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CASE 756: PHYLLODES TUMOR, Dr PHAN THANH HẢI, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A 51 year-old woman with a huge # 12 cm breast tumor BI-RAD 4B,  and fibroadenoma on two sides  were confirmed on breast ultrasound and mammography.






Results of 2 times of biopsy were fibroadenoma, benign tumor.



A lumpectomy performed and result was  phyllodes tumor.



Phyllodes tumors (or phylloides tumors) are rare breast tumors that start in the connective (stromal) tissue of the breast, not the ducts or glands (which is where most breast cancers start). Most phyllodes tumors are benign and only a small number are malignant (cancer).Jun 15, 2022



CASE 757: ILEOCECAL TUBERCULOSIS, Dr PHAN THANH HẢI, Dr LÊ ĐÌNH TÍN, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A 48 year-old man with RLQ pain for 3 years.

Ultrasound detected terminal ileum wall # 9 mm thickening and nephrocalcinosis due to gout.


Colonoscopy detected a diverticule of the cecum.



But MSCT represented an ileum tumor with left kidney stone.




Operation removed the terminal ileum and the right colon.


But the result  of histopathology was an ileocecal tuberculosis.


In reviewing of his past history, the patient may suffer from lung tuberculosis.



CASE 758: LUNG LEIOMYOMA, Dr PHAN THANH HẢI, Dr TRẦN THỊ BÍCH THÙY, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A 58 year-old woman with a #53x35 mm mass at the base of the right lung was detected incidentally by ultrasound in annual check-up. The mass rubbed out the liver mirror artifact.



MSCT confirmed the right lung tumor.



Operation removed the right lung tumor.

Histopathological result was a lung leiomyoma.



CASE 759-760: GI GIST, Dr PHAN THANH HẢI, Dr TRẦN THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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Case 1: Jejunum GIST in a 69 year-old woman.





Case 2: Stomach GIST in a 83 year-old woman.





References:






CASE 761: GASTRIC SLIDING HERNIA, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A 71 year-old woman with cardiovascular disorders: extrasystolic, ischemic heart, aortic valve regurgitation.







Lab data: Troponin T elevated.


MSCT for 30% coronary  branches obstruction but incidentally detected gastric sliding hernia through esophageal split of the diaphragm.



Chest X-ray and barium esophage: diaphragmatic hernia.


Endoscopy confirmed  diaphragmatic sliding hernia of the stomach.


Normal Respiratory function.



Operation for gastric hernia was done and the woman remains well. 

Coronary symptoms may mimick gastric signs, and in this case, coronary MSCT could also detect a gastric sliding hernia beside 30% stenosis of branches of coronary arteries.

CASE 762: UNCONTROLLED ARTERIAL HYPERTENSION due to RENAL ARTERY STENOSIS, Dr PHAN THANH HẢI, Dr TRẦN THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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 A 48 year-old female diabetic with uncontrollable arterial hypertension for years. TA max 200mmHg.

Ultrasound detected  stenosis of the left renal artery over 70% and, on the right one 30%.






AngioMSCT confirmed the left renal artery stenosis than the right one.



The  left renal artery  successfully stenting for the  stenosis then the arterial hypertension was solved.

Before stenting of the left renal artery


After stenting.

CASE 763: PHYLLODES TUMOR in a Young Girl, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ MỸ HOÀNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A 14 year-old with a palpable cystic tumor in the right breast.




Two months later the cystic tumor rapidly grew up, may be a hemorrhagic cyst, but it was hardly differentizied from a phyllodes tumor.


Histopathological result was a phyllodes tumor, and chemohistoimmunologic staining result was a BI-RADS 4 B malignant phyllodes tumor in a young girl.




CASE 764: SCHWANNOMA of FACIAL NERVE SHEATH in PAROTID GLAND, Dr PHAN THANH HẢI, Dr NGUYỄN XUÂN HOÀNG, MEDIC MEDICAL CENTER, VIETNAM.

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A 37 year-old  with swelling of his left face.


Parotid gland on left side existed a cluster of lymph node-like, solid, echo poor, # 5-4-4mm in parotid gland and in subcutaneous layer.



MRI confirmed a Kikuchi - Fujimoto disease,  necrotizing histiocytic lymphadenitis.






But biopsy result was a Schwannoma of the left facial nerve sheath.




CASE 765: MESENTERIC ABSCESS due to FISHBONE, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A male patient with his right flank pain for 3 days.

Abdominal ultrasound detected a # 12mm fluid-filled appendix with thin wall that was not enough to  diagnosing an acute appendicitis.





Lab data with hs CRP =56.91 represented an infectious syndrome of the abdomen.



To confirm the source of abdominal infection and ruling out an inflamed appendix, an abdomen MSCT was done.


MSCT detected a #14 mm fishbone in an  abscess at the left flank which was wall-off by the mesentery.

Surgery removed the abscess with fishbone succcessfuly which adhesived critically the transverse colon but no clue of coming from the bowel or colon.





MSCT is more sensitive in case of foreign body with high density like fishbone in the abdomen.

CASE 766: RENAL CLEAR CELL CARCINOMA, Dr PHAN THANH HẢI, Dr PHẠM THẾ ANH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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 A 60 year-old woman with a cystic renal tumor on the left side which was detected by ultrasound.


MSCT confirmed the left renal tumor at the lower pole of the left kidney.



An ultrasound-guided renal biopsy was conducted at Medic Center.





Result of  renal biopsy was a renal clear cell carcinoma. And a surgery for the left renal tumor was done one week later the diagnostic was made.



The risk of seeding of tumor cell  in renal biopsy is very rare before removing the renal tumor by surgery.

CASES 767, 768: PARATHYROID TUMOR, Dr PHAN THANH HAI, Dr LY VAN PHAI, Dr VO THI THANH THAO, Dr HO KHANH ĐUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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 Two cases of pararthyroid tumor were spontanously detected by ultrasound with renal stones, bone mineral density [BMD] measurement for osteoporosis  and the neck tumor.

Case 767: A 58 year-old woman with renal stones on abdominal ultrasound who went through neck ultrasound, BMD measurement and parathyroid hormone (PTH) lab data.




Her PTH was coming back post-op.



Case 768: Female patient 57 year-old with neck tumor.





References:






CASE 769: APPENDICULAR MUCOCELE, Dr PHAN THANH HẢI , Dr VÕ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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 A 62 year-old woman in check-up with her past history of surgery for an intracrania hemorrhagia and ovarian cyst.

Abdominal ultrasound detected a RLQ cystic mass #47×27mm beside the right colon which filled off debris that maybe a mucocele or a  pseudomyxoma peritonei.



Lab data were normal.

MSCT confirmed an # 42x22 mm appendiceal mucocele.



Surgery removed  a cystic mass at the end of the appendix.



Histopathological result was mucocele low grade.


Reference:



CASE 770: INSULINOMA (PNET, PANCREATIC NEUROENDOCRINE TUMOR), Dr PHAN THANH HẢI, Dr TRẦN THỊ TRÚC PHƯƠNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A 66 year-old diabetic man with hypoglicemic crisis after meal 3-4 hours, Whipple's triad positive.

Lab data: FPG low, C-peptid (fasting) elevated




Ultrasound detected a  # 20#6.5mm mass at the pancreatic tail and some hepatic cyts.


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Cystic lesion of the pancreas tail # 2.6x2.2 mm with Doppler sign.





MSCT confirmed a 32x20mm PNET at the tail of pancreas: tissue density, highly captured contrast media.



Histoimmunopathologic stainning was a pancreatic neuroendocrine tumor [insulinoma].


References:










CASE 771: BOWEL G.I.S.T, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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A 38 year-old woman with a # 47x58 mm GIST of her small bowel at LUQ, and later MSCT confirmed it.





The author would like to describe the sonographic appearances of a bowel GIST: echo mixed, with hypoechoic or cystic areas in case of large tumor. The adhered GIST from one side developes out of the lumen, exophytic, while the other side is intact. Endoscopic ultrasound could represent the layers of the wall of the tumor and help to guide the tumor biopsy.


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Merriam- Webster

exo​phyt​ic tending to grow outward beyond the surface epithelium from which it originatesused of tumors compare endophytic.tending to grow outward beyond the surface epithelium from which it originates.





CASE 772: THYROID CANCER METASTATIC to ESOPHAGUS ?, Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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 A  47 year-old diabetic man, hoarsening, with thyroid tumor on the left lobe.

Ultrasound represented a # 49x34 mm solid mass, blurred contour, strong posterior shadowing, close to cervical esophagus with thickening wall.


He had got the lefl vocal paralysis.


MSCT and endoscopy detected  an esophageal tumor at 1/3 middle part, invading the left lobe of thyroid.



Histopathogical results were an esophageal cancer, poor differentiazed squamous cell carcinoma.



Patient died some weeks later in chemotherapy management.

 



CASE 773: PCC MIMICKING RENAL CYSTIC TUMOR, Dr PHAN THANH HAI, Dr NGUYEN MINH THIEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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 A 61 year-old diabetic man in  annual check-up with a #15-17mm left renal cyst known by non CE MSCT for years.

MSCT of full body detected a #21x16mm left adenal tumor, a thyroid cyst and renal cysts and a #17mm renal  tumor  which moderatly captured CE cannot ruled out a RCC.


He has got a thyroid tumor#19mm and a colon polyp.



Coronary arteries were slightly stenosis.

Lab data were not interested except an endocrinal adrenal tumor.



Endoscopic surgery removed the left papillary cell carcinoma PCC and a 

hafl of kidney 


with the left adrenal tumor.







Histopathological results were left PCC and left endocrine 0cortical adrenal tumor.









CASE 774: THORACIC AORTIC PENETRATION DUE TO A FISH BONE, Dr PHAN THANH HẢI, Dr PHAN THANH VIỆT BÌNH , and FELLOW DOCTORS from BINH DAN HOSPITAL, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A 35 year-old woman with chest pain for 5 days who failed in gastritis management.

Abdominal ultrasound was nothing, but GI endoscopy detected 1/3 midle of esophagus in edema and narrowing of the lumen that may be perforated by a foreign body. The endoscopic examination must be stopped in waiting for a MSCT.



MSCT revealed a #34×2 mm fish bone which penetrated the esophageal wall to the thoracic aorta that made a critical pseudoaneurysm of the thoracic aorta.




The female patient was transmitted rapidly to Binh dan hospital. A planed management was conducted in emergency for reconstructing the thoracic aorta, sewing the hole of  the thoracic esophageal perforation and removing the fish bone.

Thoracic surgery was done successfully for reconstructing the thoracic pseudoaneurysm,






sewing the penetrated esophageal wall

and removed the fish bone with 2 sharp ends.


The woman remains well post op.

REFERENCE:





CASE 775: ECTOPIC TESTICULAR SEMINOMA, Dr PHAN THANH HAI, Dr TRAN THI BAO CHAU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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 A 52 year-old male monk with LUQ pain.

Ultrasound revealed 2 left kidney stones # 6 mm. And a RLQ mass#40x37 maybe GIST beside the cecum. His scrotum were empty both 2 sides.



MSCT detected right testis at RLQ and left testis inside the left inguinal canal. And a left renal stone.




Surgery removed the right testicular tumor and reconstructed the left inguinal canal in bringing back the left testis to the left scrotum.

Result of histoanapathogy of the right testicular tumor was seminoma.


CASE 776: RUPTURED LEFT LIVER ABSCESS, Dr PHAN THANH HAI, Dr LE VAN TAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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A 52 year-old man with LUQ pain for 4 days in body bending walking. History noted he got liver abscess in one year before which was successfully in medical management.

Ultrasound detected a left liver abscess with fluid collection close by the inferior border of the left lobe of liver.










Chest Xray film was normal and the heart was nothing abnormal detected.


MSCT confirmed a 104× 56 mm left liver abscess in rupture with abdominal fluid collection close by the left lobe, the stomach and the spleen.




The left liver abscess was drained out  4 hours
 later by via endoscopic surgery.



CASE 777: BREAST LYMPHOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ LOAN, MEDIC MEDICAL CENTER, VIETNAM

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 A 33 year-old woman in annual check-up.

Breast Ultrasound, AVBS detected 2 phyllodes tumors, mixed echogenic, hypervascular without axilarry node.


An Automated Volume Breast Sonography [AVBS] video clip:



Mammography revealed 2 blurred masses # 5 cm, BI-RADS 4.


Breast MSCT confirmed right breast mass 7x5 cm and left one 4x3 cm.


2 breasts were getting bigger and painful in 3 weeks later and the breasts becoming more reddish skin appearance.



Core biopsy and histoimmunostaining result was Lymphoma B high malignancy.


REFERENCE:

VMU CASE 391











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