CASE 222: LIVER MULTIPLE SPOTS due to COLON CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 31 yo  onset fever one month ago but not control by antibiotics. Pain in liver region.

Ultrasound  detected  some round spots  like  liver abscesses.(US  B mode, CDI, Elasto).

MRI  with  gado CE detected  also  many  round  spots,   same size of  2 cm, with central necrosis looked like metastasis.

Blood tests=   WBC rising of 20k with 85% neutro, negative sero amibe, normal CEA.

Colonoscopy for detection of primary cancer disclosed, at splenic angle of colon, infiltrated induration lesion which was suspected colon tumor .

 And biopsy with microscopic report was colon cancer.

Summary; this case is colon cancer metastases to liver.   

CASE 221:ELASTOSCANNING of FACIAL SKIN SPOT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

MAN 59 YO, 3 MONTHS AGO THE FACIAL SPOT GETTING GROWTH FASTLY  AND BLEEDING. THERE WERE 2 SPOTS ON RIGHT AND ANOTHER ONE ON LEFT SITE. [SEE IMAGE 1,2].

HIGH FREQUENCY ULTRASOUND WITH ELASTOSCAN SCANNING HAD  DEEP PENETRATION UNDERSKIN  AND HARDER PATTERN WHICH SUGGESTED BASAL CELL CARCINOMA INVASIVE. [ULTRASOUND IMAGES 1,2,3 BELONGED  LEFT SPOT, IMAGE 4 WAS RIGHT SPOT].

Biopsy the mass, microscopic report  is  BCC  (Basal cell carcinoma).

Discussion: Elastoscan map preop of  skin lesion  is  best evaluation for guiding of  biopsy and planning operation  .

REFERENCE:.Elastoscan of skin.

CASE 220:SMALL BOWEL G. I. S T.: Dr LÊ THANH LIÊM, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male 65 yo, occult blood stool  (+) in check-up,  then underwent  colonic endoscopy to confirm colon tumor, but only colonic polyp was detected.

Ultrasound pre endoscopy disclosed  a hypoechoic mass in LLQ, semilunar shape, with size of 28x25mm which  one part of contour was regularly round and another part close by lumen gas inside a loop of small bowel . There was vessels into this mass. 

The LLQ mass was thought to be a GIST of small bowel.

CEA rising of 5.38ng/mL

MSCT confirmed  the small bowel GIST later.

Surgery was done, macroscopic result was mural tumor of small bowel. 

Microscopy and immunohistostaining were proved for GIST tumor of small bowel.

CASE 219: RETROPERITONEAL TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN HỮU CHÍ, CHILDREN HOSPITAL 1 and MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Girl 6 yo, recurrent abdominal pain. Ultrasound detected one ovoid mass at the head of pancreas with size of 3x5cm, solid and well-bordered.

Image 1: this mass and IVC.

Image 2: CDI relation with right renal hilus.

Image 3: this mass expanding artery and renal vein.

Image 4:echo structure this mass is inhomogeneous, microcalcification and

hypovascular supplying.

MSCT  with CE: clear borders and  location of  this mass.

Blood tests were normal .

What is your suggestion based on  ultrasound and CT images?

PRE-OPERATION  THERE WERE  3  SUGGESTIONS OF DIAGNOSIS, AS  RETROPERITONEAL TUMOR, ADRENAL  GLAND TUMOR AND PANCREATIC TUMOR OF  PROCESSUS  UNCINATUS.

THIS CASE  WAS OPERATED REMOVING  THIS TUMOR EASILY.  IT  HAD APPEARANCE OF HEAD OF MEDUSA  (SEE  FOTO). THE STRUCTURE  INSIDE THE TUMOR WAS IN  RED COLOR  LIKED  BONE MARROW TISSUE.

MICROSCOPIC REPORT IS NEUROBLASTOMA.

CASE 218: LEFT SUPRACLAVICULAR MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 55 YO, LUMBAGO FOR 3 MONTHS.  MRI  SPINAL  SHOWED SOME  DESTRUCTIVE  SPINES SUSPECTING  METASTASIS  AND  A BIG  MASS  ON  LEFT  SUPRACLAVICULAR AREA.

ON ULTRASOUND  B MODE,  IT WAS A BILOBED MASS WHICH HAS DIFFERENT  ECHOSTRUCTURE . 

COLOR DOPPLER PRESENTED THIS HYPOVASCULAR MASS  LIKED SANDWICH SIGN.

ON ELASTOSCAN  ONE  PART OF THIS MAS WAS  SOFT  AND  ANOTHER ONE  WAS  HARD MASS.

WHERE DO YOU GUIDE  FOR  FNAC (HARD MASS OR  SOFT  MASS)?

WE DID PERFORM FNAC OF THIS SOFT MASS, REMOVING EASILY THE FLUID LIKED MILK;

FLUID ANALYSIS  : GRAM STAINING= NEGATIVE BACTERIA, BK NEGATIVE, BUT CELL BLOCK WAS ADENOCARCINOMA [SEE REPORT].

CASE 217: THYROID TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

WOMAN 41 YO, 5 YEARS AGO DETECTED SWOLLEN RIGHT SITE OF THE NECK.

ULTRASOUND DETECTED  A RIGHT LOBE OF THYROID, SOLID,  WELL- BORDERED, WITH SIZE OF 3 - 4 CM IN DIAMETER WHILE THE LEFT LOBE WAS ATROPHY. ON  COLOR DOPPLER  IT WAS NOT A  HYPERVASCULAR NODULE.

ELASTOSCAN WAS SOFT TUMOR.

NO CERVICAL LYMPH NODE DETECTABLE

BLOOD TESTS WERE NORMAL  VALUE OF TSH , T3, AND T4.

WHAT IS YOUR SUGGESTION,  FNAC OR NOT FOR THIS CASE.

Ultrasound guided for FNAC this mass and the result was colloidal goiter.

DISCUSSION:

B-mode ultrasound of thyroid is not full examination of the thyroid, only about the thyroid anatomy .Color Doppler explaines the vasculature, and ELASTOSCAN can guide for FNAC with high accuracy.

REFERENCE