CASE 527: SPINE METASTASES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 50 YO  3 YEARS AGO BEING TREATED  AT CANCER CENTER BY NPC  RADIOTHERPY AND RADICAL NECK DISSECTION. BUT NOW PAIN AT DORSAL  AREA.

ULTRASOUND OF PARAVERTEBRAL  AREA DETECTED  ONE MASS HYPOECHOIC AT THE LEFT LATERAL OF THE D10 SPINE.

 US 1, US 2  LONGITUDINAL SCAN,  US 3  CDI  NO MORE COLOR DOPPLER SIGNAL.

MRI  SPINE    DETECTED ABNORMAL D10  ( MRI1)   MRI 2  FOCUS  D10, MRI 3   CROSSED SECTION  D10,  MRI 4  TUMOR  T2   CALCIFICATION INTRATUMOR , MRI5  FRONTAL VIEW  NEAR  KIDNEY  UPPER POLE.

CORE BIOPSY  REPORT  IS  METASTASIS   BY  UNDIFFENTIATED CELL TUMOR .

CASE 526: BIG OVARIAN CYSTIC TUMOR, Dr PHAN THANH HAI, Dr TRAM THI TU HUONG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

FEMALE PATIENT 17YO,   SINGLE,  IRREGULAR MENTRUAL CYCLE AND  ABDOMEN DISTENTION.

ULTRASOUND  DETECTED  BIG CYSTIC TUMOR FROM PELVIS TO EPIGATRIC AREA.

US 1 : LONGITUDINAL SCAN OF ABDOMEN AT MIDDLE LINE.

US 2 : AT PELVIS.

 US 3 : CROSSED-SECTION AT ILIAC ARTERY DIVISION.  

US 4 : SMALL UTERUS AND ASCITES AROUND.

MSCT  WITH CE.

CT1 : CROSSED-SECTION OF ABDOMEN AT KIDNEY LEVEL.

CT2 : CROSSED- SECTION OF TUMOR.

  

CT3 : FRONTAL VIEW  

BLOOD TEST : ROMA TEST NEGATIF  

SUMMARY =IT IS BIG OVARY CYSTIC TUMOR, SIZE 50CM,  MULTISEPTATION.  IOTA CLASSIFICATION B4.

OPERATION REMOVED RIGH BIG OVARY TUMOR CASE.

IOTA Classification

MICROSCOPIC RESULT IS MUCINOUS CYSTADENOMA BORDERLINE MALIGNANCY of OVARY.

CASE 525: LIVER ABSCESS, Dr PHAN THANH HẢI, Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male  62yo, with history of removing biliary stones in liver for 10 years. 

Ultrasound in 5 times shows biliary stones intraliver, aerobilia and right liver cyst from liver cirrhosis and splenomegaly patient. Blood tests= WBC:19,800g/L, hs CRP=177.2H. AFP=19.8ng/mL.

He came back Medic for reexamination as pain at RUQ and slight fever in Feb 2018.

Ultrasound suspected a liver tumor  with biliary stones and cirrhosis and splenomegaly.

But MRI thought about a new liver abscess with biliary stones of cirrhosis patient.

He entered CR hospital and  the results of ultrasound and CT  were liver tumor and aerobilia. With the diagnosis of CR hospital on liver tumor necrosis and aerobilia he felt no pain and nor fever after using of prescribed medicine drugs in 17 days.

He came back Medic  2 months later. 

Ultrasound detected no liver tumor, only biliary stones and aerobilia. 

MRI revealed no liver tumor, and in reviewing,  MRI noted a sign of head of cauliflower that means a pyogenic abscess  appearing of peripheral lobulated increasing signal intensity on MRI.

SUMMARY: Ultrasound was in mistake as no pay attention of clinical signs. A tumor necrosis could not be in concordance with infectious syndrome. And patients remained quite well because of resolving of liver abscess.

 REFERENCE:

CASE 524: DOUBLE AORTIC ANEURYSMS, Dr PHAN THANH HAI, Dr VO HIEU THANH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man  72 yo with  blood test of PSA high 15ng/mL. MRI  FOR  PROSTATE EVALUATION.

MRI 1 = AT PELVIS, PROSTATE BIG, SUSPECTED  CANCER   PI-RADS 3 

MRI 2 =  GO UP FOR  EVALUATION  LYMPH NODE   DETECTED  ABDOMINAL AORTIC  ANEURYSM THAT HAD BEEN TREATED BY STENT ENDO LUMEN FOR 2 YEARS.

MRI 3 =  MRI RISE TO THORACIC AREA DETECTED ONE MASS  OF ANEURYSM #4 CM  BELONGS AORTIC DESCENDING.

MRI 4 = CROSSED SECTION AT SECOND ANEURYSM.

ULTRASOUND FOR  SECOND LOOK.

 US 1 US 2 : LONGITUDINAL SCANNING AT ABDOMEN AORTA  ANEURYSM.

US 3 AND US 4 : SCANNING AT PARASPINAL THORACIC   WITH  FLOW  EJECTION INTRA ANEURYSM.

SUMMARY = DOUBLE AORTIC ANEURYSMS WERE DETECTED INCIDENTAL BY MRI AND SECOND LOOK BY US.

CASE 523: FIBULAR BONE TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 58 YO  WITH PAIN AT LEFT KNEE  AND SWELLING, DIFFICULTY IN WALKING (PHOTO)

ULTRASOUND   DETECTED ONE BIG MASS HYPOECHOIC FROM THE KNEE JOINT 20 CM LONG  WELL BORDERED  (US1).

US 2 : CDI  SHOWS HYPERVASCULAR.

US 3:  THIS MASS IS FROM THE  FIBULAR BONE OUTGROWTH  INTRA MUSCLE.

US 4: THIS MASS  COMPRESSED THE VASCULAR BENDING.

X-RAYS OF THE  KNEE  SHOWS THE UPPER PART OF FIBULAR BONE BEING EROSION.

MRI OF LEFT KNEE   WITH GADO:

 MRI 1= HYPOINTENSE MASS  LIKE CYST.

MR 2 = THIS MASS WITH CENTRAL NECROSIS.

MRI 3 = CROSSED SECTION   VERY HIGH CONTRAST ENHANCEMENT.

MRI 4 =THIS MASS IS FROM PROXIMAL PART OF LEFT FIBULAR BONE.

RADIOLOGIST SUGGESTED  IT SARCOMA OR GIANT CELL TUMOR.

CORE BIOPSY WAS DONE.

Microscopic report is  giant cell tumor of  fibular bone, proximal part.

CASE 522: MOBILE THORACIC UNDERSKIN TUMOR, Dr PHAN THANH HẢI, Dr ĐẶNG BỬU THẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 54 YO WITH WEAKNESS,  ANOREXIA FOR  ONE MONTH,  NO FEVER  BEING DETECTED ONE MASS AT RIGHT DORSAL AREA, DIFFICULTY IN DORSAL LAYDOWN.

CLINICAL PALPATION of THIS MASS IS ROUND, SOFT, MOVING UNDER SKIN (VIDEO).

CHEST X-RAY FILM IS NORMAL.

ULTRASOUND SHOWS CYSTIC MASS , SIZE 20CM,   WELL BORDERED,  WITH CONTENT LIQUID AND SEPTATION ( US 1, US 2, US 3).

CT SCAN :  THIS MASS IS INTRA THORACIC WALL LOOKS LIKE AN ABSCESS ( CT1, CT2, CT3).

PERCUTANEOUS PUNCTURE  REMOVED SERUM AND BLOOD,   ANALYSIS OF ADA NEGATIVE.

OPERATION  REMOVED THIS MASS  WHICH WAS WELL BORDERED AND HAVING BLOOD  CLOTS INSIDE . 

MACROSCOPIC VIEW LIKES HEMANGIOMA.  

  

MICROSCOPIC REPORT of  THIS TUMOR IS CAVERNOUS  HEMANGIOMA BLEEDING INTRA TUMOR.