HETEROTOPIC BONE FORMATION in the COLON, Dr PHAN THANH HẢI - Dr LỮ MINH TÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 43yo male patient from Dong nai province came to Medic Center as LUQ pain and loose stools (in average 4 times per day) for over one year.

Ultrasound revealed an 1.1 x 9cm infiltration of the left colon as colonic wall thickening with some hyperechoic irregular lines inside which made a strong posterior shadow.





Colonic enema showed a strange opaque mass without barium close to the sigmoid colon which had no filling defect.



Colonic endoscopy detected an infiltrated wall of the sigmoid which made narrow the lumen of colon and failed by going upper.



The histopathologic results (2 times) were an unspecified chronic colitis : Only the normal colonic mucosa and glands or benign hyperplasia with infiltrating of chronic inflamation cells in the stroma.



MSCT represented a thick wall of the left colon due to edema. There were a 6cm foreign body which was wrapped by bowel and omentum, with high attenuation next to and adhesion to the left colon.






An operation performed to remove out the mass. It was a huge calcified mass which was in adhesion to the surrounded small bowel, inside the sigmoid wall and no foreign body was found. The histopathological results = The specimen contained fibrous tissue, fatty tissue with lymphatic tissue and hemorrhagic spots. There were infiltration of chronic inflammed cells and some calcified pieces. No image of tumor nor malignancy existed in all part of the specimen.






So it was the first huge heterotopic bone formation in the sigmoid colon wall that we had ever seen.

SCHWANNOMA of LESSER OMENTUM MIMICKING LEFT LOBE of LIVER TUMOR, Dr LE THONG NHAT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 55yo female patient from Baclieu province went to Medic Center because of an epigastric mass which made abdominal distension, loss of weight and dyspepsia.

Ultrasound represented a hypoechoic and mixed mass in relation with the left lobe of the liver in 13x14cm, few vascularisation and some small cysts within its more echoic center.



MSCT confirmed that a mass, in close relation with the left lobe of the liver, bent downward the duodenum, the head of the pancreas and the celiac artery. The mass caught the contrast media but was in lower attenuation than the normal liver parenchyma.



In operation, the mass appeared in the lesser omentum and beneath the left lobe of the liver and was removed in 13x18cm, reliably solid, ovoid shape with its own capsula.

Histopathological results: The mass concludes some schwann cells which have lozenge shape, few cytoplasma, flat and small nuclei, gather in bundle, spiral or hedge. There are degenerating mucinuous area of stroma with some macrocytes and asteroid cells.

Immunohistochemistry staining = CD 117 (-), NSE (+), Desmin (-) proves a mesenteric Schwannoma for the lesser omentum tumor.

SPINE TUBERCULOSIS in a CHILD, Dr LY VAN PHAI, MEDIC MEDICAL CENTER, HCMC VIETNAM

A 10yo MALE CHILD in DONG THAP PROVINCE, SUFFERED from a LONG PERIOD of CONTINUOUS HIGH FEVER for 31 DAYS in FOLLOW UP by PRIVATE DOCTOR, DONG THAP POLYCLINICS, TROPICAL DISEASE HOSPITAL of the HCMC.

LAB DATA of URINE ANALYSIS, BLOOD PICTURE, HEPATITIS, TYPHOID FEVER, MALARIA, BLOOD CULTURE, CHEST X-RAYS, SINUS CT, LUMBAR PUNCTURE, ABDOMINAL ULTRASOUND WERE NOTHING ABNORMAL .

At last, TROPICAL HOSPITAL SENT HIM to MEDIC ULTRASOUND to REEXAMINE in spite of FINDING out the CAUSE of FEVER. At that TIME, ULTRASOUND MEDIC DISCLOSED FORTUNATELY a PARAVERTEBRAL ABSCESS WHICH BENT outside the LEFT PSOAS MUSCLE.
Later MRI CONFIRMED that by the IMAGES of VERTEBRAL CARIES on L2-L3 VERTEBRA in SETTING up a PARAVERTEBRAL ABSCESS .










Under a TUBERCULOSIS TREATMENT for 3 MONTHS, the PATIENT HAD NO FEVER after the FIRST MONTH and the PARAVERTEBRAL ABSCESS REDUCED the SIZE and NOW a VERTEBRAL SPLINT WAS PERFORMED for the 10yo CHILD.