Leptospirosis is a zoonosis with worldwide distribution. It is often referred to as swineherd's disease, swamp fever or mud fever. In recent years there is increase incidence in leptospirosis in human. The incidence varies from sporadic in temperate zones to endemic in the tropical countries. Leptospirosis generally present with features of bacterial infection in acute phase following with multi organs complications. Acute bowel ischaemia with perforation following leptospirosis is a rare presentation . To the best of our knowledge, this is the first case report of such condition. The surgical management of this rare incidence will be discussed.
Congenital leukaemia (CL) is a rare malignancy that accounts for < 1% of cases of childhood leukaemias. Leukaemia cutis (LC) refers to cutaneous infiltration with leukaemic cells, and is seen in 30-50% of CL cases. It may precede, follow or occur simultaneously with leukaemia. If left untreated, the prognosis is usually poor, but early diagnosis and treatment may result in a favourable prognosis. We report a case of congenital leukaemia cutis with a progressive, violaceous papulonodular eruption (a 'blueberry muffin' rash), which had been noted at birth, as a presenting sign of acute myeloid leukaemia (AML), which on investigation was classified as AML, FAB M2 type with a t(8; 21)(p11;q22) chromosomal defect. The patient had a favourable response to AML chemotherapy.
To describe a case of isolated infraorbital mass which had been present for the past 9 years in a young woman. Despite the size, the mass was successfully excised in total.
Matched MeSH terms: Myxoma/pathology; Orbital Neoplasms/pathology
The case of a 10-year-old girl is presented who had a slow-growing, painless swelling on the left side of the tongue since six months. This was associated with disturbances in mastication and phonation. Examination revealed a 5 cm x 4 cm. globular smooth, mobile mass on left side of the tongue. There was no neurological deficit and no neck nodes palpable. She underwent excision of the mass under general anaesthesia. Complete enucleation with primary closure was carried out. The patient had an uneventful postoperative recovery and histological evaluation was consistent with schwannoma. The patient was recurrence free after one year.
Asymmetrical eyelid skin crease may be mistaken for ptosis due to apparent narrowing of the palpebral fissure in the eye without the skin crease. This study describes a series of patients who were mistakenly referred for ptosis operation as a result of absent skin crease.
Yellow nail syndrome (YNS) is an uncommon disorder characterized by a triad of nail dystrophy, lymphedema, and pleural effusion. It is rare in children and congenital occurrence of YNS has been very rarely described. We report a 2-year-old Arab boy having congenital yellow nail syndrome with mild facial dysmorphism and bilateral conjunctival pigmentation born to consanguineous parents. One of his older siblings had died of nonimmune fetal hydrops (NIFH). The case supports the genetic basis of yellow nail syndrome with a possible relationship to nonimmune fetal hydrops.
Matched MeSH terms: Nails/pathology*; Yellow Nail Syndrome/pathology*
Deep penetrating nevus (DPN) is a variant of melanocytic nevus which goes unrecognized due to its relative rarity and may be misinterpreted as malignant melanoma. It commonly presents in young adults as a dark pigmented lesion on the face, neck, or shoulder. A 60-year-old lady presented with a mole over the left arm of 8 years duration. A biopsy of the lesion was performed under the clinical impression of a compound nevus with suspicion of malignancy. Based on the histologic features, a diagnosis of DPN was put forward.
The occurrence of congenital diaphragmatic hernia in a pregnant adult is rare. In contrast to neonatal diaphragmatic hernias, most of the adult patients present with vague gastrointestinal symptoms mimicking other diseases hence the importance of high index of suspicion. We report a case of a young pregnant lady with congenital diaphragmatic hernia presenting with symptoms and clinical signs suggestive of acute pancreatitis. The patient had a laparotomy performed to reduce the hernial content and the diaphragmatic defect was successfully repaired.
A 30-year-old man presented to the genitourinary medicine clinic with the sudden appearance of an asymptomatic, 2 mm wide, flesh-colored, firm, and cord-like lesion encircling the coronal sulcus circumferentially following vigorous sexual intercourse with his wife. An initial diagnosis of sexually transmitted disease-associated penile swelling was entertained. He was given antibiotics for this condition. Failure of resolution and negative screening tests for sexually transmitted diseases prompted a skin biopsy and extensive literature search, with an ultimate diagnosis of nonvenereal sclerosing lymphangitis of the penis, a rare, self-limiting condition. Reassurance and abstinence of sexual intercourse for a few weeks led to complete recovery.
The influence of age on various histological types of breast cancer at both age <50 years and >50 years to simulate menopause was studied retrospective from 2002 to 2004 in Malaysia. One hundred and fifty five cases were reviewed. Ninety two cases recorded at age <50 years, 60 (65.2%, 95%CI: 54.6 - 74.8%) were infiltrating ductal carcinoma in 11(12.0%, 95% CI: 6.1-20.4%), ductal carcinoma in situ (DCIS) in 9 (9.8%, 95% CI: 4.6-17.8%), medullary carcinoma in 6 (6.5%, 85%CI: 2.4-13.6%), invasive lobular carcinoma in 4 (4.3%, 95%CI: 1.2-10.8%), mucinous carcinoma and poorly differentiated carcinoma in 2 cases (2.2%, 95%CI: 0.3-7.6%). At >50 years of age, 63 cases were recorded. Forty seven (74.6%, 95%CI: 62.0- 84.7%) cases were of infiltrating ductal carcinoma, ductal carcinoma in situ in 9 (14.3%, 95%CI: 6.7-25.4%), mucinous carcinoma in 5 (7.9%, 95%CI: 2.6-17.6%), medullary carcinoma (8.5%) and papillary carcinoma in 1 case each (1.6%, 95%CI: 0.0-8.5%). Infiltrating ductal carcinoma was the commonest histology at both age <50 years and >50 years.
Matched MeSH terms: Breast Neoplasms/pathology*; Carcinoma/pathology*
Leiomyosarcoma is a malignant smooth-muscle tumour that has a predilection for the gastrointestinal and female genital tract. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report a rare case of leiomyosarcoma of the maxilla in a patient who sought treatment for maxillary swelling, nasal obstruction with no epistaxis, orbital involvement or cervical lymph node metastasis. The patient underwent subtotal maxillectomy followed by radiotherapy. At present, he is symptom free with no recurrence and under regular follow up.
Lucio's phenomenon is a rare and aggressive necrotising variant of erythema nodosum leprosum that classically occur in patients with undiagnosed, diffuse non-nodular lepromatous leprosy. It is a potentially fatal leprosy reaction characterised by extensive, bizarrely-shaped, painful purpuric skin lesions and ulcerations. Lucio's phenomenon is very rarely reported outside of Mexico and Costa Rica.
Psoriasis is a skin disorder which is caused by a genetic fault. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, the current gold standard method, PASI (Psoriasis Area and Severity Index), is used to measure psoriasis severity by evaluating the area, erythema, scaliness and thickness of the plaques. However, the determination of PASI can be tedious and subjective. In this work, we develop a computer vision method that determines one of the PASI parameters, the lesion area. The method isolates healthy and healed skin areas from lesion areas by analysing the hue and chroma information in the CIE L*a*b* colour space. Centroids of healthy skin and psoriasis in the hue-chroma space are determined from selected sample. The Euclidean distance of all pixels from each centroid is calculated. Pixels are assigned to either healthy skin or psorasis lesion classes based on the minimum Euclidean distance. The study involves patients from different ethnic origins having three different skin tones. Results obtained show that the proposed method is able to determine lesion areas with accuracy higher than 90% for 28 out of 30 cases.
Study site: Dermatology Clinic, Hospital Kuala Lumpur
We report here a case of primary colorectal T-cell lymphoma of the cecum in a 30-year-old man. Patient presented with a history of abdominal pain, fever, vomiting and hematochezia. Clinical examination was unremarkable and colonoscopy showed an ulcerating mass in the colon. A right hemicolectomy with dissection of the paracolic lymph nodes was performed. The final histopathological examination showed a primary T- cell lymphoma of the cecum. Staging didn't show any involvement in any other sites of the body. Primary colon lymphoma is a rare gastrointestinal tumor that represents less than 1% of the gastrointestinal lymphomas. Peripheral T-cell lymphoma represents a relatively small proportion of lymphomas and has a lower prevalence in Western countries. The risk factors, clinical presentation, staging, prognostic factors and treatment modalities of extra-nodal lymphoma are discussed.
Immunohistochemistry has become part of normal routine diagnostic work in the Stomatology Unit, Institute for Medical Research, Kuala Lumpur. Of 9523 cases received from the year 2000 to 2005, 197 cases (2.1%) required immunohistochemical staining. These cases ranged from benign to malignant lesions. They include lymphomas (n=41), epithelial tumours (n=29), neural lesions (n=21), fibroblastic/myofibroblastic tumours (n=16), small round cell tumour (n=11), vascular tumours (n=4), smooth muscle tumours (n=4), myxomatous tumours (n=4) and skeletal muscle tumours (n=1). In most of the cases (69.5%), immunohistochemical staining was mandatory to reach a definite diagnosis, while 60 cases (30.5%) required immunohistochemistry in confirming the diagnosis. In 32 cases (16.2%), definitive diagnosis could not be made due to the small size of the specimens received or the results of immunohistochemistry were inconclusive. Standardization of techniques, competent medical laboratory technologists and sufficient budget allocation are important in producing a high quality immunohistochemistry service.
Schwannomas are benign tumors. A series of three unusual cases involving the head and neck region at the Department of ENT, Hospital Ipoh from July 2004 to June 2005 is presented. The first case was a pedunculated schwannoma of the tongue base. The second was a schwannoma of the cervical sympathetic chain who developed a transient Horner's Syndrome upon fine needle aspiration cytology. The third case was a bilobed cervical vagal schwannoma which developed immediate vocal cord palsy postoperatively which was evident at six months follow-up. All tumors were removed surgically.
Matched MeSH terms: Head and Neck Neoplasms/pathology*; Neurilemmoma/pathology*
Primary tracheal tumors are very rare. Pleomorphic adenoma is rarely found in the trachea, despite being the most common histological form of salivary gland neoplasm. We present a case of pleomorphic adenoma of the trachea. Bronchoscopic excision using cold instruments resulted in apparently normal tracheal mucosa.