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Fulltext Kimura's Disease with Atypical Musculoskeletal Presentation

Hafiz A., Yusuf, A., Rosmaliza, I., Premchandran, N., Kalavathy, R.

Malays Orthop J, 2010;4(2):44-47.
MyJurnal

We would like to highlight an unusual clinical presentation of Kimura's disease, a rare, benign, idiopathic condition, usually seen as swelling and lesions of the head and neck region and commonly affecting young men of Asian descent. It is rare for this disorder to present with lesions on other parts of the body, especially the lower limbs. We report a 27-year-old man who presented with a large mass located at the inguinal region and extending down to the upper thigh. Due to the large size of the mass (28 x 18 cm), our provisional diagnosis was a soft tissue sarcoma. Open biopsy showed that the lesion was benign.

Matched MeSH terms: Biopsy
Signet-ring Cell Lymphoma-a Case Report

Masir N, Cheong SK, Noordin K

Hematology, 2001;6(3):187-92.
PMID: 27420125 DOI: 10.1080/10245332.2001.11746571

A case of signet-ring cell lymphoma diagnosed initially by fine needle aspiration cytology is reported. This rare tumor is a variant of follicular lymphoma, which closely resembles metastatic adenocarcinoma and other tumors which exhibit signet-ring cell appearance. Correct diagnosis can be achieved by careful morphologic analysis together with positive reactivity with lymphoid markers. The cytohistologic, immunohistochemical and electron microscopic features are described, and the differ ential diagnostic considerations are discussed in the report.

Matched MeSH terms: Biopsy, Fine-Needle
Fulltext Thumb Schwannoma : A Frequent Misdiagnosis

Mooi SS, Ahmad TS

Malays Orthop J, 2016 Mar;10(1):53-54.
PMID: 28435548 MyJurnal DOI: 10.5704/MOJ.1603.010

A 32 year-old Malay lady presented with a swelling over the dorsal surface of her right thumb for 6 months. The swelling was non-tender, smooth surfaced, mobile and nonfluctuating with no bony involvement. The provisional diagnosis was ganglion cyst. Excisional biopsy did not show features of ganglion cyst as it appeared to be wellencapsulated, multi-lobulated and yellowish in colour. Histopathological examination showed that it was a schwannoma. Schwannomas are relatively rare benign tumours which are frequently misdiagnosed. In this case, it was misdiagnosed both as a ganglion and a lipoma.

Matched MeSH terms: Biopsy
Fulltext Ganglion of the Flexor Tendon Sheath at the A2 Pulley - Case Report

Gunaseelan P, Jeremy P, Chua CK, Rashdeen F

Malays Orthop J, 2015 Mar;9(1):28-29.
PMID: 28435592 MyJurnal DOI: 10.5704/MOJ.1503.002

There are few reported cases of flexor tendon sheath ganglion arising from the A2 pulley. We report a case of a flexor tendon sheath ganglion in a 17-year old female who presented with pain, triggering and a swelling at the base of her right ring finger. During the excision biopsy, a ganglion measuring 0.5×0.8×0.4 cm in size was removed from the A2 pulley area.

Matched MeSH terms: Biopsy
Fulltext Fine Needle Aspiration (FNA) Cytology of the Thyroid: A Cyto-Histopathological Study of 361 Cases in Hospital Universiti Kebangsaan Malaysia

Nurismah, M.I., Sharifah, N.A., Usama, A.E., Rohaizak, M., Naqiyah, I., Jasmi, A.

Medicine & Health, 2007;2(1):58-65.
MyJurnal

Thyroid nodules are common but thyroid malignancies are not. Fine needle aspiration (FNA) cytology is a diagnostic tool used to screen patients with thyroid nodules who require surgery. We study the diagnostic accuracy of FNA as the initial diagnostic modality in the clinical assessment of thyroid nodules. Between January 1995 until December 2000, 2131 FNA of thyroid nodules were performed. Four hundred and forty-one (20.7%) of these were unsatisfactory and 1690 (79.3%) cases were satisfactory for cytological evaluation. Histopathological diagnosis were available for 361 cases. Cyto-histopathological correlation was carried out for these cases. Our results showed a diagnostic accuracy of 96.2% with sensitivity and specificity rates of 87.7% and 98.4% res- pectively. Our positive predictive value is 93.4% and our negative predictive value is 96.8%. From this study, we conclude that fine needle aspiration is an important initial screening diagnostic tool for the investigation of thyroid nodules.

Matched MeSH terms: Biopsy, Fine-Needle
Fulltext Kimura’s Disease Mimicking Hodgkin’s Lymphoma: An Unusual Cause of Parotid Swelling

Fadilah, S.A.W., Shanty, V., Goh, AS

Medicine & Health, 2007;2(1):99-102.
MyJurnal

Kimura’s disease (KD) is a rare, benign chronic inflammatory disease of unknown aetiology, typically presents in the Orientals as subcutaneous masses in the head and neck region that could be easily misdiagnosed as a malignant tumour, leading to unnecessary radical surgery or intensive cytotoxic therapy. It has been mainly reported in the Chinese and Japanese literature. It is difficult to diagnose before tissue biopsy and fine needle aspiration cytology (FNAC) has limited value. Hence, unless the pathologists are aware of this entity, it might be mistaken as a malignant lesion. We encountered a case of KD in a Malay patient presenting as a parotid mass that was initially diagnosed as Hodgkin’s lymphoma (HL). This disorder should be suspected in young male Asian patients presenting with a painless unilateral mass in the head and neck region with associated hypereosinophilia.

Matched MeSH terms: Biopsy, Fine-Needle
Fulltext The Incidence of Malignant Infiltration in the Biopsy Tract of Osteosarcoma

Mohana, R., Faisham, W.I., Zulmi, W., Nawfar, A.S., Effat, O., alzihan M.S.

Malays Orthop J, 2007;1(2):7-10.
MyJurnal

Biopsy is a crucial step in the management of musculoskeletal sarcoma. The surgical approach to the biopsy site is important, as the tract must be removed en bloc with the tumour during limb sparing surgery so as to reduce the risk of local recurrence. The biopsy tracts of 26 osteosarcoma patients were evaluated histologically for tumour infiltration. Horizontal sections of 1 mm thickness with 2 cm radius from were evaluated from each excised biopsy tract. Five out of 26 cases (19.2%) showed positive tumour infiltration. One case (3.85%) had tumour infiltration in the pseudocapsule, two cases (7.69%) had tumour infiltration into the muscle and two other cases (7.69%) had tumour infiltration into the subcutaneous tissue. None had skin infiltration. We conclude that resection of the entire biopsy tract is indeed mandatory for surgical treatment of osteosarcoma.

Matched MeSH terms: Biopsy
Fulltext Management of large mandibular ameloblastoma - a case report and literature reviews

Kahairi, A., Ahmad, R.L., Wan Islah, L., Norra, H.

Archives of Orofacial Sciences, 2008;3(2):52-55.
MyJurnal

Ameloblastoma is a slow growing benign tumour of the jaw and patients usually present late after the tumour achieved considerable size to cause facial disfigurement. Diagnosis mainly from tissue biopsy and characteristic findings on plain X-rays does assist in differentiating between types of ameloblastoma. The challenges in the management of this tumour are to provide complete excision as recurrence may occur in incomplete removal and also to reconstruct the bony defect in order to give reasonable cosmetic and functional outcome to the patient.

Matched MeSH terms: Biopsy
Fulltext From the lung to the breast: a young lady in distress – a case report and literature review

Ng, T.H., How, S.H., Kuan, Y.C., Salmah, B.

JUMMEC, 2012;15(1):1-4.
MyJurnal

Metastases to the breast from non-mammary malignant neoplasm are relatively rare. We report a case of metastatic disease to the breast from a primary lung adenocarcinoma in a young 22-year-old lady. Computed tomography of the thorax confirmed right upper lobe mass with multiple lung nodules and a breast lump. The diagnosis of breast metastasis was confirmed by fine needle aspiration cytology of the breast lump with histopathological findings and immunohistochemical features consistent with lung adenocarcinoma.

Matched MeSH terms: Biopsy, Fine-Needle
Meningioma Mimicking Fibrous Dysplasia

Kamaluddin NA, Samsudin AHZ, Wan Hitam WH, Ibrahim M

Cureus, 2019 Sep 27;11(9):e5782.
PMID: 31723541 DOI: 10.7759/cureus.5782

Despite being among the common primary intracranial tumors, intraosseous craniofacial meningioma is the least common subtype of meningioma accounting for only 1-2% of intracranial meningiomas. Interestingly, it can display clinical and radiologic features that can be confused for fibrous dysplasia. Scan imaging and biopsy are crucial for the diagnosis as well as for further proper treatment. We report a case of unilateral eye proptosis and optic neuropathy which was initially thought for fibrous dysplasia. Later the histopathology revealed meningioma grade 1. As the clinical presentations are almost undifferentiated, diagnosis and further prompt treatment are challenging.

Matched MeSH terms: Biopsy
Why are nasopharyngeal carcinoma patients diagnosed at late stage ?

Prasad U, Pua KC

JUMMEC, 1999;4:39-42.

100 consecutivnee wly diagnosed patients with nasopharyngeal carcinoma (NPC) since January 1994 were the subjects for studying various factors related to the delay in the confirmation of the diagnosis. 79 of them were ttlales and the peak age of incidence was the 5th decade. 92% of them were Chinese, 7% Malay and 1% Indian. 76% were agriculture worker or labourers with 66% having either no formal education (16%) or only primary level education (50%). For 50% of patients neck swelling was the first symptom, 26% had nasal symptoms, 12% ear symptoms and 11% hads symptoms due to intracranial extension of tumour. As many as 80% were at UICC Stage IV at the time of diagnosis. While the median delay, on the part of patients, in consulting a doctor was 2.5 days, the median delay on the part of the doctors to confirm the diagnosis of NPC was as long as 127 days, which was particularly worse when the patients presented with ear symptoms (266 days) followed by those with neck swelling (94 days). For those patients who were required to undergo more than one nasopharyngoscopy and biopsy the median doctor's delay was 144 days. Since 82% of patients had consulted general practitioners who remained the first-line health-service provider, it is suggested that their level of awareness with regards to NPC be significantly raised so that the delay on their part be greatly minimized. KEYWORDS: Nasopharyngeal carciuotna, delay in diagnosis, patient's delay, doctor's delay.

Matched MeSH terms: Biopsy
Visual Dermatology: Scalp Involvement in Pemphigus Vegetans

Huei LT, Yee EYW

J Cutan Med Surg, 2020 05 22;25(3):329.
PMID: 32442016 DOI: 10.1177/1203475420928927
Matched MeSH terms: Biopsy
Fulltext A rare case of Tuberculous Prostatitis

Nurul Yaqeen Esa, Mohammad Hanafiah, Marymol Koshy, Hilmi Abdullah, Ahmad Izuanuddin Ismail, Mohamed Fauzi Abdul Rani

Journal of Clinical and Health Sciences, 2016;1(2):33-36.
MyJurnal

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

Matched MeSH terms: Biopsy
Fulltext High-risk cutaneous squamous cell carcinoma (CSCC): Challenges and emerging therapies

Halim AS, Ramasenderan N

Asian J Surg, 2023 Jan;46(1):47-51.
PMID: 35545474 DOI: 10.1016/j.asjsur.2022.04.079

Cutaneous squamous cell carcinoma (CSCC) is a common type of skin malignancy that affects people who have been exposed to sunlight for a long time. It has been associated to a high mutational load, making treatment problematic, especially for individuals with high-risk CSCC characteristics. Patients with high-risk CSCC are difficult to define since definitions are still imprecise. Firstly, we review the evidence to see how relevant locoregional involvement is in terms of patient survival and recurrence risk. Second, we go through the difficulties and obstacles that come with sentinel lymph node biopsy (SLNB) and their importance in the management of locally progressed CSCC. Methods and findings from a variety of lymph node investigations are described. There is yet no empirical evidence for the involvement of SLNB in CSCC. Finally, we discussed the most recent developments in the treatment of CSCC. The mainstays of treatment are surgery and radiation. To slow the disease progression, cancer medicines have switched to disrupting particular signaling pathways. Advanced nations have more easily accessible drugs like Cetuximab (epidermal growth factor receptor inhibitor) and Cemiplimab (anti-programme receptor-1 antibodies), which are utilized in advanced CSCC. The response rate varies based on the patient, although there is still a lack of proof. This article discusses the misconception that CSCC is a tumor with a favorable prognosis, as well as the difficulties in treating high-risk CSCC.

Matched MeSH terms: Sentinel Lymph Node Biopsy
Introduction of a newly created AW stereotactic frame: a phantom-based accuracy evaluation and an initial experience in clinical usage

Lau BL, Idris Z, Abdullah JM, Bujang MA, Wong ASH

Br J Neurosurg, 2023 Dec;37(6):1572-1579.
PMID: 33191803 DOI: 10.1080/02688697.2020.1837728

BACKGROUND: A new stereotactic frame was created in 2015, based on a linear algorithm. It is called Albert Wong (AW) frame. A simple AW stereo-calculator was also designed based on Excel® (Microscoft Corporation, Redmond, WA) programme for the frame.
OBJECTIVE: The aim of this study is to test the accuracy of the AW frame by a direct head to head comparison with CRW® frame (Integra Life Sciences, Plainsboro, NJ) on a phantom.
METHODS: This is a prospective pilot cross-sectional phantom study with a total of 42 (21 for AW and 21 for CRW®) laboratory testings performed in 2017 at our institute to compare the accuracies of both frames in a consecutive manner. A phantom (BL phantom) was newly created, where targets can be placed at different heights and positions on a platform attached under the frame for accuracy testing comparing between the AW and CRW® frames.
RESULTS: A comparable accuracy testing results were observed between the AW and CRW® frames of 0.64 mm versus 1.07 mm respectively. Approval from the local ethics committee for a clinical trial was obtained. We report on three case illustrations who had the AW frame-based biopsies with definitive diagnoses and without any post-biopsy related complication.
CONCLUSION: AW frame successfully demonstrated a good accuracy of 0.64 mm in phantom testing using the BL phantom by a linear algorithmic calculation. The clinical trial with three patients demonstrated definitive diagnoses and safety with its use.

Matched MeSH terms: Biopsy
Fulltext Enhanced diagnosis of advanced fibrosis and cirrhosis in individuals with NAFLD using FibroScan-based Agile scores

Sanyal AJ, Foucquier J, Younossi ZM, Harrison SA, Newsome PN, Chan WK, et al.

J Hepatol, 2023 Feb;78(2):247-259.
PMID: 36375686 DOI: 10.1016/j.jhep.2022.10.034

BACKGROUND & AIMS: Currently available non-invasive tests, including fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM by VCTE), are highly effective at excluding advanced fibrosis (AF) (F ≥3) or cirrhosis in people with non-alcoholic fatty liver disease (NAFLD), but only have moderate ability to rule-in these conditions. Our objective was to develop and validate two new scores (Agile 4 and Agile 3+) to identify cirrhosis or AF, respectively, with optimized positive predictive value and fewer indeterminate results, in individuals with NAFLD attending liver clinics.
METHODS: This international study included seven adult cohorts with suspected NAFLD who underwent liver biopsy, LSM and blood sampling during routine clinical practice or screening for trials. The population was randomly divided into a training set and an internal validation set, on which the best-fitting logistic regression model was built, and performance and goodness of fit were assessed, respectively. Furthermore, both scores were externally validated on two large cohorts. Cut-offs for high sensitivity and specificity were derived in the training set to rule-out and rule-in cirrhosis or AF and then tested in the validation set and compared to FIB-4 and LSM.
RESULTS: Each score combined LSM, AST/ALT ratio, platelets, sex and diabetes status, as well as age for Agile 3+. Calibration plots for Agile 4 and Agile 3+ indicated satisfactory to excellent goodness of fit. Agile 4 and Agile 3+ outperformed FIB-4 and LSM in terms of AUROC, percentage of patients with indeterminate results and positive predictive value to rule-in cirrhosis or AF.
CONCLUSIONS: The two novel non-invasive scores improve identification of cirrhosis or AF among individuals with NAFLD attending liver clinics and reduce the need for liver biopsy in this population.
IMPACT AND IMPLICATIONS: Non-invasive tests currently used to identify patients with advanced fibrosis or cirrhosis, such as fibrosis-4 index and liver stiffness measurement by vibration-controlled transient elastography, have high negative predictive values but high false positive rates, while results are indeterminate for a large number of cases. This study provides scores that will help the clinician diagnose advanced fibrosis or cirrhosis. These new easy-to-implement scores will help liver specialists to better identify (1) patients who need more intensive follow-up, (2) patients who should be referred for inclusion in therapeutic trials, and (3) which patients should be treated with pharmacological agents when effective therapies are approved.

Matched MeSH terms: Biopsy
Fulltext Prebiopsy localisation of impalpable breast lesions

Hisham AN, Harjit K, Fatimah O, Yun SI

Med J Malaysia, 2004 Aug;59(3):402-5.
PMID: 15727388

Prebiopsy localization of impalpable breast lesions (IBL) assures removal of suspicious mammographically detected lesions. Specimen radiograph of the excised specimen is mandatory to confirm complete excision. The aim of this study was to audit our series of percutaneous hookwire localization and to determine the positive biopsy rate of the mammographically detected impalpable breast lesion in our center. Thirty-eight patients with suspicious IBL underwent excision biopsy under mammographic localization in our unit from late February 1998 to May 2003. The excised specimen is immobilized and compressed within the Transpec device. This device incorporates a reference grid visible in the specimen radiograph. Hence, the target lesion marked in the reference grid of the specimen radiograph will allow precise examination and exact localization of the suspicious lesion by the pathologist. The positive biopsy rate for malignant lesion was 26.3%, the majority fall in the range of 40-59 age group. Thirty-two (84.2%) of the patients had clustered micro-calcifications, 4 (10.5%) had impalpable mass lesions and in 2 (5.3%) spiculated lesions were seen on the preoperative mammogram. Mammographic feature of clustered micro-calcification accounts for all the malignant lesions in our series. Utilization of Transpec device has shown to be practical, reliable and cost effective in the management of IBL. Nonetheless, it should be emphasized that optimal specimen radiography and pathological correlation requires close cooperation between radiologist, surgeon and pathologist.

Matched MeSH terms: Biopsy/methods*; Biopsy/standards
Pulmonologist-led ultrasound guided lung biopsy safety and efficacy: a 4-year experience from a tertiary centre in Northern Malaysia

Ismail IN, Alaga A

Med J Malaysia, 2023 Nov;78(6):751-755.
PMID: 38031216

INTRODUCTION: Ultrasound guided lung biopsy (USLB) is a minimally invasive diagnostic tool with short examination time and real-time monitoring conducted bedside for accurate diagnosis in order to provide the best treatment. However, it is not widely performed by pulmonologists. We aim to explicate the efficacy and safety of USLB led by pulmonologists. The objective of this study is to assess safety and efficacy of USLB performed by pulmonologists in an outpatient setting.
MATERIALS AND METHODS: We retrospectively enrolled patients who underwent the procedure from January 2018 to April 2022. Under real time ultrasound (Hitachi Medical ProSound F37), thoracic lesions adjacent to the chest wall were sampled with a full-core biopsy needle (CT Core Single Action Biopsy Device, 18G × 15 cm, Vigeo, Italy). Chest x-ray was performed 30 minutes post procedure ruling out pneumothorax. Patients were discharged home 1-2 hours post biopsy. Data was analysed using Microsoft Excel 2010 and Statistical Package for Social Science (SPSS) Version 26.
RESULTS: A total of 18 patients (14 males, 4 females) underwent USLB for lung tumours. Biopsies were histologically deemed adequate with an overall diagnostic yield of 77.8% (14/18). A total of 57% were positive for thoracic malignancy (21% squamous cell carcinoma, 21% adenocarcinoma, 15% small cell carcinoma) and another 43% were positive for extra thoracic malignancy (1 hepatocellular carcinoma, 2 DLBCL, 1 Hodgkin's lymphoma, 1 seminoma, 1 thymoma). Four patients had inconclusive results but managed to get positive results from surgical or lymph node biopsy (thymoma and adenocarcinoma). Statistical analysis showed more than two passes are needed to achieve a positive HPE yield (p value<0.05). There were nil complications to all the cases done.
CONCLUSIONS: USLB can safely and effectively be performed by trained pulmonologists with excellent accuracy and low complication rate in outpatients.

Matched MeSH terms: Image-Guided Biopsy/adverse effects; Image-Guided Biopsy/methods
The efficacy of periprostatic local anaesthetic infiltration in transrectal ultrasound biopsy of prostate: a prospective randomised control study

Kuppusamy S, Faizal N, Quek KF, Razack AH, Dublin N

World J Urol, 2010 Dec;28(6):673-6.
PMID: 20623289 DOI: 10.1007/s00345-010-0578-7

It is still uncertain as to which form of anaesthesia is the optimum. We conducted a study to identify the best location and optimum volume of anaesthetic agent in order to achieve best pain relief and cooperation from our patients. We also assessed the need for local anaesthetic gel for probe lubrication and if the number of cores during biopsy makes a difference in the pain score.

Matched MeSH terms: Biopsy/adverse effects; Biopsy/methods
Fulltext Diagnostic accuracy of tomosynthesis-guided vacuum assisted breast biopsy of ultrasound occult lesions

Bohan S, Ramli Hamid MT, Chan WY, Vijayananthan A, Ramli N, Kaur S, et al.

Sci Rep, 2021 01 08;11(1):129.
PMID: 33420200 DOI: 10.1038/s41598-020-80124-4

This study aims to evaluate the diagnostic accuracy of digital breast tomosynthesis-guided vacuum assisted breast biopsy (DBT-VABB) of screening detected suspicious mammographic abnormalities comprising of calcifications, asymmetric densities, architectural distortions and spiculated masses. In this institutionally approved study, a total of 170 (n = 170) DBT-VABB were performed, 153 (90%) were for calcifications, 8 (4.7%) for spiculated mass, 5 (2.9%) for asymmetric density and 4 (2.4%) for architectural distortion. All these lesions were not detected on the corresponding ultrasound. Histopathology results revealed 140 (82.4%) benign, 9 (5.3%) borderline and 21 (12.4%) malignant lesions. The total upgrade rate at surgery was 40% for atypical ductal hyperplasia and 5.9% for ductal carcinoma in-situ. 3.6% discordant benign lesions showed no upgrade. DBT-VABB showed 100% specificity, 91.3% sensitivity and 100% positive predictive value (PPV) for detecting malignant lesions. The negative predictive value (NPV) was 80%. 2 (1.2%) patients had mild complications and 1 (0.6%) had severe pain. Our study showed that DBT-VABB was a safe and reliable method, with high sensitivity, specificity, PPV and NPV in the diagnosis of non-palpable benign and malignant breast lesions. Our data also confirmed the accuracy of DBT-VABB in detecting malignant lesions and we suggest further surgical excision in borderline lesions for a more accurate diagnostic evaluation.

Matched MeSH terms: Biopsy/instrumentation; Biopsy/methods*

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