CASE 152: PLEXIFORM NEUROFIBROMA of URINARY BLADDER on Von RECKLINGHAUSEN PATIENT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 30 yo, hematuria and anemia with many cafe-au-lait skin spots.

Ultrasound of abdomen detected normal kidneys; at pelvis, there was a big mass with size of 25 cm from pubis to umbilicus.
 

Fig. 01 : Cross- sectional scanning of ultrasound.
 

 

This mass was made by many small hypoechoic nodules, hypovascular and no detection of urinary bladder. The mass deplaced uterus to right side.

(Fig.02 : longitudinal US scan, Fig.03: uterus at right side).
 

 

Along sciatic nerve route, scanning of the right thigh disclosed many hypoechoic nodules non compressible (Fig.04).

.

 

MSCT Urology with CE, this mass was urinary bladder with urine contrast inside (Fig. 05-06).
 

Cystoscopy detected inflammation and bleeding site, then performing of biopsy of bladder wall and the tumor of the right thigh.

Microscopic biopsy report from intra-urinary bladder is granuloma inflammation,

and from tumor along the sciatic nerve is neurofibroma (image microscopic).

 

 

Reference from AFIP, plexiform urinary bladder of NF1.

 

 

CASE 151: LEFT BREAST CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Women 58 yo, 5 years before being biopsy of a right breast tumor which was  fibroadenoma, and now she detected herself a breast tumor on the left.

Ultrasound scans at right breast (Fig.1, 2 CDI, PWD) and left breast in which was found a big cystic tumor with septation and axillary nodes on the same side (Fig.3, 4).

Mammography is done showing the left breast tumor with axillary nodes in suspection malignant tumor T2N1.
 

MSCT no CE also suspected breast cancer T2N1Mx.

We performs FNAC of left breast tumor, the result is cancer, but the axillary node is not yet reported.

Do you thing the ultrasound image of this lymph node and CT scan can make diagnosis ?.

Mastectomy is done on left breast with one removed bloc (see 2 pictures).
 

Microscopic lymph node report of this axillary nodes is chronic inflammation.
 

 

Summary:

 

Clasification of TNM  of Breast Cancer  is not based on the images of axillary nodes by ultrasound or mammo or CT, but based on clinical palpation.

CASE 150: PERIUMBILICAL MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 53 YO ONE WEEK AGO PERI-UMBILICAL PAIN AND FEVER

HE WAS TREATED WITH ANTIBIOTIC, AND GOING WELL AFTER.

ULTRASOUND ABDOMEN DETECTED ONE MASS CYSTIC OF 7 CM,  OVOID, NO SEPTATION , LOCATED AT THE MIDDLE LINE FROM UMBILICUS TO PELVIS. PRESSING IT OVER HAD LITTLE PAIN, ONE SONOLOGIST SUSGESTED THAT PELVI-ABDOMINAL TUMOR, WITH  RAISING OF WBC.

PICTURE 01 US LONG SCAN, 02 and 03 CROSS-SECTION SCAN WITH CDI.

 

 

MSCT IS DONE WITH CE SHOWED THAT MASS IS SUSPECTED ABSCESS BUT DON’T KNOW ORIGIN.

PICTURE 04 CT AXIAL WITH CE, 05 FRONTAL, AND 06 SAGITTAL .

 

Blood test with WBC neutrophil raising suggested abscess, but its origin still unknown.
 

Operation laparo-endoscopy detected a big abscess from the tip of appendix, then removing abscess and drainage out.

A walled off abscess intraabdomen is quite often from appendicitis.

 

 

CASE 149: LIVER and ABDOMINAL WALL ABSCESSES, Dr PHAN THANH HẢI-Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

    
Female patient 59yo has got epigastric pain for 5 months.

Ultrasound detected an abscess of left lobe of liver and expanding to abdominal wall.

FNAC and abdominal wall biopsy proved non malignant cells.

Abscess treatment was done but clinical nothing changing.
MSCT and MRI confirmed liver abscess and abdominal wall lesion.

PCR of fluid of abdominal wall showed TB positive.

Conclusion: A case of abdominal wall and left hepatic abscesses due to TB without history of TB infection. Ultrasound, MSCT and MRI findings, and with FNAC and biopsy results  were of the same opinion of liver and abdominal abscesses, but only PCR proved the final clue of TB infection.

CASE 148: GALLBLADDER CANCER POST TRAUMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

ARTER TRAUMA, WOMAN 59 YO PAIN IN RIGHT COSTAL AREA .

ULTRASOUND ABDOMEN DETECTED ABNORMAL GALL BLADDER, BIGGER THAN NORMAL, AND NO BILE FLUID INSIDE.

( Fig 01 GB in  BLACK AND WHITE, Fig 02 in CDI, Fig 03 in DOPPLER SW, Fig 04 CROSS- SECTIONAL GB).

CDI SHOWED THE LUMEN OF GALLBLADDER MORE HYPERVACULAR LOOK LIKE
A-V MALFORMATION.

MSCT with CE,  hypervascular gallbladder is supplied by cystic artery, and the central portion of gallbladder is very high enhancement.

The GB returned vein is drained to hepatic vein.

Radiologist proposes a hemangioma for her gallbladder.

Gallbladder being removed, and microscopy says it cancer.

Discussion: Why the gallbladder cancer enhances like that (more central than peripheral part)?. 

CASE 147: LIVER TUMOR MIMICKING HEPATIC ABSCESS , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 35 YO, PAIN AT RIGHT SUBCOSTAL AREA, CLINICAL POSITIVE MURPHY'S SIGN.

ULTRASOUND DETECTED  A FOCAL LESION NEARBY GALLBLADDER, SIZE OF 4,9 CM, HYPOECHOIC  WITH CENTRAL WHITE SPOT, THEN SUSPECTED LIVER ABSCESS.

MSCT OF LIVER WITH CE ALSO SUGGESTED A LIVER ABSCESS.

Blood tests  showed that patient infected HBV with AFP L3  high risk.

Laparotomy was done for resection the liver tumor and gallbladder.

In macroscopy, it is an invasion to gallbladder of a very hard liver tumor.



MICROSCOPIC REPORT IS  LIVER CANCER .

 

 

 

BUT SOME QUESTIONS: IN THIS CASE, WHY   THE CENTRAL PART OF TUMOR  IS VERY HYPODENSE ON  CT  SCAN WHILE ITS  VERY  HYPERECHOIC ON  ULTRASOUND, AND IN COMPARISON TO THE MACROSCOPIC SPECIMEN,   AND WHAT IS THE REASON ?