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Monday, 25 September 2017

CASE 453: SMALL BOWEL MELANOMA, Dr PHAN THANH HẢI, Dr TRẦN MINH ĐÚNG, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, TÂM TRÍ GENERAL HOSPITAL, HCMC, VIETNAM


Man 56 yo with acute abdomen pain,  vomitting, and dark stool [melaena]. Clinical examination was oriented to 4th day bowel occlusion.


Abdomen US scan in emergency  detected  dilated bowel  with  crossed sectional view  presented typical oignon sign  of intussusception  ( US 1,   crossed section;  US 2,  longitudinal  scan.    With linear probe, US 3, CDI examination;  US 4,  multilayer of  intussuscipiens [boudin].





MSCT  with CE of abdomen =   





CT 1: bowel dilatation  due to  bowel obstruction
CT 2 : mass  with  multilayer of small bowel wall.
CT 3 :  intussusception with target sign or pseudokidney sign
CT4 :  sagittal view of the abdomen
Lab test is normal.

Emergency  operation  via laparotomy  with diagnosis  intussusception by small bowel tumorSurgeon reported that  tumor is black color, intra jejunum, size 5 cm. Microscopic report  with immunohisto chemistry is  malignant melanoma.




UPDATE:

For DISCUSSION  whatever PRIMARY OR SECONDARY MENALOMA?
                       CAREFUL EXAMINATION FULL BODY  DETECTED  ONE SCAR AT THE  LEFT PLANTAR FOOT DUE TO OPERATION 6 YEARS BEFORE AT CANCER CENTER.
BUT PATIENT DID NOT REPORT THIS ISSUE and HAS NOT REPORT FROM THIS OPERATION.
THIS CASE  MAY BE CASE of SECONDARY MELANOMA METASTASIZING TO SMALL BOWEL ( SEE FOTO).


REFERENCE:   SMALL BOWEL MELANOMA
                 

Friday, 15 September 2017

CASE 452: MESENTERIC CASTEMAN DISEASE, Dr PHAN THANH HẢI, Dr NGUYỄN PHÚ HỮU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 65 yo with  anorexia,  weigh loss # 5 kg in 3 months.
Ultrasound of abdomen for general check-up detected  one round mass, mobile  at  RLQ.

US 1 :  hypoechoic homogeneous  mass looked like a cyst,  size 3 cm, round border  with  low posterior enhancement,  intra mesenteric situation.






US 2 : CDI   vascular  around this mass not branching inside this mass   
US 3: CDI with another section, no vascular in the mass
US 4 scanning by linear 14 MHz  probe:  this mas  like a cyst.
US 5 :  elastoscan of this mass  mean  9 kPascal.

MSCT with CE=




CT 1:  crossed section of this mass very quick and  high contrast enhanced,  

CT 2:  frontal section of  this mass = intra mesentery

CT 3:  sagittal section of this mass:  near  anterior wall of abdomen  

Blood tests= normal  CBC, negative all cancer markers.

DISCUSSIONS=

 1. This mass is  intra mesenteric area not related with GI TRACT

 2..THIS MASS IS VERY  HYPOECHOIC AND HOMOGENEOUS  LOOKED LIKE A CYST  BUT IT IS SOLID MASS

 3. THIS MASS IS VERY QUICK AND HIGH CONTRAST ENHANCEMENT, HOMOGENEOUS STRUCTURE.


 4.  BOOD TESTS   BETA 2  MICROGLOBULINE and FERRITIN , LDH NOT RISING


THE FIRST CHOICE OF  THIS MASS IS LYMPHOMA.






Laparoscopic operation  detected the mass intra mesenteric  jejunum; open surgery removed this mass out the abdomen cavity and web resection.

Microscopic report with  immunohisto- staining is  CASTLEMAN DISEASE.




REFERENCES: With 2 VMU Cases in the past.







Sunday, 10 September 2017

CASE 451: CARDIAC MYXOMA, Dr PHAN THANH HẢI Dr NGUYỄN TUẤN VŨ, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Woman 33 yo, with  dypsnea progressing for one year but being normal chest X-Rays , EKG and abdomen ultrasound.   

  
Cardiac ultrasound  detected  one mass 5 cm intra left atrium  covering  near all cavity space ( US 1, US 2, US 3). 




And  echocardiologist says  cardiac myxoma.
CTA  of cardiology  non CE showed  this round mass  related to  left atrium, and radiologist confirmed  myxoma in left atrium.






Emergency heart operation was done.
OPERATION  REMOVED BIG TUMOR 5 CM  WITH  STRUCTURE LIKE  MYXOMA.






MICROSCOPIC REPORT IS MYXOMA.

Reference:



Saturday, 2 September 2017

CASE 450: PID with PELVIC MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  34 yo with  onset 2 weeks ago,  fever  and pain at pelvic region.
Ultrasound  first at an obgyn hospital  says  ovary cyst or endometriosis. But medical  management  with antibiotis failed in clearing fever.








(US 1: scanning  after 2wks,  uterus and cystic mass # 10cm with very thickening wall; US 2 : on CDI;  US 3:  intracystic mass detecting one structure like a bridge: US 4:  ascites intra RLAQ;  US 5:  this mass was scanned with linear 12 MHz probe. 
MRI of pelvis with gado=   this cystic mass is  in left ovary  with  the wall very thick, and  black spot intra mass  unknown  original,   but radiologist  suspected an ovary cancer.





   
Blood tests=   WBC  12k with 70% neutron,  Plt= 515,  CA 125  rising  100 UI.


 18 DAY FEVER AGO CANNOT STOP BY ANTIBIOTICS.  OPERATION BY LAPAROENDOSCOPY WITH DIAGNOSIS  OF P I D.
Picture OPE1: LEFT OVARY IS VERY BIG MASS AND FALLOPEAN TUBE IS BIG ALSO.  





Picture OPE 2: INCISION OF THE WALL OF CYSTIC MASS SHOWING VERY THICK AND an AMOUNT of PUS  GOES OUT.




Picture OP 3: VASCULAR THROMBOSIS INTRACYSTIC MASS.


BACTERIOLOGY  REPORT  of THE PUS from STREPTOCOCCUS  and  MICROSCOPIC REPORT of THE WALL of CYST IS  ABSCESS WALL.



Reference: