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.

 For ten years following the initial bone fracture, the patient has experienced many bone problems, including kidney stones. The patient was not able to comprehend the connection between renal stones and bone fractures because the source of the bone fracture and renal stones, which was a parathyroid tumor, had disappeared. 

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 prior history are 17 year known gallstone, and denies any RUQ pain or gastrointestinal  troubles.  He had been controlled well his glycemia. He was taken transplant  coronary arterial 2 stents as 2 times of myocardial infarction 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 is 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 wall. The GB mucosa is partially necrosis and hemorrhage. Thicken GB wall leads endoscopic surgery cut it into small pieces for removing the gallstone and the inflamed gallbladder.

Pigmented gallstone and inflamed gallbladder in small pieces.

Endoscopic view of the  inflamed gallbladder.

Microscopic result is  a necrotic cholecystitis due to gallstone.  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.