CASE 680: CHOLECYSTITIS and GALLSTONE, Dr PHAN THANH HẢI, Dr HỒ KHÁNH ĐỨC, Dr LÊ VĂN TÀI, Dr LÊ THANH TÙNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 70 year-old diabetic male patient with an acute abdominal pain for hours enters the emergency room of Medic Center. His prior history are 17 year known gallstone, and denies any RUQ pain or gastrointestinal  troubles.  He had been controlled well his glycemia. He was taken transplant  coronary arterial 2 stents as 2 times of myocardial infarction for over 10 years. His EKG shows a life-rhythmic extrasystolic. WBC: 11.4H, CRP:0.4.

Ultrasound represents a 17 mm stone in a # 98x31 mm gallbladder with thickened wall of GB # 5-7mm. SonoMurphy sign is positive and no fluid exist around the GB.

The cholecystitis pain reduces rapidly with taken diclofenac IM, drotaverin per os after 20 minutes. But a cholecystectomy via endoscopy is planned in regarding his Clopidogrel, diabetic status and the life-rhythmic extrasystolic EKG.

Endoscopic surgery removes a 17 mm pigmented stone within a thicken gallbladder wall. The GB mucosa is partially necrosis and hemorrhage. Thicken GB wall leads endoscopic surgery cut it into small pieces for removing the gallstone and the inflamed gallbladder.

Pigmented gallstone and inflamed gallbladder in small pieces.

Endoscopic view of the  inflamed gallbladder.

Microscopic result is  a necrotic cholecystitis due to gallstone.  The patient remains well and discharged in safety after 2 days in hospital.

In reviewing the gallbladder, the gross specimen of GB shows a cholecystitis image more interesting than the ultrasound view. So it makes alert when facing a painful gallstone than a silent stone of gallbladder.

Furthermore there is a proposal that should think about acute cholecystitis while seeing a gallstone in a RUQ painful patient.

CASE 679: ECTOPIC TESTICULAR TUMOR, Dr PHAN THANH HẢI, Dr BÙI HỒNG LĨNH , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 53 year-old male patient  having HBV infected with hypogastric pain and without his left testis.

Ultrasound detects a # 76x50 mm hypogastric mass, with Doppler signals, and hard code of elastography ultrasound, 23.8 kPA.

MSCT confirms a 75x60x85 mm left ectopic testicular tumor maybe a seminoma in the pelvic region.

Surgery removes the ectopic testicular tumor from left hypogastric region.

The  microscopic result of the ectopic testicular tumor is a seminoma invading its capsule. 

CASE 678: COMPLICATED DIVERTICULITIS, Dr PHAN THANH HẢI, Dr LÊ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 55 year-old female diabetic patient suffers from epigatric pain crisii for 4 days and diarrhea.

Ultrasound detects an amount of abdominal free fluid,  two RLQ abscesses, and edema of peritoneum.

MSCT confirms the peritonitis due to 2 abscesses at the right flank of the abdomen.

A right colectomy is performed as perforation of colonic diverticulitis # 2x2 cm of transverse colon and the other one of cecum.

Subhepatic drainage is made to withdraw fluid out and an artificial anus is done.

 And the female patient remains well.

CASE 677: LUNG TUMOR, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THỤC QUYÊN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 53 year-old female patient with left thoracic pain for some months. She went through 2  lung tumor (hemangioma) surgeries respectively for 15 years  in K hospital and 4 years (Binh Dan hospital) before.

Pulmonary function report is normal.

Ultrasound notes a round mass  #50x39 mm at the bottom of left lung. It is a cystic lesion, well-limited capsule, and  belongs to the soft code on elastography ultrasound.

MSCT confirms a left pulmonary septated cyst  # 45x29 mm with sludge.

Surgery in the third time (on Tuesday 12, April, 2023) performs for removing the left lung cystic lesion. 

Gross specimen of the left lung tumor.

Microscopic result is malignant hemangiopericytoma.

CASE 676: LUNG TUMOR or TB LUNG, Dr PHAN THANH HẢI, Dr LÊ HỮU LINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 57 year-old female patient with a left lung (lingula) mass on chest X-Ray film on January 2023 without any symptom.

But its size changes for months on the chest X-ray film (Mars 2023).

Lung ultrasound notes a consolidation region #44x31mm of left lower lobe of lung, with air bronchogramme, and soft code of elastography ultrasound (ARFI technique).

Chest MSCT later confirms the 50 mm left lung mass and biopsy.

Result of biopsy is a TB lung mass with TB cyst, caseous necrosis,  lymph cells  and Langhans cells.

The female patient then starts a TB regimen. 

CASE 675: SCHWANNOMA of C5 ROOT of LEFT BRACHIAL PLEXUS, Dr PHAN THANH HẢI, Dr LÊ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A  56 year-old female patient  with left facial numbness [?] for 3 days.

Neck ultrasound at left supraclavicular region detects # 8-19 mm hypoechoic enlargement of left brachial plexus maybe due to schwannoma or neurinoma. While ultrasound examines at the neck region the female patient feels her left upper arm numb sensation (due to affecting the left upper brachial nerves from C 5 root).

MRI confirms a schwannoma tumor #21x12mm of left C 5 root.

Surgery removes the tumor of C 5 root from left brachial plexus which the pathohistology result is the schwannoma of the C5 root.

REFERENCE

CASE 674: BREAST SARCOMA, Dr PHAN THANH HẢI, Dr LÊ THÔNG LƯU, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A  61 year-old female patient  with right breast tumor and axillary nodes.

Breast ultrasound detects a  # 28x10 mm mass of the right breast BI-RADS 4 B and second tumor of this one, #19×10mm. And elastography ultrasound notes a hard code of it.

Breast MRI represents 2 right breast tumors, BI-RADS 5.

Biopsy of right axillary node is inflammed node, but result of core biopsy of the right breast tumor is poor differentiated breast sarcoma (C 49).

Total right mastectomy is performed,  and the final results are the right breast sarcoma and the chronic inflammed axillary node.