MyMedR

Fulltext Actinomycosis of the spine: two case reports

David CV, Jayalakshmi P

Med J Malaysia, 1983 Jun;38(2):161-3.

Two cases of Actinomycosis of the spine with paraparesis are reported. The characteristic radiological features involving both the vertebral bodies and the ribs are seen. Confirmation by means of histopathology and culture was necessary and both patients responded well to penicillin.

Fulltext Acute appendicitis--the University Hospital experience

Lee HY, Jayalakshmi P, Noori SH

Med J Malaysia, 1993 Mar;48(1):17-27.

PMID: 8341168

A 1 year review of 529 cases of acute appendicitis, treated at the University Hospital in 1990, was performed. Perforation rate was 23.7% and delay in diagnosis was found to be significant. Patients above 50 years of age were particularly at risk. Diagnostic error was 19.3% and it was a problem not only in young women but also in children. Temperature and rectal examinations were not found to be helpful in the diagnosis in contrast to leukocytosis. Waiting time for operation was long (median 7 hours), be it for a perforated or a nonperforated appendicitis.

Adjuvant cytotoxic chemotherapy following Wertheim radical hysterectomy for cervical cancer

Sivanesaratnam V, Sen DK, Jayalakshmi P

Aust N Z J Obstet Gynaecol, 1987 Aug;27(3):231-3.

PMID: 2449159

Patients at high risk of recurrence or metastases following radical surgery for Stage 1B and 2A cervical carcinoma include those with pelvic node metastases, lymphatic or vascular space permeation in the cervix by tumour cells, large size of the primary tumour, involvement of the full thickness of the cervix and parametrial spread. We report the initial results of adjuvant chemotherapy using a combination of cisplatinum, bleomycin and vinblastine in 22 patients who had undergone Wertheim radical hysterectomy and were thought to be at high risk of developing recurrence. The mean duration of follow-up was 23 months. All are alive after follow-up ranging from 13 to 43 months. Three patients developed recurrences--one in the pelvis, another at the posterior aspect of the urethral meatus and the third developed pulmonary secondaries at 20 to 23 months after surgery. Toxicity from the chemotherapy was acceptable.

Fulltext An extensive cervical vagal nerve schwannoma: a case report

Chiun KC, Tang IP, Prepageran N, Jayalakshmi P

Med J Malaysia, 2012 Jun;67(3):342-4.

PMID: 23082434 MyJurnal

Vagal nerve schwannoma is extremely rare. The majority of cases present with a slow growing neck swelling without neurological deficit. Magnetic resonance imaging is the gold standard investigation to establish a pre-operative diagnosis. We report a case of a 32-year-old man with an extensive right vagal nerve schwannoma involving the right jugular foramen and parapharyngeal space. The tumour was resected via a transcervical approach. Complete excision of the tumour is the key to prevent recurrence.

Anaplastic lymphoma kinase (ALK) mutations in patients with adenocarcinoma of the lung

Mohamad N, Jayalakshmi P, Rhodes A, Liam CK, Tan JL, Yousoof S, et al.

Br J Biomed Sci, 2017 Oct;74(4):176-180.

PMID: 28705139 DOI: 10.1080/09674845.2017.1331520

BACKGROUND: Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death. Approximately 2-16% of NSCLC patients with wild-type epidermal growth factor receptor (EGFR) harbour anaplastic lymphoma kinase (ALK) mutations. Both EGFR and ALK mutations occur most commonly in Asian patients with NSCLC. As targeted therapy is available for NSCLC patients with these mutations, it is important to establish reliable assays and testing strategies to identify those most likely to benefit from this therapy.

MATERIALS AND METHODS: Patients diagnosed with adenocarcinoma of the lung between 2010 and 2014 were tested for EGFR mutations. Of these, 92 cases were identified as EGFR wild type and suitable candidates for ALK testing utilising immunohistochemistry and the rabbit monoclonal antibody D5F3. The reliability of the IHC was confirmed by validating the results against those achieved by fluorescence in situ hybridisation (FISH) to detect ALK gene rearrangements.

RESULTS: Twelve (13%) cases were positive for ALK expression using immunohistochemistry. Of the 18 evaluable cases tested by FISH, there was 100% agreement with respect to ALK rearrangement/ALK expression between the assays, with 11 cases ALK negative and 7 cases ALK positive by both assays. ALK tumour expression was significantly more common in female compared to male patients (29.6% vs. 6.2%, P P P = 0.047).

CONCLUSIONS: Detection of ALK expression by IHC is reliable and the most practical way of identifying NSCLC patients likely to benefit from crizotinib treatment.

Fulltext Autopsy findings in 35 cases of leprosy in Malaysia

Jayalakshmi P, Looi LM, Lim KJ, Rajogopalan K

Int. J. Lepr. Other Mycobact. Dis., 1987 Sep;55(3):510-4.

PMID: 3655465

The findings of autopsies performed on 35 leprosy subjects in the University Hospital, Kuala Lumpur, between January 1981 and December 1985 are presented. This is the first report based on autopsy findings from Malaysia. The patients were elderly subjects with a mean age of 74 years. Sixty-six percent had lepromatous leprosy. None had active skin lesions. The most common cause of death was pyogenic infection, particularly bronchopneumonia. Tuberculosis was noted in 25% of the cases. The other important causes of death included cardiac and renal failure. Renal lesions were evident in 71% of the cases, and the most common pathology was interstitial nephritis. Generalized amyloidosis complicated six (17%) patients.

Blastocystis sp. reduces the efficacy of 5-fluorouracil as a colorectal cancer chemotherapeutic treatment

Kumarasamy V, Kuppusamy UR, Jayalakshmi P, Govind SK

Exp Parasitol, 2023 Aug;251:108564.

PMID: 37308003 DOI: 10.1016/j.exppara.2023.108564

Blastocystis is an enteric protozoan parasite with extensive genetic variation and unclear pathogenicity. It is commonly associated with gastrointestinal symptoms such as nausea, diarrhea, vomiting and abdominal pain in immunocompromised individuals. In this study, we explored the in vitro and in vivo effects of Blastocystis on the activity of a commonly used CRC chemotherapeutic agent, 5-FU. The cellular and molecular effects of solubilized antigen of Blastocystis in the presence of 5-FU were investigated using HCT116, human CRC cell line and CCD 18-Co, normal human colon fibroblast cells. For the in vivo study, 30 male Wistar rats were divided into six groups, as follows; Control Group: oral administration of 0.3 ml Jones' medium, Group A: rats injected with azoxymethane (AOM), Group A-30FU: Rats injected with AOM and administered 30 mg/kg 5-FU, Group B-A-30FU: rats inoculated with Blastocystis cysts, injected with AOM and administered 30 mg/kg 5-FU, Group A-60FU: rats injected with AOM and administered 60 mg/kg 5-FU and Group B-A-60FU: rats inoculated with Blastocystis cysts, injected with AOM and administered 60 mg/kg 5-FU. The in vitro study revealed that the inhibitory potency of 5-FU at 8 μM and 10 μM was reduced from 57.7% to 31.6% (p p

Can Giant Cell Tumor of the Bone Occur in the Skeletally Immature?

Haseeb A, Singh VA, Jayalakshmi P

J Am Podiatr Med Assoc, 2020 Mar 01;110(2).

PMID: 32556225 DOI: 10.7547/19-030

Giant cell tumor (GCT) of the bone is a benign, locally aggressive neoplasm that has a high tendency for local recurrence. It usually has a higher incidence in the third decade of life. This is a retrospective review of a case with histologic confirmation of GCT in a skeletally immature patient involving the metatarsal bone, which is a rare site. At our institution, 1.3% of skeletally immature patients had GCT of the bone. From an extensive literature review, only four cases of GCT of the metatarsal bone in the skeletally immature were identified. Giant cell tumor in a skeletally immature patient can be confused for an aneurysmal bone cyst because of similar radiologic findings. Giant cell tumor of the bone can occur in an immature skeleton and should be sought out as a differential diagnosis despite being rare.

Fulltext Can gout mimic a soft tissue tumour?

Hee LW, Singh VA, Jayalakshmi P

BMJ Case Rep, 2010;2010.

PMID: 22400059 DOI: 10.1136/bcr.09.2009.2266

Gout is a disease where an abnormal collection of uric crystals (gouty tophi) can often be found in the foot and ankle. Occasionally such tophies are found at unusual sites and this can pose a challenge to the clinician where diagnosis and treatment is concerned. We describe a patient who presented to our oncology department with a swelling on his right thigh which was clinically diagnosed to be a soft tissue sarcoma, but after further investigations it turned out to be a gouty tophi. The purpose of this case report is to emphasise the variable presentation of gout and the challenges that can be faced by clinicians in diagnosing a soft tissue swelling.

Chromoblastomycosis in Malaysia

Jayalakshmi P, Looi LM, Soo-Hoo TS

Mycopathologia, 1990 Jan;109(1):27-31.

PMID: 2325747

Nine cases of histologically diagnosed chromoblastomycosis are reported from Malaysia. All the patients were males and ranged in age from 56 to 65 years. The duration of symptoms varied from 5 months to 13 years. All the lesions were noted in the lower limbs. Malignancy was suspected clinically in 5 cases. The diagnosis was established by finding characteristic brown muriform cells in the tissue sections.

Cutaneous adnexal neoplasms in biopsy specimens processed in the Department of Pathology, University of Malaya

Jayalakshmi P, Looi LM

Ann Acad Med Singap, 1996 Jul;25(4):522-5.

PMID: 8893922

A review of consecutive biopsies of adnexal tumours from 112 patients, received by the Department of Pathology, University of Malaya, over a 13-year period was undertaken. The age range of the patients was from 1 to 84 years, with a mean of 29.8 years. Thirty-three (32%) patients were under 20 years of age. There were 68 females with a male to female ratio of 1.0:1.5. In 105 cases (93.7%), the neoplasm was solitary. The tumour measured less than 2 cm in the largest dimension in 103 cases (92%). The common sites of occurrence were the head and neck region (59%) and extremities (25%). Neoplasms of hair follicle origin accounted for 63.4% (71 cases) of all lesions. Intra-tumour deposition of amyloid was noted in one of the 14 cases of trichoepithelioma.

Dapsone-induced liver necrosis

Jayalakshmi P, Ting HC

Histopathology, 1990 Jul;17(1):89-91.

PMID: 2146206

Fulltext Desmoid Type Fibromatosis of the Breast Masquerading as Breast Carcinoma: Value of Dynamic Magnetic Resonance Imaging and Its Correlation

Ng WL, Teoh SY, See MH, Rahmat K, Jayalakshmi P, Ramli MT, et al.

Eur J Breast Health, 2021 Apr;17(2):197-199.

PMID: 33870121 DOI: 10.4274/ejbh.galenos.2020.5482

Desmoid type fibromatosis of the breast is a rare stromal tumor that accounts for <0.2% of all breast tumors. Bilateral and multicentric lesions are extremely rare, with only less than ten cases reported in the literature. Although benign, it is locally aggressive with frequent recurrence in up to almost one-third of the cases. We experienced our first case of bilateral multicentric breast fibromatosis in a 19-year-old woman, with a paternal aunt diagnosed with breast cancer at age 30, who presented to our institution with the chief complaint of retracted nipples for 1 year. The patient denied any history of trauma to her chest. Sonography showed suspicious bilateral hypoechoic masses. Magnetic resonance imaging (MRI) was performed for further evaluation because of the extensive involvement of both the breasts. This report aimed to illustrate the main clinical, radiological, and histopathological characteristics of this rare disease to increase awareness of this entity and discuss the role of MRI.

Disseminated histoplasmosis presenting as penile ulcer

Jayalakshmi P, Goh KL, Soo-Hoo TS, Daud A

Aust N Z J Med, 1990 Apr;20(2):175-6.

PMID: 2344324

A 59-year-old Chinese man presented with a three month history of penile ulcers and abdominal pain. Syphilis and a gastric malignancy were diagnosed clinically. Biopsy of the genital and stomach ulcers revealed histiocytic granulomata containing numerous intracellular fungal bodies. Histoplasma capsulatum was subsequently cultured from the penile ulcer. Antifungal therapy was instituted. However the patient's general condition deteriorated rapidly and he died within two weeks of admission. A post-mortem liver biopsy showed numerous intracellular fungi.

Fulltext Erythema nodosum leprosum in Malaysians

Jayalakshmi P, Ganesapillai T, Ganesan J

Int. J. Lepr. Other Mycobact. Dis., 1995 Mar;63(1):109-11.

PMID: 7730709

Fulltext Exacerbation of colon carcinogenesis by Blastocystis sp

Kumarasamy V, Kuppusamy UR, Jayalakshmi P, Samudi C, Ragavan ND, Kumar S

PLoS One, 2017;12(8):e0183097.

PMID: 28859095 DOI: 10.1371/journal.pone.0183097

Colorectal cancer (CRC) is one the most commonly diagnosed cancers worldwide and the number is increasing every year. Despite advances in screening programs, CRC remains as the second leading cause of cancer deaths in the United States. Oxidative stress plays an important role in the molecular mechanisms of colorectal cancer (CRC) and has been shown to be associated with Blastocystis sp., a common intestinal microorganism. In the present study, we aimed to identify a role for Blastocystis sp. in exacerbating carcinogenesis using in vivo rat model. Methylene blue staining was used to identify colonic aberrant crypt foci (ACF) and adenomas formation in infected rats whilst elevation of oxidative stress biomarker levels in the urine and serum samples were evaluated using biochemical assays. Histological changes of the intestinal mucosa were observed and a significant number of ACF was found in Blastocystis sp. infected AOM-rats compared to the AOM-controls. High levels of urinary oxidative indices including advanced oxidative protein products (AOPP) and hydrogen peroxide were observed in Blastocystis sp. infected AOM-rats compared to the uninfected AOM-rats. Our study provides evidence that Blastocystis sp. has a significant role in enhancing AOM-induced carcinogenesis by resulting damage to the intestinal epithelium and promoting oxidative damage in Blastocystis sp. infected rats.

Expression of WT1 and PAX8 in the epithelial tumours of Malaysian women with ovarian cancer

Rhodes A, Vallikkannu N, Jayalakshmi P

Br J Biomed Sci, 2017 Apr;74(2):65-70.

PMID: 28367736 DOI: 10.1080/09674845.2016.1220709

BACKGROUND: Ovarian cancer is particularly lethal due to late stage at presentation. The subtypes behave differently with respect to their biology and response to treatment. Two recent markers reported to be useful in assisting in the diagnosis are WT1 and PAX8. Malaysia, with its multi-ethnic population provides an opportunity to study the expression of these biomarkers in ovarian cancer in the three most populous ethnicities in Asia and ascertain their usefulness in the diagnosis of ovarian carcinoma.

MATERIALS AND METHODS: Tissues from ovarian epithelial neoplasms diagnosed between 2004 and 2012 were tested using antibodies to WT1 and PAX8. The slides were assessed to determine levels of marker expression and related to ethnicity, ovarian tumour type, grade and stage.

RESULTS: Serous tumours were the main histological type (n = 44), the remaining being endometrioid (n = 15), mucinous (n = 15) and clear cell tumours (n = 7). Late stage at diagnosis was significantly associated with serous (p p 0.026) tumours. The vast majority of serous tumours were positive for WT1 (87%, p p

Follicular adenoma with squamous metaplasia and cystic change: report of a case with fine needle aspiration cytological and histological features

Jayaram G, Jayalakshmi P

Malays J Pathol, 1999 Dec;21(2):101-4.

PMID: 11068414

Squamous metaplasia (SM) of thyroid follicular epithelium is known to occur in a variety of non-neoplastic lesions as well in thyroid neoplasms, notably papillary carcinoma (PC). In follicular thyroid tumors, on the other hand, SM is very rare. This case describes cytological and pathological findings in a follicular adenoma (FA) that presented as a cystic lesion with extensive SM. The fine needle aspiration (FNA) cytology sample in this case yielded only necrotic material from the cystic area and squamous cells, which being mostly of immature type, were not recognised as squamous in the cytological smears. The needle missed the solid (neoplastic) component of the lesion and on the whole the cytological picture was considered to be equivocal. FA can now be added to the spectrum of thyroid lesions that can show SM. Awareness of this will enable cytopathologists to consider non-papillary lesions in the differential diagnosis of thyroid nodules that yield squamous cells.

Fulltext Fulminant hepatitis due to infectious mononucleosis

Krishnan R, Jayalakshmi P

Med J Malaysia, 1989 Dec;44(4):362.

PMID: 2520052

Gastric Metastasis from Hepatocellular Carcinoma: A Rare Manifestation

Abdul Hakim MS, Azmi AN, Jayalakshmi P, Mahadeva S

J Gastrointest Cancer, 2018 Sep;49(3):346-348.

PMID: 28066868 DOI: 10.1007/s12029-016-9913-6