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Sunday, 19 June 2016

CASE 383: SKIN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 31 yo  with history of 2 weeks ago, onset at the left hand, itchying skin and induration then  color skin changed  from red to  brown with many  erupted nodules  on the skin, and  stopped  at the left shoulder  [see  foto1, 2, 3, and foto 4( bleedding  under nail of finger 4,and 5).


No fever but easy bleedding from this nodule.
Ultrasound  of this nodule showed  from subcutaneous, echo  poor ( US 1)
CDI US  2, US 4: blood supply  this nodule is from the deep vessel, hypervascular liked a ring.


Blood test is no  changing of   WBC, and HIV  negative.

What is your  suggestion for  diagnosing this case ? 

One  dermatologist  suggested it is Sarcoidosis. Comparing with  picture atlas.



Update case 383 : Biopsy report is sarcoma of Kaposi.


   Skin sarcoma Kaposi
Ref   Eponym of Dr Kaposi and virus HHV8



Sunday, 12 June 2016

CASE 382 :LIPOSARCOMA METASTASIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.



Woman  29 yo,  2 years before  had been removed   right leg tumor  but did not to know what kind of this was, no pathology  report but now she  feels shortness breathing.
MSCT of total body  detected  many masses  in  mediastinum, left breast, retroperitoneal  abdomen and right buttock (See  CT scanning).


Ultrasound scanning for  verifying this mass (US1); 






US 2:In epigastrum



US 3: retroperitoneum mass displaced left kidney,  



US 4:  mass in left breast



US 5:  mass in right  buttock.




Biopsy of the mass in right buttock  is  liposarcoma.




Conclusion:  Multiple sites in the body of liposarcoma metastasis .

REFERENCE:



Sunday, 5 June 2016

CASE 381 : HIP PAIN in APPENDICITIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Woman 56 yo, pain in RLAQ  1 week ago, ambulatory treatment, pain in the back and to the right hip, difficulty in walking.
XRay of  the  right hip looked like fracture.

MRI  showed that R. hip no fracture but  fluid  collection in retroperitoneum space,  intrapsoas  muscle to pelvis and to righ thigh with intramuscular air detection ( MRI 1, 2 , 3 ).





Ultrasound  examination of pelvis  detected cystic  mass with air inside  likely an abscess..( US 1,US 2, US 3 detected air in muscle of righ thigh).




The sonologist  diagnosis is  abscess of the right thigh muscle.
Blood tests =  very high WBC= 19,6 k  with neutrophil 1,3 k,  hsCRP=   207.9ng/ml/.
Emergency CT scan of abdomen  and hip, thigh detected   retroperitoneum  abscess from the  coecum extending to liver and the righ thigh with air in muscle ( CT 1, CT 2, CT3)





Emergency operation confirmed  abscess due to necrosis of retrocoecum appendix  with perforation of cecum  extending to liver and the righ thigh.

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Wednesday, 1 June 2016

CASE 380: PEDUNCULATED GASTRIC TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.




Woman 54 yo  general check-up by abdominal ultrasound detected  one mass  at  left  upper  abdominal  area (US 1:   longitudinal scanning of  spleen and tumor).


US2:  tumor and left kidney, longitudinal scanning.


US 3: cross-sectional  scanning, tumor inner  of left kidney.


Gastroscopy is normal.


MSCT scan  with CE:  CT 1 tumor  nearby great curvature of stomach, CT 2:tumor near  pancreas and stomach.



Report of  radiologist is  retroperitoneum tumor.
MRI   made clear  relation of  tumor and left adrenal gland..( MRI 1), MRI 2 tumor is near  gastric border.



Laparoscopic  detected this tumor came from  the wall of  great curvature  of stomach (laparostomy image).


Macroscopic  tumor is solid structure.



Microscopic report is  GIST tumor  with potential  median malignancy.



Conclusion: difficulty in pre- op  diagnosis  one exophytic pedunculated gastric GIST tumor


Wednesday, 18 May 2016

CASE 379: ECTOPIC PANCREAS TISSUE in JEJUNUM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNA



Man 41 yo, headache, high BP, clinical looked like  pheochromocytoma.
Ultrasound detected nothing abnormal in abdomen.
CT scan of  abdomen  with CE detected small tumor in jejunum wall size of 2.5 cm, very high contrast enhancement (see CT1).


Blood test  is not  clear diagnosis.



2 weeks after CT with C E  again also detected  this tumor in same size (see CT2).


Gastro-colono endoscopy  is normal,  report  no polyp detected. Laparoendoscopy detected  this tumor is  in jejunum wall..( lap1, lap 2 , ope.. ) 






and resection  this tumor (see macro 1,2)



Surgery report is small intramural tumor of jejunum, 20 cm far from  D3, well bordered looked like ectopic pancreatic tissue. Microscopic report is  ectopic intramural jejunum pancreas tissue. 

DISCUSSION: Ectopic pancreas in jejunum is very rare, reviewing of  CT with CE  made sure  pancreas  in  normal size and structure  CT number ( HU) is 126. Comparison with  HU of  ECTOPIC  PANCREAS is 120. It  is criteria for diagnosis in suspection of  ECTOPIC PANCREAS

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