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Heterotopic ossification in psammomatous spinal meningioma: a diagnostic controversy

Wong YP, Tan GC, Mukari SAM, Palaniandy K

Int J Clin Exp Pathol, 2021;14(5):627-632.
PMID: 34093948

Heterotopic ossification (HO), a synonym for osseous metaplasia, is a pathological phenomenon, characterized by abnormal bone formation outside the skeletal system observed commonly in various neoplastic and non-neoplastic diseases. HO occurring in meningioma is exceptionally rare. We reportherein an unusual case of spinal meningioma containing numerous calcified psammoma bodies and extensive HO in a 75-year-old woman, who presented with progressive worsening bilateral lower limb weakness and numbness. The presence of remarkable bone formation within a meningioma is controversial among pathologists; while some regard them as psammomatous meningioma as the primary diagnosis, others prefer osteoblastic meningioma, a form of metaplastic meningioma. There is compelling molecular data to advocate that HO is an active disease process involving metaplastic (osseous) differentiation of meningioma stroma mesenchymal stem-like cells, but not the meningothelial-derived tumor cells. Henceforth, the term "metaplastic meningioma" may not be appropriate in this context. A plausible designation as "psammomatous meningioma with osseous metaplasia" defines this entity more accurately. This paper highlights the need for a unifying nomenclature to reduce diagnostic controversy caused by conflicting terms in the literature. The possible pathogenesis of this intriguing phenomenon is discussed.
Fulltext Rare and Unique Case of Midline Anterior Arch of Atlas Non-formation Mimicking Jefferson Type 1 Fracture

Das S, Palaniandy K, Abu Bakar A, Idris Z, Abdullah JM

Cureus, 2020 Feb 03;12(2):e6850.
PMID: 32181085 DOI: 10.7759/cureus.6850

Cervical spine injuries are rare occurrences in children, especially the congenital anomalies of the atlas vertebra. Any injury involving the craniovertebral junction such as Jefferson fracture, is a valid cause for alarm due to the complex nature of the craniovertebral junction and the morbidity associated with it. We report the case of a 10-year-old male, who had failure of fusion of anterior arch of atlas due to the failure of formation of the anterior midline synchondrosis, and this mimicked a Jefferson fracture. If it was not for the peculiar absence of any corresponding evidence to suggest spinal injury, we might have mistaken this extremely rare but benign anomaly for a Jefferson fracture and subjected the patient to needless surgical treatment. Hence, it is concluded that keen clinical acumen and clear understanding of the developmental anatomy of these patients may be necessary to adequately manage them.
Prediction of Histological Grade and Completeness of Resection of Intracranial Meningiomas: Role of Peritumoural Brain Edema

Palaniandy K, Haspani MSM, Zain NRM

Malays J Med Sci, 2017 May;24(3):33-43.
PMID: 28814931 MyJurnal DOI: 10.21315/mjms2017.24.3.5

BACKGROUND: Meningioma is the commonest primary intracranial tumour in adults. Excision is curative for low grade meningioma, whereas high-grade meningioma requires adjuvant therapy following surgery. Several studies have examined the association between peritumoural brain Edema - a common feature in meningioma - and histological grading with mixed results. The present study attempted to elucidate this association and if peritumoural brain Edema affects the intra-operative judgement of surgeons on the completeness of resection.
METHODS: An observational study was conducted among those who underwent surgery for meningioma. Eighteen subjects were recruited each for low- and high-grades, respectively. Magnetic resonance imaging (MRI) prior to surgery was employed for interpreting the Edema index and MRI after surgery was used to determine residual tumour.
RESULTS: Median age was 50 years, male to female ratio was 1:3.5, 69.4% had peritumoural brain Edema and 75% had reported gross resection. Among the reported gross total resection cases, 40.7% had residual tumour. Analysis showed statistically significant association between peritumoural brain Edema (P = 0.027) and tumour volume (P = 0.001) with high-grade meningioma, however multivariate analysis did not present any association. No association was noted between judgement of tumour resection by surgeons and peritumoural brain Edema.
CONCLUSION: Odds ratio for peritumoural brain Edema remained high and the tumour volume exhibited marginal P-value marginal significance for prediction of high grade meningioma. These two factors may still contribute to the tumour grade and should be included in further studies on the prognosis of meningioma.
Now You See, Now You Don't: A Case Of Spontaneous Regression of Pituitary Tumour

Jaafar AS, Mohd Shokri SS, Paramasvaran S, Palaniandy K, Fadzil F

Cureus, 2020 Jul 14;12(7):e9174.
PMID: 32802610 DOI: 10.7759/cureus.9174

Spontaneous regression of pituitary tumours are rare and can be due to tumour ischaemia, pituitary apoplexy, or lymphocytic hypophysitis. We report a case of a 32-year-old female, who presented with symptoms and signs of extrasellar pituitary enlargement and hypothyroidism. MRI revealed a pituitary mass that spontaneously regressed after a month, with complete resolution of symptoms. Not all pituitary tumours require surgical intervention especially in the case of autoimmune lymphocytic hypophysitis.
Fulltext Nonporous, Strong, Stretchable, and Transparent Electrospun Aromatic Polyurea Nanocomposites as Potential Anticorrosion Coating Films

Auckloo SAB, Palaniandy K, Hung YM, Lazzara G, Chai SP, Pasbakhsh P

Nanomaterials (Basel), 2021 Nov 08;11(11).
PMID: 34835761 DOI: 10.3390/nano11112998

This study, for the first time, focused on the fabrication of nonporous polyurea thin films (~200 microns) using the electrospinning method as a novel approach for coating applications. Multi-walled carbon nanotubes (MWCNTs) and hydrophilic-fumed nanosilica (HFNS) were added separately into electrospun polyurea films as nano-reinforcing fillers for the enhancement of properties. Neat polyurea films demonstrated a tensile strength of 14 MPa with an elongation of 360%. At a loading of 0.2% of MWCNTs, the highest tensile strength of 21 MPa and elongation of 402% were obtained, while the water contact angle remained almost unchanged (89°). Surface morphology analysis indicated that the production of polyurea fibers during electrospinning bonded together upon curing, leading to a nonporous film. Neat polyurea exhibited high thermal resistance with a degradation temperature of 380 °C. Upon reinforcement with 0.2% of MWCNTs and 0.4% of HFNS, it increased by ~7 °C. The storage modulus increased by 42 MPa with the addition of 0.2% of MWCNTs, implying a superior viscoelasticity of polyurea nanocomposite films. The results were benchmarked with anti-corrosive polymer coatings from the literature, revealing that the production of nonporous polyurea coatings with robust strength, elasticity, and thermal properties was achieved. Electrospun polyurea coatings are promising candidates as flexible anti-corrosive coatings for heat exchanges and electrical wires.
Fulltext Case report: Triple whammy: Synchronous radiotherapy induced glioblastoma multiforme and papillary thyroid cancer following nasopharyngeal carcinoma

Palaniandy K, Kamarudin Z, Wong YP, Mohamed Mukari SA, Jiau WXH, Bakar AA

Front Oncol, 2022;12:1012395.
PMID: 36452494 DOI: 10.3389/fonc.2022.1012395

Secondary malignancies following radiotherapy are well documented, with an estimated incidence of 5%. These may manifest as carcinomas, gliomas, or sarcomas within the previous radiation field. Glioblastoma multiforme following radiotherapy for nasopharyngeal carcinoma is an uncommon occurrence and carries a poor prognosis, whereas papillary thyroid carcinoma following radiotherapy is well documented, though the exact incidence is not well documented. The occurrence of synchronous radiotherapy-induced malignancy over both sites has not been described in the literature before. We describe a middle-aged gentleman diagnosed with glioblastoma multiforme and papillary thyroid carcinoma 6 years after radiotherapy for nasopharyngeal carcinoma. Though our case is the first reported case of a synchronous tumour of its nature, it is likely that such cases are under-reported. Long-term vigilance for loco-regional radiotherapy-induced secondary malignancies is a must, and the presence of a second distinct secondary malignancy must be entertained.
Somatic mitochondrial DNA mutations in different grades of glioma

Soon BH, Abu N, Abdul Murad NA, Then SM, Abu Bakar A, Fadzil F, et al.

Per Med, 2022 01;19(1):25-39.
PMID: 34873928 DOI: 10.2217/pme-2021-0033

Aim: Mitochondrial DNA (mtDNA) alterations play an important role in the multistep processes of cancer development. Gliomas are among the most diagnosed brain cancer. The relationship between mtDNA alterations and different grades of gliomas are still elusive. This study aimed to elucidate the profile of somatic mtDNA mutations in different grades of gliomas and correlate it with clinical phenotype. Materials & methods: Forty histopathologically confirmed glioma tissue samples and their matched blood were collected and subjected for mtDNA sequencing. Results & conclusion: About 75% of the gliomas harbored at least one somatic mutation in the mtDNA gene, and 45% of these mutations were pathogenic. Mutations were scattered across the mtDNA genome, and the commonest nonsynonymous mutations were located at complex I and IV of the mitochondrial respiratory chain. These findings may have implication for future research to determine the mitochondrial energetics and its downstream metabolomics on gliomas.