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CASE 778: GASTRIC YOLK SAC TUMOR, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

August 22, 2024, 3:18 am
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A 84 year-old myocardial ischemia man with stenting cononary artery in annual check-up.

Since September 2023, AFP value was 6,015 ng/mL, and April 2024, ultrasound and MSCT detected an exophytic cardia gastric wall tumor # 69x90x30mm and metastatic lymph nodes.







But gastric endoscopy was negative. 

While AFP value elevated highly  3,667 ng/mL ultrasound and MSCT detected no liver tumor.




Later in May 2024, the cardia gastric wal tumor # 82x83mm, and lymph nodes were getting bigger on ultrasound and MSCT . 

A higher AFP value =5,685 ng/mL noted again. And at that time, it appeared some liver nodules in the right and left lobe =73-61-46-20-14mm on ultrasound. The echogenic structure of these nodules were complex, one hyperechoic, another mixed echoic that might come from the gastric tumor instead a multiple HCC.











No surgery was performed for the elderly patient and he died some days in this week.


But in the literature there were only 6 cases of the gastric tumor with high value of AFP . These cases belong to the primary gastric yolk sac tumor with immunohistochemistry stain results.

The primary gastric yolk sac tumor with high value of AFP is still a very rare malignant entity.

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CASE 779: VIRTUAL COLONOSCOPY for SIGMOID COLON CANCER, Dr PHAN THANH HẢI, Dr LÂM CẨM TÚ, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

August 31, 2024, 9:27 pm
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 A 66 year-old man post cerebral ischemic disorder with constipation for 2 months. Sometimes he notes a bloody stool. His doctor would like a diagnosis for his client before the day of  September 2nd, so sending him to Medic Center on August 31. Because all of the hospitals will be in the day off from September 1 to 3 to celebrate the day of the National Independence of Vietnam.


Abdominal ultrasound detected nothing but a virtual CT colonoscopy revealed rapidly a sigmoid colon tumor and some colonic polyps.




Later a conventional colonoscopy was performed and biopsy of a # 2cm tumor of sigmoid colon which is far from the anus about 20 cm, and some polyps.


The  imaging diagnostic results last in some hours in one day of the August 31, for a sigmoid colon tumor. And waiting for the histoanapathologic result will be reply on the September 5.

REFERENCE:

Computed tomographic (CT) colonography, also called CTC, virtual colonoscopy (VC) or CT pneumocolon, is a powerful minimally invasive technique for colorectal cancer screening [from Radiopaedia.org].




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CASE 780: UROEPITHELIAL PAPILLOMA and IBS, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 6, 2024, 11:20 pm
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 A 69 year-old man with IBS syndrome and dysuria. But he concerned more his colon for 3 months which went through a polypectomy in the past. And the dysuria maybe due to an enlarged prostate of the elderly as in his thought.

Ultrasound revealed a papilloma in the full of urine of the bladder which was not rule out a malignant tumor. And it existed nothing about enlarged prostate also the colon tumor.



Bladder endoscopy was done and confirmed a bladder tumor with its stalk at the bladder neck.



A cauterised endoscopy was performed to remove the 2x3 cm bladder tumor.

Histoanapathological result was an uroepithelial papilloma.



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CASE 781: ELEVATED PSA VALUE and PROSTATE CANCER, Dr PHAN THANH HẢI , Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 11, 2024, 12:36 am
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 A 69 year-old male with high PSA value wants to examine his prostate.


MRI prostate noted an enlarged prostate PI-RADS 3.


But TRUS, transrectal ultrasound, revealed a malignant lesion #9×5 mm in left peripheral zone of the prostate, and performing 12 point-biopsy.



Histoanatopathologic result was a prostatic adenocarcinoma. Gleason score 6 (3+3) and ISUP Gleason group 1.


Robot endoscopy removed the prostate cancer. And PSA value reduced : 6.4 ng/mL.
Microscopic result was prostatic adenocarcinoma, intact capsule, Gleason 6.


 








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CASE 782: TOOTHPICK PENETRATING TO ABDOMINAL WALL, Dr PHAN THANH HẢI, Dr NGUYỄN NGỌC XUÂN GIANG, BÌNH AN HOSPITAL KIÊN GIANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 12, 2024, 5:00 am
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 A 49 year-old man with an abscess at the left flank of the abdomen for one week and WBC = 14,000.



Ultrasound detected a # 6cm foreign body in the wall of the abdomen lead to the descending colon wall.



MSCT confirmed a toothpick penetrating the abdominal wall from the left colon, and stone of pancreatic duct.



Operation removed the # 6cm toothpick and drained out the chocolate pus from the abdominal wall abscess.




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CASE 783: CECUM CANCER in a Young Woman, Dr PHAN THANH HẢI, Dr TRƯƠNG CÔNG THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 26, 2024, 4:58 am
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 A 31 year-old woman with loose stool but no blood nor glue secretion 1-2 times/day for two months. She lost of her weight # 1 kilogram and has some cramps at her right flank. Her past history noted a gastritis management and her familial history denies any tumoral diseases.

Abdominal ultrasound at Medic Center detected a thickening wall of the terminal ileum, the cecum and the ascending colon which were thought maybe due to an GI inflammation.

But CEA elevated # 5.04 ng/mL. FOBT positive and calprotectin raised# 240 microgram/gr.



Colonoscopy revealed an ulcer with hard border of the cecal tumor; and MSCT confirmed a tumor of the cecum and metastase lymph nodes and a  metastase node in the right lobe of the liver, T3 N2 M1.




Result of microscopic biopsy was a  well differentiated adenocarcinoma of the colon.


She went through a chemotherapy before the right colonoectomy.
CEA came back normally: 2.73 ng/mL post of therapy. 
5 months later the treated liver node shows no a relapse on abdominal MSCT.







Cancer of the colon is taken the 5th place of tumor diseases in Vietnam, and seems to be appeared more early in the young patient without any symptome.

REFERENCE:




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CASE 784: SKIN ULTRASOUND for PACHYDERMOPERIOSTOSIS [PDP], Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

September 28, 2024, 12:33 am
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 A 26 year-old man with lion- like face [dermatological face]  and drumstick- like fingers [digital clubbing](hypertrophic osteoarthropathy) for 6 years.



X-rays films show thickening of the periosteum of ribs, upper and lower limb bones.



  

Skin ultrasound with 23 MHz probe reveales thickening of subcutanous layer and skin of forehead # 5mm, neck #1mm, cheek #3 mm. It exists  distorted structures as hyperechoic and hypoechoic layers in appearance without vascularisation.



             Cheek (L) and  neck (R) skin.
 


      
        Forehead skin # 5 mm of the patient (L) and                evidence # 2mm (R).

Skin biopsy result is related to Tourain-Solente-Gole syndrome (pachydermoperiostosis) which is a rare hereditary disorder affecting to bone and skin.



Pachydermoperiostosis (PDP) is a form of primary hypertrophic osteoarthropathy (see this term), a rare hereditary disorder, and is characterized by digital clubbing, pachydermia and subperiosteal new bone formation associated with pain, polyarthritis, cutis verticis gyrata, seborrhea and hyperhidrosis (from Orphanet).

REFERENCES:








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CASE 785: COLONOURINARY BLADDER FISTULA, Dr PHAN THANH HAI, Dr NGUYEN NGHIEP VAN. MEDIC MEDICAL CENTER, HCMC, VIETNAM.

October 10, 2024, 5:37 am
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A 71 year-old man with dysuria for one month but failed in management of infectious urinary system. The patient noted foaming at his penis after urination.

Ultrasound detected gas in urinary bladder and thickening of sigmoid colon. May it exists a fistula of colon and urinary bladder as appearance ò foaming at the penis.





Endoscopy revealed colonic diverticula.

 

Cystoscopy showed acute cystitis but not ruling out a colonobladder fistula.



MSCT confirmed the tract between the sigmoid colon and urinary bladder and colonic diverticula.


Surgery detected an abscess between sigmoid colon and bladder. But there was not any fistula of the urinary bladder. A left colonoectomy was performed.


Result of histopathology of the specimen was fibrotic inflammation of colonic wall and diverticulum.




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CASE 786: ACCESSORY BREAST TUBERCULOSIS, Dr PHAN THANH HAI, Dr NGUYEN THI THAO HIEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

October 10, 2024, 6:03 am
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A 31 year-old woman with her left axillary swollen for one week.


Ultrasound detected an 54x51 mm axillary abscess on left side with microcalcification that maybe an accessory breast abscess.



 
Result of biopsy was a soft tissue abscess.


An antibiotic regimen was done for one month.


Biopsy at that time was TB inflammation of the left accessory breast.



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CASE 787:TUBERCULOSIS of RIGHT AXILARY LYMPH NODE and RIGHT 3rd Digital Flexor Tendon, Dr PHAN THANH HAI, Dr NGUYEN THI TRINH, MEDIC MEDICAL CENTER,HCMC, VIETNAM

October 10, 2024, 7:00 am
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A 22 year-old girl with inflammation of her right axillary lymph node for 2 days  and the right elbow and the 3rd flexor digitorium for 5 months. But it failed in management in 2 hospitals.


Ultrasound  and  axillary lymph node biopsy at Medic Center detected  TB inflamation of the right axillary  lymph node and the right 3rd flexor digitorium.

 After the TB management for 6 months the TB inflammation of the lymph node and the right flexor digitorium were controlled successfully.






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CASES 788, 789, 790: ACHALASIA in WOMEN, Dr PHAN THANH HẢI, Dr ĐINH MINH TUẤN, MEDIC MEDICAL CENTER, HCMC,VIETNAM.

October 13, 2024, 12:22 am
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03 women 62 yo, 41 yo and 27 yo with disphagia were detected as abdominal ultrasound, barium swallow, and endoscopic upper GI diagnostics and managements as ballooned dilatation.

Ultrasound revealed dilated 1/3 lower part of the esophagus which terminated at the cardia of the stomach. And its existed not any tumor outside nor tumor of the gastric wall. It appeared like the bird beck sign of the barium swallow on the XRay films.

One patient  (case 01) relapsed after 4 months managed esophagial dilatation by balloon.

CASE 01: A 61 year-old in malnutrition as achalasia with dilatation from the neck to upper part of the stomach.
















Barium swallow images post 4 months achalasia ballonned showed relapsed achalasia.

CASE 02: Woman 41 year-old with nausea, lost of weight due to achalasia.











CASE 03: Girl 27 year-old with dysphagia one year as achalasia. 








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CASE 791: OVARIAN CANCER with POLYORGAN METASTASIS, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr NGUYỄN THỊ KIM THÚY, MEDIC MEDICAL CENTER, HCMC.

October 24, 2024, 6:30 am
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 A  67 year-old woman  PARA 2002 with lower abdominal pain for 2 days and irritable bowel syndrome. She is diabetic, arterial hypertension and asthma. Her past history denied any pelvic tumor before 2021.

Ultrasound detected abdominal ascites, a liver small nodule and pelvic tumor which invaded the pelvic organes, maybe an ovarian cancer.




MRI confirmed the ovarian cancer metastasized to liver, pleural membranes, lymph noded, epiploon and peritoneum.


Blood tests data.



But abdominal fluid were negative results in two times.
Endoscopic surgery  was done  for removing the ovarian tumors, uterus and the pelvic peritoneum.




Histoanapathological results were poorly differentiazed ovarian carcinoma  stage IV, metastase.

Post-op and chemotherapy, the woman  remains  stable status.



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CASE 792: FISHBONE PENETRATED the ESOPHAGUS GOING to the MEDIASTINUM and REENTERING the ESOPHAGUS , Dr PHAN THANH HẢI, Dr LÊ HỮU LINH, Dr HỒ KHÁNH ĐỨC, BINH DAN HOSPITAL and MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 10, 2024, 2:12 am
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 A  41 year-old woman misswallowed a fishbone for 5 days.

In Medic Center, MSCT and upper GI endoscopy detected a fishbone penetrating her esophagus which was going to the mediastinum and may enter the descending thoracic aorta.




 
At the emergency department of Binh Dan hospital, an open surgery for thorax was done. The result showed not any thoracic aorta lesion nor fishbone inside the mediastinum.

But the C-arm on the operation table revealed the fishbone changing its direction from transversal to longitudinal position.



An endoscopy was performed in the operation detected the fishbone coming back to the esophagus. And it was removed successfully by via endoscopy.


Fishbone came back to the esophagus is an incredible event. Patient and doctors were stunned by the fact that may have to go through an operation for reconstruction the thoracic aorta in finding the fishbone somewhere, but fortunately not have to do.
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CASE 793: INFLAMMATORY BREAST CANCER, Dr PHAN THANH HẢI, Dr TRẦN THÙY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 14, 2024, 5:27 am
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 A 31 year-old woman with the right breast appearing bigger fastly than the left one and covered by the red skin its upper part. The right breast felt hard and tumorless in touching.



Breast ultrasound with elastography detected some axillary lymph nodes and the breast tissue being distortion. That is belonged a breast cancer BI-RADS 5 classified.  Maybe it is a breast infiltrated lymphoma or an inflammatory breast cancer.






Breast MRI confirmed an inflammatory breast cancer BI-RADS 5 and metastase axillary lymph nodes.


But results of histopathology of lymph node FNAC was breast carcinoma and nonspecific chronic inflammation.


Histopathological result of the breast specimen by core biopsy was chronic inflammation non specific (N 61) of the breast.



In consultation later, a chemohistoimmunostaining was done and the result was an invasive breast carcinoma of no special type, grade 3.




Inflammatory breast cancer (IBC) is a rare entity among the breast cancer [1-5%]. The cancer cells may obstruct the lymphatic vessels then make the breast being swollen and covered by the red skin as an inflammation breast.


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CASE 794-795: PHYLLODES TUMOR, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 15, 2024, 1:15 am
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 Case 1: 

A 52 year-old woman with left breast tumor and bloody stool. Her past history noted an ovarian cancer for 3 years.

Ultrasound detected a pelvic mass and metastase liver nodes. Left breast noted  2 tumoral masses classified BI-RADS 5 with axillary lymph nodes.




In pelvis ultrasound revealed a left mass maybe a recurrent left ovarian tumor which metastasized her liver.

MSCT confirmed 18-35 mm left breast tumors and left pelvic tumor which invaded the sigmoid colon and metastase liver nodes.



Core biopsy of the left breast tumors was malignant phyllodes.


Left breast mastectomy was done and managed the recurrent left ovarian tumor with metastases in Cho ray hospital.

Post-op result of the left breast tumor was malignant phyllodes non invaded the skin and the nipple.

Case 2:

A 31 year-old woman PARA 1001 with left breast tumor growing bigger rapidly for one year after cessation of breastfeeding her 14 month child. Her history noted small left breast tumor since 2022.




Ultrasound detected a BI-RADS 4a multinodular breast tumor.

Mammography noted a left phyllodes in full of the left breast volume.


Core biopsy result was a benign fibroadenoma of the left breast.

Surgery removed the left breast tumor. The specimen result was a benign phyllodes.



Phyllodes tumor (1-3% breast tumor) comes from the fibrous tissue, 27 % malignant, growing rapidly with large size [ > 20 cm].
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CASE 796: INTRARENAL AVM, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 15, 2024, 10:23 pm
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 A 47 year-old woman with lumbago for 7 months but without hematuria. She doubted that may due to  practice belly twirling.

Ultrasound detected incidentally an upper pole renal cystic lesion # 13x23mm in B mode with aliasing sign on Doppler ultrasound.  RI = 0.3-0.5 and V= 130-230 cm/sec. It maybe an intrarenal AVM.


MSCT confirmed an intrarenal AVM that created an intrarenal aneurysm and managed stenting successfully the AVM.




Doppler ultrasound could differentialize an intrarenal aneurysm from a renal cystic lesion while B mode ultrasound could not to do.


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CASE 797: PELVIC ABSCESS and DIVERTICULITIS, Dr PHAN THANH HẢI, Dr PHAN NGUYỄN THIỆN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 21, 2024, 1:53 am
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A 54 year-old  diabetic woman with left lower quadrand pain for one year.  About one week before entering Medic Center, she got fever, cold and shivering and LLQ pain more and increasing CRP.

Abdominal ultrasound detected one left pelvic #46x56x64mm septated mass beside the sigmoid colon cannot ruling out an ovarian tumor.




MSCT confirmed a pelvic abscess with a high density foreign body inside # 2 mm.



Endoscopic surgery revealed an abscess due to colonobladder fistula. Then an open surgery performed to remove the pelvic abscess which was from an inflammed diverticulum and penetrated the urinary bladder,  and to create an artificial anus at the LLQ and cystostomy. The foreign body could not find out.



Post-op the patient was getting better but still in urinary infection.




It was a rare of case of complicated diverticulitis.
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CASE 798: GASTRIC GIST, Dr PHAN THANH HẢI, Dr LÊ ĐÌNH TÍN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 28, 2024, 4:12 am
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 A 42 year-old man with gastric pain and iron deficiency anemia management.




Ultrasound of abdomen detected a # 6x3x3,8 cm tumoral necrotic mass at lesser curvature of the stomach.


But GI endoscopy result was only gastritis.


MSCT performed and represented a # 3X5x6 cm gastric GIST.


Gastric endoscopy in the second exam concluded a submucosal tumor.




 Surgery removed the gastric tumor. 





and anapath and immunohistostaining results were gastric GIST with high index of cellular division.




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CASE 799: ENDOCRINOLOGICAL PANCREAS TUMOR METASTASIZED LIVER, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THỤC QUYÊN, MEDIC MEDICAL CENTER, VIETNAM.

November 29, 2024, 10:32 pm
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 A 65 year-old man with anorexia, epigastric pain and weight loss # 2kilogram for one month but without nausea nor jaundice 

Abdomen ultrasound detected some metastase nodes in the liver may come from the tail of the pancreas tumor. 

A hypoechoic mass at the spleen hilus # 35 mm was revealed through the spleen window that leads to a pancreatic tail tumor.




Lab data was not any interesting clue for diagnosis.



MSCT confirmed a pancreas tumor of the pancreatic tail and metastase liver.




Biopsy of metastases liver nodule was done. The result of the liver biopsy was an endocrinological pancreatic tumor.


Endocrinological pancreatic tumor is still a rare entity and hardly to diagnose. It has to combine some kinds of the diagnostic imaging as the diversity and complexities of the tumor.

A chemotherapy had been planned for the patient.


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CASE 800: SMALL BREAST CANCER INCIDENTALLY DETECTION, Dr PHAN THANH HAI, Dr JASMINE THANH XUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 10, 2024, 1:47 pm
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 A 66 year-old woman with a #10x7 millimeter spicular hypoechoic mass which invaded the skin above,  and a # 3.8 millimeter small node satellite, both of two lesions were nearby the nipple of the right breast. They were incidentally detected by ultrasound as small carcinoma, BI-RADS 4C. Strain elasticity was hard code. Axillary lymph nodes were inflamed nodes, LN-RADS 2.





Mammogram showed one right breast lesion beside the nipple, BI-RADS 4.



MRI confirmed the #11x9x10 millimeter tumor of the right breast, BI-RADS 5. Right axillary nodes still exist the hilus.




Results of core biopsy was an invasive breast carcinoma of no typical type, grade 2.


Histoimmunostaining result was an invasive carcinoma of the right breast.




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