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Friday, 12 May 2017

CASE 430: FACIAL EDEMA, Dr PHAN THANH HAI, Dr LE NGOC VINH [MEDIC CA MAU], MEDIC MEDICAL CENTER, HCMC, VIETNAM



Woman 33yo, from Ca mau province, with history onset one year ago, fever and some red macula appeared at abdominal skin that biopsy result of macula was lipoma. But it is not in stop of progress, a lot of red macula were getting more over 2 legs and upper arms to her right face.
In palpation, red macula is hot and induration (Photo1,2.3).




Ultrasound scanning of  her right face represents edema of subcutaneous fatty layer, no hypervascular.







CT scan of the face shows normal bone and subcutaneous edema of her right hemifacial side.





MRI also detected facial edema of subcutaneous fatty tissue (MRI 1,2).





Blood tests= pancytopenia, 
negative ANA test and anti-dsdna, very high ferritin >2,000, LDH =2,581 UI,  beta2 microglobulin=  3,701,  CRP = 64 ng/mL, c3 =122 (normal), c4=  66 (n: 15-450), kappa and lambda  not detectable.

Biopsy at  lesion in forearm, report with  immuno histo chemetry stainning is  subcutaneous panniculitis like T-cell lymphoma.




REFERENCE;


Wednesday, 10 May 2017

CASE 429: DOUBLE UTERUS, Dr PHAN THANH HẢI- Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 48yo, PARA 2002 , detected herself one prolapsed mass from her vagina 1 year ago, no pain, no fever but with SUI [ stress urine incontinence] syndrome.


Ultrasound of pelvis by the transcutaneous: (US1) uterus normal size,




by via TVS ( US2, US 3) detected one mass at lateral left uterus, hypoechoic, size 7 cm look-liked second uterus.





CT scan of pelvis:  CT 1 : this mass at left site uterus, hypodense like fatty tissue.


CT2, CT3 the mass is anterior the urinary bladder.



 MRI 1, MRI 2 in sagittal section, this tumor is like a second uterus.



OPERATION  REMOVE  THIS TUMOR..BY LAPAROTOMY..
( OP. IMAGES:THIS TUMOR  IS  NOT  FROM UTERUS)





MICROSCOPY IS FIBRO-LIPOMA  

Saturday, 15 April 2017

CASE 428: BUTTOCK TUMOR ASPS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


8yo female child detected one mass at left buttock that was in slow growth for 3 month and getting  pain now.
Ultrasound of this mass which is  located at gluteus medius muscle of left buttock.


US 1: Hypoechoic mass, size of 5 cm, well bordered.


US 2 : CDI, hypervascular color mapping looked like a ring.



US 3: PWD, RI low of  the artery supply.

MRI  with gado of the mass.




MRI 1, MRI 2, MRI 3 of  this mass  showed  erosion of the iliac bone  and  MRI 4 revealed a small mass intraspinal canal.



Open biopsy of  this tumor with  the specimen  looked like  brain tissue and microscopic result is ASPS  (alveolar soft part sarcoma).



REFERENCE: CASE REPORT.


Monday, 10 April 2017

CASE 427 : POLYCYTIC BREAST, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM


   












  
Woman 27 yo  with history of the left polycystic  breast detecting by herself since April 2016 .
 FNAC reported  nothing  abnormal detected, and she went to Medic for 3 times [each in 3 months]
 with the same result of polycystic left breast without tumor.


















 But now she got pain at left breast and decided to reexamination.

Ultrasound of the left breast in the 4th examnination showed many small simple cysts but one   of them  is biggest
 with  size of 3x 4 cm.  At later time, the biggest cyst with thin wall but  having one   hypervascular 
vegetation mass, size #1.5 cm.



   














 US 1:Big cyst with  fine septation.



   











US 2 :  Small simple cyst.



   














US 3: Intracystic mass.



  












 US  4: CDI  hypervascular mass.


Strain elastography of intracystic mass showed a stiff area (mixed pattern)
which was corresponded with a score of 2 (Tsukuba score).















FNAC again with no abnormal cell,  only red blood cells.




   
Liquide analysis: no  abnormal  of markers  CEA, CA 125, CA 15-3.

  ABVS ( AUTOMATIC  BREAST  VOLUME  SCANNING) shows the  intracystic tumor
  by 3D VIEW.















  Operation for removing this big cyst (see macro).



  












Microscopic report is  benign cyst with  intracystic papilloma.


 

Thursday, 6 April 2017

CASE 426: MULTIPLE TUBERCULOSIS ABSCESSES, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


https://mail.google.com/mail/u/0/images/cleardot.gif
Male 26yo with umbilicus swelling and pain.
Abdominal ultrasound   detected  abscess of umbilicus  ( US 1, US 2), liver abcess and  left pleural  abscess.





MSCT  confirmed  abscess  of  left pleural, liver and umbilicus.




Blood tests:   WBC 12k, CRP  normal.



Punction of the umbilicus abscess  withdrawed  white thick pus, high ADA test :104 UI/mL
Conclusion: it is multiple abscesses due to tuberculosis.

Reference: ADA.pdf