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Wednesday 17 March 2021

CASE 609: INTERESTING GASTRIC TUMOR, Dr LÊ THANH LIÊM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 54 yo, with hemorrhagia due to gastric ulcer for 2 years. From late 2 months patient got pain  from neck to epigastric area, loss of appetite and weight. (Weight=58 kg, height=160 mm).

Ultrasound detected some nodes in both 2 lobes=10-38mm with halo sign and without Doppler signal. No thrombus in portal vein,  IVC and hepatic veins. None lymph node. Small amount fluid in pelvic area.



Stomach= Irregular thickening wall, d#27-69 mm of  nearly total gastric wall of corpus and fundus  that formed hypoechoic mass d# 161x166x163mm, hypervascular which takes wide place of lumen and  compressed cardia. Though about Gastric GIST with hepatic metastases.






MSCT with contrast confirmed  gastric GIST # 16 cm, adhesing around and liver metastases. Some low signal liver lesions 10-35 mm were in lower density than liver parenchyma. Corpus of stomach has lesion d= 16 cm with soft tissue density and has big ulcer at center. Lesion was adhesive and compressed around. Pelvic area has a little of fluid.







Blood tests= Severe anemia Hb 6.0 g/dl; Hct 25%; MCV 57.6 fL; MCH 13.9 pg; WBC slight raised=11.90 x 10^9/L; PLT high raised 794x10^9/L. HP Test-IgG (Elisa) POS 69.88 U/mL; HP Test-IgM (Elisa) POS 68.48 U/mL.


In Binh dan hospital, gastroendoscopy shows big  gastric tumor in fundus with deep ulcer having hard border and compresses lower 1/3 part of esophagus.



Histopathologic results= Infiltrating of lymphocytes and plasmocytes gastric mucosa proliferates fiber tissue and fibrosis. Masses of cells line in band with fusiform nucleii on base of fiber tissue. Follow up  GI GIST.

Waiting for histoimmunostaining.





CONCLUSION= Interesting diffuse appearance of entire gastric wall tumor helps diagnosing gastric GIST based on ultrasound and MSCT findings.

Saturday 6 March 2021

CASE 608: APPENDICOLITH, Dr NGUYỄN NGHIỆP VĂN, Dr VÕ NGUYỄN THÀNH NHÂN, Dr NGUYỄN PHÚ HỮU, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Male patient 17yo, RLQ pain at 01:00 a.m. March 6, 2021.

Ultrasound at Medic Center at 10:00 a.m. detected an 33x10 mm swollen appendix at RLQ with fecolith =11 mm inside which has echo rich pattern and posterior shadowing. No free fluid around. A diagnosis of acute appendicitis with fecolith was made.





Lab results= WBC with neutrophil raised and CRP raised.




Later MSCT of abdomen confirmed an acute appendicitis with fecolith.






Patient was hospitalized  at 12:00 p.m. in Binh dan hospital. Endoscopic operation performed at 12:30 p.m..

And surgical macroscopic specimen (received via email at 03:00 p.m.).




Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072212/