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CASE 539: DENGUE FEVER and ASCITES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

February 28, 2019, 4:27 am
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MAN 25 YO WITH 3 DAYS  FEVER  AND EPIGASTRIC DISTENTION.
ULTRASOUND  FIRST :  
US 1: HEPATOMEGALY.  

US 2: GALL BLADDER WALL IS THICKENING 3 MM  NO STONE.

US 3:  FLUID IN MORRISON SPACE ( LIVER KIDNEY SPACE).

US 4: FLUID AROUND RIGHT KIDNEY.


US 5: IN PELVIS  BIG VOLUME OF ASCITES.

US 6: NORMAL SPLEEN WITH FLUID IN HILUS.


CHEST X-RAYS SHOWS  SMALL FLUID IN COSTO-PLEURAL SPACE.

BLOOD TESTS  SHOW   WBC HIGH, CRP HIGH  PLATTELETS  DROPPED TO 19K.          
ELISA  DENGUE FEVER TESTS  POSITIVE FOR IgG  AND IgM.



EMERGENCY ADMISSION IN INFECTIOUS TROPICAL HOSPITAL.
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CASE 540: URINARY BLADDER TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 6, 2019, 12:01 am
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MAN 32 YO  with HEMATURIA.  

ULTRASOUND of ABDOMEN.  
US 1 : LONGITUDINAL SCAN AT HYPOGASTRIC  REGION DETECTED  ONE CYSTIC MASS INTRA URINARY BLADDER WALL.  


US 2  : THIS MASS IS  FIXED TO ABDOMEN WALL .


US 3 : CROSSED SECTION OF  CYSTIC MASS  IN URACHUS AREA.


CYSTO-ENDOSCOPY  DETECTED  ROUND TUMOR  MUCOSA OF UB INTACT.


MRI OF   URINARY BLADDER .
MRI 1, MRI 2  =  TUMOR 3 CM  INTRA UB WALL  CYSTIC 


MRI 3  DWI,   MRI 4 =  TUMOR IS  LOCATED AT URACHUS REMNANT.



OPERATION  FOR PARTIAL CYSTECTOMY.
OPE 1= AFTER  INCISION  THE TUMOR IS CYSTIC FILLED WITH MUCUS.
OPE 2 = FLUID CLEAR AND MUCUS GOES OUT.



WAIT FOR  MICROSCOPIC REPORT.
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CASE 541: RIB TUMOR, Dr PHAN THANH HAI, Dr HO CHI TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 11, 2019, 2:24 pm
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Woman 45 yo  with pain at left thorax.   
Chest X-rays detected one mass at left  lower lung.




Ultrasound detected this mass from thorax wall.  US 1 :  solid mass  hypovascular.



US 2:  crossed section of this mass is round border freely with pleural space.



US 3 : longitudinal scan of this tumor is  hypovascular.



MSCT with CE of thorax,  this tumos is from 9th  rib, size 9cmx5 cm   ( CT 1  cross section,  C T 2   sagittal  section,   CT 3  3 D  view).




Biopsy of this mass is cavernous hemangioma.  
Operation for resection this tumor is planned on. 
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CASE 542: NECK TUMOR LIPOMA, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 24, 2019, 6:15 am
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Man 65 yo with  history of 5 years ago having a tumor at right neck that  was in growth slowly and no pain nor voice change (photo).




In examination, this mass is soft and mobile.  
Ultrasound,   
US 1 :  crossed section of this mass is subcutaneous  structure as fatty tissue,  size of 5
x 4 cm.


US 2 : this tumor  deplaces SCM and  not  connected to  normal thyroid gland.


US 3 : this tumor is nearby right CCA.



MSCT of the neck,    
CT 1=  crossed section, this tumor is subcutaneous, hypodensity,   out of thyroid gland.


CT 2=  frontal view,   this tumor  has CT density HU  IT  FROM SUB MENTAL AREA TO THE CLAVICULAR AREA.


CT3 = FRONTAL VIEW, THIS TUMOS HAD SEPTATION.


CT4 = CROSSED SECTION  TUMOR.


RADIOLOGIST DIAGNOSIS IS SUBCUTANEOUS LIPOMA.

OPERATION FOR REMOVE THIS TUMOR.

Operation removed this tumor and some cervical lymph nodes.


Microscopic report is lipoma.


Reference of case report.





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CASE 543: PELVIC WALL ABSCESS, Dr PHAN THANH HAI, Dr HO CHI TRUNG, Dr VO NGUYEN THANH NHAN, Dr NGUYEN THANH DANG, Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 28, 2019, 7:57 am
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Male patient 31yo with right pelvic pain for some weeks in deep palpation.

X- Rays : Normal chest and vertebral column.
Blood tests : WBC , hs CRP : normal.

Ultrasound of pelvis:

Mass with mixed pattern of structure presses on urinary bladder that connects retroperitoneum and covers right poas muscle.

 Mass goes forward under right pelvic wall and presses on peritoneum.


And enters muscle layers of right pelvic wall.
A diagnosis of pelvic abscess is made by sonologist.



MSCT : Lesion in right pelvic wall#5x8cm, cystic , multicrescent, thick capsule with septation which takes contrast and presses urinary bladder and goes down to right inguinal canal. Radiologist thinks about a pelvic wall abscess.

MRI : Right pelvic abscess in retroperitoneum goes forward that presses on urinary bladder then goes upward to right pelvic wall muscles.


FNAC withdraws some milky fluid, like abscess fluid.

Core biopsy  results TB pelvic abscess.



A 6 month TB planning is done for this patient.

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CASE 544: GASTRIC PERFORATION DUE TO FISHBONE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 1, 2019, 5:01 am
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MAN 53 YO WITH EPIGASTRIC PAIN HAS BEEN  TREATED AS GASTRITIS BUT NO RESPONSE.
ULTRASOUND OF ABDOMEN  DETECTED ONE ECHOGENIC BODY AT ANTRUM. 

US1/US 2 LOOK LIKE  FOREIGN BODY.




MSCT of ABDOMEN  ALSO  DETECTED  FB(  FORGEINE BODY )  3 CM  AT ANTRUM  


CT 1 /CT2 :SAGITTAL  SHOW THAT PENETRATING THE WALL ofANTRUM TO PANCREAS.



CT3  3D VIEW.

EMERGENCY GASTROENDOSCOPY  REMOVE ONE FISHBONE 3 CM.

Nota= VUD published 18 cases of fishbone ingestion, including 4 cases of perforation of stomach that were removed endoscopically 2 cases.

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CASE 545: AORTIC DISSECTION, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 12, 2019, 6:17 am
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Man 72 yo with epigastric pain and back pain.
Ultrasound of abdomen   detected   aortic  dissection.  
US 1 : longitudinal scan of aortic  epigastric area  having of septation intra aortic lumen, double lumen sign,  to lower division.



US 2 ,  US 3 : Doppler  flow.  



US 4 : crossed section,  Doppler flow  of
echocardiography detected dissection of aorta.


MSCT angio= CT 1   crossed section  of  aortic arch
CT 2= crossed section of aorta shows double lumen in  epigastric area.
CT 3 =longitudinal scan of aorta.   
CT 4 = 3D  view of  aortic  thoraco-abdomen.




Conclusion : ultrasound detected thoraco-abdomen aortic dissection.

Treatment :  Intervention of stenting graft for aortic arch.

NOTA= In a survey of AAA at Medic Center for 10 years (1990-2000), 246/987 cases of AAA dissecting were detected and documented by ultrasound and CT scanning confirmed, # 24.9%, that had been prothesis grafting later in Binh dan hospital.
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CASE 546: LUNG CANCER, Dr PHAN THANH HAI, Dr HUYNH TRAC LUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 23, 2019, 10:09 pm
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MAN 52 YO WITH  PROLONGED COUGH.     
CHEST X-RAYS DETECTED A  MEDIASTINUM TUMOR.



MSCT with CE  =
CT  LUNG 1:   FRONTAL VIEW:  LARGE NECK BY LYMPH NODES. MEDIASTINUM  ENLARGED BY MANY LYMPH NODES  AND LEFT LUNG TUMOR.




CT 2 :  CROSSED SECTION,  TUMOR OF LEFT LUNG WITH LYMPH NODES in MEDIASTINUM.

CT 3: LEFT LUNG TUMOR .

CT 4: SUPRACLAVICULAR LYMPH NODES  BOTH 2 SIDES.


ULTRASOUND OF THE NECK   
US 1=  BIG LYMPH NODES AT RIGHT SUPRACLAVICULAR AREA.


US 2 = AT LEFT SUPRACLAVICULAR  AREA , NODE SUSPECTED  METASTASIS.



BLOOD TESTS =CYFRA 21-1 : 3.05 ( N=  3.3)  PROGRP : >5000 pg/ml( N=65)
ACTH  282 pg/ml (N= 7-63)    CORTISOL  23 pg/ml (N=  6.2-19.4)
Biopsy of  right supraclavicular  lymph node.

HISTOLOGY REPORT WITH  IMMUNO STAINING IS  SCC.( NEUROGENIC ENDOCRINE TUMOR).


REFERENCE    Pro-GRP  [Pro-gastrin-releasing peptide] TEST for small cell carcinoma.


NOTA= VUD published 2 cases of SCC from 07 cases of lung tumor topic.
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CASE 547: MONDOR'S DISEASE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 27, 2019, 4:15 am
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WOMAN 60YO WITH PAIN AT RIGHT UPPER QUADRAN OF RIGHT BREAST. 
ULTRASOUND DETECTED  ONE MASS  NOT CLEAR BORDER  WITH ONE TUBULAR STRUCTURE  LOOKED LIKE  A  THROMBOSIS  OF VEIN .
PRESSURE OVER THERE IS PAINFUL.
(US1).



CROSSED SECTION  THIS STRUCTURE ( US 2) .

US 3 : WITH COLOR DOPPLER  THIS STRUCTURE IS NEARBY AN ARTERY.


US 4 : WITH PDI  THIS MASS IS NO FLOW IN COMPRESSION.


US 5 : ELASTOGRAPHY  THIS STRUCTURE IS HARD BORDER .


MAMMOGRAPHY XRAY   
M1   THE RIGHT BREAST VASCULAR STRUCTURE  HAD BEEN DILATED 

M2  ZOOM THIS MASS .


M3  ANOTHER VIEW 

SUMMARY = ONSET PAIN  NOT TRUE A MASS TUMOR  WITH   TUBULAR STRUCTURE  AS A VEIN THROMBOSIS. THE DIAGNOSTIC IS  MONDOR'S  DISEASE.

Image history of Dr Henri MONDOR.


CASE REPORT PDF.

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CASE 548: APPENDICITIS in PREGNANCY, Dr PHAN THANH HAI, Dr DANG VINH PHUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 30, 2019, 10:31 pm
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WOMAN 37YO IN GESTATION 16 WKS,  10 DAYS AGO PAIN IN RLAQ.
ULTRASOUND   
US1  PREGNANCY 16WKS  

US2  CROSSED SECTION AT RLAQ  SUSPECTED  APPENDICE RETROCOLON ASCENDING.


US3  LONGITUDINAL SCAN   APPENDICE  EDEMA.

BLOOD TESTS:  WBC  9,2K WITH 75% neutro. CRP  110ng/mL.

MRI  IS DONE.   
MRI1  CROSSED SECTION.


MRI2  CROSSED SECTION AT COLON ASCENDING.


MRI3  SAGITTAL VIEW.


 MRI4  FRONTAL VIEW.


RADIOLOGIST SAYS RETROCOLON APPENDICULAR ABSCESS.

EMERGENCY OPERATION   
OP1,2.



CONCLUSION=   IN PREGNANCY   US AND MRI  CAN DO DIAGNOSTIC  for RETROCECAL APPENDICITIS.

REFERENCE: AJOG DEC 2006, APPENDIITIS IN PREGNANT PATIENTS:  DIAGNOSTIC EFFICACY OF ULTRASOUND vs MRI.


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CASE 549: RENAL CYSTIC TUMOR, Dr PHAN THANH HAI, Dr NGUYEN PHUOC TOAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

May 8, 2019, 10:42 pm
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Man 38yo with health check up for every year ; 3 years ago ultrasound detected  right renal cystic growing bigger everyyear. 

NOW   US 1: LONGITUDINAL SCAN R KID   NOTES THAT CYSTIC TUMOR OF UPPER  POLE OF R KID.



US 2: CDI  IN CROSSED SECTION OF R KIDNEY.


US 3:  LONGITUDINAL SCAN OF R KID WITH CDI.


MSCT CE    
CT1 : CROSSED SECTION OF R KID  CYSTIC TUMOR  WITH FINE SEPTATION


CT 2 : FRONTAL VIEW  R KID.




CT 3 : TUMOR  COVERS  UPPER POLE OF R KID TO OVER HILUS OF R KID  



CT4  SAGITAL VIEW OF R KID.




RADIOLOGIST  SAYS CYSTIC TUMOR OF R KID  TOO BIG  THAT COVERS MORE R KID  BOSNIACK III  CLASSIFICATION.
THIS PATIENT PLANS TO  NEPHRECTOMY OPERATION.
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CASE 550: ULTRASOUND FOR BUCCAL TUMOR, DR PHAN THANH HAI, DR TRAN THI THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

May 13, 2019, 2:59 am
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WOMAN 63 YO  DETECTED AT RIGHT FACIAL BUCCAL AREA  ONE MASS  THAT DEFORMED HER FACE,  NO PAIN FOR 3 MONTHS  (SEE FOTO).




ULTRASOUND=   

US 1: SCANNING OVER TUMOR,  NEAR MASSETER MUSCLE  and OVER  BUCCALIST MUSCLE  EXISTS ONE  HYPOECHOIC MASS MOVING BY PRESSING OF THE PROBE, THAT LOOKED LIKE FLUID, BUT ON DOPPLER NO DETECTED ANY VESSELS.

US 2 : VIDEO IN OPENING OF THE MOUTH and THIS MASS IS MOVING.


US 3: OPENING OF SUPERB MICROVASCULAR IMAGING [SMI] SCANNING (CANON  APLIO A I 450)  DETECTED  MORE SMALL VESSELS, THEN  IT IS NOT FLUID  BUT LIKED FATTY TISSUE.

  
SONOLOGIST SUSGESTED FATTY PAD PROCESS ( BUCCAL FATTY PAD).
  
OPERATION REMOVED FATTY MASS.


MICROSCOPIC  REPORT IS FATTY TISSUE.


ANATOMY OF BFP ( BUCCAL FAT PAD).


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CASE 551: PNEUMOPERITONEUM POST CTC, Dr PHAN THANH HAI, Dr VO NGUYEN THANH NHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

May 18, 2019, 5:38 am
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WOMAN 68YO  WITH  FOBT TEST POSITIVE  TO DO  VIRTUAL CT COLONOGRAPHY. 
REPORT OF CT DETECTED FREE AIR IN ABDOMEN CAVITY, AND NO DETECTED TUMOR IN COLON (SEE  CTC , CT1).


   
CLINICAL EXAMINATION OF THE ABDOMEN IS NOT PAINFUL BY COMPRESSION, NO CHANGE  VITAL STATUS.  
US  SCANNING DETECTED FREE AIR  IN HYPOGASTRIC AREA AND  LIVER BORDER ( US1).


TREATMENT   FOLLOW_UP   THE STATUS  NO EATING BY MOUTH 24 HRS.  REVIEW  AGAIN THE VITAL STATUS  NO PERITONITIS   
MSCT AGAIN  DETECTED THE FREE AIR IN ABDOMEN IS  REABSORPTION (CT2). 



ULTRASOUND OF ABDOMEN AGAIN DON'T SEE  FREE AIR  IN THE PERITONEUM.




CONCLUSION=   CTC  BY CO2  COMPLICATION IS PNEUMOPERITONEUM  NO DETECTED TUMOR IN COLON OR SITE OF PERFORATION. NO NEED OPERATION.

WAIT AND SEE.

REFERENCE : CASE of CAT SCRATCH COLON.



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CASE 552: ULTRASOUND OF A CYSTIC NECK MASS, DR PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

May 26, 2019, 4:43 am
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WOMAN 46 YO  HAD BEEN DIAGNOSED A RIGHT NECK MASS, CYSTIC APPEARANCE WITH PUNCTURE ASPIRATION REMOVED YELLOW FLUID MANY TIMES FOR 3 YEARS.  

NOW SHE  RECOGNIZED THIS MASS REFORMING AND GETTING BIGGER ( SEE FOTO).




ULTRASOUND OF THE NECK SHOWS THYROID IS NORMAL, and   CYSTIC MASS LOCATED AT LATERAL OF RIGHT NECK   ALONG OF SCM MUSCLE.

US1= (CROSSED SECTION)

US2 = LONGITUDINAL SCANNING  WITH SUPERB MICROVASCULAR IMAGING [SMI] TECHNIC  SHOWS THAT MICROVASCULAR PATTERN OF TUMOR 
US3=  LONGITUDINAL SCANNING WITH CDI TECHNIC.




US4=  VIDEO  WITH  SMI TECHNIC  SHOWS VERY HIGH VASCULAR SUPPLY  FOR THE MASS.


MSCT WITH  CE  OF THE NECK=

CT1:  THE MASS IS LATERAL OF  COMMUN CAROTID ARTERY [CCA].

CT2:  THIS MASS APPEARES  MIXED CYST AND SOLID STRUCTURE.

CT3:  LONGITUDINAL SCANNING OF THIS MASS WITH CALCIFICATION OF THE WALL.




CT AND ULTRASOUND CANNOT  MAKE SURE DIAGNOSTIC for THIS CYSTIC MASS.

FNAC   REPORTS CANCER CELLS IN CYSTIC MASS   BUT CANNOT SHOW THE ORIGINAL OF THESE CELLS.


FNA OF THE FLUID AFTER  FNAC AND QUANTIFIED THYROGLOBULIN IN FLUID IS VERY HIGH THAT HELPS MAKE DIAGNOSTIC OF THYROID CYSTIC CANCER IN ECTOPIC SITE.



REFERENCE


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CASE 553: MANTLE CELL LYMPHOMA, DR PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC. VIETNAM.

May 31, 2019, 7:09 pm
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Woman 40 yo, 2 years ago  detected at left frontal  area over eye brow a tumor slow growth, no pain  hard palpation (photo).




CT scan of the head,  this tumor is out of skull bone  below the skin  3 cm.
CT1 CT2 with ce,  this tumor had ce enhancement  



Ultrasound of this tumor.
US 1  with Bmode  this mass is hypoechoic very black look like a cyst,   with mirror effect  ( us 1)  US2  cdi  it had vascular    
US 3  with pdi   detected vasculature intra tumor  US4  with SMI many small vascular







US 5  video of SMI.

Ultrasound suspected lymphoma.
Open surgery removed this tumor and histology with immuno histo chemystry is  MANTLE CELL LYMPHOMA.

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CASE 554: PULMONARY AVM, Dr PHAN THANH HAI, Dr TRAN THUY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

June 2, 2019, 6:21 am
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A 40 YO WOMAN in ANNUAL HEALTH CHECK UP, SHE HAS RECOGNIZED DULL LEFT CHEST PAIN FOR MANY YEARS.
US1: IN CROSSED SECTION OF SPLEEN AND LEFT LOWER PULMONARY LOBE NOTES THAT A CYSTIC IN LUNG TISSUE AND PLEURAL EFFUSION.



US2:  CDUS IN THIS CYSTIC LESION REPRESENTS YIN-YANG SIGN.


US3: SPECTRAL DOPPLER TRACE FROM THIS CYSTIC CONFIRMING ARTERIAL BLOOD FLOW.



US 4, US 5: THERE IS A PULMONARY ARTERIAL AND VENOUS FLOW BESIDE THE CYST.



MSCT CE:
CT1, CT2: FRONTAL VIEW CONFIRMS AN ANEURYSM IN THE LEFT LOWER LOBE WITH AN FEEDING ARTERY AND A DRAINING VEIN.


RADIOLOGICAL DIAGNOSIS IS A PULMONARY ARTERIOVENOUS MALFORMATION CASE.

MICROSCOPIC REPORT IS HAEMORRHAGE OF PULMONARY VASCULAR CONGESTION.


Conclusion:
This is a pulmonary AVM case incidentally found out in a pleural effusion that was discovered by ultrasound and confirmed by MSCT later.

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CASE 555 :R_CCA Obstruction, Dr PHAN THANH HAI, Dr DUONG XUAN TUNG, Dr PHAN THANH HAI PHUONG, Dr LE THI THANH THAO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

June 16, 2019, 8:41 pm
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Woman 66yo with past history  of 10 years ago had been treated by radiation of the neck as NPC.
Now her chief complaint is headache.

ULTRASOUND OF THE NECK   DETECTED R CCA OBSTRUCTION  COMPLETELY BUT R/ECA STILL HAD FLOW.
US1, US2, US3 =  R -CERVICAL ARTERY  HAD FLOW UP.




MSCT ANGIO OF THE NECK ARTERY.

CT1   ( DISCONTINUE RCCA )  CT2   CERVICAL SINE ARTERY  
CT3  3 D  VASCULAR OF THE NECK  WITH ANASTOMOSIS.




CONCLUSION= RADIATION OF THE NECK INDUCED STENOSIS of  R-CCA.

REFERENCE  CASE REPORT

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CASE 556: LUNG TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

June 29, 2019, 2:01 am
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MAN 62 YO  GETS  GENERAL CHECK- UP   EVERY YEAR .
CHEST X-RAYS DETECTED ONE NODULE AT LEFT LUNG, SIZE 1 CM  ( CHEST XRAY).




MSCT CE OF THE LUNG.
CT 1 =    FRONTAL VIEW  THE NODULE AT LEFT LUNG FROM THE PLEURAL SPACE.
CT 2= CROSSED SECTION  WITH  CE ENHANCEMENT.



ULTRASOUND   DETECTED THIS MASS ROUND HYPOECHOIC, HYPOVASCULAR   PATTERN.

OPERATION REMOVED THIS MASS    MICROSCOPIC REPORT IS INFLAMATION PSEUDO TUMOR.


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CASE 557: LEG TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

July 6, 2019, 10:01 pm
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Man 51 yo  detected  his right ankle  pain and swollen, difficult to walk  ( see photo). There is a   mass at achille tendon with small skin nodule ).






Ultrasound  scan of  this mass.
US 1=  this mass is solid, #5 cm  round bordered, displacing achille tendon)
US 2 = vascular supply from peripheric wall   
US 3 =  SMI can see  more vascular structure intra tumor   
US 4  = ultrasound detected big lymph node at right inguinal region





US 5  video : Doppler of vascular supply this lymph node suspected metastasis.





X-Rays  the right foot :  the bone is normal.

Biopsy of the lymph node  at right inguinal region is  metastasis from sarcoma.


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CASE 558: OVARIAN TUMOR but RISING CA 19-9, Dr PHAN THANH HAI, Dr LE DINH TIN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

July 15, 2019, 4:27 am
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WOMAN  39YO  SINGLE, WITH  PELVIS PAIN


ULTRASOUND  DETECTED  LEFT OVARY CYST  SIZE 4 CM, CLASSIFIED IOTA 3   SUSPECTED  ENDOMETRIOSIS OF LEFT OVARY.  

US 1=   CYST  MIXED   SOLID.
US2 = ELASTO  SUSPECTED  BENIGN CYST.



ROUTINE BLOOD TEST   HAD  CA19-9  VERY HIGH VALUE  MORE THAN 1000 UI, CA 125 = 32 UI.



MSCT OF ABDOMEN WITH CE 

CT1:  PELVIS   HAD CYST OF LEFT OVARY  LOOKED LIKE SIMPLE CYST. 
CT2 :IN UPPER ABDOMEN,  LIVER,  BILIARY SYSTEM AND PANCREAS ARE NORMAL.




LAPAROOPERATION   REPORTED  LEFT OVARY CHOCOLATE CYST  THAT SUSPECTED  ENDOMETRIOSIS.


MICROSCOPIC REPORT OF THIS CYST IS   ENDOMETRIOSIS CYST.


LAB TEST AGAIN AFTER 2 WEEKS  OF OPERATION  THE CA19-9 DROPPED DOWN TO 123 UI.

CONCLUSION :  ENDOMETRIOSIS CYST RISED VERY HIGH CA-19-9 VALUE  WHICH IS RARE CASE

UNKNOWN REASON. 

REFERENCE CASE .



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