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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.

 

Thursday, 20 March 2014

CASE 243: GALLBLADDER TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 69 yo,  pain  at  epigastric area, no  fever,  no GI tract trouble.
Abdominal  ultrasound  detected  abnormal  gallbladder: thickening of the wall with one  mass  at gall bladder  fundus  invasion to liver, suggestion of gallbladder abscess ( see 4 ultrasound pictures).





Blood test  are normal:   WBC  not rising, CA 19-9  normal
MRI with CE gado  showed this mass  in  high  enhancement  invasion in to  liver and  transverse colon, the  biliary system was  normal.




With  this clinical situation and blood tests, US first and  MRI,  what is your diagnosis ?

DISCUSSION: this case  had no  clinical signs of acute  cholecystisis, no stone  in gallbladder; ultrasound  showed  the  wall of  the gallbladder   perforated and  adherent , invading  liver  tissue, this mass was  hypovascular  in protruding  into lumen of gallbladder as a tumor and  going to extra wall of gallbladder.

Open operation  with  diagnosis  of  tumor of gall bladder (surgeon  removed  gallbladder  and  resection one part of liver  and  great omentum).  Specimen was  hard and necrosis.



Microscopic with imunohistostaining is leiomyosarcoma of the gallbladder..it is very rare  case in the word  had been published.
REFERENCE:


Saturday, 15 March 2014

CASE 242: IVC TUMOR, Dr PHAN THANH HẢI, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Woman 35 yo, pain at epigastric area. Ultrasound in a provencial hospital suspected liver tumor, and  reviewing of ultrasound at MEDIC center.
This mass was hypoechoic structure with  size of 7cm X 5cm along of upper portion of IVC in covering over right kidney and duodenum (see 4 ultrasound pictures). 





MSCT with CE of  this mass was slow enhancement, and in invasion of the wall of IVC ( see 3 CT pictures).




Gastroendoscopy was ruling out a tumor from duodenum.
Blood test : CA19-9 rising of  62.58 UI/mL
What is your suggestion of diagnosis and planning for treatment ?.

Discussion: this case did not have GI tract  symptoms , no endocrinal effect, and the mass  situated  in retroperitoneum  and  IVC compression, we can rule out  liver tumor, GIST of duodenum, kidney tumor. The rest of retroperitoneal tumors  near I V C are  neuroendocrine tumor  or leiomyosarcoma, liposarcoma with CA 19-9 rising, we cannot explain  what is  situation. Pre-op  diagnosis is retro peritoneum tumor looked like sarcoma. Operation was done for removing completely  this mass  with one part of IVC (see 2 operation samples). Microscopy report was a retroperitoneal leiomyosarcoma.



REFERENCE:


Thursday, 13 March 2014

CASE 241: SEMINAL TUBERCULOSIS : Dr NGUYỄN MINH THIỀN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCM C,VIETNAM


Man  51 yo, one month ago suffered from lowgrade  fever and dysuria. Chest Xray was in suspection of  lung tuberculosis.


Abdomen ultrasound  detected  many  lymph nodes around  aorta ( 2 ultrasound pictures) scanning  at level  of pancreas  (cros-sectional and longitudinal scan).


Ultrasound at pelvis detected one hypoechoic mass of right seminal vesicle, no vascular structure intra this mass.




MSCT also detected one mass on right site of prostate, suspected  abscess (2 CT pictures).


TRUS guided puncture this mass withdrew out the pus in white color  looked like caseum. Analysis this pus was  positive PCR tuberculosis.





 
Conclusion of this case :  tuberculosis of the lung, lymph nodes, and  seminal  vesicular mass.  Medical treatment  of antituberculosis drugs was setting up for the patient.

REFERENCES:


Monday, 10 March 2014

CASE 240: ADRENAL GLAND TUMOR SECRETING ALDOSTERONE, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Female patient 22 yo from Daklak province, student. Arterial hypertension for 1 year and weknesss of 4 limbs in effort and remaining normal in rest.
Abdominal ultrasound detected  right adrenal mass of 21x28x24mm, well bordered which was thougt to be an adrenal tumor.


MDCT confirmed an adrenal tumor on right side.




Blood tests:  Kalemia =1.77mmol/l ( N= 3,5-5), Aldosterone  = 380pg/ml ( N= 10-210).

Operation was done and microscopic report was a benign adrenal tumor.

 

 


REFERENCES:
http://en.wikipedia.org/wiki/Primary_aldosteronism
http://www.studyblue.com/notes/note/n/en1-03-adrenal-glands-1/deck/1600308