Two cases of breast tumor classified BI-RADS 5 with disconcordance between ultrasound features and core biopsy and immunochemistry staining results.
CASE 01:
A 22 year-old girl with right breast mass: solid and microcalcifications. Ultrasound findings were malignant characteristic but FNAC and IHC resulted a fibrocystic changeof the breast.
CASE 02:
A 44 year-old woman with malignant breast tumor: solid, spiculated border, tissue contraction that were on left breast ultrasound examination.
FNAC, and 2 times of core biopsy were fibrocystic change results. Lumpectomy for biopsy result was non-malignant mass with immunohistochemistry (IHC) staining.
A 55 year-old woman with epigastric pain, flatulence for 2 months that failed in gastric management. Two days before she vomited out the old gastric contents.
Ultrasound detected a dilated stomach and obstruction of extra and intrahepatic biliary ducts which may due to pancreatic head tumor #30x35 mm. CBD dilated # 15-17mm in diameter.
Lab data showed increased CA 19.9.
MSCT confirmed head of pancreas tumor which made obstruction of biliary ducts and the stomach in dilatation.
Open surgery was done for removing the pancreatic tumor and performing the gastroenterology anastomosis and common bile duct- ileum anastomosis.
Result of pathology was adenocarcinoma metastasized duodenum, transverse colon and lymph node.
A 60 year-old diabetic man with cough and LUQ pain for 10 days. He denied any trauma in history.
Going to Medic Center in pain and anemia; POCUS in emergency detected free fluid in abdomen and hyperechogenic mass around the spleen, and left pleural effusion.
Lab data noted anemia and infectious syndrome of a diabetic patient.
MSCT confirmed a splenic rupture and free fluid in abdomen and pleural effusion both two sides.
A splenectomy was done and the patient remains well.
Coughing is a rare cause induced a non-traumatic splenic rupture besides jogging, squash, cycling and electroconvulsive therapy.
References:
1/
COMMENTS
Background NSR is a rare condition in emergency surgery. NSR may be seen along with different diseases, such as malaria, infections, malignancies, metabolic disorders, as well as vascular and hematological diseases. Also, spontaneous rupture of the spleen may be observed. Absence history of a trauma may not remind a rupture needs a high index of suspicion for diagnosis in spleen.
Research frontiers The criteria for NSR were first described by Orloff et al in 1958 and our patients with NSR were in accordance with these criteria.
Innovations and breakthroughs Our study emphasized that rapid diagnosis, aggressive resuscitation, and surgical intervention are important for successful outcome in patients with NSR. If the patient with intra-abdominal hemorrhage has no associated trauma, splenic rupture should be considered.
Applications NSR may be shown in particular in endemic regions of malaria, hematological malignancies, and spontaneous and chronic renal failure.
Peer review In this study, NSR was presented with different diseases. Diagnosis of NSR, using ultrasonography or CT, and paracentesis, is difficult. Splenectomy may lead to a successful outcome in patients with NSR.
2/ The diagnosis of atraumatic splenic rupture (ASR) can be made with the Orloff and Peskin criteria, which states that ASR can be diagnosed when the following four criteria are met: 1) thorough history reveals no antecedent trauma; 2) no evidence of disease in organs other than the spleen that can cause rupture; 3) no perisplenic adhesions or scarring consistent with trauma or past rupture; and 4) normal spleen on gross and histological examination.
From
. 2014 Nov 30;8:396. doi: 10.1186/1752-1947-8-396: Possible infectious causes of spontaneous splenic rupture: a case report Grace Y Lam1,Adrienne K Chan2,3,Jeff E Powis2,✉
A 35 year-old woman in an annual check-up. Ultrasound detected a left kidney mass without any sign or symptom.
MSCT confirmed the left kidney tumor which may belong a RCC or oncocytoma.
Histopathological result was an RCC, clear cell carcinoma.
Renal cell carcinoma (RCC) accounts for the majority (80% to 90%) of kidney cancers. Most RCCs have a clear cell histology. Often asymptomatic and diagnosed incidentally. Most cases are sporadic, although several hereditary clinical kidney cancer syndromes have been identified.
A 53 year-old woman with right knee pain for 8 weeks, stiff limb, limited movement and failed in anti-inflamed treatment. She went through lymph node TB in her childhood.
Liver and kidney functions were normal, normal CRP, only positive QuantiFERON-TB.
Ultrasound noted swollen soft tissue of the right knee, blurred contour, poor vascularised. Bone were intact.
X-ray of the chest and the right knee were still nothing.
But MRI detected the lesions of the soft tissue of the right knee.
Core biopsy result was a TB soft tissue of the right knee.
The anti-TB treatment was done, the right knee pain released after ten weeks, and no limitation of the right knee movement and stiff limb.
MRI post anti-TB treatment showed the successful management as the exact diagnostic and attack treatment.
Knee pain due to infected TB which is unusual and should be think about when failed in traditional treatment.
A 43 year-old man with neck pain progressing to his shoulders for 3 months.
Neck ultrasound detected a # 180x65x25mm hypoechoic mass with sludge which was anterior of the neck spine from C4-7 that noted an TB neck abscess.
X-Ray detected an anteroir mediastinal mass, damages of cervical spines and neck soft tissue lesion.
MSCT and MRI confirmed a TB abscess from C6 to T4 and damages of the body of cervical spines from C7 to T4.
TB of cervical spine is rare entity of MSK inflammation due to infected Mycobacterium tuberculosis which is the causative organism damages the body and disc of cervical spines and forms cold abscess. If untreated it could paralyze upper limbs or go out in fistula.
