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CASE 725: INFECTED HBV and HCC, Dr PHAN THANH HẢI, Dr HỒ TẤN ĐẠT, MEDIC MEDICAL CENTER, HCMC , VIETNAM

December 9, 2023, 1:32 am
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A 53-year-old man who had been infected with HBV since 2011 arrived at Medic Center because of rumors that he had liver cirrhosis, but he refuses any knowledge of illness. 


Ultrasound detected  a # 30 mm liver tumor in the left lobe and in caudate lobe of the liver and F4 on Fibroscan while his clinical status is almost nothing abnormal detected.

 

 

Lab data noted  a HCC high risk (WAKO test).

MSCT confirmed liver tumors and chronic hepatitis


 

The man died in hospital 6 months later. 

DISCUSSIONS:






 

HBV infection causes liver cancers which are highly prevalence in Vietnam.

In HCM city the seroprevalence of HBV is still high, ranging from 8 to 13 percent. On the other hand, 70% HBV patient have no symptoms which may develop the liver cancer at a later stage.

It must be identified the  infected HBV cases in the community as soon as feasible and the family members must get care and vaccination. Patients with HBV infection require monitoring every three to six months for detection liver cancer  in order to treat them quickly and save them from dying.

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CASE 726: BOWEL TUMOR, Dr PHAN THANH HẢI, Dr PHAM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC,

December 14, 2023, 4:41 am
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 A 55 year-old woman with anemia and dark stool complained epigastric and subcostal pain for one year.

Ultrasound detected a bowel tumor # 20-40mm above aorta, hypoechoic without vascular signals maybe bowel GIST. 




MSCT confirmed  a #20×43 mm bowel GIST.


Surgery removed the tumor. Histopathological result is GIST (spindle cell tumor).

DISCUSSIONS 

GIST of the GI tract can be found by ultrasound, particularly from the bowel wall. Three cases from the bowel—one from the rectum, one from the stomach—are being revealed at Medic Center.

However, using chemohistopathological staining and histopathological results, MSCT plays a crucial role in the diagnosis of GIST of gastrointestinal tract.


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CASES 727-728-729: SUBCLINICAL ABDOMINAL AORTIC ANEURYSM, Dr PHAN THANH HẢI, Dr TRẦN MỘC HIỆP, MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 14, 2023, 5:46 am
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 3 cases (1 female,  2 males ) with subclinical abdominal aortic aneurysm [AAA] were incidentally detected firstly by abdominal ultrasound, and confirmed later by MSCT. 

Surgery repaired abdominal aorta with Y tube silver graft and all of patients were well post-op.

Case one: 

A 61 year-old man with hematemesis, normal BP: 120/80 mmHg, but  gets hypogastric pain. AAA # 60x90 mm from renal artery level to iliac artery.





Case 02:

A 71 year- old woman with lordosis for a check-up,  BP :125/80 mmHg. AAA # 60X103 mm from renal artery level in risk of rupture, and iliac artery aneurysms.







Case 03:

A 78 year-old man with sleep trouble, BP :124/79 mmHg. AAA# 40x70 mm and iliac artery aneurysm.








DISCUSSIONS:

Elderly patients complaining of lumbago, lower limb weakness, erectile problems in males, or occasionally feeling of "a heart in the abdomen" may have a silent abdominal aortic aneurysm. 

In our facility, the annual incidence of subclinical abdominal aortic aneurysm is around 10%. Additionally, the AAA dissection may occur in 10% of those AAA.

In Vietnam, applying ultrasound first, POCUS in particular, may be useful in identifying the AAA (and then MSCT to confirm) that helps preventing the elderly patient's death. Sonologists should make it a practice to check for abdominal aortic aneurysms before concluding the ultrasound examination.

REFERENCE:
Nguyễn Thiện Hùng, Phan Thanh Hải et al (1998): Ultrasound for diagnosing abdominal aortic aneurysm and prognosis in 10 years, Journal of Medicine Practice of Medicine and Pharmacy Society in HCM City:3:pp 3-7.

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CASES 730-731: APPENDICITIS in ELDERLY PATIENTS, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 15, 2023, 11:08 pm
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There are two instances of inflamed appendices in senior patients that might make for intriguing clinical notes.

Case 01.

A 78 year-old man with RLQ colicky pain for one month and loose stool. Ultrasound detected an appendiceal lump with a big appendix which was #69x17mm.


But MSCT noted an inflamed cecum and appendiceal mucocele.




Report of surgery was cecum cancer and a dilated acute appendicitis.

Case 02:

A 78 year-old  man with acute RLQ pain.

Ultrasound detected cecum cancer which caused dilated appendicitis. Later MSCT confirmed the cecum cancer and the appendicitis which was compressed by the colon tumor.


The right colon tumor and the nearby appendix filled with fluid were discovered during surgery.

DISCUSSION 

Appendicitis seldom develops in senior patients above the age of 70. This might be because the appendix's tip and the colon's lymph tissue were underdeveloped.

The issue of appendix blockage brought on by colon tumor compression may be explained by the two appendicitis instances with colon cancer mentioned above.

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CASES 732-733-734: SUBCLAVIAN ARTERY ANEURYSM, Dr PHAN THANH HẢI, Dr ĐINH MINH TUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

December 21, 2023, 5:50 am
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03 cases of SUBCLAVIAN ARTERY ANEURYSM [ 2 right, 1 left side] from 3 males 34-32-44 year-old revealed by chest X-Ray, vascular ultrasoud and MSCT. Patients complaint weakness upper limb, numbness and right chess pain or  just only for a check-up without symptoms.




Chest X-Rays noted a blurred node close by the clavicle which could not differentiate from anterior mediastinal tumor or lung tumor. Vascular ultrasound could detect a yin-yang sign of a round mass with thrombus of the wall and MSCT could determine exactly the size, location, and reconstruct in 3D view.

CASE  01

Male patient 34 year-old for check-up. A 69 round mass was on the left clavicle. Yin-yang sign positive and thickening wall due to thrombus on ultrasound. The left brachial artery was intact.




CASE 2

Male patient 34 year-old with cough and chest pain. The subclavian aneurysm size was # 49x52 mm with calcified its wall on chest X-ray. Thrombus of the aneurysmal wall on ultrasound and MSCT. Turbulent flow on Doppler vascular ultrasound. 



CASE  3

Male patient 44 year-old weakness right upper limb, hoarseness and chest pain. The subclavian aneurysm was # 10×8 mm with turbulent flow, and thrombus filled up nearly the lumen. 3D view of MSCT reconstruction was not seen the aneurysmal lumen.







Surgery repaired the subclavian aneurysm with Y unigraft and the patient remains well. The aneurysm with its calcified contour was seen on the post-op chest X-ray.



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CASES 735-736-737: ENHANCED MYOMETRIAL VASCULARITY [EMV], Dr PHAN THANH HẢI, Dr DƯƠNG ĐĂNG NGỌC PHƯƠNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

January 4, 2024, 6:31 am
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3 cases of EMV post partum were discovered by Doppler ultrasound and were managed successfully in ceasing the menorrhagia by curettage.

Case 01:

After 3 months delivery without menorrhagia and beta HCG negative but EMV on transvaginal sonography (TVS). Doubtful placental retention.





Case 02:

Menorrhagia for 20 days after miscarriage, blood beta HCG = 19.25mUI/mL, TVS detected EMV.





Case 03: 

Menorrhagia in small amount for each batch every 2-3 days with  beta HCG highly rising = 66.975  mUI/mL, TVS detected uterine bloody retention, noted placental retention and EMV.



Microscopic specimen was placental villous structure.



BetaHCG = 2.1mUI/mL after curettage procedure.

REFERENCE
EMV Ultrasound findings ( from Radiopaeda)

It is impossible to distinguish enhanced myometrial vascularity from a true arteriovenous malformation on ultrasound 5. 

On greyscale ultrasound, there are anechoic, tortuous, tubular structures within the myometrium that may involve the endometrium. Echogenic intrauterine material in keeping with concurrent retained products of conception is commonly seen.

On color Doppler ultrasound, there is a mosaic turbulent pattern with multiple flow reversals. This demonstrates low impedance flow with a high peak systolic velocity (PSV) ≥20 cm/s and low arterial waveform pulsatility. It should be noted that while some authors consider a PSV >60 cm/s to be high risk 4,9,10, studies have shown that higher PSV values do not necessarily confer a greater hemorrhagic risk 1. 




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CASE 738-739: OBI and CIRRHOSIS and HCC, Dr PHAN THANH HẢI, Dr LÊ ĐINH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

January 5, 2024, 10:08 pm
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Case 738:

A male patient 54 year-old with fever for 4 days and epigastric pain.

Abdominal ultrasound detected a right lobe hepatic tumor # 12cm, but with negative infected HBV lab data except value of AFP of 51.40 ng/mL. MSCT confirmed liver tumor.








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Case 739:

A female nurse 56 year-old  with unknown cause of rising liver enzymes and HBsAg negative for 3 years. But HBV DNA positive  and AntiHBc total  positive at this time. Liver FibroScan F 3. Obstruction of branch of portal vein on MRI Primovist. Only cirrhosis and no sign of liver cancer. 



REFERENCE





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CASE 740: DIFFUSE SCLEROSING VARIANT of PTC, DR PHAN THANH HẢI, Dr NGUYỄN KIM HIẾU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

January 10, 2024, 5:28 am
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A woman 42 year-old with swollen neck on right side and hoarseness.

Neck ultrasound detected a hypoechoic thyroid, hypovascularized and diffuse microcalcification. It exists lymph nodes both 2 sides of her neck.


FNAC result is  a papilary thyroid carcinoma [PTC] with lymph nodes metastases, Bethesda classification group VI.



A thyroid total  and metastasized lymph nodes removed  and radiotherapy was done.

Reference:




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CASE 741: HEMORRHAGIC MESENTERIC HEMANGIOMA, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

January 12, 2024, 10:41 pm
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A woman 49 year-old  with a critical left flank pain for 1 day which was progressed continously. It made the woman in rigidity of her body to against her abdominal pain and to defecate many times.

Ultrasound detected a #58 mm well-limited mass containing sludgy fluid full-filled at left side of abdomen nearby her left kidney, and abdominal wall. And a renal cystic  and a kidney stone also existed.


MSCT confirmed a # 50x60 mm mesenteric cystic tumor as it was non captured CE,  HU 51.0 maybe a mesenteric cyst including hemangioma that adhered to left colon, left kidney  and abdominal wall.


Endoscopic surgery revealed the mass adhered the mesentery and the left colon, and the abdominal wall, then an open surgery was done.  



Microscopic result was a hemorrhagic hemangioma of the mesentery. 

Hemangioma in hemorrhagia of the mesentery is a rare entity. The scenario is too complex for exactly diagnosing pre-op.



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CASES 742-743: 2 CASES of BREAST TUMOR with NEGATIVE MAMMOGRAPHY, Dr PHAN THANH HẢI, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

January 18, 2024, 5:28 am
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2 CASES of BREAST TUMOR with UNCLEAR MAMMOGRAPHY

Case 742:

A woman 64 year-old in check-up.

Mammography findings noted breast in B group, nearly a doubtful breast mass on right side.



Ultrasound revealed a small # 7 mm spidicular mass in right breast. Elastography was a hard tumor. BI-RADS 5. Axillary nodes were metastases 



Core biopsy and chemoimmunologic staining resulted a small invasive carcinoma of the breast. A mastectomy was done and microscopic result was  carcinoma.



Case 743:
 
A woman 34 year-old with right lung cancer, positive EGFR and right pleural effusion has bee managed for 4 months. She herself found her right breast harder.




On mammography her right breast belonged type D (dense) which could not detect the tumor.




But ultrasound detected easily a big 37×19 mm tumor in BI-RADS 5 with cervical metastasized nodes.





The poor young woman with 2 kinds of cancer at the same time. 

Core biopsy resulted invasive breast carcinoma metastasized cervical nodes. And rib bones
and left pelvic bone on scintigraphy.





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CASE 744: BREAST MUCINOUS CARCINOMA, Dr PHAN THANH HẢI, Dr PHAN THỊ CẨM VÂN. MEDIC MEDICAL CENTER, HCMC, VIETNAM.

January 19, 2024, 11:19 pm
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A young woman 28 year-old with a left breast lump.

Mammography noted a left breast mass at 7 0' clock on a breast type D. BI-RADS 4.


Ultrasound detected a #20×14 mm left breast multilocular tumor, far from nipple 3 cm. BI-RADS 4a.





Mammothermography


MRI confirmed a 23×20 mm left breast tumor captured strongly CE. BI-RADS 5. Axillary nodes inflammatory form.





Biopsy results was mucinous carcinoma invasive.


Microscopic specimen post-op was mucinous carcinoma invasive.



Young woman with a rare breast tumor.



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CASES 745-746: PTC in CHILDREN, Dr PHAN THANH HẢI. Dr NGUYỄN TUẤN CUONG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

January 25, 2024, 5:01 am
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CASE 745: 

A male child 11 year-old presented  a calcified node in left lobe of thyroid by  ultrasound.




Microscopic specimen was papilary thyroid carcinoma, group V Bethesda classification. 

 CASE 746:

A girl 14 year-old with a left thyroid tumor and cervical lymph nodes.



Microscopic result was papilary thyroid carcinoma,  group VI Bethesda classification. 



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CASE 747: HCC and infected HBV, Dr PHAN THANH HẢI, Dr PHẠM CÔNG CHÁNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

January 25, 2024, 8:08 am
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A woman 51 year-old infected HBV for one year only using herself functional foods.

Ultrasound revealed a # 18 mm hypoechoic mass in right lobe of liver and splenomegaly and cirrhosis.



Lab data noted platelets # 50,000, liver enzymes raised and AFP negative, but HCC risk WAKO test elevated: PIVKA II (DCP): 84.2 mAU/mL


Liver MRI with Primovist confirmed a right hepatic node that maybe was  a nodular regenerative hyperplasia (NRH, FNH) or small HCC.



Liver tumor was removed by RFA after liver biopsy and DCP downed to 72mAU/mL.







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CASES 748-749: GASTRIC WALL ABSCESS, Dr PHAN THANH HẢI,Dr PHAN THANH VIỆT BÌNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

February 1, 2024, 5:32 am
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2 cases of gastric wall abscesses were incidentally detected  with epigastric pain for one month and were failed in the urban medical management.

Case 748:

A 32 year-old man with epigastric pain for one month. 3 years before he went through a gastritis.

Ultrasound detected thickening of antrum wall with fluid collection inside may having foreign body and fatty liver.



Endoscopy represented a gastric wall abscess. 


MSCT confirmed a gastric wall thickening without foreign body and ruling out a gastric tumor.


By antibiotics  treatment the gastric abscess disappeared after one month.


Case 749:

A 22 year- old girl with epigastric pain for a half of month. 

Ultrasound detected gastric wall thickening maybe gastric polyp.



Endoscopy described a gastric wall abscess.


Biopsy results was gastric hyperplasia.


MSCT detected no gastric tumor, but gastric wall abscess was noted.


She took a medical management and remained well after one month.


Gastric wall abscess is a rare entity  and endoscopy may help detecting it.

Infected Streptococcus is the main source of infection (75%). And Staphylococcus, E.coli Hemophilus influenza, Pseudomonas. Candida [rare].




REFERENCES:



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CASE 750: PERFORATED APPENDICITIS due to FISH BONE, Dr PHAN THANH HẢI, Dr BÙI HỒNG LĨNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

February 16, 2024, 10:05 pm
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A 58 year-old infected HBV man with RLQ pain for 5 days.

Ultrasound detected edema of the last part of jejunum maybe due to inflamation. It existed edema of pelvic peritoneum beside the appendix. 


MSCT  represented an inflamed appendix and foreign body  as fish bone # 30mm which perforated the appendiceal wall.


Endoscopic surgery confirmed a fish bone and removed the inflamed appendix.


Result of histopathological specimen was an acute necrotized appendicitis.




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CASE 751: PERFORATED COLON CANCER, Dr PHAN THANH HẢI, Dr NGUYỄN VĂN HIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

February 22, 2024, 5:03 am
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 A 45 year-old man with epigastric pain  for 2 months but failed in gastritis management in a hospital and getting worse his status.

At Medic Center, ultrasonography revealed the transverse colon wall thickening =12-17 mm associated with malignancy,  which was linked to a neighboring abscess measuring 59x21 mm that was sealed off. A fistula between the cancer and the abscess was seen on ultrasound.



Lab data: WBC=20,51x10^9/L, CEA: 5.47ng/mL

MSCT confirmed the abscess at posterior of the transverse colon due to perforated transverse colon cancer.



Open surgery removed the # 5x5 cm transverse colon cancer which perforated at posterior face and an arteficial anus was done. But 3 days later, this artificial anus was necrotizing then the proctotoreusis was done secondly. 

The histopathological result was a high differentiazed carcinoma invasive of colon. 

The patient remained well after the 2 complex operations.



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CASE 752: COLON CANCER in Young Woman, Dr PHAN THANH HẢI, Dr TRƯƠNG CÔNG THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

February 23, 2024, 10:01 pm
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 A 31 year-old woman with loose stool for 2 months and epigastric pain that was in gastritis treatment  but not the loose stool not resolving. She lose her weight of one kilogram and cramping feeling in her right flank.

Ultrasound detected right colon wall thickening maybe due to tumor.


Colonoscopy showed the right colon tumor with ulcer and vegetations.




MSCT confirmed the right colon tumor and liver metastase in the right lobe.




Lab data showed occult blood in stool [FOBT] and stool calprotectin positive.




Result of histopathological specimen was well differentiazed carcinoma of colon.

Cancer of colon seems to be more early in appearance in the young patients. And in late stage [liver metastase] liked the young woman in this case.




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CASE 753: INCIDENTAL RCC, Dr PHAN THANH HẢI, Dr NGUYỄN THỊ THẢO HIỀN, Dr PHẠM LÊ DIỄM CHI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 7, 2024, 11:59 pm
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A 51 year-old man without any symptom in an annual check-up.

Ultrasound revealed a right kidney tumor 37x40 mm, at the middle of anterior face, solid, hyperechoic pattern without rim sign that not ruling out a RCC, and a 13 mm small cyst of right lobe of the liver.




Lab data normal.

MSCT represented a 17x20mm right renal tumor maybe a RCC.




Robot surgery removed successfully a right kidney tumor. Histopathological result was a renal clear cell carcinoma of kidney.








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CASE 754: OVARIAN CANCER, Dr PHAN THANH HẢI, Dr TRẦN MỘC HIỆP, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 23, 2024, 1:09 am
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 A 66 year-old woman with loss of weight and constipation for months.

Ultrasound detected a # 86x106 mm right pelvic cystic tumor which was in front of the sacrum-coccyx and elevated the rectum from behind. It may a GIST but could not ruled out of an ovarian tumor.


Both two kidneys were in hydronephrosis without stone, may due to be pressed in pelvic region.



Lab data were not interested.


MSCT represented an 9x10 cm ovarian tumor and vegetations in the pelvis which caused the hydronephrosis .



Surgery removed the ovarian tumor FIGO IIB, uterus, anexals, rectum and sigmoid colon, epiploon, and an arteficial anus was made.
Histopathologic result was Retroperitoneal malignant tumor [high grade adenocarcinoma], primary peritoneal cancer.

Remaining well post-op, the patient was going through a chemotherapy planning.



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CASE 755: PARATHYROID TUMOR, Dr PHAN THANH HẢI, Dr LÝ VĂN PHÁl, Dr HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

April 1, 2024, 10:00 pm
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 A 58 year-old woman with osteoarthritis pain for years but failed in management. Blood calcium raising ( 3.14mmol/l) and elevated PTH, critical osteoporosis.



Ultrasound detected a # 34x11 mm hypoechoic mass at posterior face of left lobe of thyroid maybe a parathyroid tumor. 


And many stones in both two kidneys.


MSCT confirmed the left parathyroid tumor.



Operation performed to remove the parathyroid tumor.




Histopathological result was a parathyroid tumor with intact capsule.




PTH came back of 15.89 pg/mL after removing the parathyroid tumor.






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