CASE 387: LIVER ABSCESS DUE TO FISHBONE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 52 yo with pain  in liver and history of treating  liver abscess by ultrasound  guided puncture and drainage for 1 month..

Ultrasound  scanning with linear probe=

 US 1:detecting  liver  abscess  in recovery phase with one  echo rich foreign body  came from duodenum. in the boder of liver.

US 2: CDI  no change of  vascular structure of liver.

US 3 : elastoscan  showed  this body having  very red code whicn means very hard.

CT liver  scanning  also detected  foreign body ( fb) intra liver and one site was intra duodenum wall.

Emergency  endoscopy  cannot detect  this fb.

Laparoscopy  removed the fish bone  with length of3.5 cm  (photo).

Conclusion: liver abscess  due to  fishbone  migrated from duodenum to liver.
Reference:

Fish Bone Penetration of the Duodenum: A Rare Cause of Liver Abscess

Fishbone_ Liver Abscess 

CASE 386: ADRENAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 44yo  high blood pressure. Ultrasound  screening of kidney detected one mass with size of  12 cm at upper pole of right kidney which was well bordered  and hyperechoic ( see  US 1)

US  2 and  US 3=  CDI  findings of  normal vascular kidney.

CT scan  with CE=  this mass is well bordered,  below liver  and pushed righ kidney down.

MRI  detected this mass more fatty structure  and  suggested that was a myelolipoma of right adrenal gland.

Blood tests detected nothing abnormal.

Do you make a diagnosis  of  myelolipoma for  adrenal gland?

OPERATION REMOVED  A ROUND TUMOR ( SEE MACRO).

Microscopic report   of this tumor is Myelolipoma  of adrenal gland.

REFERENCE

http://downloads.hindawi.com/journals/criu/2013/789481.pdf

CASE 385: PLANTAR, PALMAR KERATOSIS= HOWEL- EVANS SYNDROME, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 61 yo consulted  by  right and left plantar pain. He says  it happened more one year ago with skin in foot and hand  thickening (photo). 

Now he has got progressive dysphagia for one month.

Ultrasound at his neck detected  dilatation of cervical esophagus (US 1) and  one mass  intra  esophagus at  longitudinal scanning (US 2).  

Ultrasound suggestion is  tumor of cervical esophagus.

MSCT  with  oral contrast [CT 1, CT 2, CT 3] : cervical esophagus is  thickening of the wall by tumor  covered the lumen.

Endoscopy detected  exotic tumor intra esophagus lumen (endoscopic foto)  and  biosy is done.

Microscopic report is SCC (squamous cell carcinoma).

Do you see  another  case  having  relation  between  palma-plantar  keratosis and esophagus cancer ?

UPDATE= HOWEL-EVANS SYNDROME.

CASE 384 : NEONATE PERINEUM TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Neonate female 02 day-old   detected  one mass  in perineum, size of 10cm, soft in palpation [see 2 fotos].

Ultrasound  scanning of  this mass=  US1: structure of this mass is cystic  septation  with solid part.

US 2 : vessels in septation.

US 3 :sacrum and  the mass.

Sonologist  suggestion is  cystic lymphangioma.

MRI  report  is   fatty  content, cystic part  not connected to spinal  canal. 

Radiologist  suggestion is  sacro-coccygeal teratoma.

Operation  removed  this mass with  solid structure and cystic part [see foto].

Report by surgeon is  mature  sacro coccygeal teratoma type 1.

MICROSCOPIC REPORT   IS MATURE  TERATOMA.

CASE 383: SKIN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 31 yo  with history of 2 weeks ago, onset at the left hand, itchying skin and induration then  color skin changed  from red to  brown with many  erupted nodules  on the skin, and  stopped  at the left shoulder  [see  foto1, 2, 3, and foto 4( bleedding  under nail of finger 4,and 5).

No fever but easy bleedding from this nodule.

Ultrasound  of this nodule showed  from subcutaneous, echo  poor ( US 1)

CDI US  2, US 4: blood supply  this nodule is from the deep vessel, hypervascular liked a ring.

Blood test is no  changing of   WBC, and HIV  negative.

What is your  suggestion for  diagnosing this case ? 

One  dermatologist  suggested it is Sarcoidosis. Comparing with  picture atlas.

Update case 383 : Biopsy report is sarcoma of Kaposi.

   Skin sarcoma Kaposi
Ref   Eponym of Dr Kaposi and virus HHV8

CASE 382 :LIPOSARCOMA METASTASIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman  29 yo,  2 years before  had been removed   right leg tumor  but did not to know what kind of this was, no pathology  report but now she  feels shortness breathing.

MSCT of total body  detected  many masses  in  mediastinum, left breast, retroperitoneal  abdomen and right buttock (See  CT scanning).

Ultrasound scanning for  verifying this mass (US1); 

US 2:In epigastrum

US 3: retroperitoneum mass displaced left kidney,  

US 4:  mass in left breast, 

US 5:  mass in right  buttock.

Biopsy of the mass in right buttock  is  liposarcoma.

Conclusion:  Multiple sites in the body of liposarcoma metastasis .

REFERENCE: