CASE 241: SEMINAL TUBERCULOSIS : Dr NGUYỄN MINH THIỀN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCM C,VIETNAM

Man  51 yo, one month ago suffered from lowgrade  fever and dysuria. Chest Xray was in suspection of  lung tuberculosis.

Abdomen ultrasound  detected  many  lymph nodes around  aorta ( 2 ultrasound pictures) scanning  at level  of pancreas  (cros-sectional and longitudinal scan).

Ultrasound at pelvis detected one hypoechoic mass of right seminal vesicle, no vascular structure intra this mass.

MSCT also detected one mass on right site of prostate, suspected  abscess (2 CT pictures).

TRUS guided puncture this mass withdrew out the pus in white color  looked like caseum. Analysis this pus was  positive PCR tuberculosis.

 
Conclusion of this case :  tuberculosis of the lung, lymph nodes, and  seminal  vesicular mass.  Medical treatment  of antituberculosis drugs was setting up for the patient.

REFERENCES:

CASE 240: ADRENAL GLAND TUMOR SECRETING ALDOSTERONE, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female patient 22 yo from Daklak province, student. Arterial hypertension for 1 year and weknesss of 4 limbs in effort and remaining normal in rest.

Abdominal ultrasound detected  right adrenal mass of 21x28x24mm, well bordered which was thougt to be an adrenal tumor.

MDCT confirmed an adrenal tumor on right side.

Blood tests:  Kalemia =1.77mmol/l ( N= 3,5-5), Aldosterone  = 380pg/ml ( N= 10-210).

Operation was done and microscopic report was a benign adrenal tumor.

 

 

REFERENCES:

http://en.wikipedia.org/wiki/Primary_aldosteronism

http://www.studyblue.com/notes/note/n/en1-03-adrenal-glands-1/deck/1600308

CASE 239: COLON TUMOR and WALLED-OFF ABSCESS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  dob 1951,  too painful  in left  flank with  digestive trouble  in  defecation.

Ultrasound  first  detected  a hypoechoic  mass   along   left  flank with  pseudocervix sign. Sonologist   suggested that  descending colon tumor and  peritumoral  abscess ( see 3  ultrasound pictures).

MSCT  with CE   diagnoses this mass  being  colon tumor  subocclusion and  abscess   arround tumor ( see CT  pictures).

Colo-endoscopy  detected  lumen stenosis of   descending tumor, but  reports  of biopsy  2 times   all   were free of cancer cell.

Blood tests=   WBC  not  rising , CEA, CA 19-9  were negative.

Open operation was done in  detecting  big mass  due to colon cancer  invading to around  structures,   .. making   the wall-off mass ( see  foto).

Microscopic report was colon cancer.

REFERENCE:

CASE 238: HBV PATIENT with 2 SIDE KIDNEY TUMORS, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

  Male patient 34yo from  Binh duong province in follow-up  from HBV infection since 2006. He had got 2 kidney cysts and nothing abnormal, but now B-mode ultrasound detected kidney tumors on his 2  sides. Both 2 kidney tumors hyperechoic, homogenous seem to be looked like AML tumor. But they were different on color Doppler, hypervascular, with venous and arterial patterns, maybe oncocytoma or RCC (renal cell carcinoma).

On 3 D ultrasound reconstruction  the left kidney tumor more clear than on B-mode ultrasound.
And elastographic ultrasound (ARFI) proved tumors  more hard than kidney parenchyma.

 

CT proved 2 kidney tumors on 2 sides of one patient.

 

 

He underwent 2 operations for removing 2 kidney tumors, on left side first, partial nephrectomy, with microscopic result of papillary RCC, and right one, total nephrectomy for pRCC again after half of month.

 

pRCC is a unusual kidney tumor, mimicking AML on B-mode ultrasound so we should  use color Doppler to examine kidney tumors.

REFERENCE:

CASE 237: HORSESHOE TUMOR, Dr PHAN THANH HẢI - Dr NGUYỄN TUẤN VINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 57 yo, diabetes and  gallbladder stone. He's got Murphy's pain.
Abdominal CT with CE detected the  horseshoe kidney with tumor of 3cm.( Fig.CT 1).

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Ultrasound  for  evaluation of this tumor  was hypoechoic, at the  left part of  horseshoe kidney and hypovascular( Fig. US 1, US 2).

MSCT 640 slices performed with CE again for staging  of this tumor (see 4 CT pictures).

One urologist  said no biopsy.
Operation  for  removing left part of  horseshoe kidney.

Macroscopic appearance of  tumor  is well-bordered into parenchyma of kidney.  Microscopic report is clear cell carcinoma.

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CASE 236: LYMPHOMA MIMICKING PANCREATIC TUMOR and METASTASIZING LYMPH NODES in ABDOMEN and NECK, Dr LÊ THANH LIÊM - Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

        58yo  male patient, slight fever  and  fatigue for 6 months, a lymph node on right neck getting bigger.  

           Lymph node at supraclavicular area was hypervascular and looked-like a cyst on color Doppler ultrasound. 

      Ultrasound  of abdomen detected epigastric tumor between left lobe of liver and pancreas, hypervascular and celiac vessels penetrating the tumor. Some nodes were  around the tumor, and body of pancreas not well-bordered. 

     Ultrasonologist thought about lymphoma infiltrating in abdominal cavity and neck,  but keepng a different diagnosis with pancreatic tumor metastasizing abdominal and neck lymph nodes.

       MSCT confirmed lymph nodes lymphoma in abdomen and no pancreas tumor but lower density of the body.

     FNAC of neck lymph node and the result was big B cell lymphoma. So this is another case of big B cell lymphoma with the evident of neck FNAC result.

CASE 235: PERIAORTIC MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

Man 63 yo,  medium arterial hypertension with umbilical battement with the heart beat.

Ultrasound of abdomen detected  kidney on 2 sides  in hydronephrosis due to ureteral compression by the mass covering arround the abdominal aorta. Of which structure was echo-poor looked like a cyst. The aorta was pull up near the umbilicus (see 5 ultrasound pictures ).

MSCT with CE (4 CT pictures); CT 1..kidney hydronephrosis, CT 2, CT 3, CT 4 .. intratumor abdominal aorta.

Blood tests were normal WBC, PSA, CEA, with beta MICROGLOBULIN was 2298ng/ml (N <2164

Urologist  suggestion was retroaortic lymphoma and he put 2 jj stent intra ureter and operation for biopsy this mass.

Open operation detected this mass being fixed and covering aorta and compressing completely causing collaped  IVC.( see foto per op.1 and 2..right ureter with jj stent inside).

Pathology report was big B cell lymphoma.

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