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Monday, 30 December 2013

CASE 228: Thyroid Toxicosis Periodic Paralysis, Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM


Thyroid Toxicosis Periodic  Paralysis
Man 47 yo,  3 times  paralysis  at  get up in the  morning, he  came to hospital  for  emergency  perfusion  potassium and to  MEDIC  for check- up.
Ultrasound  of abdomen  no abnormal  detected,  no adrenal tumor, but  ultrasound  of thyroid gland is black , CDI hypervasular , typical of  hyperthyroidis .and  soft  with  elastoscan.






Blood test are very low TSH  , high T3, T4, TPO.
EMG was signal of  hypokalemia.



video

This case is TpP. Medical treatment of anti thyroidism  is requested.

REFERENCES:



Saturday, 21 December 2013

CASE 227: Umbilical Tumor, Sister Mary Joseph Nodule, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM




Woman 74 yo with chief complains of anorexia, colicky pain for one month. Ultrasound detected ascites and left pleural effusion, and at  periumbilical area, there was an umbilical tumor with size of 1.5cm, solid and low vascularity.






MSCT of abdomen also doesn’t find any intra-abdomen mass, but the umbilical tumor was very high CE enhancement.




Blood tests :   CRP= 806 ng/mL, albumine = 2.4 mg/mL,  CEA  normal, CA 125 = 611 UI/mL.
Ascites in puncture :  yellowish fluid.


Cytology analysis= 71% lymphocyte, ADA=16 ng/mL , Amylase=  109 UI/mL , CA 125 = very high more than 600 UI.
Biopsy of  umbilical tumor was done.




MICROSCOPIC REPORT WAS ADENOCARCINOMA METASTASES TO UMBILICUS. IT IS SMJN. (SISTER MARY JOSEPH NODULE ).


REFERENCES



Wednesday, 18 December 2013

CASE 226: UTERINE MASS: Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Woman 45 yo,  nulliparous, vaginal bleeding.
Ultrasound  of pelvis showed  big uterus and  thickening of endometrium.


Elastoscan detected  the mass of  intrauterine cavity is soft and multiple white spots  in myometrium.


MRI  SUSPECTED  INTRAUTERINE  POLYP. 





Biopsy result was endometrium hyperplasia. Hysterectomy was done. See macroscopic photo in correlation with ultrasound and MRI appearances.


Microscopic report is adenomyosis with endometrium hyperplasia.

Wednesday, 11 December 2013

CASE 225: LEFT RENAL MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Woman 32 yo in health care check-up:  ultrasound of abdomen detected  left renal mass in hyperechoic central  kidney with size of 2.5 cm, irregular border, and  hypovascular. Elastoscan  showed that hard mass.






MSCT with CE of this mass is in rapid enhancement and quickly washed-out.

video



What is your suggestion?
THIS CASE MUST BE BIOPSY OR NOT?
WHY OPERATION IS DONE; LEFT LAPOROSCOPIC NEPHRECTOMY
SEE MACROSCOPIC SPECIMEN.




Discussion:
Why we do not biopsy this case, see Ref. 2009-AUA guideline


The  microscopic report  of histo-immunostaining  is AML.


Friday, 6 December 2013

CASE 224: LEFT SUPRACLAVICULAR MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Man 41 yo, cough  and  pain at left arm; chest  x-rays suspected lung tuberculosis, then he had been treated as antituberculosis  for 3 months. 



But the pain was getting worse and  one mass appeared at  left supraclavicular  fossa.
X-rays  again  showed this  first rib in erosion on the left site.




Ultrasound scanning at left supraclavicular fossa and disclosed a solid  mass in calcification




 and fluid collection on the right site.




MSCT with  CE  of the lungs detected the mass destructing the first rib. 




Biopsy was done.  

Biopsy  microscopy report  is   adenocarcinoma , it is PANCOAST TOBIAS  SYNDROME.

Ref  PANCOAT -TOBIAS SYNDROME:


History photo of  Dr  PANCOAST K Henry.