CASE 485: CONGENITAL RENAL LYMPHANGIOMATOSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female patient 15 yo with  pain at lumbar region.

Ultrasound and CT detected  perirenalcystic  collection, kidney deplacement no stone no hydronephrosis. CT  urology with CE: no leaking of contrast to fluid,  but urologist suspected  urinoma  ( CT 1, CT 2,  crossed section , CT3  frontal section, CT 4  2 kidneys  deplacement, CT 5 urinary system).

Puncture of this fluid  analysis is not urine,  like  lymphatic fluid.

Operation at right kidney  with argon laser for ablation of right renal capsule, and the left kidney was removed perirenal capsule.

Ultrasound of 2 kidneys shows  normal structure with vascular supply  (US 1, US 2, US 3, US 4  ascites).

And  MRI   after 3 months of  operation=The right kid has  many perirenal cysts,    and  left  kid  has fluid  collection arround without hydronephrosis ( MRI 1, MRI 2)​​.

Conclusion:   this case  is a congenital renal lymphangiomatosis case.

REFERENCE:

CASE 484: SPLEEN TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN PHÚ HỮU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 59yo with history of  trauma  at the right lung 10 years ago; today  getting pain at right costal area. Chest X-rays detected an old fracture of one rib with changing  costo-diaphragmatic sinus (chest film).

Ultrasound of abdomen detected a liver hemangioma and a big tumor of spleen ( US 1:  liver with hemangioma),  US 2:   round tumor in the pleen, size 9.26cm. US 3:   vascular supply of this tumor.

MRI  with gado  = MRI 1: liver tumor  as a hemangioma and  spleen tumor; MRI 2, MRI 3.  

Blood tests and cancer markers are negative.

Operation  removed the big spleen;   see  macro  looks like hemangioma.

MICROSCOPIC REPORT IS  CAVERNEOUS HEMANGIOMA.

REFERENCE:

CASE 483: UTERINE GIANT MYOMA, Dr PHAN THANH HẢI, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 47yo  still has mense with the big growth of abdomen (photo).

US scanning  detected  a solid tumor cover over abdominal cavity ( US 1, US 2  US 3  longitudinal scanning over aorta),  US 4 : elastoscanning of tumor structure is hard and  inhomogeneous.

CT scan with CE of this mass is enhanced CE slowly: CT1, CT 2  sagittal view of  the tumor and uterus, CT 3: tumor near right kidney.

MRI  with gado= MRI 1:  crossed section, necrotic cystic formation of tumor structure. MRI 2 : longitudinal scan, MRI 3:  frontal view.

Preoperative diagnosis is big uterine myoma.

Macroscopic  photo of this tumor.

Hysterectomy was done.
Microscopic report is  leiomyoma.

REFERENCE= case pdf.

CASE 482 : SPLENOSIS, Dr PHAN THANH HẢI- Dr TRẦN CÔNG DUY LONG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 38yo with  abdominal pain  like gastritis. Clinical detected arterial hypertension.

In past history he had been in an urgent operation of rupture of spleen by trauma for 10 years ( photo).

Ultrasound  detected  one  mass at border of right liver near upper pole of right kidney  and  sonologist suspected an adrenal gland tumor  ( US 1, US 2 CDI , US 3  view with linear probe).

MSCT of  abdomen=   CT 1:crossed section of  tumor  at border of liver, 

CT 2 with CE  is  low enhanced  tissue.

After being treated in stable blood pressure, a laparotomy removed  big tumor at liver border in retroperitoneum  and  some intra abdomen small nodules.

Microscopic report is normal tissue of spleen.

It is  splenosis  due to rupture of the spleen 10 years before.   

DISCUSSION:
For this case  ULTRASOUND, CT, MRI  CANNOT  DIAGNOSE  SPLENOSIS.

With BLOOD TEST of WAKO NEGATIF  and HISTORY  of SPLENECTOMY, SUGGESTION pre-op IS SPLENOSIS.( MRI  WITH GADO  ALSO CANNOT  DIAGNOSE THIS CASE).

REFERENCE:

1-Thoracic splenosis  dr Nguyen quy Khoang

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