CASE 719: BREAST ULTRASOUND versus AI on 119 BREAST TUMOR CASES, A COMPARISON of Two METHODS, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, Dr VÕ THỊ PHƯƠNG TRINH, Dr JASMINE THANH XUÂN, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Of 119 cases of breast tumor enrolled in a comparison report of breast ultrasound by conventional breast  ultrasound and AI at Medic Center;  the authors, between 2 methods, declared AI helps exactly diagnosing the classified  BI-RADS 4c cases while the results of both 2 methods had statistically the same sensibility for all classified BI-RADS. It’s maybe, in our knowledge, the first report concerning AI on breast ultrasound in Vietnam and other southern Asian countries.

But conventional breast ultrasound described more characteristics of the malignancy of  the breast tumor than AI that only based on the 5 classic criterii : boundary, circumscribed, axe, echogeneicity, and tumoral form. However AI could use like a screening tool of ultrasound for the malignant breast tumors. In the protocol, biopsy and, in particular conditions, breast MRI  are gold standard for correct evaluation of breast tumor.

In condition, AI improved the malignancy for cases of classified BI-RADS 4c and over. And the authors said that naturally needs more informed reports of other studies with more tumor breast cases. 

CASE 718: BREAST CARCINOMA, DR PHAN THANH HẢI, Dr VÕ THỊ LOAN, MEDIC MEDICAL CENTER, HCMC,VIETNAM

A 54 year-old woman with lump feeling in her right breast came to a breast ultrasound examination.

Breast ultrasound detected right breast tumor which was BI-RADS 3 classified.

But mammography represented a right breast BI-RADS 4 with microcalcification.

MRI confirmed a right breast tumor classified BI-RADS 4.

FNAC  result was normal  but core biopsy with chemo immunologic staining showed invasive breast carcinoma.

A right mastectomy was done.

CASE 717: MATURE OVARIAN TERATOMA, Dr PHAN THANH HẢI, Dr NGUYÊN PHƯỚC TOÀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 23 year-old girl in annual general check-up with raised CA 19-9= 230u/mL.

Ultrasound detected a mixed tumor of the right ovary.

MRI confirmed the right ovary teratoma,  which represented  #110×98 ×100mm mass, well -limited capsule,  fatty tissue in majority. And normal chest X-ray. 

Endoscopic surgery removed the right ovary teratoma and  the value of  CA 19-9 came back to normal value=23.9u/mL.

Annual check-up for everyone's  health is really necessary. 

CASE 716: SISTER MARY JOSEPH NODULE and AXILLARY NODE METASTASIS, Dr PHAN THANH HẢI, Dr TRẦN THÙY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 55 year-old woman with mass at right axilla, and her private physician wanted a lymph node biopsy.

Ultrasound and MSCT detected thickening skin of right areola and swollen right axillary lymph node.

Microscopic result of lymph node biopsy was metastasized adenocarcinoma.

But sonologist noted an umbilical mass, solid, hypervascularized that appeared in the same time of the right axillary nodes.  Then she tried to find out an abdominal neoplasm in remembering a case of Mary Joseph nodule. 

Ultrasound,  colonoscopy and MSCT detected a sigmoid colon  wall thickening due to tumor.

Surgery removed the tumor and microscopic result was a moderately differentiated adenocarcinoma of colon.The colon tumor metastasized to umbilicus and right axillary lymph node.

So we have a case of metastasized axillary lymph node, a Sister Mary Joseph nodule with the origin of sigmoid colon cancer. 

CASE 715: INTRAHEPATIC CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 42 year-old woman without jaundice came to check-up. Her prior history noted managed thyroid cancer for 5 years and detected intrahepatic biliary dilatation 2 years before but the cause still unknown.

Ultrasound revealed  a hyperechoic mass at the hepatic hilus on normal hepatic bed.

MSCT  and MRI confirmed right intrahepatic dilatation and MRI noted cholangiocarcinoma.

Open surgery was done to remove gallbladder, V-VI subsegment of liver, connecting right hepatic duct to small  bowel [Roux-en-Y hepaticojejunostomy].

Microscopic result is cholangiocarcinoma invasive and chronic cholecystitis.

CASE 714: ENDOMETRIOSIS at Posterior Pouch, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ XUÂN HOA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 

A 48 year-old woman,  G2P2, with colicky pain of her colon is getting worse for one month. She has been managed for vaginitis and inflammed uterine cervix, and irritable bowel syndrome that was noted usually existing in her periods.

TVS and colposcopy showed  acute inflammed cervix and vaginitis. Colonoscopy denied colon disorders.

But in the second reexamination she has got menorrhagia for 7 days and there was continuous feelings of crapping with loose stool.

At that time colposcopy revealed some white spots at 13 and 16 o'clock of the cervix. These spots were swollen and getting in brownish color that lead to think about an endometriosis case.

MRI confirmed  the 38x17 mm [deep infiltrating endometriosis, DIE] endometrial mass at the posterior [rectouterine] pouch of the peritoneum and at the posterior cervix.

Understanding her condition, the patient accepts no further intervention.

CASE 713: CHORIOCARCINOMA and ECTOPIC PREGNANCY , Dr PHAN THANH HẢI, Dr PHAN NGOC NGOAN, BINH AN HOSPITAL - MEDIC MEDICAL CENTER, HCMC, VIETNAM

There are  03 cases in the topic of Choriocarcinoma that are noted a correlation to the corneal ectopic pregnancy. All of cases went through a laparoscopic resection of the angle of the uterus and monitoring the value of betaHCG for months to coming back of normal betaHCG  value. 

Case 01: A 34 yo female patient in hemorrhagic shock, painful abdomen due to ectopic pregnancy.  

TVS proved a corneal ectopic pregnancy and a laparoscopic resection of the angle of the uterus was done. But beta HCG raised continuously # 15,535 and a decision of hysterectomy was made. And chemotherapy later was managed. 

Case 02: A 37 yo female patient went through a laparoscopic resection of the angle of uterus as  left corneal ectopic pregnancy aged 7 weeks. 

Post-op the beta HCG was 15,055. So it was a choriocarcinoma with ectopic pregnancy. MTX chemotherapy was done and saved the female patient. 

Case 03: A 28 yo female patient with right corneal ectopic pregnancy and laparoscopic resection of the angle of uterus was done for the right corneal uterus. 

But beta HCG got down slowly  for 2 months and it was only a case of placental retention.