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Diffuse large B-cell lymphoma of the small intestine in a patient with refractory coeliac disease

Ahmad Affandi K, Abd Shukor N, Mohamed Rose I, Raja Ali RA, Masir N

Malays J Pathol, 2019 Apr;41(1):65-69.
PMID: 31025641

INTRODUCTION: Coeliac disease enteropathy is associated with an increased risk of lymphomas. Enteropathy-associated T-cell lymphoma is the principal malignancy related to coeliac disease. However, studies have shown that other types of lymphoma such as diffuse large B-cell lymphoma may also be associated with coeliac disease.
CASE REPORT: We report a 54-year-old Caucasian man who presented with chronic diarrhoea and weight loss. He was diagnosed with coeliac disease based on positive serology results and duodenal, jejunal, and ileal biopsies that showed villous atrophy. Despite adherence to a gluten-free diet, there was no clinical remission and enteropathy-associated T cell lymphoma was suspected. Repeated endoscopic biopsy showed persistent mucosal disease but no evidence of lymphoma. Several weeks later he presented with a perforated jejunum. Histology of the resected jejunum showed diffuse infiltration of submucosa and muscularis propria by malignant lymphoid cells sparing the mucosa. The cells expressed CD20, CD79α, CD10 and BCL6 and ki67 of 80%, consistent with diffuse large B-cell lymphoma.
DISCUSSION: It is suspected that the undetected lymphoma may have contributed to the persistent malabsorption syndrome rendering the patient unresponsive to treatment. Despite thorough clinical and endoscopic evaluation and multiple biopsies, histologic diagnosis of DLBCL was only confirmed following resection of the perforated jejunum.
Fulltext The Osseous Pathology of Purpura Fulminans in a Two-Year-Old Child: A Case Report

Mohd-Razali S, Ahmad-Affandi K, Ibrahim S, Abdul-Rashid AH, Abdul-Shukor N

Malays Orthop J, 2023 Mar;17(1):180-183.
PMID: 37064633 DOI: 10.5704/MOJ.2303.021

Purpura fulminans (PF) is a severe clinical manifestation of Neisseria meningitides infection that is associated with high mortality rates in children. Survivors are frequently left with debilitating musculoskeletal sequelae. There is a paucity of reports on the musculoskeletal pathology of purpura fulminans. We report on a 2-year-old boy with purpura fulminans due to meningococcemia. The child developed distal gangrene in both the upper and lower limbs. Amputations were done for both lower limbs. Histological examination of the amputated specimens showed an inflammatory process and features of osteonecrosis. The latest follow-up at the age of 6 years showed a right knee valgus due to asymmetrical growth arrest of the proximal tibia. PF and its complications are challenging to treat and may require a multidisciplinary approach to improve patient's functional ability.
Fulltext An Unusual Presentation of Papillary Thyroid Carcinoma That Resembles Lymphoma: A Case Report

Yung Chwen WL, Abdul Wahab AH, Ahmad Affandi K

Cureus, 2024 Oct;16(10):e72381.
PMID: 39583538 DOI: 10.7759/cureus.72381

Papillary thyroid carcinoma often emerges within the middle-aged group as a painless, irregular thyroid mass, and it can be accompanied by other symptoms such as hoarseness and dysphagia. Cervical node metastasis typically involves the ipsilateral jugular chain and remains confined to cervical node levels III and IV in most of the patients. Here, we present a case highlighting the uncommon presentation of papillary thyroid carcinoma. A 63-year-old Malay man with no known medical issues initially exhibited a painless swelling on the right neck level V region. The swelling progressively grew in size and later extended toward the anterior and contralateral sides of the neck for a duration of a year. He reported a weight loss of 10 kg past a year and experienced consistent fatigue. Physical examination showed multiple firm swellings with regular borders over levels I to V bilaterally. The swellings did not move upon swallowing. Due to the absence of initial thyroid swelling and the presence of multiple cervical lymphadenopathies in his medical history, lymphoma was suspected. A referral to ENT was made for an excision biopsy, but the procedure was abandoned to prevent potential injury to important underlying structures such as blood vessels and nerves. An ultrasound-guided biopsy was subsequently performed over multiple neck regions. It resulted in papillary thyroid carcinoma instead of lymphoma. Despite a suggestive history of lymphoma, papillary thyroid carcinoma should be considered a potential differential for a multilobulated neck mass. Excision biopsy has the potential to upstage the tumor and worsen the patient's prognosis. Fine-needle aspiration for cytology should be prioritized when investigating any neck swelling.
Fulltext The Elusive Primary: Metastatic Adenocarcinoma of the Breast Presenting Solely as a Hard Sternal Mass

Mohd Omar R, Ismail IA, Md Yasin M, Ahmad Affandi K, Hasbullah HH, Mohamad Ali ND

Am J Case Rep, 2023 Aug 23;24:e940594.
PMID: 37608536 DOI: 10.12659/AJCR.940594

BACKGROUND Carcinoma of unknown primary (CUP) is a diverse category of malignancies diagnosed in patients who have metastatic disease but without an identifiable primary tumor at initial presentation. CASE REPORT We report a case of CUP which was later diagnosed to be metastatic adenocarcinoma of the breast in a 62-year-old woman. The patient initially presented to a primary care clinic with an incidental finding of a small hard mass in the middle of the sternum, with no other clinical findings in the breast or axillary lymph nodes. Chest X-ray, ultrasound, and CT scan of the sternum suggested a benign sternal lesion, and a mammogram was normal. Due to the persistence of the mass, a biopsy was performed. The histopathological findings revealed a metastatic adenocarcinoma, most likely from breast origin, with positive estrogen receptor (ER) and mammaglobin on immunohistochemistry studies. The patient subsequently underwent PET scan, repeat mammogram, and MRI of the breast. Following high uptake in the rectum on PET, a colonoscopy was performed, revealing a suspicious rectal mass. The mass was surgically excised, and the final histopathological examination concluded the mass was a second primary adenocarcinoma of the rectum. Genetic analyses for BRCA1 and BRCA2 were negative. CONCLUSIONS This is a rare case of an isolated bone-like lesion on the sternum due to metastatic adenocarcinoma of the breast in a patient with no prior history of breast cancer and lacking any clinical or radiological evidence of breast or axillary lymph node lesions on presentation. The patient was also subsequently diagnosed with 2 primary carcinomas. Thorough clinical examination, extensive radiological investigations, laboratory investigations, histopathological examination, and a multidisciplinary approach are essential in managing CUP.