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Tuesday, 23 May 2017

CASE 433: GEANT RETROPERITONEUM LIPOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.




Woman 44yo nullipareous, with abdomen  distention, and  clinical  suspected   ovary tumor.
US scanning of abdomen detected  all bowell loops in deplacement to left flank.

US 1: epigastric scanning detected  right kidney near left lobe liver.


US 2: big solid mass, hyperechoic  like  fatty tissue.


US 3, US 4  color Doppler  of this mass showed from  retroperitoneum which extended from the epigastric  to pelvis but  no deplacement of abdominal aorta.



MRI  with  gado:  This  big mass is in retroperitoneum deplaces right kidney to liver (MRI 1, MRI 2, MRI 3,  MRI 4 , MRI 5).  








Radiologist reports   that is retroperitoneal lipoma or retroperitoneal liposarcoma.
Operation removed this mass easily.(see macro).



Wait for microscopic report.

Sunday, 21 May 2017

CASE 432: A K I by STONE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM




Man  51 yo with acute  pain at  right flank, type colicky  pain. History of being treated  renal stone of  left kidney by operation and ESWL for 2 years.
Emergency  ultrasound  detected right and left kidney hydronephrosis (US 1, US 2).



CT scanning  with CE:  CT 1= kidneys no CE.


CT 2 with CE,  arterial phase.




CT 3,  venous phase.


CT 4,  delay phase.



CT 5,  frontal view.


 CT 7,  3D view.


Blood test: EGFR=  23mL/s.

Discussion: Ultrasound  scanning in acute renal colic crisis cannot make diagnosis of  A K I ( acute kidney insufficiency);   CT  non CE  with HU  low and CE phase in delay  secretion that suspected AKI.

 Emergent  operation was done  for removing  of the stuck stone in right ureter for this case.


Friday, 19 May 2017

CASE 431: BIG GASTRIC TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM




Man 44 yo with one month complaining of epigastric distention but normal gastroendoscopy.  
Ultrasound  detected  big epigastric mass,  looked like  left hepatic tumor with size of 15 cm,  central necrosis (US 1, US 2).



MSCT CE represented that this tumors is  nearby  left lobe of liver  and  deplaces  gastric fundus [CT1, CT 2,  CT 3] with central  necrosis.



   
Blood tests with all cancer markers are normal. Wako test is  negative.  
Operation  removed  this big tumor   which came from  gastric wall.




Microscopic is GIST with high malignant potential.  

Reference:



Friday, 12 May 2017

CASE 430: FACIAL EDEMA, Dr PHAN THANH HAI, Dr LE NGOC VINH [MEDIC CA MAU], MEDIC MEDICAL CENTER, HCMC, VIETNAM



Woman 33yo, from Ca mau province, with history onset one year ago, fever and some red macula appeared at abdominal skin that biopsy result of macula was lipoma. But it is not in stop of progress, a lot of red macula were getting more over 2 legs and upper arms to her right face.
In palpation, red macula is hot and induration (Photo1,2.3).




Ultrasound scanning of  her right face represents edema of subcutaneous fatty layer, no hypervascular.







CT scan of the face shows normal bone and subcutaneous edema of her right hemifacial side.





MRI also detected facial edema of subcutaneous fatty tissue (MRI 1,2).





Blood tests= pancytopenia, 
negative ANA test and anti-dsdna, very high ferritin >2,000, LDH =2,581 UI,  beta2 microglobulin=  3,701,  CRP = 64 ng/mL, c3 =122 (normal), c4=  66 (n: 15-450), kappa and lambda  not detectable.

Biopsy at  lesion in forearm, report with  immuno histo chemetry stainning is  subcutaneous panniculitis like T-cell lymphoma.




REFERENCE;


Wednesday, 10 May 2017

CASE 429: DOUBLE UTERUS, Dr PHAN THANH HẢI- Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 48yo, PARA 2002 , detected herself one prolapsed mass from her vagina 1 year ago, no pain, no fever but with SUI [ stress urine incontinence] syndrome.


Ultrasound of pelvis by the transcutaneous: (US1) uterus normal size,




by via TVS ( US2, US 3) detected one mass at lateral left uterus, hypoechoic, size 7 cm look-liked second uterus.





CT scan of pelvis:  CT 1 : this mass at left site uterus, hypodense like fatty tissue.


CT2, CT3 the mass is anterior the urinary bladder.



 MRI 1, MRI 2 in sagittal section, this tumor is like a second uterus.



OPERATION  REMOVE  THIS TUMOR..BY LAPAROTOMY..
( OP. IMAGES:THIS TUMOR  IS  NOT  FROM UTERUS)





MICROSCOPY IS FIBRO-LIPOMA