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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.







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