CASE 684: PRIMARY BREAST SARCOMA, Dr PHAN THANH HẢI, Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 61 year-old female patient suffers from 2 tumors of her right breast which are abandoned for 2 years by a deadly illness of her husband.

Ultrasound and elastography technique represent two BI-RADS 4B tumors of her right breast which one has perivascular signals.

Mammography notes an asymetric sign in superiolateral region of the right breast.

MRI confirms the two BI-RADS 5 right malignant breast tumors: # 34x28 mm and # 21x 27 mm, with spiculated border, high signals on T2W2 and moderate signals on T1W1, captured contrast media type 3.

But the report of histoimmunology of the breast tumor is a breast sarcoma while axillary lymph nodes are not in malignancy.

Surgery is done in large field, no mastectomy nor lymph node curetage due to the sarcoma tumor characters.

As no clue of gene mutation, the patient goes through a planning of radiation therapy  for 3 months of 54 Gy dosages in 27 times.

DISCUSSIONS:

Breast sarcome is a rare mesenchymal breast tumor (<1% cancer breast tumor). MRI,  mammography and ultrasound could not differentiaze breast sarcoma from other breast cancer tumors.

Core biopsy and histoimmunologic exam are keys of diagnosis.

Surgery could save patient life that sarcoma invades in situ and rarely goes far via the blood stream. Chemotherapy and radiation may be managed in case of metastase and spreading exist. Liver, lung, bone marrow and recurrent breast tumor may happen in the first 2 years.  The 5-year survival rate reported in the literature ranges from 50% to 64% for the breast sarcoma.

The female patient remains well and in schedule of reexamination.

REFERENCES:

A rare case report of breast sarcoma - PMC-NCBI.

Primary breast sarcoma: case report-African Journal online.

Breast sarcoma: a case report and review of literature.

CASE 683: A TB CASE: Dr PHAN THANH HẢI, Dr TRẦN THỊ TRÚC PHƯƠNG, MEDIC MEDIC CENTER, HCMC, VIỆT NAM

 A 29 year-old female  patient in a general chek-up for a preparation of a study abroad.

Ultrasound detects lymph nodes in her mesentery in the abdomen and on her neck # 5-25 mm in suspecting TB infiltrating type. Also a slight thickening of wall of colon is noted.

Report of the neck lymph node full biopsy is an TB  infected node.

 

A colonoendoscopy performs shows findings of ulcerative colitis from the cecum to the transverse colon due to TB infected.

A TB regimen is planned for the patient, and during 2 months of TB management, her status is getting better, that is proven by the clear chest X-Ray and decreasing of lymph node in size and numeration.

CASE 682: RIB CHONDROSARCOMA, Dr PHAN THANH HAI, Dr HO CHI TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 56 male patient with right shoulder pain for a half of month.

Chest X-Ray and ultrasound show a #3.1x2.5 cm right posterior legion of  the 7th rib  with hypoechoic pattern, neovascular signals and moderate hard code on elastography ultrasound.

 

CT confirms and  suspects malignancy to the # 3.5 cm diameter of rib lesion with erosions of upper border of the 7 th rib which is strongly capturing CE.

Surgery removes the tumor and the histopathologic report is a mesenchymal chondrosarcoma.

It is a rare entity of cancer of  low metastase cartilage in middle aged patient.

CASE 681: PARATHYROID TUMOR, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr HỒ CHÍ TRUNG, Dr LÊ VĂN TÀI, Dr LÊ TUẤN KHUÊ, Dr BÙI BỈNH HUÂN, Dr TRẦN THANH CƯỜNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 33 year-old male patient with dysuria and nausea.

His 10 year history noted 10 times of long bone fracture, and renal stones and double JJ sonde on the right kidney in hydronephrosis.

Ultrasound detects right hydronephrosis with a sonde JJ, and some renal stones on 2 sides. With experience sonologist herself reveales a left parathyroid tumor next to the lower pole of left lobe of thyroid.

Lab data and X-Rays show a case parathyroid tumor with severe bone complications.

 

Osteogram: Osteoporosis in severe level.

Surgery removes the left parathyroid tumor  and the PTH level rapidly goes down after removing the tumor.

So the patient suffers from the renal stones, and the seveve bone complications from the first time of bone fracture for 10 years. Due to loss  of the bone fracture cause which belongs to the parathyroid tumor, the patient could not understand the relationship between renal stone and bone fractures.

CASE 680: CHOLECYSTITIS and GALLSTONE, Dr PHAN THANH HẢI, Dr HỒ KHÁNH ĐỨC, Dr LÊ VĂN TÀI, Dr LÊ THANH TÙNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 70 year-old diabetic male patient with an acute abdominal pain for hours enters the emergency room of Medic Center. His history are gallstone, controlled glycemia and  coronary arterial 2 stents for over 10 years. His EKG shows a life-rhythmic extrasystolic. WBC: 11.4H, CRP:0.4.

Ultrasound represents a 17 mm stone in a # 98x31 mm gallbladder with thickened wall of GB # 5-7mm. SonoMurphy sign positive and no fluid exist around the GB.

The cholecystitis pain reduces rapidly with taken diclofenac IM, drotaverin per os after 20 minutes. But a cholecystectomy via endoscopy is planned in regarding his Clopidogrel, diabetic status and the life-rhythmic extrasystolic EKG.

Endoscopic surgery removes a 17 mm pigmented stone within a thicken gallbladder which GB mucosa is in necrosis and hemorrhage. Thicken GB wall leads to cut it into small pieces for removing the gallstone and the inflamed gallbladder.

Pigmented gallstone and gallbladder in small pieces.

Endoscopic image of the inflamed gallbladder.

The patient remains well and discharged in safety after 2 days in hospital.

In reviewing the gallbladder, the gross specimen of GB shows a cholecystitis image more interesting than the ultrasound view. So it makes alert when facing a painful gallstone than a silent stone of gallbladder.

Furthermore there is a proposal that should think about acute cholecystitis while seeing a gallstone in a RUQ painful patient.

CASE 679: ECTOPIC TESTICULAR TUMOR, Dr PHAN THANH HẢI, Dr BÙI HỒNG LĨNH , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 53 year-old male patient  having HBV infected with hypogastric pain and without his left testis.

Ultrasound detects a # 76x50 mm hypogastric mass, with Doppler signals, and hard code of elastography ultrasound, 23.8 kPA.

MSCT confirms a 75x60x85 mm left ectopic testicular tumor maybe a seminoma in the pelvic region.

Surgery removes the ectopic testicular tumor from left hypogastric region.

The  microscopic result of the ectopic testicular tumor is a seminoma invading its capsule. 

CASE 678: COMPLICATED DIVERTICULITIS, Dr PHAN THANH HẢI, Dr LÊ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 55 year-old female diabetic patient suffers from epigatric pain crisii for 4 days and diarrhea.

Ultrasound detects an amount of abdominal free fluid,  two RLQ abscesses, and edema of peritoneum.

MSCT confirms the peritonitis due to 2 abscesses at the right flank of the abdomen.

A right colectomy is performed as perforation of colonic diverticulitis # 2x2 cm of transverse colon and the other one of cecum.

Subhepatic drainage is made to withdraw fluid out and an artificial anus is done.

 And the female patient remains well.