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  1. Fulltext Odontogenic Carcinosarcoma: An Updated Literature Review and Report of a Case
    Awang Hasyim N, Ismail S, Ling XF, Tilakaratne WM
    Head Neck Pathol, 2023 Sep;17(3):731-738.
    PMID: 36997684 DOI: 10.1007/s12105-023-01545-x
    BACKGROUND: Odontogenic carcinosarcoma (OCS) is an exceptionally rare malignant mixed odontogenic neoplasm, which mostly arises from recurrent benign odontogenic tumour that undergoes malignant transformation.

    METHODS: A literature review was conducted using the keyword of "Odontogenic carcinosarcoma" and all relevant articles were screened. The data collected include demographic profile (age, gender), clinical information (symptoms, location, size), radiologic features, histopathological examination, management, recurrence, metastases, and survival status.

    RESULTS: A total of 17 OCS cases including a new case from our hospital. The incidence of OCS was highest in the third decades of life with predilection for male and posterior region of mandible. Clinically, patients may present with swelling and neurological symptoms. Radiographic examination often showed radiolucency with ill-defined border. This tumour demonstrates an aggressive behaviour with reported cases of distant metastases to the lung, lymph nodes, rib, and pelvis. Here, we report an interesting case of OCS in a 38-year-old man with a previous diagnosis of ameloblastoma. The patient was diagnosed with ameloblastoma but refused surgical intervention and returned after 10 years with rapidly enlarging mass on the right side of mandible. Microscopically, the lesion appears as biphasic odontogenic tumour with malignant cytological features seen in both epithelium and mesenchymal components. The spindle to round mesenchymal tumour cells were only positive for vimentin. Ki67 proliferation index was high in both epithelium and mesenchymal components.

    CONCLUSION: This case showed the tendency of untreated ameloblastoma to undergo malignant changes in the long term.

    Matched MeSH terms: Mandible/pathology
  2. Chronic Silicosis
    Ing SK, Kho SS
    N Engl J Med, 2024 May 16;390(19):e46.
    PMID: 38738767 DOI: 10.1056/NEJMicm2312247
    Matched MeSH terms: Lung/pathology
  3. Blood-brain Barrier and Neurovascular Unit Dysfunction in Parkinson's Disease: From Clinical Insights to Pathogenic Mechanisms and Novel Therapeutic Approaches
    Khor SLQ, Ng KY, Koh RY, Chye SM
    CNS Neurol Disord Drug Targets, 2024;23(3):315-330.
    PMID: 36999187 DOI: 10.2174/1871527322666230330093829
    The blood-brain barrier (BBB) plays a crucial role in the central nervous system by tightly regulating the influx and efflux of biological substances between the brain parenchyma and peripheral circulation. Its restrictive nature acts as an obstacle to protect the brain from potentially noxious substances such as blood-borne toxins, immune cells, and pathogens. Thus, the maintenance of its structural and functional integrity is vital in the preservation of neuronal function and cellular homeostasis in the brain microenvironment. However, the barrier's foundation can become compromised during neurological or pathological conditions, which can result in dysregulated ionic homeostasis, impaired transport of nutrients, and accumulation of neurotoxins that eventually lead to irreversible neuronal loss. Initially, the BBB is thought to remain intact during neurodegenerative diseases, but accumulating evidence as of late has suggested the possible association of BBB dysfunction with Parkinson's disease (PD) pathology. The neurodegeneration occurring in PD is believed to stem from a myriad of pathogenic mechanisms, including tight junction alterations, abnormal angiogenesis, and dysfunctional BBB transporter mechanism, which ultimately causes altered BBB permeability. In this review, the major elements of the neurovascular unit (NVU) comprising the BBB are discussed, along with their role in the maintenance of barrier integrity and PD pathogenesis. We also elaborated on how the neuroendocrine system can influence the regulation of BBB function and PD pathogenesis. Several novel therapeutic approaches targeting the NVU components are explored to provide a fresh outlook on treatment options for PD.
    Matched MeSH terms: Brain/pathology
  4. Malignant melanoma of the choroid in a naevus of Ota
    Singh M, Kaur B, Annuar NM
    Br J Ophthalmol, 1988 Feb;72(2):131-3.
    PMID: 3349013
    A rare case of choroidal malignant melanoma in a naevus of Ota is described. This is the first reported case from Asia outside the Japanese population. This case illustrates the need for close observation of all pigmented lesions of the eye.
    Matched MeSH terms: Choroid Neoplasms/pathology*; Eye Neoplasms/pathology; Melanoma/pathology*; Neoplasms, Multiple Primary/pathology*; Nevus of Ota/pathology*; Nevus, Pigmented/pathology*; Skin Neoplasms/pathology*
  5. Rhabdomyolysis and vascular thrombosis supporting the electrocution related death
    Chng KL, Umul Khairil Fatimah MM, Hafizatul Solehah Z, Husna Syaza H
    Malays J Pathol, 2024 Aug;46(2):331-337.
    PMID: 39207012
    INTRODUCTION: Electrocution related death remains an ambiguous judgement and requires numerous valid evidence for proper medico-legal diagnosis. While the presence of electrical burn marks is a significant macroscopic indicator, it can be absent, especially on moist skin. The electrical mark still represents a fundamental indicator above all in the medico-legal field, but the identification of pathognomonic elements and signs not limited to the skin alone could be a valid help in the future, especially in unclear cases.

    CASE REPORT: The deceased was brought-in-dead to the hospital from their workplace, with no signs of fatal natural diseases. External examination revealed a Y-shaped burn mark on the right side of the neck and collapsed blisters with greying rings on both heels. Internal examination showed no alarming findings. Further, histopathological analysis of the foot blisters and neck burn revealed intraepidermal detachment, elongated nuclei, and coagulative necrosis. Notably, the presence of muscle fibre casts in kidney tubules and microthrombi in lung sections which indicate rhabdomyolysis and vascular thrombosis supported electrocution-related death.

    CONCLUSION: These positive findings of the electrical burn marks externally and significant histopathological changes, collectively support the death was due to electrocution, after excluding any major, fatal injuries. Albeit, a detailed inspection of the crime scene plays an important role, in order to classify the electrocution related death.

    Matched MeSH terms: Burns, Electric/pathology
  6. Fulltext Single-stage inferior vena caval intravenous leiomyomatosis excision
    Aimanan K, Koay KL, Hayati F, Tajri HM
    BMJ Case Rep, 2022 Aug 11;15(8).
    PMID: 35953149 DOI: 10.1136/bcr-2022-250261
    Intravascular tumour extension can occur in many different types of cancer. Those with the highest tendency include renal cell carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma. Inferior vena cava (IVC) tumour thrombus in gynaecological malignancy is rarely reported. We present a report on a female patient with extensive IVC tumour thrombus (intravenous leiomyomatosis) with concurrent intrauterine leiomyomatosis. She underwent a single-stage procedure, involving laparotomy and a sternotomy to remove her pelvic tumour, as well as the intracaval and intracardiac thrombus. The clinical presentation and management of this rare tumour will be detailed in this case report.
    Matched MeSH terms: Vena Cava, Inferior/pathology
  7. Fulltext A novel hybrid classification model of genetic algorithms, modified k-Nearest Neighbor and developed backpropagation neural network
    Salari N, Shohaimi S, Najafi F, Nallappan M, Karishnarajah I
    PLoS One, 2014;9(11):e112987.
    PMID: 25419659 DOI: 10.1371/journal.pone.0112987
    Among numerous artificial intelligence approaches, k-Nearest Neighbor algorithms, genetic algorithms, and artificial neural networks are considered as the most common and effective methods in classification problems in numerous studies. In the present study, the results of the implementation of a novel hybrid feature selection-classification model using the above mentioned methods are presented. The purpose is benefitting from the synergies obtained from combining these technologies for the development of classification models. Such a combination creates an opportunity to invest in the strength of each algorithm, and is an approach to make up for their deficiencies. To develop proposed model, with the aim of obtaining the best array of features, first, feature ranking techniques such as the Fisher's discriminant ratio and class separability criteria were used to prioritize features. Second, the obtained results that included arrays of the top-ranked features were used as the initial population of a genetic algorithm to produce optimum arrays of features. Third, using a modified k-Nearest Neighbor method as well as an improved method of backpropagation neural networks, the classification process was advanced based on optimum arrays of the features selected by genetic algorithms. The performance of the proposed model was compared with thirteen well-known classification models based on seven datasets. Furthermore, the statistical analysis was performed using the Friedman test followed by post-hoc tests. The experimental findings indicated that the novel proposed hybrid model resulted in significantly better classification performance compared with all 13 classification methods. Finally, the performance results of the proposed model was benchmarked against the best ones reported as the state-of-the-art classifiers in terms of classification accuracy for the same data sets. The substantial findings of the comprehensive comparative study revealed that performance of the proposed model in terms of classification accuracy is desirable, promising, and competitive to the existing state-of-the-art classification models.
    Matched MeSH terms: Breast Neoplasms/pathology; Diabetes Mellitus/pathology; Pathology, Clinical/classification*; Pathology, Clinical/methods
  8. Eyes on MEGDEL: distinctive basal ganglia involvement in dystonia deafness syndrome
    Wortmann SB, van Hasselt PM, Barić I, Burlina A, Darin N, Hörster F, et al.
    Neuropediatrics, 2015 Apr;46(2):98-103.
    PMID: 25642805 DOI: 10.1055/s-0034-1399755
    Pediatric movement disorders are still a diagnostic challenge, as many patients remain without a (genetic) diagnosis. Magnetic resonance imaging (MRI) pattern recognition can lead to the diagnosis. MEGDEL syndrome (3-MethylGlutaconic aciduria, Deafness, Encephalopathy, Leigh-like syndrome MIM #614739) is a clinically and biochemically highly distinctive dystonia deafness syndrome accompanied by 3-methylglutaconic aciduria, severe developmental delay, and progressive spasticity. Mutations are found in SERAC1, encoding a phosphatidylglycerol remodeling enzyme essential for both mitochondrial function and intracellular cholesterol trafficking. Based on the homogenous phenotype, we hypothesized an accordingly characteristic MRI pattern. A total of 43 complete MRI studies of 30 patients were systematically reevaluated. All patients presented a distinctive brain MRI pattern with five characteristic disease stages affecting the basal ganglia, especially the putamen. In stage 1, T2 signal changes of the pallidum are present. In stage 2, swelling of the putamen and caudate nucleus is seen. The dorsal putamen contains an "eye" that shows no signal alteration and (thus) seems to be spared during this stage of the disease. It later increases, reflecting progressive putaminal involvement. This "eye" was found in all patients with MEGDEL syndrome during a specific age range, and has not been reported in other disorders, making it pathognomonic for MEDGEL and allowing diagnosis based on MRI findings.
    Matched MeSH terms: Basal Ganglia/pathology*; Deafness/pathology*; Putamen/pathology; Dystonic Disorders/pathology*; Mitochondrial Diseases/pathology*
  9. Clear cell variant of calcifying epithelial odontogenic tumor without calcification: a rarity
    Mutalik VS, Nichat P, Carnelio S, Solomon M, Radhakrishnan R
    J Contemp Dent Pract, 2014 Jan 1;15(1):119-21.
    PMID: 24939279
    Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign, locally aggressive odontogenic epithelial tumor that affects the jaws. Although there are numerous reports on the variants of CEOT, occurrence of clear cells with complete absence of calcification has been a rarity. Histochemical analysis of tumor cells revealed glycogen granules with PAS staining, with absence of CD 1a staining in clear cells, while the amyloid-like deposit associated with clear cells showed green birefringence with Congo red. We report an unusual variant of CEOT occurring in a 27 years old male patient.
    Matched MeSH terms: Cytoplasm/pathology; Epithelial Cells/pathology; Mandibular Neoplasms/pathology*; Odontogenic Tumors/pathology*; Skin Neoplasms/pathology
  10. Fulltext Childhood idiopathic myelofibrosis: a case report and review of literature
    Noor-Fadzilah Z, Leong CF, Sabariah MN, Cheong SK
    Malays J Pathol, 2009 Dec;31(2):129-32.
    PMID: 20514856 MyJurnal
    Idiopathic myelofibrosis occurs predominantly in older adults. It is very rarely seen in children. We describe a 3-year-old girl with Down's syndrome who presented with recurrent chest infections associated with anaemia and easy bruising. There was mild hepatosplenomegaly. Full blood picture revealed pancytopaenia with leucoerythroblastosis with absence of circulating blast cells. Repeated attempts at bone marrow aspiration and trephine biopsy were unsuccessful. A trephine biopsy from the tibia showed depressed myelopoiesis and erythropoiesis, megakaryocytes with atypical morphology and increased bone marrow reticulin fibres, findings compatible with idiopathic myelofibrosis. She was treated symptomatically as she was clinically stable. Review of the English literature online yielded 46 reported cases of childhood idiopathic myelofibrosis with variable outcome from spontaneous remission to an indolent course with shortened survival. 6 cases evolved to another malignancy. 5 cases were associated with Down's syndrome.
    Matched MeSH terms: Bone Marrow/pathology*; Down Syndrome/pathology*; Megakaryocytes/pathology; Pancytopenia/pathology; Primary Myelofibrosis/pathology*
  11. Silent bony calcification of coronaries in an adolescent--an unusual case
    Murty OP, Mun KS, Hussin H
    J Forensic Leg Med, 2008 Jan;15(1):37-41.
    PMID: 18309549
    This is a case report of 16-year-old adolescent school boy who died due to unusual calcification of coronary arteries. He died while cycling with his friends. While cycling fast he fell. He was brought dead to hospital. At times unsuspected cardiac lesions cause sudden death during extraneous physical activities in healthy persons. Sudden death in adolescents is not very common. It is an unusual case as apparently healthy adolescent boy actively participating in sports had stony hard coronary arteries. The coronaries showed advanced calcification and early bone formation. The myocardial septum had extensive fibrosis. The pathogenesis and other possible similar conditions are also discussed in the report.
    Matched MeSH terms: Calcinosis/pathology*; Coronary Vessels/pathology*; Heart Septum/pathology; Myocardium/pathology; Forensic Pathology
  12. Pilomatrixoma as a diagnostic pitfall in fine needle aspiration cytology: a case report
    Sivakumar S
    Acta Cytol., 2007 Jul-Aug;51(4):583-5.
    PMID: 17718128 DOI: 10.1159/000325801
    BACKGROUND: Pilomatrixoma (pilomatrixoma, calcifying epithelioma of Malherbe) is a relatively uncommon, benign neoplasm arising from the skin adnexa. The tumor can cause diagnostic difficulty not only for the clinician but also for the cytologist.

    CASE: A 62-year-old woman presented with a right submandibular swelling of 4 months' duration. The clinical findings were highly suspicious for malignancy. A fine needle aspiration biopsy was performed. Three preliminary differential diagnoses were offered: mucoepidermoid carcinoma of the submandibular salivary gland, squamous cell carcinomatous deposit in a submandibular lymph node and calcifying odontogenic tumor. Computed tomography demonstrated no bony lesion. No primary site of squamous cell carcinoma could be identified. An excisional biopsy of the swelling was performed, and the histologic diagnosis of pilomatrixoma was made.

    CONCLUSION: The cytologic presentation of pilomatrixoma of the right submandibular region can masquerade as that of a malignant tumor, in this case mucoepidermoid carcinoma, squamous cell carcinoma or odontogenic tumor. This case delineates the cytomorphologic features of pilomatrixoma that may mimic carcinoma.
    Matched MeSH terms: Cell Nucleus/pathology; Epithelial Cells/pathology; Hair Diseases/pathology*; Skin Neoplasms/pathology*; Pilomatrixoma/pathology*
  13. Dental arch shape and size in Malay schoolchildren with Class II malocclusion
    Banabilh SM, Rajion ZA, Samsudin R, Singh GD
    Aust Orthod J, 2006 Nov;22(2):99-103.
    PMID: 17203572
    To quantify and localise differences in Class I and Class II dental arches in Malay schoolchildren.
    Matched MeSH terms: Dental Arch/pathology*; Malocclusion, Angle Class I/pathology; Malocclusion, Angle Class II/pathology*; Mandible/pathology; Maxilla/pathology
  14. Papillary breast lesions diagnosed on cytology. Profile of 65 cases
    Jayaram G, Elsayed EM, Yaccob RB
    Acta Cytol., 2007 Jan-Feb;51(1):3-8.
    PMID: 17328487
    OBJECTIVE: To analyze the cytologic features of nipple discharge and fine needle aspiration (FNA) cytologic smears from breast lesions reported as showing papillary features and to correlate them with histopathologic features.

    STUDY DESIGN: The study group consisted of FNA smears and/or nipple discharge smears from 65 breast lesions diagnosed on cytology as duct papilloma, papillary lesion, fibrocystic condition, fibroadenoma, papillary neoplasm or papillary carcinoma. Cytomorphologic features assessed included cellularity, cell pattern (clusters, papillary, 3-dimensionality, etc.) and cell characteristics (monomorphism, pleomorphism, apocrine change, plasmacytoid features). Histological material was available for review and cytohistologic correlation in all cases.

    RESULTS: Forty-six specimens were FNA smears, and 16 were nipple discharge smears; in 3 cases FNA and nipple discharge cytologic smears were available for review. Cytologic study could predict the presence of a papillary pattern in all neoplasms with pure or focal papillary differentiation. There was an overlap in cytomorphologic features between papillary and nonpapillary benign lesions as well as between benign and malignant papillary neoplasms. Frank blood in the aspirate, cell dissociation and atypia, however, were more frequent in the last.

    CONCLUSION: Overlap of cytologic features in nonneoplastic and neoplastic benign papillary lesions and between benign and malignant papillary neoplasms necessitates histologic evaluation in all cases diagnosed as papillary on cytology. Since 49.2% of lesions showing papillary features on cytology prove to be malignant, all cases reported as papillary on cytology should be excised urgently for histologic assessment.
    Matched MeSH terms: Breast Neoplasms/pathology*; Carcinoma, Papillary/pathology*; Fibrocystic Breast Disease/pathology; Fibroadenoma/pathology; Papilloma, Intraductal/pathology
  15. Fulltext Kimura's disease: an unusual cause of cervical tumor
    Asma A, Maizaton AA
    Med J Malaysia, 2005 Aug;60(3):373-6.
    PMID: 16379197
    Kimura's disease (KD) is an angiolymphoid proliferative disease of soft tissue with peripheral blood eosinophilia and elevated serum immunoglobulin (Ig) E. The treatment options range from conservative observation for the asymptomatic patient to surgical excision, steroid therapy and radiotherapy for symptomatic patients. Surgical excision is the most common diagnostic measure and is the treatment of choice. A case of KD in a 13-year-old Malay girl is presented. Clinically there was painless right jugular digastric mass measuring 3cm by 3cm. Her blood investigation showed pronounced eosinophilia. She underwent excision biopsy uneventfully. The biopsy from the swelling showed reactive follicular hyperplasic with prominent eosinophilia. There was no evidence of malignant change. Postoperatively after 3 years follow up, she was asymptomatic and no signs of tumor recurrence.
    Matched MeSH terms: Angiolymphoid Hyperplasia with Eosinophilia/pathology; Uterine Cervical Neoplasms/pathology; Eosinophilia/pathology; Lymphatic Diseases/pathology; Neoplasms/pathology
  16. Bandaged penis
    Murty OP, Mahinda HA
    J Forensic Leg Med, 2007 Jul;14(5):301-3.
    PMID: 16962816
    This is a case of a male in his late 30s who died due to acute myocardial ischemia. His penis was bandaged. The penis was inflamed and had infected abrasions. The possible relevances of such an incidental finding and its contribution to sudden death is explored. The case report shows photographs of the bandage in situ and its components, inflammation of frenulum, injury to the shaft, and the generalized inflamed and mildly swollen penis. These changes were considered to be caused by bites. The micro-photographic findings in the case were of acute myocardial ischemia, pulmonary oedema, and fatty liver.
    Matched MeSH terms: Fatty Liver/pathology; Penis/pathology; Pulmonary Edema/pathology; Myocardial Ischemia/pathology; Forensic Pathology
  17. Fulltext Large fungating thyroid cancers: a unique surgical challenge
    Harjit KD, Hisham AN
    Asian J Surg, 2005 Jan;28(1):48-51.
    PMID: 15691799
    Large goitres are common in the developing world, particularly in Asia and Africa. Nonetheless, large fungating goitres are extremely rare and represent a unique challenge to surgeons. Surgery should always be considered, when the general condition of the patient permits, to provide a better quality of life as it offers the only hope of long-term survival. The potential gain with surgery is that it allows maximum benefit for more effective radioactive iodine ablation and radiotherapy treatment. We report two cases of large fungating thyroid cancers complicated by anaemia and foul-smelling discharge.
    Matched MeSH terms: Carcinoma, Papillary/pathology; Goiter/pathology; Thyroid Gland/pathology; Thyroid Neoplasms/pathology; Carcinoma, Medullary/pathology
  18. The study of the function of AQP4 in cerebral ischaemia-reperfusion injury using poroelastic theory
    Mokhtarudin MJ, Payne SJ
    Int J Numer Method Biomed Eng, 2017 01;33(1).
    PMID: 26991256 DOI: 10.1002/cnm.2784
    Brain oedema is thought to form and to clear through the use of water-protein channels, aquaporin-4 (AQP4), which are found in the astrocyte endfeet. The model developed here is used to study the function of AQP4 in the formation and elimination of oedema fluid in ischaemia-reperfusion injury. The cerebral space is assumed to be made of four fluid compartments: astrocyte, neuron, ECS and blood microvessels, and a solid matrix for the tissue, and this is modelled using multiple-network poroelastic theory. AQP4 allows the movement of water between astrocyte and the ECS and the microvessels. It is found that the presence of AQP4 may help in reducing vasogenic oedema shown by a decrease in brain tissue extracellular pressure. However, the astrocyte pressure will increase to compensate for this decrease, which may lead to cytotoxic oedema. In addition, the swelling will also depend on the ionic concentrations in the astrocyte and extracellular space, which may change after ischaemic stroke. Understanding the role of AQP4 in oedema may thus help the development of a treatment plan in reducing brain swelling after ischaemia-reperfusion.
    Matched MeSH terms: Brain/pathology; Brain Edema/pathology; Brain Ischemia/pathology; Reperfusion Injury/pathology; Stroke/pathology
  19. Malignant proliferating trichilemmal tumour: a case report
    Fernandez SH
    Malays J Pathol, 1999 Dec;21(2):117-21.
    PMID: 11068417
    An 86-year-old man presented with a painless, pea-sized growth over the left angle of his jaw, which had been gradually enlarging over two years. A clinical diagnosis of pilar cyst was made. Histopathological examination of the mass revealed a malignant proliferating trichilemmal tumour. During follow-up 4 months later, a palpable small upper jugular lymph node was noted at the left side of the neck. Biopsy revealed a metastatic malignant trichilemmal tumour. This case illustrates a rare malignant tumour which is a challenge to clinical diagnosis.
    Matched MeSH terms: Epidermal Cyst/pathology; Jaw/pathology; Lymph Nodes/pathology; Skin Neoplasms/pathology*; Hair Follicle/pathology*
  20. 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.
    Matched MeSH terms: Adenoma/pathology*; Cell Nucleus/pathology; Cysts/pathology*; Thyroid Neoplasms/pathology*; Neoplasms, Squamous Cell/pathology*
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