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  1. Fulltext Masking of central diabetes insipidus and hypogonadotrophic hypogonadism by germ cell tumour in suprasellar--pineal region
    Isa SH, Wong M, Khalid BA
    Med J Malaysia, 2006 Dec;61(5):630-2.
    PMID: 17623967
    A patient with beta hCG-secreting germ cell carcinoma of the pineal and suprasellar regions presented with hydrocephalus, Parinaud's syndrome, hypopituitarism and polyuria. Central diabetes insipidus was strongly suspected although the water deprivation test was not diagnostic. The polyuria however, responded to ADH analogue when the hypothyroidism and hypocortisolism were treated. Pubertal development was evident and serum testosterone was normal despite the low FSH/LH, suggesting hCG stimulation of Leydig cells. This case illustrates that a beta hCG-germ cell tumour of the suprasellar region causing hypopituitarism can mask the presence of central diabetes insipidus and hypogonadotrophic hypogonadism.
    Matched MeSH terms: Hypogonadism/pathology; Neoplasms, Germ Cell and Embryonal/pathology; Pineal Gland/pathology; Diabetes Insipidus, Neurogenic/pathology
  2. Carcinosarcoma of the palate: report of a case with a diagnosis of sarcomatoid metastasis by fine needle aspiration cytology
    Jayaram G, Elsayed EM
    Acta Cytol., 2005 Sep-Oct;49(5):520-4.
    PMID: 16334029
    BACKGROUND: Carcinosarcoma (sarcomatoid carcinoma) is a rare tumor with a high predilection for the aerodigestive tract. Cytologic diagnosis of metastatic carcinosarcoma has been reported in very few cases.

    CASE: An 84-year-old woman presented with a 2-cm-diameter, right cervical lymph node that was referred for fine needle aspiration cytology (FNAC). She had received radiotherapy for a palatal squamous cell carcinoma 2 years earlier. The FNAC smears had a sarcomatoid appearance. Repeat fine needle aspiration was performed, with cytologic and immunocytochemical staining. Careful consideration of the cytologic and immunophenotypic features led to an impression of carcinosarcoma. Histologic sections of the palatal biopsy that had been previously diagnosed as squamous cell carcinoma were reviewed, and a final diagnosis of carcinosarcoma was established.

    CONCLUSION: Metastasis of rare lesions, such as carcinosarcoma may be confusing and difficult to diagnose on FNAC, especially when the cytologic sample shows a predominantly sarcomatoid component. The difficulty is compounded when the sarcomatoid component happens to have been overlooked on the initial histologic assessment. With representative cytologic sampling, immunocytochemical staining and review of the histologic material, the correct diagnosis was achieved in this case.
    Matched MeSH terms: Carcinosarcoma/pathology; Lymph Nodes/pathology*; Palatal Neoplasms/pathology; Palate/pathology*
  3. Human telomerase reverse transcriptase expression in oral carcinogenesis--a preliminary report
    Kumar SK, Zain RB, Ismail SM, Cheong SC
    J Exp Clin Cancer Res, 2005 Dec;24(4):639-46.
    PMID: 16471328
    Human telomerase reverse transcriptase (hTERT), the catalytic subunit of telomerase, is strongly associated with telomerase activity implicated in cellular immortalization and tumorigenesis. In situ detection of hTERT will aid in determining the localization of telomerase positive cells. The aim of this study was to detect hTERT protein expression in multistep oral carcinogenesis using paraffin embedded tissue samples, and to study the relationship of hTERT expression with different histological stages in oral carcinogenesis. Normal (n = 4), hyperplastic (n = 4), dysplastic (n = 4) and neoplastic (n = 10) oral epithelia representing different histological stages in oral carcinogenesis were included in the study. hTERT protein detection was done by immunohistochemistry (IHC) technique. Nuclear staining intensities were noted and the hTERT-labelling index was determined. Dysplastic and neoplastic oral epithelia showed an increased percentage of hTERT positive cells (Grade 4: > 50% positive staining nuclei) with intense staining in the basal, parabasal and superficial layers of the epithelia, unlike normal oral mucosa which showed intense staining only in the basal and parabasal cell layers, which are the normal proliferative progenitor compartments. hTERT protein expression was elevated with the corresponding advancement of the histological stages of oral carcinogenesis, from normal to hyperplasia to dysplasia to carcinoma. There seems to be an upregulation of hTERT protein expression during the progression of oral cancer, therefore, this may indicate the feasibility of IHC detection of hTERT protein in oral carcinogenesis as a potential diagnostic or prognostic marker.
    Matched MeSH terms: Cell Transformation, Neoplastic/pathology; Hyperplasia/pathology; Mouth Neoplasms/pathology*; Precancerous Conditions/pathology
  4. Fulltext Giant serpentine middle cerebral artery aneurysm
    Pany A, Sobri M, Valarmathi S, Latif AZ
    Med J Malaysia, 2004 Aug;59(3):422-4.
    PMID: 15727392
    A rare case of partially thrombosed giant serpentine right middle cerebral artery aneurysm presented. A 26 year old man initially presented with headache and 3 months later developed neurological deficit. Various stages of clot with patent residual lumen seen on neuroimaging, led to the diagnosis. Catheter angiography is the investigation of choice for evaluating the location, flow dynamics and extent of the serpentine aneurysm. The patient had embolisation done for the giant serpentine aneurysm.
    Matched MeSH terms: Brain/pathology*; Intracranial Aneurysm/pathology*; Cerebral Arterial Diseases/pathology; Middle Cerebral Artery/pathology*
  5. Review on CFD simulation in heart with dilated cardiomyopathy and myocardial infarction
    Chan BT, Lim E, Chee KH, Abu Osman NA
    Comput Biol Med, 2013 May;43(4):377-85.
    PMID: 23428371 DOI: 10.1016/j.compbiomed.2013.01.013
    The heart is a sophisticated functional organ that plays a crucial role in the blood circulatory system. Hemodynamics within the heart chamber can be indicative of exert cardiac health. Due to the limitations of current cardiac imaging modalities, computational fluid dynamics (CFD) have been widely used for the purposes of cardiac function assessment and heart disease diagnosis, as they provide detailed insights into the cardiac flow field. An understanding of ventricular hemodynamics and pathological severities can be gained through studies that employ the CFD method. In this research the hemodynamics of two common myocardial diseases, dilated cardiomyopathy (DCM) and myocardial infarction (MI) were investigated, during both the filling phase and the whole cardiac cycle, through a prescribed geometry and fluid structure interaction (FSI) approach. The results of the research indicated that early stage disease identification and the improvement of cardiac assisting devices and therapeutic procedures can be facilitated through the use of the CFD method.
    Matched MeSH terms: Cardiomyopathy, Dilated/pathology*; Heart Failure/physiopathology; Heart Ventricles/physiopathology; Myocardial Infarction/pathology*; Myocardial Infarction/physiopathology*; Myocardium/pathology; Thrombosis/pathology
  6. Fulltext Malignant melanoma of the gastrointestinal tract presenting as a bleeding gastric ulcer
    Noraidah M, Jasmi AY
    Malays J Pathol, 2003 Jun;25(1):57-61.
    PMID: 16196379
    Malignant melanoma involving the gastrointestinal tract is diagnosed antemortem in only a small percentage of patients with the disease. Presenting symptoms are often non-specific, causing a diagnostic problem. The vast majority of such melanomas are metastatic from a cutaneous primary, however there is evidence that the tumour can arise de novo in the gastrointestinal system. We report a 74-year-old man with malignant melanoma with an unusual presentation simulating a symptomatic gastric ulcer. He presented with epigastric pain, haematemesis and melaena. Explorative laparotomy revealed a large ulcerated tumour with several pigmented satellite nodules in the proximal stomach, multiple ileal nodules and widespread nodal and liver metastases. Proximal gastrectomy and limited small bowel resection was performed. Histology revealed the tumour to be composed of nests of epithelioid cells with melanin pigment. The tumour cells showed immunohistochemical positivity for S100 protein and HMB45 antibodies. This report emphasizes that melanoma should be a diagnostic consideration in patients with gastric ulcer.
    Matched MeSH terms: Gastrointestinal Neoplasms/pathology*; Melanoma/pathology; Sarcoma/pathology; Stomach Ulcer/pathology*
  7. Fulltext First report of cervicofacial lymphadenitis due to Mycobacterium haemophilum in an immunocompromised adult patient
    Atiya N, Sulaiman H, Chong J, Ng KP
    J Infect Dev Ctries, 2015 Mar;9(3):313-6.
    PMID: 25771471 DOI: 10.3855/jidc.5208
    We report the first case of an immunocompromised adult patient presenting with cervicofacial lymphadenitis due to Mycobacterium haemophilum, confirmed using hsp65 gene sequencing and line-probe assays. In resource-limited settings, especially in developing countries, appropriate culture methods and rapid molecular diagnostic tools such as hsp65 gene sequencing for identification of this organism may not be readily available. This may cause M. haemophilum infections to go unrecognised or lead to delays in diagnosis. Lack of heightened awareness about the potential for this mycobacterial species to cause infections may also contribute to possible underestimation of M. haemophilum cases in the developing world.
    Matched MeSH terms: Face/pathology*; Lymphadenitis/pathology; Mycobacterium Infections/pathology; Neck/pathology*
  8. Flat colonic adenomas in Malaysia: fact or fancy?
    Rajendra S, Kutty K, Karim N
    J Gastroenterol Hepatol, 2003 Jun;18(6):701-4.
    PMID: 12753153
    BACKGROUND: Some two-thirds of colorectal carcinomas arise from adenomatous polyps, and as such, screening by colonoscopy and polyp removal should significantly reduce colorectal cancer. This has not been the case, as evidenced by recent studies, which revealed that endoscopy failed to prevent up to 50% of all subsequent carcinomas. Flat or depressed adenomas, frequently reported from Japan but rarely elsewhere, might explain the 'missed carcinomas.' Detection of flat adenomas has not been previously reported from Malaysia.

    METHODS: In the present prospective study, 426 consecutive patients underwent colonoscopic examination between March 1997 and January 2000, for a variety of bowel symptoms. The examinations were performed by an experienced endoscopist using a standard colonoscope and methylene blue dye spraying technique. Macroscopically, flat adenomas were defined using the criteria proposed by Sawada.

    RESULTS: Twenty-nine adenomas were identified in 12 patients, of which 15 were polypoid and 14 were flat, with no depressed lesions. Eight polypoidal lesions and all the flat adenomas contained mild or moderate areas of epithelial dysplasia. Seven severely dysplastic polyps were identified. One Duke's A polypoidal cancer and two advanced carcinomas were also found. All the severely dysplastic lesions and Duke's A carcinomas were found in polyps greater than 10 mm in mean size. The flat adenomas were all less than 5 mm in size.

    CONCLUSIONS: A significant proportion of colonic adenomas in Malaysian patients appear as small flat lesions, which could easily be missed during endoscopy. Increased recognition and treatment of flat adenomas among colonoscopists is warranted.

    Matched MeSH terms: Adenoma/pathology; Colonic Neoplasms/pathology; Colonic Polyps/pathology; Hyperplasia/pathology
  9. Calibre persistent submucosal artery of the jejunum: a rare cause of massive gastrointestinal bleeding
    Wan Muhaizan WM, Julia MJ, Al Amin D
    Malays J Pathol, 2002 Dec;24(2):113-6.
    PMID: 12887171
    Historically a calibre persistent submucosal artery was most often described in the stomach. However in later years it was also discovered in the duodenum and jejunum. It is an uncommon and important cause of massive gastrointestinal bleeding in which failure of detection and early intervention would lead to death. In this paper we report a 27-year-old man with no significant medical history who presented at the emergency unit for recurrent melaena, haematochezia and hypotension. Initial investigations failed to localize the source of bleeding. Emergency exploratory laporatomy revealed a small jejunal mucosal nodule that was actively spurting blood. Histopathological evaluation identified a calibre persistent submucosal artery.
    Matched MeSH terms: Arteriovenous Malformations/pathology; Gastrointestinal Hemorrhage/pathology; Jejunal Diseases/pathology; Jejunum/pathology
  10. Recent trends in histological pattern of cervical carcinoma among three ethnic groups in Malaysia
    Cheah PL, Looi LM, Sivanesaratnam V
    J Obstet Gynaecol Res, 1999 Dec;25(6):401-6.
    PMID: 10680337
    To study the trend of different histological types of cervical carcinoma among the 3 major ethnic groups in Malaysia.
    Matched MeSH terms: Adenocarcinoma/pathology; Carcinoma, Squamous Cell/pathology; Uterine Cervical Neoplasms/pathology; Carcinoma, Adenosquamous/pathology
  11. Fulltext Large adrenocortical carcinoma extending into the inferior vena cava and right atrium
    Hisham AN, Sarojah A, Zanariah H
    Asian J Surg, 2003 Jan;26(1):40-2.
    PMID: 12527494
    A case of large adrenocortical carcinoma extending into the inferior vena cava and right atrium is reported. Computed tomography showed a large mass displacing the left kidney inferiorly with an intravascular tumour thrombus extending into the inferior vena cava and right atrium. Radical surgery under hypothermia and cardiopulmonary bypass was performed and the tumour mass, together with the tumour thrombus, was successfully removed. The presence of intravascular tumour extension alone should not be a contraindication to radical surgical therapy, as it is the best hope for prolonged survival.
    Matched MeSH terms: Adrenal Cortex Neoplasms/pathology*; Heart Atria/pathology*; Vena Cava, Inferior/pathology*; Adrenocortical Carcinoma/pathology*
  12. Adrenal cytomegaly associated with diaphragmatic hernia: report of a case
    Ong BB, Wong KT
    Malays J Pathol, 1996 Dec;18(2):121-3.
    PMID: 10879233
    A rare case of a 22-week-old foetus with unilateral adrenal cytomegaly and left diaphragmatic hernia is reported. Typical cytomegalic cells were found focally in the left adrenal but the right adrenal was normal. There was no stigmata of the Beckwith-Wiedermann syndrome. The association of adrenal cytomegaly with various congenital malformations, the significance and possible pathogenesis of this condition is discussed.
    Matched MeSH terms: Adrenal Cortex Diseases/pathology; Cell Nucleus/pathology; Inclusion Bodies/pathology; Hernia, Diaphragmatic/pathology
  13. An immunohistochemical study of two cases of either peripheral odontogenic fibroma (WHO type) or peripheral ameloblastoma
    Chong Huat Siar, Kok Han Ng
    J Nihon Univ Sch Dent, 1996 Mar;38(1):52-6.
    PMID: 8648412
    Two cases of either peripheral odontogenic fibroma (POF) (WHO type) or peripheral ameloblastoma are reported. Their immunohistochemical characteristics were investigated in an attempt to clarify their histogenesis. The results showed that the epithelial component of this neoplasm tended to retain its distinct odontogenic character and expressed a keratin profile different from that of the overlying oral epithelium from which both cases most probably originated. The connective tissue element of these tumors was vimentin-positive and S-100 protein negative, confirming their mesodermal nature but precluding the possibility of ectomesenchymal derivation. No reactivity for desmin was noted.
    Matched MeSH terms: Ameloblastoma/pathology; Gingival Neoplasms/pathology*; Odontogenic Tumors/pathology*; Palatal Neoplasms/pathology
  14. Unusual granular cell odontogenic tumor. Report of two undescribed cases with features of granular cell ameloblastoma and plexiform granular cell odontogenic tumor
    Siar CH, Ng KH
    J Nihon Univ Sch Dent, 1993 Jun;35(2):134-8.
    PMID: 7692017
    Granular cell ameloblastoma (GCA) is a well recognized variant of follicular ameloblastoma with extensive granular cell change. In contrast, plexiform granular cell odontogenic tumor (PGCOT) is a rare and recently described lesion characterized histologically by a monophasic plexiform pattern of granular cells. In this paper, two cases of an unusual granular cell odontogenic tumor exhibiting combined features of these two entities are described along with their immunohistochemical characteristics. The granular cells of both the GCA and PGCOT areas showed similar patterns of expression for keratin and S-100, which differed from those of typical ameloblastoma. No reactivity for desmin or vimentin was noted. The histomorphologic and immunohistochemical features of these hybrid tumors suggest that the granular cells present have a common origin, most probably the odontogenic epithelium.
    Matched MeSH terms: Ameloblastoma/pathology*; Mandibular Neoplasms/pathology*; Odontogenic Tumors/pathology*; Granular Cell Tumor/pathology*
  15. Alterations in mucin type: an indicator for suspicion of malignant gastric transformation
    Cheah PL, Ramachandran K
    Malays J Pathol, 1994 Jun;16(1):39-42.
    PMID: 16329574
    Mucins are produced by both benign and malignant gastric epithelium. In general, mucins can be classified into neutral and acidic mucins. The latter are of 2 major types, sulphated (sulphomucins) and carboxylated (sialomucins). A retrospective study was initiated at the Department of Pathology, University Hospital, Kuala Lumpur to histochemically study the mucin profiles of cases of intestinal (IGC) and diffuse (DGC) types of gastric carcinoma in Malaysian patients to determine whether a significant change of mucin type occurs in the event of malignant transformation. 42 IGC and 37 DGC were subjected to alcian blue-periodic acid Schiff and high iron diamine-alcian blue histochemical staining. In addition, 18 cases of gastrectomies performed for benign lesions in the stomach served as normal controls. The number of cases of IGC and DGC which exhibited sulphomucin production was significantly increased (p < 0.001) compared to normal controls. Also, the number of cases of DGC which produced neutral mucin were significantly less (p < 0.05) than the control group. However, there was no significant difference between the number of IGC and DGC cases which demonstrated sialomucin production and normal controls. It appears that while not pathognomonic, a lack of neutral mucin production should alert the pathologist to the possibility of a gastric malignancy, in particular DGC. The likelihood of a malignant lesion would be further supported if there is an increased sulphomucin production.
    Matched MeSH terms: Adenocarcinoma/pathology*; Cell Transformation, Neoplastic/pathology*; Stomach/pathology; Stomach Neoplasms/pathology*
  16. Fine needle aspiration cytology of benign breast lumps: a review of experience with 651 cases
    Jayaram G, Gupta M
    Malays J Pathol, 1994 Jun;16(1):29-38.
    PMID: 16329573
    A detailed cytomorphologic study was done on fine needle aspiration smears from 651 benign breast lumps. Cytological categorization enabled the distinction of proliferative from non-proliferative and infective lesions in the majority of the cases. Lumpectomy provided the histological diagnosis in 584 cases, most of which were proliferative lesions. Gross cystic disease and fibroadenoma were the most common lesions encountered. Microcysts with apocrine change, sclerosing adenosis, proliferative disease without atypia, atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ were associated with the dominant lesion in many of the cases. In all these cases, retrospective analysis of the cytological smears was done in an attempt to identify cytological features which may indicate these lesions.
    Matched MeSH terms: Breast Neoplasms/pathology*; Fibrocystic Breast Disease/pathology*; Gynecomastia/pathology; Fibroadenoma/pathology*
  17. Induction of intestinal lesions in rabbits with Koyan and Baling strains of Schistosoma malayensis Sp N
    Shekhar KC, Pathmanathan R
    Southeast Asian J. Trop. Med. Public Health, 1992 Mar;23(1):92-7.
    PMID: 1523486
    Schistosoma malayensis Sp N is a putative new species of schistosome discovered in Peninsular Malaysia in 1973. This paper comprises the first report on the detailed gastrointestinal pathology present in rabbits infected with strains of the parasite. Two different strains of schistosome--the Baling and Koyan strains--from two different ecosystems were used to infect inbred rabbits and the resulting pathophysiology was studied. Our results showed that the Baling strain of S. malayensis was more virulent than the Koyan strain and produced nodular, segmental circumferential lesions and large bilharziomas measuring 1-7 cm in diameter in the distal jejunum, ileum and the ileo-caecal junction. The findings indicate that the Baling strain of S. malayensis was more pathogenic for rabbits as compared with the Koyan strain--in relation to the gross pathology of the gut and the tissue egg load. Earlier reports have shown that rabbits infected with S. japonicum induces significant intestinal lesions in rabbits (Cheever et al, 1980 a,b) but these animals are refractory to infection with S. mekongi (Byram and Lichtenberg, 1980). Our studies show that the two strains of S. malayensis adapted well in rabbits. It is also established that in rabbits, the virulence of the Baling strain of S. malayensis is greater than that of S. mekongi and approximates that of S. japonicum.
    Matched MeSH terms: Intestinal Diseases, Parasitic/pathology*; Liver/pathology; Schistosomiasis/pathology*; Spleen/pathology
  18. Hepatotoxicity of amiodarone
    Jeyamalar R, Pathmanathan R, Wong D, Kannan P
    Ann Acad Med Singap, 1992 Nov;21(6):838-40.
    PMID: 1295429
    Amiodarone, a commonly used antiarrhythmic agent, has numerous adverse effects. The purpose of this case report is to highlight its hepatotoxicity, an unusual complication of long term amiodarone therapy. Our patient is a 76-year-old man with underlying ischaemic heart disease and recurrent ventricular tachycardia. Eleven months after commencing amiodarone, he developed asymptomatic raised aminotransferases which resolved following drug withdrawal. Amiodarone was then reintroduced and four years later, the patient developed hepatomegaly, worsening liver biochemistry and histopathological changes consistent with early cirrhosis. His symptoms improved following discontinuation of amiodarone. However, hepatomegaly and a low serum albumin still persist four years later.
    Matched MeSH terms: Coronary Disease/pathology; Liver/pathology; Tachycardia, Ventricular/pathology; Drug-Induced Liver Injury/pathology*
  19. Causative effect of cow's milk protein and soy protein on progressive small bowel mucosal damage
    Iyngkaran N, Yadav M, Boey CG, Kamath KR, Lam KL
    J Gastroenterol Hepatol, 1989 3 1;4(2):127-36.
    PMID: 2490907
    Some infants intolerant to cow's milk protein (CMP) are often also intolerant to other food proteins including soy protein (SP). The effect of CMP and SP in infants recovering from diarrhoeal disease was studied in 22 infants who were maintained on an hypo-allergenic formula for 4-6 weeks. The infants were then challenged successively, initially with SP, followed 24 h later with CMP and then rechallenged with SP 24 h after CMP provocation. Three groups were recognized on the basis of clinical symptoms and mucosal changes following SP challenge. Group 1 comprised four infants who developed clinical and histological reactions on SP challenge. The subsequent CMP challenge, 24 h after the initial SP challenge, resulted in clinical symptoms in three of the four infants, and they developed increased mucosal injury. Rechallenge with SP in the three infants caused development of severe clinical symptoms. Group 2 comprised 12 infants who developed histological reaction but had no clinical symptoms to initial SP challenge. The subsequent CMP challenge caused further progression in mucosal pathology in 11 of the 12 infants and six also had associated clinical symptoms. Rechallenge with SP in the latter six infants resulted in development of clinical symptoms in three and tolerance to SP in three infants. Group 3 comprised six infants who tolerated SP and CMP but one of these infants developed mild histological changes to CMP. The progression of mucosal injury following SP and CMP challenge was associated with a significant decrease in mucosal disaccharidases, alkaline phosphatase levels and presence of reducing sugar in the stools. The 1 h blood xylose level continued to decrease significantly following the pre-SP, post-SP, and post-CMP challenge. It appears that the small bowel mucosa of young infants recovering from diarrhoeal disease remains sensitive not only to CMP but also to SP. The feeding of these proteins in rapid successive sequence to infants with mucosal damage might result in further progression of the mucosal injury. Thus, the exclusion for a variable period of time of antigenic food proteins like CMP and SP from the diet of young infants recovering from diarrhoea might reduce the risk of inducing mucosal sensitivity to these proteins in susceptible infants.
    Matched MeSH terms: Food Hypersensitivity/pathology*; Intestinal Mucosa/pathology*; Jejunum/pathology; Milk Hypersensitivity/pathology*
  20. Fulltext Acute appendicitis: pathology of 1,000 cases
    Thanaletchimy N
    Med J Malaysia, 1986 Dec;41(4):336-42.
    PMID: 3670157
    A retrospective study of the pathology seen in 1,000 consecutive appendicectomy specimens with a pre-operative diagnosis of acute appendicitis, was made in an attempt to find common factors which might throw light on the aetiology of the disease. Acute inflammation was seen in 775 cases. In 225 cases where no inflammation was seen, 168 appendices were associated with other pathology, i.e., lymphoid hyperplasia, fibrosis and tumour. In 57 cases the appendix was not inflamed. Acute inflammation was seen more in males and in patients aged below 30 years, while normal appendices were more commonly seen in females of reproductive age.
    Matched MeSH terms: Appendiceal Neoplasms/pathology; Appendicitis/pathology*; Appendix/pathology*; Carcinoid Tumor/pathology
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