CASE 472: INCIDENTAL BREAST TUMOR , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 58YO   FOR SCREENING  TO DO WHOLE BODY MSCT. 

RADIOLOGIST REPORTED ONE MASS AT  RIGHT  BREAST  SIZE# 1.3 CM.(  CT1  FRONTAL VIEW, CT2  AXILLARY AREA).

ULTRASOUND POST CT VERIFIED THIS MASS  WITH  SIZE  # 2 CM   VERY STRONG  SHADOWING, AND HYPERVASCULAR.

US1,  US2  ELASTO  IS  31.9 kPa .

US3 , AXILLARY NODE    SIZE 1.5CM WITH HILUS 

US4 ,  CDI  = VASCULAR  HILUS DEFORMATION.

CORE BIOPSY  RESULT IS  BREAST CANCER, STAGE T2 N2.

OPERATION  for MASTECTOMY AND   AXILLARY   LYMPHADENECTOMY. SPECIMEN  TUMOR IS SMALL SCLEROSIS   MANY LYMPH NODES.

POST OP  HISTOLOGY REPORTED   THIS CANCER  METASTATIZES TO AXILLARY LYMPH NODES.

REFERENCE:

CASE 471: MESENTERIC LYMPHOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 70yo  with  epigastric pain. Ultrasound of abdomen detected  one hypoechoic mass like a cyst # 4.9cm near SMA.

US 1=   longitudinal scan at epigastric area.

US 2 = CDI:   this mass  is near SMA.

US  3 = crossed scanning= this mass  is placed over the head of pancreas in relation  with  celiac artery and vein.

US 4=  some  small lymph nodes near the big anesthetic mass.

MSCT CE=

CT  1 : crossed section  this mass  over the artery and vein.

CT 2:  the pancreas is normal.

   

CT 3:  frontal section of this intramesenteric mass near  SMA and vein   with some  lymph nodes in mesentery.

Endoscopy gastric and colon are normal, blood test and all cancer markers are normal 

Laparotomy for  biopsy= many nodes in mesentery.

Microscopic with histobiochemistry  is  follicular B CELL LYMPHOMA.

SUMMARY :  MANY LYMPH NODES IN MESENTERY  WITH TYPICAL APPEARANCE HYPOECHOIC PATTERN LOOKED LIKE A CYST,THE MOST COMMON IS LYMPHOMA.

Reference :    MEDIC ULTRASOUND case 452 : Castleman disease.

CASE 470: TROISIER-VIRCHOW NODES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 70 YO  COUGH . NO FEVER. CHEST CT   DETECTION  IS LEFT LUNG  LESION  WITH WIDERING OF MEDIASTINUM.
(CT1/ CT2:   SUPRA LEFT CLAVICULAR  MASS SUSPECTED LYMPH NODES.

ULTRASOUND  of SUPRA LEFT CLAVICULAR  AREA IS  MULTIPLE LYMPH NODES.

US1=LYMPH NODES ROUND 2CM, LOSS HILUS, HYPOECHOIC,  HYPOVASCULAR.

US 2 =THE VASCULAR SUPPLY IS  INTER-NODES  LIKE A RING.

US 3= ELASTOSCAN of THIS NODES WITH CENTRAL 23 kPa.

ULTRASOUND EXAMINATION REPORT IS METASTASIS  LYMPH NODES   THAT WERE TROISIER-VIRCHOW NODES.

WAIT FOR  BIOPSY.
MICROPATHOLOGY REPORT WITH  IMMUNOHISTOCHEMISTRY  IS   NEURO ENDOCRINO-

CARCINOMA METASTASIS TO  TROISIER -VIRCHOW NODE.

REFERENCE :  ANATOMY TROISIER NODE

                         PICTURE OF  DR TROISIER --PROF VIRCHOW.

CASE 469: T CELL LYMPHOMA OF SUBMANDIBULAR NODES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC

Man 30 yo, detected 3 months ago submandibular nodules, subcutaneous neck , no fever.

Ultrasound of the neck

US 1: normal thyroid , and subcutaneous nodule is round, black like a cyst .

US 2:  Lymph nodes have the hilus.

US 3:  CDI  Hypervascular with the vascular tree.

  

US 4: MP4  VIDEO

US 5:  PW DOPPLER  RI  0.56,  PSV  46cm/S 

US 6:  ELASTOSCAN  = 2 kPa

Clinical suspected  lymph node lymphoma.

Blood test   EBV IgG positive   118.5 UI/mL,  IgM  negative.

BETAMICROGLOBULINE IN BLOOD TEST IS  LOWER  = 1412   (  NORMAL CUT- OFF=  2164)    

HISTOBIOCHEMYSTRY  REPORT  IS  T-CELL LYMPHOMA

DISCUSSION= THE  NODULE IS LYMPH NODE  HAVING HILUS  AND  HYPOECHOIC  LIKE CYST ;  ELASTOSCAN IS VERY SOFT = 2 kPa   LOOKED LIKE LYMPHOMA.

Structure of lymph node.

CASE 468: ADRENAL GLAND TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN PHỨƠC TÒAN, Dr VĨNH TUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 26yo,  ultrasound of abdomen for screening  incidentally detected  one mass of 5 cm at the right adrenal gland area.

US1= longitudinal scanning of  this tumor at upper area of right kidney, well bordered.

  

US2=  CDI of  this mass pulled down right kidney.

US3=  crossed section  of this mass is well bordered  under liver near IVC.

US4=  very  small vascular signals  in mass.

• US5=   elastoscanning of this mass: very hard  32 kPa in comparison to  liver = 9.3 kPa.

Sonologist reported solid adrenal tumor for this mass.

MSCT revealed:

CT 1= this mass is  hypodense like a cyst.

MSCT with CE, CT 2=  this mass is very low enhancement.

CT 3=  crossed section and sagittal scanning like a cyst of adrenal tumor.

Blood tests :  no abnornal  of cortico-medullary  adrenal function.

Pre-op   suggestion of surgeon is cyst of adrenal gland.

OPERATION REMOVED THIS TUMOR COMPLETLY.  MACROSCOPIC SPECIMEN WAS  WHITE AND HARD STRUCTURE, SECTION SURFACE SWELLED UP.

MICROSPIC REPORT IS  PARAGANGLION NEUROMA, BENIGN TUMOR.

REFERENCE:

https://journals.viamedica.pl/endokrynologia_polska/article/view/EP.2014.0017/32252