Primary peritoneal carcinoma (PPC) is a rare tumor that is histologically and immunohistochemically indistinguishable from epithelial ovarian carcinoma. The diagnosis is usually made after excluding gross ovarian involvement or the ovarian involvement is only confined to the surface. A 68-year-old lady presented with right iliac fossa pain and increasing CA125. The CT scan showed bilateral pelvic adnexal masses with peritoneal deposits within the right side of abdomen. She was initially diagnosed as carcinomatosis peritonei from the omental cake removed after exploratory surgery. She was managed as advanced ovarian tumor with peritoneal metastasis and was then administered six cycles of chemotherapy. Surgical intervention included debulking surgery consisting of total abdominal hysterectomy, bilateral salpingooophorectomy and omentectomy and also with right hemicolectomy. The histopathological findings were of primary peritoneal serous carcinoma with only minimal involvement of the serosal surface of the right ovarian capsule. No microscopic invasion into underlying ovarian cortex and stroma was observed. Multiple tumor deposits were also seen over the right paratubal and paraovarian tissue, both parametrium as well as serosal surface of the terminal ileum and periappendicular tissue. Immunohistochemically, the malignant cells were positive to CA125, focally positive to CK7 and negative to CD20 and Calretinin. PPC is one of important differential diagnosis which needs to be considered in cases of advanced ovarian tumor, although the former can only be ascertained after excluding the ovarian involvement microscopically.
Sir, We here are highlighting the scenario of presentation of renal dysfunction in developing countries like India where a large number of patients present clinically as acute renal failure (ARF) but on thorough evaluation found to have advanced stages of chronic kidney disease (CKD stages 4 and 5)1 . Historically these patients are symptomatic for few days prior to presenting. Preceding slight unwell-ness is ignored either by patient or his family physician. They are often being treated with non-specific medications like analgesics and multivitamins which act as placebo. Iron deficiency anemia is unevaluated for a renal cause. Non-standardized laboratories under diagnose early CKD. Ultrasound imaging too is of poor quality. All the more there are no nationalized health screening programmes. To add to the dismal scenario, at the tertiary care centres they are initially admitted as ARF, with a hope of significant recovery. But later on they turn out to be CKD 5.
Tubercular tenosynovitis is an uncommon condition and usually affects the upper limb. We report a case of a patient with Systemic Lupus Erythematosus who presented with wrist swelling. The clinical findings were suggestive of rheumatoid nodules, but the radiographic finding of calcification associated with the nodules and marked erosive changes primarily of the radio-carpal joint with sparing of the metacarpal joints led the radiologist to believe that the nodules may not be rheumatoid nodules. The presence of solid and fluid nature of the nodule and hyperechoic small echogenic foci (matted rice bodies within thickened synovium) on ultrasound suggested the presence of chronic synovitis of tuberculous infection rather than rheumatoid nodule as in our case. We recommend the use of ultrasound to determine the nature of nodular swellings seen clinically in patients with arthropathy.
An Indian man from Malaysia presented with contracture of his hands. He is 55 years of age and has a history of chronic alcohol consumption. Examination revealed bilateral thickened structure at the palms.
Pain remains as one of the most common reasons for visits to a doctor. The paper by Zalinawati et all published in this issue of the Journal confirmed this in two primary care settings, showing that a complaint of pain was recorded in almost a third of patients, similar to the prevalence reported in European studies.
Ossifying fibromyxoid tumor (OFMT) is a rare benign tumor, most of which occurs in adults with localization in the subcutaneous tissue or muscle of the extremities. A five-year-old girl presented with a mass in her right upper thigh. Due to the large size of the mass (10 x 7 cm), our provisional diagnosis was a soft tissue sarcoma. A tru-cut biopsy showed that the lesion was benign. The mass was excised and has not recurred since. To the best of our knowledge, this patient is the youngest case of OFMT reported in the English literature.
The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field.
Primary mucoepidermoid carcinoma (MEC) of thyroid is an uncommon tumour and reports on its' cytology are consequently scanty. A 46-year-old male presented with a thyroid nodule of nine months duration. Fine needle aspiration (FNA) cytology of the nodule showed features of a malignant tumor that was different from the usual types of thyroid carcinoma. Monolayers and syncytial clusters of round and spindle tumour cells with large vesicular nuclei and single macronucleoli were present. A diagnosis of carcinoma was given with the comment that this was unlike any of the usual types of thyroid cancer and that a metastatic malignancy should be ruled out. The cytological picture of MEC may not always be distinctive enough for accurate tumour typing. Nevertheless the cytological features are usually sufficiently different to rule out all of the usual types of thyroid carcinoma. This distinction may be important from the point of view of differing prognosis in MEC of thyroid (as compared to differentiated thyroid cancers) and the need to exclude a metastatic carcinoma, especially from a primary in one of the salivary glands.
An asymptomatic subject with radiographic changes due to welders' siderosis is described. This condition has not been well recognized and described in our community. Siderosis of the lung is generally considered to be a benign condition not associated with respiratory symptoms. However, recent reports have associated welding with various disorders of pulmonary function as well as lung cancer. There is a need for future epidemiological studies to better define the risk of long term welding.
The term "choristoma" is used to describe a mass of histologically normal tissue presenting in an aberrant site. A rare case of osseous choristoma of the tongue is presented and the literature is briefly reviewed.
Double teeth or joined teeth have been described under several different terms and the terminology is often confusing. There are several ways in which union of teeth can occur and the terms that are commonly used to describe the condition are fusion and gemination. Although primary double teeth themselves may be regarded as harmless anomalies, its presence can cause some abnormalities to occur in the permanent dentition. Therefore, early diagnosis of the anomaly is of considerable importance.
Juvenile xanthogranuloma is a benign cutaneous growth presenting as papules or nodules. It is characterized by an intradermal collection of lipid-laden macrophages and varying degrees of fibroblastic proliferation. We have recently observed two patients with xanthogranulomas: one was found to have a papular type and the second patient had multiple nodular growths. We present these cases, which should be considered in the differential diagnosis of skin nodules.
We present a young lady who satisfied the criteria for the diagnosis of toxic-shock syndrome (TSS). The differential diagnoses of TSS in the local setting are outlined. The pertinent clinical features of TSS and its increasing association with nonmenstruating females are highlighted.
Hailey-Hailey disease or Chronic Benign Familial Pemphigus is probably rare in this region and to date there is no case report from Malaysia. I report here a Malay patient with this disease but with no family history and who was believed to be suffering from Atopic Eczema for several years. Dapsone effectively controlled the disease in this patient. The clinical features, histology and the therapy are discussed.
A case of benign cystic teratoma, sufficiently large to present as an abdominal mass with pressure signs on the right ureter in a two-year old child is presented, the lowest age in this country recorded.
Leiomyoma of the caecum is a rare tumour. While leiomyomata are known to arise from any part of the large bowel, caecum is a rare site. The largest series to date is that of Mackenzie" who reviewed 37 cases of myomatous tumours of the colon, two of which were complicated by perforation. More recently, Swerdlow" reported another case of a perforated caecal leiomyoma. We now report a patient who was operated at the stage of abscess formation without perforation.