CASE 394: COLON TUBERCULOSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 43 yo with epigastric pain  crisis and  gastroendoscopy showed  gastritis.

Ultrasound  detected  one mass  like target  with  thickening of the  wall of colon (see  US 1=csoss-section  colon over  right kidney);   US  2  with linear  probe= colon wall is thickening; US 3, US 4 =  longitudinal scan).

MSCT of abdomen with CE revealed  thickening of  ascending colon wall  (CT1,  CT2).

Chest X-rays  before endoscopy  detected  infiltration of  left upper lung.

Colonoscopy reported the mass in right colon, nodular ( see foto) biopsy. 

Report of endoscopist is colon cancer.
Microscopic report  is colon tuberculosis.

Conclusion = this  case  represented colicky pain at epigastric region but  ultrasound and CT  suggested  colon cancer, same as colonoscopy, but  microscopic is tuberculosis.of colon and left lung.

REFERENCE:

CASE 393: SPLEEN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 26 yo with no clinical symptom. Ultrasound screening detected a spleen mass

US 1= longitudinal scan of this mass size of 6.0cm at lower pole of spleen, hypoechoic, well bordered.

US 2=cross-sectional view of mass.

US 3=CDI of this mass with vascular bending sign and, ( US 4) structure inside hypervascular.

Blood tests are normal.

CT with CE:CT 1 non CE , CT2 CE, delay phase with central mass lower perfusion.

MRI with gado: this tumor is well bordered, peripheral enhanced and central hypoperfusion at the late phase.

LAPAROSCOPY  FOR  SPLENECTOMY  . SURGEON REPORTED  THIS TUMOR IS INTRA SPLEEN AND ITS COLOR  LOOKS LIKE SPLEEN TISSUE ( SEE  SPECIMEN).HE SAID IT MAY BE  HEMANGIOMA.

MICROSCOPIC REPORT  IS CAVERNEOUS HEMANGIOMA.

CASE 392: PERFORATED SEAL-OFF DUODENUM, Dr LÊ TỰ PHÚC-Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM.

"A 37-year-old male presented in our hospital with moderate epigastric pain for three months. Around one week before examination, the pain became more severe, but he didn’t recognize a suddenly pain. Clinical examination revealed no muscle guarding and rebound tenderness.

Abdominal ultrasound images showed unconcentric wall thickening of the gallbladder. Beside the more thickening wall of gallbladder, a hyperechoic of air collection was found. This air collection was continuous with small hyperechoic air spots inside duodenum. A perforated duodenal ulcer with air leakage was suspected.

CT-Scan confirmed air collection beside a thickening gallbladder wall.

Blood test indicated and raised of white blood cells (10,350 / mL) with low level of CRP (0.9 mg/L) and possitive Helicobacter Pylori test.

Without surgery, the patient pain released and the air collection was disappear in ultrasound and CT-Scan images for one month follow-up. Gastroduodenal endoscopy showed a healing ulcer in the anterial wall of duodenum. White blood cell count returned to normal."

This is a case of perforated seal-off duodenum revealed by ultrasound and confirmed by CT-scan later and successfully management without surgery.

CASE 391: DOUBLE BREAST TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 53 yo, for one month  detected  her breast distention both 2 sites and  pain. In clinical examination 2 breast are hot and hard.

Ultrasound  (US 1), right breast had some echo poor focal lesions, 2-3 cm, non compressible.

US 2: same  structure at the left  breast.

US 3=

US 4: color Doppler  hypovascular.

Mammo Xray  =  very dense breast (MM1, 2).

MRI with gado=  breast are filling by  hyperintense mass  with gado enhancement.

Bood tests= WBC  normal, beta microglobuline raised 2,200 UI (n=2,100 UI)

Biopsy was done  by core biopsy  and  IHC staining  report is  lymphoma large B cell.

Conclusion= Lymphoma is most common appearance of  2 breast simultaneous infiltration.

REFERENCE

DOWNLOAD PRIMARY BREAST LYMPHOMA

CASE 390: PEDUNCULATED HCC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 56 YO REPORTED  HIS RUQ  SWOLLEN  SLOWLY FOR  6 MONTHS , NO DISTURB GI TRACK IN DIGESTION.

ULTRASOUND ABDOMEN:

US 1:ECHOGENEICITY OF LIVER  AND TUMOR  NEARBY  ARE DIFFERENT.

US 2:LONGITUDINAL SCAN,TUMOR AND LIVER BORDER ARE NOT CLEAR.

US 3: STRUCTURE OF THIS TUMOR IS SOLID, HYPOVASCULAR.

US 4: CROSS SECTION, TUMOR IS INTRA ABDOMEN, AT RIGHT  SITE OF AORTA.

MSCT WITH CE:

CT 1( 4 PICTURES): SAGITTAL VIEW, FRONTAL VIEW ,  CROSS-SECTION SHOWED VASCULAR SUPPLY OF THIS TUMOR IS FROM LIVER.

CT1:TUMOR IS  RELATED WITH  R/LIVER,   PEDUNCULATED, VASCULAR SUPPLY FROM LIVER.

CT2:MULTINODULAR, CONTRAST ENHANCE IS  IN BORDER OF TUMOR.

LAB BLOOD TESTS  =  HBV POSITIVE, AFP=651.8 ng/mL.

Operation  laparotomy  detected huge tumor connected with right liver border by
small area.

Microscopic report  is  undiffentiated  HCC 

( P-HCC; PEDUNCULATED HCC or  HANGING HCC..)

SUMMARY=   PRE OP IS SUSPECTED HCC, BUT IT  HAD PEDUNCLE  COME FROM RIGHT LIVER. LAPAROTOMY REMOVED BIG TUMOR  FROM THE RIGHT  LIVER.

REFERENCE:

PEDUNCULATED HCC