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Parents' perspectives on the important aspects of care in children dying from life limiting conditions: A qualitative study

Kuan GL, Low WY

Med J Malaysia, 2015 Oct;70(5):295-9.
PMID: 26556118 MyJurnal

INTRODUCTION: The importance of Paediatric Palliative Care (PPC) is increasingly recognised worldwide, with the World Health Organzsation (WHO) and the American Academy of Pediatrics (AAP) endorsing the development and wide availability of PPC. When these children are in the terminal phase of their illness, PPC should be tailored to the different needs and desires of the child and the family, with the goal of providing the best possible quality of life (QOL) for the days that remain.

METHOD: Malaysia has yet to develop a national PPC policy. In anticipation of this, as part of a needs based qualitative study, parents' views were solicited, as to the unmet needs of their children during the terminal phases of their illness. A purposive sampling was conducted amongst fifteen parents of nine deceased children (ages 2-14 years, eight cancer, one Prader Willi Syndrome) who had received care in the Paediatric Department, Malacca General Hospital, a Malaysian government hospital. Two focus group discussions and three in-depth interviews were conducted, based on a semi-structured interview guideline. The interviews were audiotaped with permission and the tape recordings were transcribed verbatim. The data were managed and analysed by NVivo 9 software using a thematic analysis approach.

RESULTS: The frequently emerging themes were the strengths and weaknesses pertaining to the healthcare system, processes within palliative care. These were symptom control, closed communication and lack of support and anticipatory guidance as death approached.

CONCLUSION: Dying Malaysian children and their families deserve to receive care that is more consistent with optimal palliative care.
Fulltext Seroepidemiological study of leptospirosis among the communities living in periurban areas of Sarawak, Malaysia

Thayaparan S, Robertson ID, Fairuz A, Suut L, Gunasekera UC, Abdullah MT

Med J Malaysia, 2015 Oct;70(5):288-94.
PMID: 26556117 MyJurnal

INTRODUCTION: Leptospirosis is endemic to tropical regions of the world and is re-emerging as a new danger to public health in Malaysia. the purpose of this particular study was to determine the common leptospiral serovars present in human communities living around wildlife reserves/disturbed forest habitats. the objective of this study was to estimate the seroprevalence of leptospirosis and finding infecting serovars in villages surrounded habitats where wildlife lives in Sarawak, Malaysia.

METHODS: A cross-sectional serological survey of 198 humans was conducted in four villages around Kuching, Sarawak between January 2011 and March 2012.

RESULTS: A seroprevalence of 35.9% (95%cI 29.2-43.0) to the MAt was detected in the tested humans. Antibodies to serovar Lepto 175 Sarawak were most commonly detected (31.3%; 95%cI 24.9-38.3) and were detected in individuals at all four locations. the presence of skin wounds (Or 3.1), farm animals (Or 2.5) and rats (Or 11.2) were all significantly associated with seropositivity in a multivariable logistic regression model.

CONCLUSIONS: the results of the current study are important as wildlife may act as reservoirs of leptospires for humans. Health authorities should expand disease control measures to minimise the spill-over from wildlife to humans visiting, living or working in the sampled locations. the pathogenic status of serovar Lepto 175 Sarawak also requires further investigation.
Fulltext Treating hepatitis C in HIV/HCV co-infected patients in Malaysia - the outcomes and challenges

Tan SS, Leong CL, Lee CK

Med J Malaysia, 2015 Oct;70(5):281-7.
PMID: 26556116

BACKGROUND: Co-infection by human immunodeficiency and hepatitis C viruses (HIV/HCV) is common and results in significant morbidity and mortality despite effective antiretroviral therapies (ART).
METHOD: A retrospective and prospective evaluation of the efficacy and safety of pegylated interferon alfa 2a/2b plus ribavirin (PEG-IFN/RBV) in consecutive HIV/HCV co-infected patients treated in real life clinical practice in Malaysia.
RESULTS: Forty-five HIV/HCV co-infected patients with a median age (interquartile range, IQR) of 41 years (37; 47) were assessed for treatment with PEG-IFN/RBV. All except one are of male gender and the most common risk behaviour was injecting drug use. At baseline 75.5% was on ART and the median (IQR) CD4 count was 492 cells/μl (376; 621). The HCV genotypes (GT) were 73 % GT3 and 27% GT1. Liver biopsies in forty patients showed 10% had liver cirrhosis and another 50% had significant liver fibrosis. The treatment completion rate was 79.5% with 15.9% dropped out of treatment due to adverse effects (AE) or default and 4.6% due to lack of early virological response. The AE causing premature discontinuations were neuropsychiatric and haematological. The overall sustained virological response (SVR) was 63.6% with a trend towards higher SVR in GT3 compared with GT1 (71.9% vs. 41.7%; p=0.064). In patients with bridging fibrosis plus occasional nodules or cirrhosis on liver biopsy, the SVR was significantly lower at 20% (p=0.030) compared to those with milder fibrosis.
CONCLUSION: HIV/HCV co-infected patients can be successfully and safely treated with PEG-IFN/RBV achieving high rates of SVR except in cirrhotic patients.

Study site: co-infection clinics at Sungai Buloh Hospita
Fulltext Wandering intrauterine contraceptive device: An unusual travel to the sigmoid colon

Kumarappan AL, Karthikeyan M, Gunaseelan D, Ros'aini P

Med J Malaysia, 2015 Oct;70(5):312-3.
PMID: 26556122 MyJurnal

Intrauterine contraceptive device (IUCD) is common choice for contraception. Migration of IUCD is one of the complications that are encountered. Here we report a case of IUCD migration to the sigmoid colon. A 39-year-old Malay lady carrying a copper T type of IUCD presented with missing thread then underwent examination under anaesthesia, proceeded to hysteroscopy but failed removal. Abdominal ultrasound detected it in the left lower quadrant of abdomen. She then underwent diagnostic laparoscopy where the device was found to be embedded in the sigmoid colon. Technical difficulty necessitated conversion to mini laparotomy and sigmoidotomy to remove the IUCD and the bowel closed primarily. IUCD is a relatively simple and safe contraceptive procedure but possible complications are bleeding and pain that usually co-exist, pelvic infection, expulsion and perforation. Investigations should be based on clinical suspicion and migrated IUCD in symptomatic patients should be surgically removed whereas, asymptomatic patients can be managed conservatively under certain circumstances. However in the presence of a concurrent pathology that requires exploration then retrieval of the migrated IUCD should be undertaken.
Fulltext Knowledge, attitude and practice of antibiotics prescribing among medical officers of public health care facilities in the state of Kedah, Malaysia

Tan WL, Siti R, Shahfini I, Zuraidah A

Med J Malaysia, 2015 Oct;70(5):307-11.
PMID: 26556121 MyJurnal

BACKGROUND: Antibiotic resistance is a rising problem in Malaysia. For instance, high antibiotic prescribing rate for upper respiratory tract infection and inappropriate choice of antibiotic is a significant healthcare concern in Malaysia. Our main objective was to study knowledge, attitude and practice of antibiotic prescribing among medical officers in Kedah, Malaysia.
METHODS: A cross sectional study was conducted in outpatient departments of health clinics and hospitals in Kedah from June 2013 until December 2013. Sample size was 118 and systematic sampling was conducted. Research tool used was a validated questionnaire from studies conducted in Congo and Peru.
RESULTS: Response rate was 84.8%. Majority of our respondents were female doctors (71.0%), local graduates (63.0%), and practiced for 4 years or less (61.0%). 52.0% of the respondents prescribed antibiotics more than once daily. Mean knowledge score on antibiotics was 5.31 ±1.19 (95% CI: 5.06; 5.54). More than half (62.0%) of our respondents were confident in antibiotic prescribing and there were merely 18.0% of them consulted any colleagues prior to prescription. There was a significant difference in frequency of antibiotic prescribing between junior doctors and senior doctors (P-value: 0.036). In addition, there was also a significant association between frequency of antibiotic prescribing and awareness of antibiotic resistance in their daily practice. (P-value: 0.002).
CONCLUSION: Knowledge on antibiotic was moderate among our medical officers and antibiotic prescribing was frequent. Training and courses on appropriate antibiotic prescribing should be emphasized to ensure the best practice in antibiotic prescription.
Study site: Klinik Kesihatan, outpatient clinics, district hospital, general hospital, Kedah, Malaysia
Fulltext Sharing a microbe with man's best friend: A case of canine streptococcal infection in a diabetic patient

Cheong BM, Lim AY

Med J Malaysia, 2015 Oct;70(5):318-9.
PMID: 26556125

We report a case of a diabetic patient with an infected leg wound leading to septicemia and abscess formation in the contra-lateral leg due to Streptococcus canis. This organism belongs to the Lancefield group G and is more commonly found in dogs. It is often mistaken for Streptococcus dysgalactiae which is a human strain of streptococci. Infections in humans are not common and usually involve infected wounds or ulcers and the surrounding soft tissue. In most reported cases, patients had close contact with domestic dogs and a pre-existing wound as a portal of entry. Our patient recovered after surgical debridement and drainage of abscess together with antibiotics. This organism is sensitive to common antibiotics like penicillin, amoxycillin, cephalosporins and erythromycin. The incidence of infections due to Streptococcus canis may be under-reported as laboratories may just report an isolate as group G streptococcus. Susceptible patients with wounds or ulcers should be counselled on proper wound care and advised to avoid or minimise contact with the family dog.
Study site: Hospital Raja Permaisuri Bainun, Ipoh, Perak
Fulltext Orbital compartment syndrome in idiopathic orbital inflammatory disease: A case report

Tiong KI, Aziz S, Hazlita I

Med J Malaysia, 2015 Oct;70(5):316-7.
PMID: 26556124 MyJurnal

Orbital compartment syndrome (OCS) is a visual threatening ocular emergency. We report a 50-year-old male with acute presentation of OCS, a rare manifestation of idiopathic orbital inflammatory disease. At presentation, high intraocular pressure was reduced by prompt lateral canthotomy and cantholysis. The disease responded to systemic steroids and treatment resulted in good visual outcome. Detail evaluation and early detection and treatment are mandatory to prevent permanent vision loss.
Keywords: Sarawak General Hospital
Fulltext Embryonal rhabdomyosarcoma of the middle ear presenting with aural polyp and facial nerve palsy

Vasiwala R, Burud I, Lum SK, Saren RS

Med J Malaysia, 2015 Oct;70(5):314-5.
PMID: 26556123 MyJurnal

Rhabdomyosarcoma is a rare tumour in the middle ear and mastoid cavity in children and the diagnosis is difficult. Repeated histological examination may be essential to confirm the diagnosis. We report a 6 year old boy with a left aural polyp, otorrhoea and facial nerve palsy who was initially thought to have otitis media and mastoiditis. He had polypectomy and the tissue taken for histopathology suggested an inflammatory condition. Subsequently he had mastoidectomy. Tissue taken during mastoidectomy was however reported as rhabdomyosarcoma. The child developed a cerebral abscess and eventually succumbed. A literature review of the disease, radiological findings, immunohistochemical features and treatment options is described.
Fulltext Port assisted closure of laparoscopic wound: A safe and feasible technique

Leow VM, Faizah MS, Mohd Sharifudin S, Vasu Pillai L, Yang KF, Manisekar KS

Med J Malaysia, 2015 Oct;70(5):278-80.
PMID: 26556115 MyJurnal

OBJECTIVE: Various techniques and instruments have been developed to provide safe and secure closure of laparoscopic wounds. Herein we describe a simple method to close laparoscopic supraumbilical wounds with the aid of a laparoscopic port.
METHOD: This was a retrospective review of prospective data, which were from 151 patients who underwent laparoscopic cholecystectomy for symptomatic gallstone disease from December 2009 to December 2010 in Sultanah Bahiyah Hospital. A senior consultant hepato-pancreato-biliary (HPB) surgeon and two HPB trainee surgeons performed the operations. Postoperatively, all patients were followed up at 4 weeks.
RESULTS: All patients successfully underwent closure of the supraumbilical wound with the assistance of a 5mm laparoscopic port. None of the patients had incisional hernia on follow up.
CONCLUSION: Port assisted closure of supraumbilical laparoscopic wounds is a feasible and safe technique.
Study site: Sultanah Bahiyah Hospital, Kedah
Causes of mortality in patients with psoriasis in Malaysia - Evidence from the Malaysian Psoriasis Registry

Kwan Z, Yeoh CA, Mohd Affandi A, Alias FA, Hamid M, Baharum N, et al.

Med J Malaysia, 2015 Oct;70(5):273-7.
PMID: 26556114

BACKGROUND: Patients with severe psoriasis, namely those requiring phototherapy or systemic treatment, have an increased risk of death. The aim of this study was to determine the prevalence, aetiology and risk factors for mortality among adult patients aged 18 years and above with psoriasis in Malaysia.

METHODS: This was a retrospective study involving adult patients notified by dermatologists to the Malaysian Psoriasis Registry between July 2007 and December 2013. Data were cross-checked against the National Death Registry. Patients certified dead were identified and the cause of death was analysed. Multivariate analysis using multiple logistic regression were conducted on potential factors associated with higher risk of mortality.

RESULTS: A total of 419 deaths were identified among the 9775 patients notified. There were four significant risk factors for higher mortality: age>40 years (age 41-60 years old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI 1.33,2.22), severe psoriasis with body surface area (BSA) >10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30, 2.14). Among the 301 patients with verifiable causes of death, the leading causes were infection (33.9%), cardiovascular disease (33.6%) and malignancy (15.9%).

CONCLUSION: Infection was the leading cause of death among psoriasis patients in Malaysia. Although cardiovascular diseases are well-known to cause significant morbidity and mortality among psoriasis patients, the role of infections and malignancy should not be overlooked.
Fulltext Contrast enhanced voiding urosonography (ce-VUS) as a radiation-free technique in the diagnosis of vesicoureteric reflux: Our early experience

Faizah MZ, Hamzaini AH, Kanaheswari Y, Dayang A AA, Zulfiqar MA

Med J Malaysia, 2015 Oct;70(5):269-72.
PMID: 26556113 MyJurnal

OBJECTIVE: Contrast-enhanced ultrasound has become increasingly utilised as an alternative imaging modality for the diagnosis of vesicoureteric reflux (VUR) in paediatric patients. The study objective is to evaluate the efficacy of contrast enhanced Voiding Urosonography (ce-VUS) compared with fluoroscopic micturating cystourethrography (MCU) in the detection of VUR.
METHODS: This prospective study was carried out between July 2011 and January 2013 on paediatric patients who underwent MCU. All consented patients would undergo ce- VUS prior to MCU. We documented the epidemiology details, the number of Kidney-Ureter (K-U) unit studied, baseline renal and bladder sonogram, as well as presence of VUR on ce-VUR. The technique for ce-VUS was standardized using normal saline to fill the bladder prior to administration of SonoVue® (2.5 ml) to assess the kidney-ureter (K-U) unit. Dedicated contrast detection software was used to discern the presence of microbubbles in the pelvicaliceal system (PCS). The findings were then compared with MCU.
RESULTS: 27 paediatric patients were involved in the study [17 males (63%) and 10 females (37%)] involving 55 K-U units (one patient had a complete duplex system). MCU detected VUR in 10 K-U units while ce-VUS detected VUR in 8 out of the 10 K-U units. There were 2 false negative cases (both Grade 1) with ce-VUS. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ce-VUS were 80%, 98%, 95%, 89% and 96%, respectively.
CONCLUSION: ce-VUS is a sensitive and specific radiation-free alternative for the detection of VUR in the paediatric population.
Fulltext Depression among chronic pain patients at Hospital Tengku Ampuan Rahimah, Klang

Seed HF, Hazli Z, Perumal M, Azlin B

Med J Malaysia, 2015 Oct;70(5):303-6.
PMID: 26556120 MyJurnal

INTRODUCTION: Despite the high prevalence rates of depression amongst chronic pain patients reported globally, the condition is often under-recognised and under-treated. Depression frequently complicates the effective management of pain and is associated with poor quality of life. This study aimed to explore the incidence of depression and its' associated factors in a sample of chronic pain patients in Malaysia.

MATERIALS AND METHODS: This descriptive cross-sectional study was conducted amongst clinically diagnosed chronic pain patients from the pain management clinic of Hospital Tengku Ampuan Rahimah over a period of seven months. Socio-demographics and clinical data were obtained from patients' interview and medical records. The validated Depression Anxiety Stress Scale-21 (DASS-21) was used for screening and Mini International Neuropsychiatric Interview (MINI) was used to establish the depression diagnoses among the patients. Numeric pain intensity scale was used to assess the severity of pain.

RESULTS: Eighty-three patients with a mean age of 50.4±12.50 years participated in this study. The majority of the patients were females (56.6%), married (85.5%) and being employed (49.4%). The percentage of depression was 37.4%. Depression was significantly associated with severity of pain (p<0.001) and the duration of pain (p <0.05).

CONCLUSION: Almost one third of chronic pain patients in this study have depression. Depression was significantly associated with the severity and duration of pain. Depression should be regularly screened among patient with chronic pain.
Improving the self-confidence level of medical undergraduates during emergencies using high fidelity simulation

Muniandy RK, Nyein KK, Felly M

Med J Malaysia, 2015 Oct;70(5):300-2.
PMID: 26556119 MyJurnal

INTRODUCTION: Medical practice involves routinely making critical decisions regarding patient care and management. Many factors influence the decision-making process, and self-confidence has been found to be an important factor in effective decision-making. With the proper transfer of knowledge during their undergraduate studies, selfconfidence levels can be improved. The purpose of this study was to evaluate the use of High Fidelity Simulation as a component of medical education to improve the confidence levels of medical undergraduates during emergencies.
METHODOLOGY: Study participants included a total of 60 final year medical undergraduates during their rotation in Medical Senior Posting. They participated in a simulation exercise using a high fidelity simulator, and their confidence level measured using a self-administered questionnaire.
RESULTS: The results found that the confidence levels of 'Assessment of an Emergency Patient', 'Diagnosing Arrhythmias', 'Emergency Airway Management', 'Performing Cardio-pulmonary Resuscitation', 'Using the Defibrillator' and 'Using Emergency Drugs' showed a statistically significant increase in confidence levels after the simulation exercise. The mean confidence levels also rose from 2.85 to 3.83 (p<0.05).
CONCLUSION: We recommend further use of High Fidelity Simulation in medical education to improve the confidence levels of medical undergraduates.
Fulltext Abstracts of 4th Asia Pacific Conference on Public Health, 7 - 9 September 2015, Kuantan, Malaysia

Med J Malaysia, 2015 Sep;70 Suppl 1:1-81.
PMID: 26449327

Household food insecurity in Malaysia: findings from Malaysian Adults Nutrition Survey
Current nutrient intake among Malaysia Adult: Finding from MANS 2014
The prevalence of meal patterns among Malaysia Adults: Findings from MANS 2014
Malaysia health policy adaptation toward climate change
Health Security and Health Diplomacy: New Paradigms for Global Public Health
Current intake of food according to Food Group: Finding from MANS 2014
Prevalence of habits in relation to food consumption
Food label reading and understanding among Malaysian adult: findings from MANS 2014
Dietary supplement use among adults in Malaysia: finding from Malaysian Adults Nutrition Survey (MANS 2014)
Food Consumption Patterns: Findings from the Malaysian Adults Nutrition Survey (MANS) 2014
Study name: Malaysian Adult Nutrition Survey (MANS-2014)
Fulltext Accuracy of ultrasound versus computed tomography urogram in detecting urinary tract calculi

Salinawati B, Hing EY, Fam XI, Zulfiqar MA

Med J Malaysia, 2015 Aug;70(4):238-42.
PMID: 26358021 MyJurnal

AIM: To determine the (i) sensitivity and specificity of ultrasound (USG) in the detection of urinary tract calculi, (ii) size of renal calculi detected on USG, and (iii) size of renal calculi not seen on USG but detected on computed tomography urogram (CTU).
METHODS: A total of 201 patients' USG and CTU were compared retrospectively for the presence of calculi. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of USG were calculated with CTU as the gold standard.
RESULTS: From the 201 sets of data collected, 59 calculi were detected on both USG and CTU. The sensitivity and specificity of renal calculi detection on USG were 53% and 85% respectively. The mean size of the renal calculus detected on USG was 7.6 mm ± 4.1 mm and the mean size of the renal calculus not visualised on USG but detected on CTU was 4 mm ± 2.4 mm. The sensitivity and specificity of ureteric calculi detection on USG were 12% and 97% respectively. The sensitivity and specificity of urinary bladder calculi detection on USG were 20% and 100% respectively.
CONCLUSION: This study showed that the accuracy of US in detecting renal, ureteric and urinary bladder calculi were 67%, 80% and 98% respectively.
Study site: Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur
Eosinophilic gastroenteritis: Clinical profiles and treatment outcomes, a retrospective study of 18 adult patients in a Singapore Tertiary Hospital

Wong GW, Lim KH, Wan WK, Low SC, Kong SC

Med J Malaysia, 2015 08;70(4):232-7.
PMID: 26358020

BACKGROUND: Eosinophilic gastroenteritis (EG) can mimic symptoms of common gastrointestinal (GI) disorders but responds well to appropriate treatment. Accurate diagnosis is central to effective management. Data on EG in Southeast Asia is lacking. We aim to describe the clinical profiles and treatment outcomes of adult patients with EG in a Singapore Tertiary Hospital.
MATERIALS AND METHODS: This retrospective study involved archival search of patients with GI biopsies that showed eosinophilic infiltration from January 2004 to December 2012. Patients' clinical data from computerised hospital records and clinical notes was reviewed. Diagnostic criteria for EG included presence of GI symptoms with more than 30 eosinophils/high power field on GI biopsies. Patients with secondary causes for eosinophilia were excluded.
RESULTS: Eighteen patients with EG were identified (mean age 52 years; male/female: 11/7). Fifteen patients (83%) had peripheral blood eosinophilia. Seven patients (39%) had atopic conditions. Most common symptoms were diarrhoea and abdominal pain. Small intestine was the most common site involved. Endoscopic finding was non-specific. Ten patients were treated with corticosteroids (nine prednisolone, one budesonide): eight patients (89%) responded clinically to prednisolone but four patients (50%) relapsed following tapering-off of prednisolone and required maintenance dose. One patient each responded to diet elimination and montelukast respectively. Half of the remaining six patients who were treated with proton-pump inhibitors, antispasmodic or antidiarrheal agents still remained symptomatic.
CONCLUSION: Prednisolone is an effective treatment though relapses are common. Small intestine is most commonly involved. EG should be considered in the evaluation of unexplained chronic recurrent GI symptoms.
Fulltext Purple urine bag syndrome: Case report from a nursing home resident with a false alarm of urosepsis

Mohamed Faisal AH, Shathiskumar G, Nurul Izah A

Med J Malaysia, 2015 Aug;70(4):265-6.
PMID: 26358028 MyJurnal

Purple urine bag syndrome (PUBS), as the name implies produces purplish discoloration of the urine. It is commonly observed among elderly women with constipation, and individuals with long term catheter in the setting of urinary tract infection (UTI). From the literature research, there were no publications on PUBS in Malaysia; however we believe that it is underreported. We present a unique case of this rare condition occurring in a 68-year-old man, a nursing home resident on long term urinary catheter. The urine cleared after hydration, antibiotic therapy and replacement of the catheter.
Fulltext Enlarged parietal foramina presenting as scalp swelling in an infant

Chidambaram VA, Hamouda ES

Med J Malaysia, 2015 Aug;70(4):263-4.
PMID: 26358027

"Enlarged parietal foramina" is a congenital malformation with autosomal dominant inheritance. The condition is usually self-limiting and doesn't require any treatment. However, it may also be associated with encephalocele, vascular anomalies or may be a part of syndrome. We present a case of enlarged parietal foramina in a child and discuss its imaging findings and the associated intracranial vascular malformations.
Fulltext Isolated fallopian tube torsion in prepubertal females

Gupta A, Thida W, Nazir B, Yeo CS, Low Y, Ong CL

Med J Malaysia, 2015 Aug;70(4):259-62.
PMID: 26358026

Isolated fallopian tube torsion is an uncommon diagnosis. It is particularly rare in the paediatric and post-menopausal age groups. It lacks pathognomonic symptoms, signs and imaging findings, yet each of these diagnostic steps plays a crucial role in early diagnosis. We describe two cases of isolated fallopian tube torsion in prepubertal females.
Fulltext Radiologically occult hepatocellular carcinoma in a cirrhotic liver presenting with bilateral adrenal metastases

Mundada P, Tan ML, Soh AW

Med J Malaysia, 2015 Aug;70(4):256-8.
PMID: 26358025

Although it is common to have extra-hepatic metastasis of hepatocellular carcinoma (HCC) at the time of presentation, it is extremely rare to have extra-hepatic metastatic HCC without a detectable primary in the liver. We report a unique case in which a patient presented with bilateral large adrenal masses which were subsequently proven to be metastases from HCC. However, there was no tumour seen in the liver on imaging.

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