a muscle   
MRI 2   frontal view this mas is  bordered of right sciatic nerve.
MRI 3   relation of this mass and right sciatic nerve.



Core  biopsy is done and histology report is   neuroma.


Friday, 19 January 2018

CASE 472: INCIDENTAL BREAST TUMOR , Dr PHAN THANH HẢI, MEDIC MDICAL CENTER, HCMC, VIETNAM



WOMAN 58YO   FOR SCREENING  TO DO WB MSCT. 
RADIOLOGIST REPORTED ONE MASS AT  RIGHT  BREAST  SIZE# 1.3 CM.(  CT1  FRONTAL VIEW, CT2  AXILLARY AREA).



ULTRASOUND POST CT VERIFIED THIS MASS  WITH  SIZE  # 2 CM   VERY STRONG  SHADOWING, AND HYPERVASCULAR.









US1,  US2  ELASTO  IS  31.9 kPa .
US3 , AXILLARY NODE    SIZE 1.5CM WITH HILUS 
US4 ,  CDI  = VASCULAR  HILUS DEFORMATION.


CORE BIOPSY  RESULT IS  BREAST CANCER, STAGE T2 N2.

OPERATION  for MASTECTOMY AND   AXILLARY   LYMPHADENECTOMY. SPECIMEN  TUMOR IS SMALL SCLEROSIS   MANY LYMPH NODES.







POST OP  HISTOLOGY REPORTED   THIS CANCER  METASTATIZES TO AXILLARY LYMPH NODES.

REFERENCE:


Sunday, 14 January 2018

CASE 471: MESENTERIC LYMPHOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Man 70yo  with  epigastric pain. Ultrasound of abdomen detected  one hypoechoic mass like a cyst # 4.9cm near SMA.
US 1=   longitudinal scan at epigastric area.

US 2 = CDI:   this mass  is near SMA.

US  3 = crossed scanning= this mass  is placed over the head of pancreas in relation  with  celiac artery and vein.

US 4=  some  small lymph nodes near the big anesthetic mass.


MSCT CE=
CT  1 : crossed section  this mass  over the artery and vein.


CT 2:  the pancreas is normal.

   
CT 3:  frontal section of this intramesenteric mass near  SMA and vein   with some  lymph nodes in mesentery.


Endoscopy gastric and colon are normal, blood test and all cancer markers are normal 

Laparotomy for  biopsy= many nodes in mesentery.
Microscopic with histobiochemistry  is  follicular B CELL LYMPHOMA.




SUMMARY :  MANY LYMPH NODES IN MESENTERY  WITH TYPICAL APPEARANCE HYPOECHOIC PATTERN LOOKED LIKE A CYST,THE MOST COMMON IS LYMPHOMA.

Reference :    MEDIC ULTRASOUND case 452 : Castleman disease.

Monday, 8 January 2018

CASE 470: TROISIER-VIRCHOW NODES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 70 YO  COUGH . NO FEVER. CHEST CT   DETECTION  IS LEFT LUNG  LESION  WITH WIDERING OF MEDIASTINUM.
(CT1/ CT2:   SUPRA LEFT CLAVICULAR  MASS SUSPECTED LYMPH NODES.




ULTRASOUND  of SUPRA LEFT CLAVICULAR  AREA IS  MULTIPLE LYMPH NODES.
US1=LYMPH NODES ROUND 2CM, LOSS HILUS, HYPOECHOIC,  HYPOVASCULAR.


US 2 =THE VASCULAR SUPPLY IS  INTER-NODES  LIKE A RING.


US 3= ELASTOSCAN of THIS NODES WITH CENTRAL 23 kPa.

ULTRASOUND EXAMINATION REPORT IS METASTASIS  LYMPH NODES   THAT WERE TROISIER-VIRCHOW NODES.
WAIT FOR  BIOPSY.
MICROPATHOLOGY REPORT WITH  IMMUNOHISTOCHEMISTRY  IS   NEURO ENDOCRINO-
CARCINOMA METASTASIS TO  TROISIER -VIRCHOW NODE.



REFERENCE :  ANATOMY TROISIER NODE

                         PICTURE OF  DR TROISIER --PROF VIRCHOW.


Tuesday, 2 January 2018

CASE 469: T CELL LYMPHOMA OF SUBMANDIBULAR NODES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC


Man 30 yo, detected 3 months ago submandibular nodules, subcutaneous neck , no fever.


Ultrasound of the neck
US 1: normal thyroid , and subcutaneous nodule is round, black like a cyst .


US 2:  Lymph nodes have the hilus.


US 3:  CDI  Hypervascular with the vascular tree.

  

US 4: MP4  VIDEO



US 5:  PW DOPPLER  RI  0.56,  PSV  46cm/S 


US 6:  ELASTOSCAN  = 2 kPa


Clinical suspected  lymph node lymphoma.
Blood test   EBV IgG positive   118.5 UI/mL,  IgM  negative.

BETAMICROGLOBULINE IN BLOOD TEST IS  LOWER  = 1412   (  NORMAL CUT- OFF=  2164)    
HISTOBIOCHEMYSTRY  REPORT  IS  T-CELL LYMPHOMA

DISCUSSION= THE  NODULE IS LYMPH NODE  HAVING HILUS  AND  HYPOECHOIC  LIKE CYST ;  ELASTOSCAN IS VERY SOFT = 2 kPa   LOOKED LIKE LYMPHOMA.


Structure of lymph node.