CASE 513: KIDNEY TUMOR MIMICKING DROMEDARY HUMP, Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 41 yo with  righ kidney was detected abnormally  looked like dromedary  hump in general check up

Ultrasound  CDI:  US 1=  crossed section,  hypovascular pattern mass.

US 2=  longitudinal scan,  this mass liked a hump.

US 3 = elastoUS   inhomogeneous mass.

MSCT with CE, fast enhanced  contrast mass in CT 1, CT2.

MRI  with gado  shows  exophytic mass of the kidney border  (MRI 1, MRI 2).

MRI 3,4 : cystic structure  and bleeding inside.

Radiologis report is cystic tumor of righ kidney, BOSNIAK type 3 

Operation with  robot   removed  tumor in partial nephrectomy.

Operation of  this tumor  at righ kidney looked like  the seal.

 Specimen is cystic  septation,

Microspopic report is RCC.

Reference. Bosniak criteria.

CASE 512: TESTICULAR TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 43 yo  detected left testis swollen slowly.

Ultrasound  of scrotum  finds out  left  testis too big # 4 cm x 5 cm,   solid  hypoechoic looked like a hypovascular cyst.   

US 1=  crossed section,   hypoechoic in  comparison to right testis.

US 2 = hypovascular tumor

US 3 = elastoUS,  solid tumor # 25 kPa.  

MSCT with CE   this tumor is  quick CE enhanced with calcification.

CT 1 :  frontal view

CT 2 : sagittal view

CT 3:  sagittal view of left testis tumor

Blood tests=  beta HCG , AFP = normal levels; LDH=  is 313 (n :246)

Based on clinical , ultrasound, ACD, CT  diagnostic pre op is seminoma.

Operation  removed  tumor (see macro).

Microscopic result  is  seminoma.

DISCUSSION: Why does the testis tumor being hypoechoic looked like a cyst? 

REFERENCE:

CASE 511: LUNG CANCER,Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 60 yo with pain at left  lung after trauma. Chest x-rays detected rupture of 2 ribs

and  one mass at left lung ( see chest x-rays).

CT of  chest with CE

CT 1=   frontal view    

CT 2=  crossed section  

CT 3 = sagittal view

CT 4 with CE= very high CE enhancement.

Ultrasound at left lung  detected a tumor in invasion of the chest wall  (US1)   

US  2 = Color Doppler  shows  vascular supply to tumor   

Blood tests rised:  Cyfra 21-1= 6.02 ( N=  3.3);   CEA=  7.13  ( N= 5).

Biopsy result with CT guided is 
adenocarcinoma of the lung.

Staging of this case  with  MSCT total body detected metastasis of the brain.

Conclusion:    Lung cancer detected accidentally by trauma, stage 4.

CASE 510: MITTELSCHMERZ SYNDROME, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 27 yo with  hypogastric pain. Ultrasound in emergency detected bleeding intra abdomen.

US 0=  fluid under liver area in  Morrison’s space.

US 1  = sagittal scanning at pelvis,  thickening of endometrium  and an amount of blood around pelvis.

US 2 =  transverse section at pelvis, right ovary too big  in comparison  to left one.

US 3 =  sagittal  mass at right  ovary.

Emergency blood test report  Hct 20%;  Hb 10 g/L; beta HCG  negative.

MRI 1 of abdomen detected  one mass at right  ovary.

MRI 2=  sagittal scanning of pelvis, retrouterus bleeding.

MRI 3=  frontal view of  right/left ovaries,  bleeding from right ovary.

Diagnosis is  bleeding from right ovary in Mittelschmerz syndrome.

Operation  removed 1000 ml blood clot  and right ovarian  rupture (photo) .

Mittelschmerz (German: "middle pain") is a medical term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently.

CASE 509: PANCREAS TUMOR, Dr PHAN THANH HẢI, Dr NGO VIET THI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman  25 yo with history of  epigastric pain and  jaundice slowly for one month.

Ultrasound of liver:   big liver  with dilatation of the biliary system.  

US 1=  CBD  is in dilatation  # 2cm.

US 2 =  tumor from the head of pancreas and in extension to CBD.

US 3 =  head of pancreas tumor.

Ultrasound makes diagnostic that  pancreas head tumor moves to CBD.

MSCT  with CE  diagnoses again  pancreas head tumor.

CT 1 :  tumor looks like cystic pattern.

CT 2 : contrast enhancement in delay phase due to intratumoral bleeding.

CT 3 : vascular supply for this tumor.

CT  report by radiologist is pancreas tumor in invasion to CBD.  

Blood tests  =   CA19-9 = 4.96;  CEA= 0.56;   AFP=  0.3  

Summary of this case =  Young woman 25 yo has got  tumor of head pancreas in invasion to CBD.

Operation of Whipple is done.

MICROSCOPIC REPORT IT IS  SOLID PSEUDO PAPILLARY TUMOR  IT IS BENIGN  TUMOR OF PANCREAS 
 KNOWN AS   FRANKZ TUMOR.

COMMENT :  IN THIS CASE,  BLOOD TESTS CEA AND CA19-9 ARE NORMAL, THAT ARE  SAME IN REPORT  IN  REFERENCE CASE REPORT  BY WJG   2005.

REFERENCE =