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CASE 701: BREAST TUMOR CASE, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr NGUYỄN KIM HIẾU, Dr VÕ KIM LOAN, Dr NẠI THỊ HƯƠNG NG THOANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 14, 2023, 7:28 am
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A 30 year-old female patient with a 13x17 mm right breast tumor goes through breast ultrasound 3 times.

In the first time, results are tumor BI-RADS 4A, FNAC : Fibrocystic changes.


Second time breast examnination, 14x19 mm tumor
BI-RADS 4A, FNAC , Fibroadenoma.


The third exam results are 12×20 mm,BI-RADS 4C, inhomogeneous hypoechoic with microcalcification, malignant doutfully elastography.

Core biopsy result is invasive breast carcinoma of no special type, grade 2.


Mammography BI-RADS 4 with multiformal collective microcalcification at 11o'clock 3 cm far from nipple.


Lame consultation is Atypical ductal hyperplasia with chemohistoimmunological staining results are P63+, ER + 50%, CK5/6 +.



But Breast MRI thinks about breast tumor BI-RADS 5.


In cancer hospital, guided ultrasound biopsy by VABB removes the 20×24 mm hole tumor.


The last result is Intraductal Papilloma.
The patient remains well after 2 months reexamination.

Conclusion: 
A right breast tumor of the 30 year-old patient raises gradually its size which ultrasound scoring from BI-RADS 4A to 4C. 
MRI BI-RADS 5. Mammography BI-RADS 4. 
FNAC, Core biopsy results are different.

And the last result due to VABB and Chemohistoimmunological staining is Intraductal Papilloma.










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CASE 702: SMALL INTESTINE GIST INCIDENTALOMA, Dr PHAN THANH HẢI, Dr PHAN THANH HẢI PHƯỢNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 14, 2023, 8:43 am
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 A HTA 65 year-old female with chest pain, mild apsnea and without gastroenterological symptom.

Ultrasound incidentally detects a 37x29 mm hypervascular hypoechoic mass which seems to be from the small bowel at her left abdomen.


Because of the rare incidence of small intestine (SI) tumor and in SI GIST, sonologists choose a SI polyp in differentiaziting a SI GIST.

MSCT confirms a 30x40 mm non invasive bowel wall tumor of GIST, strongly captures CE.



Endoscopic examination notes an exophytic jejunum tumor and open surgery removes  a small intestine loop which is an adequate clearance of 5 cm upper and lower of the tumor, and performs an end-to-end anastomosis. 

Gross specimen is a 5cm bowel intestine that exists at submucosa layer. The tumor section surface is solid, whitish with hemorrhagic ulceronecrosis.

Microscopic studies reveales spindle cells type of GIST with low mitose index.



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CASE 703-704: STROKE due to CEREBRAL ISCHEMIA, Dr PHAN THANH HẢI, Dr NGUYỄN THỊ ÁNH HỒNG, Dr TRẦN THỊ THANH NGA, Dr PHAN THANH HẢI PHƯỢNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 23, 2023, 2:11 am
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Cerebral ischemic diagnosing bases on spontaneity of  decreasing and loss memory and vision. And Face  Arm Speech Time [FAST] scale. Roles of diagnostic imaging in cerebral ischemia are exactly detecting and rapidly in time (less than one hour).


CASE 01:

A male patient 55 year-old with left eye blurred vision and left dull headache for 2 days. 8 months ago his right arm was in weakness in 2 hours. History notes no FAST, without HTA, DM, except smoking for 30 years.

Brain MRI notes left brain ischemia at occipital region in small area and leukoaraiosis.



Vascular ultrasound notes plaque of the left ICA from its origin to occlude all its length and cause no ICA flow;  and the left central retinal artery flow decreases.
Because of the ipsilateral ICA occlusion,  the left ECA flow becomes internalization.




CTA notes the left ICA occlusion and the left middle cerebral artery is enhanced from the left anterior cerebral artery.



CASE 2:

A HTA male patient 63 year-old with spontaneous loss memory after a critical headache for 6 days. His history is smoking and alcohol beverage for 40 years. No FAST. No loss vision.

Vascular ultrasound notes plaque at the right ICA origin which narrows up 90% lumen and total left ICA occlusion (NASCET), ICA/CCA ratio> 2.



Brain MRI shows large cerebral ischemia,  occlusion of the left middle cerebral artery and the left ICA.






FAST scale and types of diagnostic neuroimaging (vascular ultrasound, CTA and MRI) take  theirs roles in cerebral ischemia and stroke.


REFERENCES: [for vascular ultrasound]





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CASE 705: PRIMARY HYPERPARATHYROIDISM with normal CALCEMIA (nHPT), Dr PHAN THANH HẢI, Dr HUỲNH TRÁC LUÂN , Dr JASMINE THANH XUÂN, Prof NGUYỄN THY KHUÊ , Dr PHẠM HUỲNH BẢO TRÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

September 30, 2023, 12:35 am
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 A 64 year-old female patient with fatigue in general check-up.



Neck ultrasound incidentally detects a right 16×11mm parathyroid tumor in right posteroinferior face of thyroid.

PTH value highly raised but not raised calcemia value. Osteogram notes her osteoporosis with bone fracture risk 6 times more.









Parathyroid Scan BIMI-99 Tc confirms a right parathyroid tumor.



Surgery removes  the right parathyroid tumor and PTH post-op back to normal value. Histopathological result is a benign parathyroid tumor.




Summary




Normocalcemic hyperparathyroidism is a newly described variant of hyperparathyroidism. 

It is defined as persistently low or normal corrected or ionized serum calcium levels taken at least six months apart in the presence of elevated parathyroid hormone levels.

It may be primary or secondary. Normocalcemic secondary hyperparathyroidism is treated medically, while primary may need surgery.

….

The initial diagnostic approach for the patient is to rule out all secondary causes of hyperparathyroidism.

Normocalcemic primary hyperparathyroidism may be present in up to 17% of all cases of elevated PTH.

While usually asymptomatic, over one-third of nPHPT will progress to symptomatic bone disease or nephrolithiasis.

Familial hypocalciuric hypercalcemia needs to be ruled out. This can generally be done via a low calcium/creatinine clearance ratio. 



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CASE 706: CASTLEMAN DISEASE, Dr ĐÀO QUỐC TOÀN, Dr TRẦN LÊ DUNG, MEDIC CẦN THƠ, VIETNAM

October 12, 2023, 6:05 am
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A male patient 40 year-old in check-up was detected  a 39x45 mm mass nearby the head of pancreas by ultrasound. Sonologist noted a mesenteric tumor or GIST. 




MSCT described a retroperitoneal tumor maybe neurofibroma.


MRI  confirmed a retroperitoneal tumor or mesenteric tumor.

Endoscopic surgery removed a 4.5cm lymph node tumor. Gross specimen section is brownwhite and microscopic result is lymph node Castleman disease.



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CASE 707: PSEUDOTUMORAL CYSTITIS, Dr VÕ THỊ THẢO VÂN, MEDIC CẦN THƠ, VIETNAM

October 12, 2023, 7:02 am
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A male child 15 year-old with dysuria and had been failed in treatment for urinary infections many times. 

Ultrasound detected a 4x5 cm solid mass at right anterior face of urinary bladder with a calcified spot.


MSCT  noted an urachal remnant adhesive to bladder or bladder tumor.


Bladder endoscopy removed the tumor, and microscopic result is glandular cystitis.



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CASE 708: GASTROINTESTINAL GIST, Dr SƠN THANH THINH. MEDIC CẦN THƠ, VIETNAM.

October 12, 2023, 7:30 am
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A female patient 43 year-old  with right upper abdomen pain for 3 months but failed with unknown treatments.

Ultrasound at Medic Can tho detected a 78×100 mm solid hypoechoic mass with Doppler signals inside and noted a mesenteric tumor. 


MSCT confirmed a 98x76x91 mm mass with soft tissue density which adhered stomach wall maybe an exophytic gastric GIST. 



Endoscopic surgery removed the tumor and microscopic result is a gastrointestinal GIST.



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CASE 709: LIPOMA of THYMUS and MYASTHENIA GRAVIS, Dr PHAN THANH HẢI, Dr CHÂU NGỌC MINH PHƯƠNG, Dr HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER, VIETNAM

October 14, 2023, 12:43 am
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A 52 year-old female patient with  arm, face muscle weakness and slight ptosis for months in management with mestinon. She askes for knowing more about her disease and how to solve her illness.

MSCT detects multinodular blossom in the thymus and mediastinal lymph nodes. While brain MRI represents no brain tumor.




Ultrasound notes no cervical lymph node for biopsy.



Thoracic endosurgery removed the thymomal tumor and lymph nodes in mediastinum.



Microscopic result is lipoma of thymus, thymolipomatous myasthenia gravis.






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CASE 710: Right Kidney Tumor, Dr PHAN THANH HẢI, Dr TRẦN MỘC HIỆP, MEDIC MEDICAL CENTER, HCMC, VIETNAM

October 21, 2023, 12:21 am
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A 50 year-old female patient with right kidney tumor and non hematuria. CA 19-9 raised and  normal urine tests. 


And normal EKG and chest X-ray.




Ultrasound confirmed a huge right kidney cystic tumor 97x93×88mm, hypovascularized  but cystic necrotizing inside with cloudy fluid. The capsule of tumor was intact while its content was inhomogeneous echogeneicity.




MSCT  represented later a #90×100×110 mm cystic tumor of upper pole of right kidney. BOSNIAK IV.


Open surgery explored and removed the right renal cystic tumor at upper part of kidney by scissor; some sludge fluid drained out from the bottom of the cystic tumor, and surgeons left a haft of right kidney in the renal bed after sewing it.





Microscopic result is  adenocarcinoma of kidney.


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CASE 711: TENOSYNOVIAL GIANT CELL TUMOR, Dr PHAN THANH HẢI, Dr MÃ NGUYỄN MINH TÙNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

October 26, 2023, 4:29 am
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A 37 year-old man complained the pain of his knee and lower part of right thigh and first digit of foot for one year. His prior history notes no trauma.

Ultrasound detected a  inhomogeneous hyperechoic mass #49×27mm at upper part of the knee that could not describe clearly the tendon and the periost of femur bone beneath.


Laboratory findings were nothing remarkable, except diabetes and lipid metabolic disorders.



MRI described  a synovial giant cell tumor.



Core biopsy resulted a TENOSYNOVIAL GIANT CELL TUMOR.



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CASE 712: GERMINOMA METASTASIS, Dr PHAN THANH HẢI, Dr LÝ VĂN PHÁI, Dr HUỲNH TRÁC LUÂN, Dr PHẠM HUỲNH BẢO TRÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

October 26, 2023, 5:15 am
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A 42 year-old man with continuing pain in LLQ for one week and complained a light diarrhea and lymph node at his left neck. He had no fever.

Laboratory findings noted raised beta 2 microglobulin.


Ultrasound detected hepatosplenomegaly and many lymph nodes in the abdomen, groins and neck that lead to think about an infiltration of lymphoma stage IV.



Full body MSCT was done and detected a metastasized seminoma in abdomen and mediastinum.

Chest X-RAY  noted nothing remarkable.



Microscopic  and chemoimmunologic staining result of the left neck node was germinoma.




Scrotum ultrasound detected a tumor of the right testis, #75×36×66mm, vascularised , hypoechoic which metastasized pelvic and 2 groin lymph nodes.








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

October 28, 2023, 1:25 am
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There are  03 cases in the topic of Choriocarcinoma that are noted a correlation to the corneal ectopic pregnancy.

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






TVS proved a corneal ectopic pregnancy and emergency surgery was done. But beta HCG raised continuously # 15,535 and a decision of removing of uterus was done. And chemotherapy later was managed. 



Case 02: A 37 yo female patient went through  an open surgery for splitting a corneal 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 beta HCG raised 29,253. Open surgery was done to split right corneal uterus. 



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




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

November 2, 2023, 5:28 am
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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.
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CASE 715: INTRAHEPATIC CHOLANGIOCARCINOMA. Dr PHAN THANH HẢI, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

November 9, 2023, 4:53 am
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 A 42 year-old woman without jaundice came to check-up. Her prior history had thyroid cancer for 5 years and intrahepatic biliary dilatation 2 years before but unknown the cause.

Ultrasound noted 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].
Microscopic result is cholangiocarcinoma invasive and chronic cholecystitis.

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

November 9, 2023, 5:23 am
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 A 55 year-old woman with mass at right axilla, 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 was appeared in the same time of the right axillary nodes. 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.

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


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

November 9, 2023, 5:45 am
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 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.

 


MSCT confirmed the right ovary teratoma and normal chest X-ray. 


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




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

November 17, 2023, 9:24 pm
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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.



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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.

November 17, 2023, 9:52 pm
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 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. 







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CASE 720_721: MEDIASTINAL LIPOMATOSIS, Dr PHAN THANH HẢI, Dr NGUYÊN TUYẾT VÂN, Dr HÔ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 18, 2023, 12:47 am
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Case 01:A 19 year-old man with  fever and dyspnea for one month.

Cardiac ultrasound could not explore the anterior of the heart but no ventricular hypertrophy was noted.




Abdominal ultrasound revealed a right pleural effusion and the right lung in solid, hyperechoic pattern.


Chest X-RAY noted an anterior mediastinal tumor that covered the heart, maybe a mediastinal lipoma.



MSCT  confirmed an anterior mediastinal tumor.





But the patient and his family denied surgery.



Case 02: 15 years before, a 54 year-old man  with a tumor which enlarged the anterior mediastinal space on the chest X-ray film.


Cardiac ultrasound detected an anterior mediastinal mass and non cardiomegaly.




MSCT confirmed an anterior mediastinal mass.

Surgery removed the anterior mediastinal lipoma.


Chest X-RAY film post-of came back normally with no mediastinal tumor. 


Mediastinal lipoma is a rare benign entity which may detect incidentally with dyspnea, difficult speaking and swallowing.

Heart shadow is large on chest X-RAY  film but EKG and ultrasound are normally appearances.

MSCT detected exactly the tumor which has fatty density of 95 HU.

And it needs any further invasive technique to diagnose and management. 

Reference:





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CASE 722-723-724: PULMONARY EMBOLISM, Dr PHAN THANH HẢI, Dr NGUYỄN TUYẾT VÂN, MEDIC MEDICAL CENTER, HCMC. VIETNAM

November 23, 2023, 5:54 am
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 3 cases [1 man, 2 women] with dyspnea and lower limb edema and tachycardia represented pulmonary embolism. Both of them had venous thrombosis while the two women have been using oral contraceptive drugs for over 5 months. The male patient uses unknown drugs for painful lower limbs and calf cramps


Case 01: Man 39 year-old with calf cramps. Past history of left leg trauma. Dyspnea for 3 days. Tachycardia and venous thrombosis of lower limb on ultrasound. Troponin slightly rising.

Unremarkable chest X-ray. 





MSCT confirmed PE.


Case 2: Woman 33 year-old  with asthenia and dyspnea and 2 lower limbs edema. Oral contraceptive for 5 months. D-Dimer and troponin rising.









Case  3: Woman  42 yo with oral contraceptive for 6 months. Swollen left leg with pain, non dyspnea.










REFERENCE 





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