CASE 517: HCC WITH LOW AFP, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 52 YO with HBV INFECTED and   EPIGATRIC PAIN.   

ULTRASOUND CHECK UP DETECTED  LEFT LIVER TUMOR, SIZE 3.5 CM   HYPOECHOIC (US1,US2  )   BLOOD TETS: HBsAg POSITIVE, AFP 15ng/mL.

CT SCAN LIVER =  CT 1  NON CE , CT2, CT3   TRIPHASES CE , CT4 FRONTAL VIEW , CT5  SAGITTAL VIEW.

RADIOLOGIST REPORT IS  HCC.

MRI PRIMOVIST = MRI 1 DWI ,  MRI 2  T1, MRI 3 GADO INPUT,   MRI 4 GADO OUT,   MRI 5  FRONTAL VIEW.

BLOOD TEST AGAIN=  WAKO TEST  AFP-L3  RISING 16.4 %.

SUMMARY=  MAN 52 YO HBV INFECTED
WITH AFP NEGATIVE   BUT ULTRASOUND DETECTED TUMOR AND CT CE , MRI GADO   STUDYING THIS TUMOR.   WAKO TEST IS  POSITIVE  WITH L3 RISING. HOW ACCURATE DIAGNOSTIC OF   ALL FACILITIES?

OPERATION IN THE PLAN of LEFT HEPATECTOMY.

Robotic operation for  left hepatectomy.   See  macro  tumor with white area.

Microscopic with histo immunostaining  is  undiffentiated HCC.

CASE 516: PANCREAS TUMOR, Dr PHAN THANH HAI, Dr TRUONG DINH KHAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Girl  10yo with  epigastric pain.

Ultrasound of abdomen detected  one mass of 8cm  at the body of pancreas, cystic  structure,  well bordered  ( US 1,  US 2, US 3),  no lymph node around.

MSCT with CE=   this mass is from the tail of pancreas,  inhomogeneous structure (CT1 CT 2, CT 3).

Blood tests  are normal.

Operation for resection of this tumor  [see macro].

CT  SHOWS THIS TUMOR A SOLID TUMOR BUT ULTRASOUND SCAN FINDING IS CYSTIC.

Summary:  Girl 10 yo  with big mas at the pancreas,  structure is mixed solid and cystic,  the most common  is  solid pseudocystic papillary tumor.

Histology result is pancreas pseudopapillary neoplasia.

REFERENCE:PDF.

CASE 515: VENTRAL HERNIA, Dr PHAN THANH HẢI, Dr LÊ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman  78 yo,  cesarian operation for  50 years, with, 2 days ago,  pain at left umbilical area  and everytime  coughing, a swollen mass appearing at the painful site.  

Ultrasound  of  this mass: 

US 1=  longitudinal scan at pelvis  near umbilicus, detected one subcutaneous mass. 

US 2 = left lateral scanning of middle line, shows  the tearing site of rectus muscle and a hernia goes out from it.

US 3 =  linear scanning of  this mass that was builded by great omentum and fluid.

US 4 = thickening of the bowel wall.

Emergency abdomen CT scanning:

CT  1:  crossed section  of  this mass  

CT 2 :  sagittal scanning of this mass

CT 3:  frontal section.

Emergency operation by  ventral hernia with past history of  cesarian operation 

detected  omentum and one bowel loop in ischemia but not necrosis yet.

Repaired this hernia by a mesh prosthesis. And timing is about in 4 hours from diagnostic to operation.

CASE 514: IUD PENETRATING TO URINARY BLADDER, Dr PHAN THANH HAI, Dr JASMINE THANH XUAN, Dr NGUYEN MINH THIEN, Dr NGUYEN TUAN VINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 49yo with pain after urinary miction. PAST HISTORY of BEING PUT T - SHAPE IUD 20 YEARS BEFORE.

ULTRASOUND of PELVIS  DETECTED BIG URINARY BLADDER STONE ( US1)

XRAY of PELVIS  SHOWs THIS STONE  WITH IUD  INSIDE   ( X-RAYs film).

ULTRASOUND  WITH CDI  FINDs OUT TWINKLING  ARTIFACTS  WITH  COMET TAIL SIGN in GREEN AND RED COLORS ( US 2, US 3).

MSCT of  PELVIS  :

 CT 1=  THE  METALIC IUD  INTRA UB WALL.

CT 2:  SAGITTAL VIEW .

CT 3: FRONTAL VIEW : THE  IUD  INTRA UB WALL.

ENDOSCOPY DETECTED THE STONE IN VAULT OF UB.

Operation removed a big stone intra urinary bladder.

CONCLUSION =  IUD  PENETRATING TO UB WALL AND FORMATION OF STONE.

IUD Migration in MEDIC Hoa Hao

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.