MyMedR

Extramedullary CD20-positive B-lymphoblastic lymphoma in a 5-year-old child: A diagnostic challenge

Abdul Jalil D, Raja Sabudin RZA, Tang YL, Masir N

Malays J Pathol, 2020 Aug;42(2):273-276.

INTRODUCTION: Lymphoblastic leukaemia/lymphoma may present as an isolated extramedullary mass, which includes the musculoskeletal region involvement with normal or near-normal blood counts. The tumour may be in the form of B or T-lymphoblastic leukaemia/lymphoma. The clinical features and histological morphology of extramedullary B-lymphoblastic lymphoma (B-LBL) may mimic mature B-cell neoplasms, thus posing a diagnostic challenge. Arriving at the right diagnosis is crucial because these two diseases differ in their prognosis and management. A high index of suspicion is therefore important so as not to miss the correct diagnosis. The diagnosis may be overlooked because the clinical presentation may not be typical of B-LBL or the blood counts do not show any abnormalities. In this report, we highlight one such case where the diagnosis of B-LBL was missed because of its atypical presentation.

Matched MeSH terms: Diagnosis, Differential

Microcytic to hypochromic ratio as a discriminant index of thalassaemia trait in subjects with hypochromic anaemia

Wee SY, Muhamed Said SS, Raja Sabudin RZA, Alauddin H, Ithnin A

Malays J Pathol, 2020 Aug;42(2):195-201.

PMID: 32860371

INTRODUCTION: Differentiating between thalassaemia and iron deficiency anaemia (IDA) in hypochromic anaemia is a challenge to pathologists as it influences the choice of subsequent specialized confirmatory tests. In this study, we aimed to evaluate the performance of microcytic to hypochromic ratio (MicroR/ Hypo-He, M/H ratio) as a discriminant index in hypochromic anaemia.

MATERIALS AND METHODS: A retrospective study was carried out on 318 subjects with hypochromic anaemia, which comprised 162 IDA and 156 thalassaemia trait subjects with α-thalassemia, β-thalassemia and HbE trait. Optimal cut-off value, sensitivity and specificity of M/H ratio for thalassaemia trait discrimination was determined using Receiver Operating Characteristic (ROC) analysis.

RESULTS: Subjects with thalassaemia trait showed higher MicroR compared to IDA ( p< 0.001) while subjects with IDA demonstrated higher Hypo-He than thalassaemia trait (p < 0.001). M/H ratio was significantly higher in thalassaemia trait compared to IDA, with medians of 3.77 (interquartile range: 2.57 - 6.52) and 1.73 (interquartile range: 1.27 - 2.38), respectively (p < 0.001). M/H ratio ≥ 2.25 was the optimal cut-off value for discriminating thalassaemia trait from IDA in hypochromic anaemia, with the area under ROC curve (AUC) of 0.83, sensitivity of 80.8% and specificity of 71.6%.

CONCLUSIONS: M/H ratio is a useful discriminant index to distinguish thalassaemia trait from IDA in hypochromic anaemia prior to diagnostic analysis for thalassaemia confirmation. High M/H ratio is suggestive of thalassaemia trait than of IDA. However, more studies are required to establish the role of M/H ratio as a screening tool for thalassaemia discrimination in hypochromic anaemia.

Matched MeSH terms: Diagnosis, Differential

Fulltext Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

Ho YL, Ng PF, Krishinan S, Abdul Kareem BA

J Cardiothorac Surg, 2021 May 29;16(1):151.

PMID: 34051789 DOI: 10.1186/s13019-021-01526-7

BACKGROUND: Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation.

CASE PRESENTATION: We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination.

CONCLUSION: Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

Matched MeSH terms: Diagnosis, Differential

Neck pain and paraplegia

Saniasiaya J

Emerg Med J, 2021 Mar;38(3):197-216.

PMID: 33619156 DOI: 10.1136/emermed-2020-209554

Matched MeSH terms: Diagnosis, Differential

Fulltext Use of molecular tools to distinguish Entamoeba histolytica and Entamoeba dispar infection among the aborigines in Cameron Highlands

Noor Azian MY, Lokman Hakim S, Maslawaty MN

Trop Biomed, 2006 Jun;23(1):31-6.

PMID: 17041549 MyJurnal

Amoebiasis is an infectious diseased caused by parasitic one-celled protozoan called Entamoeba histolytica. Numerous protozoa also can inhabit the gastro-intestinal tract of human. Majority of these protozoa are non-pathogenic commensals or only causes disease under certain circumstances. Morphologically, E. histolytica, the invasive form, share the same characteristic with the nonpathogenic form, E. dispar. Both strains can be distinguished by using DNA identification. Many previous researches in Malaysia only reported infection with E. histolytica infection. Therefore in this study we tried to classify infection among the aborigines in Cameron Highland as true E. histolytica or E. dispar by Nested Polymerase Chain Reaction (Nested PCR) and Restriction enzyme (RE) digestion. Results showed that 31 samples were positive by microscopic examination, however of these 28 (13.2%) samples were positive for E. histolytica and 12 (5.6%) samples were positive for E. dispar by molecular tools.

Matched MeSH terms: Diagnosis, Differential

Fulltext Transmission potential of Wuchereria bancrofti by Culex quinquefasciatus in urban areas of Malaysia

Vythilingam I, Tan CH, Nazni WA

Trop Biomed, 2005 Jun;22(1):83-5.

PMID: 16880760 MyJurnal

Laboratory strain of the Malaysian Culex quinquefasciatus was susceptible to Wuchereria bancrofti. Thirty three percent of the Cx. quinquefasciatus that fed on W. bancrofti patient were infective after 12-14 days. There is a possibility for W. bancrofti to occur in the urban areas of the Malaysia in the near future.

Matched MeSH terms: Diagnosis, Differential

Fulltext A fatal case of anaphylactic shock caused by the lesser banded hornet, Vespa affinis indosinensis in peninsular Malaysia

Lee HL, Krishnasamy M, Jeffery J

Trop Biomed, 2005 Jun;22(1):81-2.

PMID: 16880759 MyJurnal

The hornets are a group of venomous stinging insects that at times cause human death. A fatal case of a child stung by the lesser banded hornet Vespa affinis indosinesis is reported. Though often covered by the mass media, this constitutes the first scientifically reported case.

Matched MeSH terms: Diagnosis, Differential

Potential severe pediatric SARS-CoV-2-induced multisystem inflammatory syndrome resembles dengue infection

Yuliarto S, Susanto WP, Kadafi KT, Ratridewi I, Olivianto E

Trop Biomed, 2021 Jun 01;38(2):129-133.

PMID: 34172701 DOI: 10.47665/tb.38.2.048

We describe a child with acute fever and abdominal pain who developed rash and edema of extremities. Blood test revealed thrombocytopenia, lymphopenia, positive dengue-IgM, and hypoalbuminemia with elevated procalcitonin. Right pleural effusion revealed from chest x-ray. Diagnosed as dengue hemorrhagic fever (DHF) grade 1, however, at 7th day of illness, altered mental status, respiratory and circulatory failure occurred. Laboratory examination showed marked thrombocytopenia, transaminitis, metabolic acidosis, elevated D-dimer, decrease fibrinogen, and elevated cardiac marker (troponin I and CKMB). The patient then developed catecholamine-resistant shock and did not survive after 48 hours. Although rapid test of SARS CoV-2 infection was negative, rapid deterioration with some unusual clinical feature suggest multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection. This case raises an awareness of MIS-C that clinical features resemble dengue infection.

Matched MeSH terms: Diagnosis, Differential

A systematic review and meta-analysis of immunohistochemical biomarkers that differentiate chromophobe renal cell carcinoma from renal oncocytoma

Ng KL, Morais C, Bernard A, Saunders N, Samaratunga H, Gobe G, et al.

J Clin Pathol, 2016 Aug;69(8):661-71.

PMID: 26951082 DOI: 10.1136/jclinpath-2015-203585

Numerous immunohistochemical (IHC) biomarkers have been employed to aid in the difficult differentiation between chromophobe renal cell carcinoma (chRCC) and renal oncocytoma (RO). A systematic review and meta-analysis of the published literature was carried out to summarise and analyse the evidence for discriminatory IHC biomarkers to differentiate the two entities.

Matched MeSH terms: Diagnosis, Differential

Fulltext Meat molecular detection: sensitivity of Polymerase Chain Reaction-Restriction Fragment Length Polymorphism in species differentiation of meat from animal origin

Ong, S.B., Zuraini, M.I., Jurin, W.G., Cheah Y.K., Tunung, R., Chai, L.C., et al.

International Food Research Journal, 2007;14(1):51-59.

MyJurnal

Three restriction enzymes were used in Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) using the mitochondrial cytochrome b region to establish a differential diagnosis which detect and discriminate between three meat species: pork, cow and chicken. DNA was extracted from samples containing meat of a single animal such as raw pork (Sus scrofa domesticus), chicken (Gallus gallus) and cow (Bos taurus) as well as mixed samples of two species of animals in different ratios. The amplified 359 base pairs (bp) portion of the mitochondrial cyt b gene from pure or mixed samples in different ratios was cut using three different restriction enzymes resulting in species specific restriction fragment length polymorphism (RFLP). This technique proved to be extremely reliable in detecting the presence of low levels of target DNA obtained from a 0.25 mg component in a particular mixed meat sample. This revealed the cyt b region as highly conserved and consequently a good molecular marker for diagnostic studies. Thus, this technique can be applied to food authentication for the identification of different species of animals in food products.

Matched MeSH terms: Diagnosis, Differential

Subcutaneous mycosis presenting as a non- healing left calf ulcer in an immunocompromised patient

Tang ASO, Yong KY, Wong J, Chua HH, Chew LP

Med J Malaysia, 2017 04;72(2):122-123.

PMID: 28473676

This is a case report of subcutaneous mycosis presenting as a non-healing left calf ulcer in an immunocompromised patient. Traumatic inoculation of the causative agent is the most likely route of infection. The diagnosis requires a detailed history and high clinical suspicion, confirmed by histopathological examination. The management requires a multidisciplinary team approach involving surgeon, pathologist, physician sub-specialised in infectious disease, wound care nursing team as well as social support services. The literature review recommended that the treatment of choice for such infection is surgical debridement in addition to optimal antifungal therapy.

Matched MeSH terms: Diagnosis, Differential

Pulmonary actinomycosis masquerading as aspergilloma

Rosdina Z, Nurul Yaqeen ME, Hanafiah M, Nor Salmah B

Med J Malaysia, 2017 04;72(2):147-149.

PMID: 28473686 MyJurnal

We report a case of a 34-year-old man who was initially treated as community acquired pneumonia following a three-month-history of productive cough, loss of weight and loss of appetite. However, three months after discharged from the hospital, he presented again with worsening respiratory symptoms and radiological evidence of a lung cavitation with intracavitary lesion resembling an aspergilloma associated with surrounding consolidation. Unfortunately, he remained symptomatic despite on antifungal therapy. The repeat computed-tomography demonstrated persistent cavitating lesion with development of necrotising pneumonia. He underwent lobectomy and the histopathological analysis of the resected specimen however revealed the diagnosis of actinomycosis.

Matched MeSH terms: Diagnosis, Differential

Right hydronephrosis and vesicocolic fistula complicating sigmoid colonic diverticulitis: report of a case

Ng KK, Tan KM, Lim KT

Dis Colon Rectum, 1975 Oct;18(7):623-5.

PMID: 1181168

Matched MeSH terms: Diagnosis, Differential

Fulltext Charles Bonnet syndrome: a precursor to Alzheimer disease

Janaki, V., Rosdinom, R., Hatta, S.

Medicine & Health, 2015;10(2):146-150.

MyJurnal

This case report highlights Charles Bonnet Syndrome as a precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment and the possible differential diagnoses that could be considered. We report a case of an elderly lady with no known previous medical illness, who presented for the first time to the psychiatric clinic with complex visual hallucinations consisting of well-formed images of people and inanimate objects of long standing duration of 18 months. About a year later, there was emergence of cognitive impairment which progressed gradually accompanied by other psychotic symptoms such as auditory hallucinations and persecutory delusions. There were no affective or obsessional symptoms. She had poor insight towards her illness. Ophthalmological examination revealed significant reduction in bilateral visual acuity. Otherwise, physical examination was unremarkable. She received inpatient treatment with Rivastigmine patch 4.6 mg/24 hours and Zydis 10 mg noctre. Her cognitive impairment and psychotic symptoms gradually improved over a period of 2 weeks upon commencing treatment and on subsequent follow-ups at outpatient clinic. She had also gained some insight into her illness. Charles Bonnet syndrome could be a possible precipitating factor and precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment which is often overlooked or misdiagnosed and hence under reported.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Diagnosis, Differential

Fulltext Florid cemento-osseous dysplasia as a possible aggravating factor in a case of trigeminal neuralgia.

Siar, C.H., Ibrahim, N., Omar, A.N., Abdul Rahman, Z.A.

Ann Dent, 2010;17(1):21-24.

MyJurnal

Differential diagnosis of orofacial pain is crucial, as the course of each process and its clinical management varies markedly. A case is illustrated here of trigeminal neuralgia in a 49-year-old Indian female whose complaint was initially diagnosed as dental pain leading to sequential extractions of her right mandibular and maxillary molars but with no pain abatement. Subsequent neurological assessment diagnosed her complaint as trigeminal neuralgia but pain remained poorly controlled even with high doses of carbamazepine and gabapentin. A dental referral and orthopantomographic examination revealed multifocal sclerotic masses in her jaws, suggestive of florid cemento-osseous dysplasia (FCOD). Right mandibular incisional biopsy confirmed the diagnosis. A decision was made to curette the right mandibular masses and lateralised the right inferior dental nerve. Follow-up disclosed considerable pain reduction. This case raises the issue as to whether the sclerotic bone masses in FCOD may have caused nerve compression which
aggravated her neuralgic pain.

Matched MeSH terms: Diagnosis, Differential

Infectious mononucleosis or toxoplasmosis?

Tan DS, Zaman V, Lopes M

Med J Malaysia, 1978 Sep;33(1):23-5.

PMID: 750891

Matched MeSH terms: Diagnosis, Differential

Subcutaneous gas in diabetes mellitus due to Aerobacter aerogenes infection

Da Costa JL

Med J Malaya, 1969 Mar;23(3):199-202.

PMID: 4240074

Matched MeSH terms: Diagnosis, Differential

Fulltext A diagnostic workup of perioperative anaphylaxis reveals a selective type 1 hypersensitivity to cefazolin

Meera Thalayasingam, Shek, Lynette Pei-Chi

International e-Journal of Science, Medicine & Education, 2015;9(2):37-39.

MyJurnal

Anaphylaxis in the operating room although infrequent can be potentially fatal. The diagnosis of perioperative anaphylaxis is complex due to a multitude of factors. Firstly, patients under anesthesia cannot verbalize their complaints, the anesthetic agents themselves can alter vital parameters (e.g. heart rate and blood pressure) and cutaneous signs in a completely draped patient may be missed. Secondly, the differential diagnosis of intraoperative anaphylaxis is wide. Conditions such as asthma exacerbation, arrhythmia, hemorrhage, angioedema, mastocytosis, acute myocardial infarction, drug overdose, pericardial tamponade, pulmonary edema, pulmonary embolus, sepsis, tension pneumothorax, vasovagal reaction, venous air embolism, laryngospasm, blood transfusion reaction and malignant hyperthermia need to be considered. Thirdly, the diagnostic workup is challenging due to the multiple medications administered and other exposures encountered such as latex and chlorhexidene. However, through a timely allergy consultation and a systematic approach, identification of the culprit agent and safe alternatives can be established to prevent future occurrences as illustrated in the case below.

Matched MeSH terms: Diagnosis, Differential

Fulltext Anaplastic Large Cell Lymphoma Presenting as a Soft Tissue Mass – A Case Report

Siti-Aishah, M.A., Salwati, S., Idrus, M., Rahimah, R., Salmi, A., Leong, C.F., et al.

Medicine & Health, 2008;3(1):69-74.

MyJurnal

Anaplastic large cell lymphoma (ALCL) is a rare tumour, accounting for approximately 3% of adult non-Hodgkin lymphomas.1 Primary systemic ALCL frequently involves both lymph nodes and extranodal sites. A 44-year-old woman presented with a firm, mobile mass in the left iliac fossa region. Ultrasound findings showed a well defined inhomogenous soft tissue mass, measuring 4x4x2.6cm in the deep subcutaneous region. Histopathological examination revealed that the mass was infiltrated by large lymphoid cells with marked nuclear atypia including kidney-shaped nuclei. These neoplastic cells expressed anaplastic lymphoma kinase (ALK) (both nuclear & cytoplasmic staining), CD30 and EMA but not for T-cell (CD45RO and CD3), and B-cell (CD20 & CD79α) markers. Fluorescence in situ hybridization (FISH) analysis showed a t(2;5)(p23;q35) chromosomal translocation. Subsequently the patient developed shortness of the breath and a thoracic computed tomography (CT) scan showed a mass encasing the right upper lobe bronchus. She also had bilateral axillary lymph nodes, measuring 1 cm in diameter (biopsy was not done). The mediastinum and endobronchial region did not show any abnormalities. She received 6 cycles of CHOP chemotherapy and remained disease free 2 years after diagnosis. ALCL, rarely present as a soft tissue tumour and this disease should be included as a differential diagnosis of any soft tissue mass.

Matched MeSH terms: Diagnosis, Differential

Mucinous cystadenoma, serous cystadenoma and benign cystic teratoma of the ovary: clinico-pathologic differences observed in a Malaysian hospital

Ong HC, Chan WF

Cancer, 1978 Apr;41(4):1538-42.

PMID: 639009

A study of 207 benign ovarian tumors seen at the University Hospital, Kuala Lumpur between 1968 and 1975 was made to evaluate the clinical features that might be useful in the preoperative differentiation of mucinous cystadenoma, serous cystadenoma, and cystic teratoma of the ovary. This study indicated that the pertinent information included the mean age of the patient, the marital and menstrual status, and the estimated tumor size. The racial background was an additional factor in serous cystadenoma. Features like parity, the location of the tumor, and ABO blood group pattern were of no value in the preoperative differentiation.

Matched MeSH terms: Diagnosis, Differential

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