MyMedR

Fulltext Endometrial stromal sarcoma with Cd56 expression: a case report

Azizan, N., Hayati, F., Madatang, A., Abu Seman, F.

Journal of Surgical Academia, 2018;8(1):36-38.

MyJurnal

Endometrial stromal sarcoma (ESS) is a rare malignant tumour of the endometrium, accounts for less than 1% of all
uterine malignancies. Routinely, it is diagnosed morphologically, supported by immunomarkers of CD10 and
vimentin. CD56 is used widely in neuroendocrine tumour. In our current practice, CD56 is not used to support the
diagnosis of ESS. We present a case of a postmenopausal lady with advanced ESS who had expression of CD56
upon immunohistochemical study

Fulltext A novel therapy for the treatment of pyoderma gangrenosum

Azizan NZ, Gangaram HB, Hussein SH

Med J Malaysia, 2008 Mar;63(1):51-4.

PMID: 18935734 MyJurnal

Pyoderma gangrenosum (PG) is an uncommon, chronic, painful, ulcerative skin disease of unknown origin, often associated with systemic diseases including inflammatory bowel disease, rheumatoid arthritis; monoclonal gammopathy, hepatitis and myeloproliferative disorders. The mainstay of therapy for PG has been high-dose corticosteroids but not all patients have a favourable outcome. Other systemic agents have also been used such as cyclosporine, azathioprine, cyclophosphamide and tacrolimus. However, all these systemic therapies can be complicated by serious side effects. In this paper, we report a series of four patients with pyoderma gangrenosum treated successfully with topical cyclosporine. No side-effects were observed in any of the patients and there was minimal systemic absorption of the topical cyclosporine.

Counter response to Response from Dr Yagnik and Dr Yagnik to Gangrenous giant Meckel's diverticulitis masquerading acute appendicitis: a surgical conundrum

Hayati F, Yeap BT, Azizan N

ANZ J Surg, 2020 01;90(1-2):190.

PMID: 32067319 DOI: 10.1111/ans.15571

Fulltext Vanek's tumor causing ileoileal intussusception in a middle-aged man

Johan S, Lee PP, Azizan N, Hayati F, Zakaria AD

Oxf Med Case Reports, 2020 Jul;2020(7):omaa050.

PMID: 32728453 DOI: 10.1093/omcr/omaa050

Intestinal obstruction is a common surgical emergency requiring urgent intervention. Small bowel obstruction secondary to intussusception is rarely encountered especially when inflammatory fibroid polyp (IFP) is the lead point. A 41-year-old gentleman with intestinal intussusception secondary to IFP presented to us with a classic symptom of intestinal obstruction. Computed tomography revealed a target or sausage-shaped soft tissue mass with a layering effect, which was confirmed by intraoperative findings. Histopathology was consistent with IFP and supported by immunoreactivity of CD34 and negative immunostaining for CD117. He recovered without any surgical complication or recurrence. Even intussusception can be managed via non-surgical technique in children; surgery is the mainstay of treatment in adults.

Fulltext Huge Pulsatile Sternal Mass

Azizan N, Hayati F, Ho HL, Sharif SZ

Oman Med J, 2020 May;35(3):e137.

PMID: 32647590 DOI: 10.5001/omj.2020.55

Fulltext The Value of Preoperative Diagnosis in Leiomyosarcoma of the Vulva

Hayati F, Soe MZ, Azizan N, Payus AO

Oman Med J, 2021 Mar;36(2):e256.

PMID: 33976908 DOI: 10.5001/omj.2021.68

Fulltext Florid papillomatosis of the nipple

Dinesh BJ, Hayati F, Azizan N, Abdul Rashid NF

BMJ Case Rep, 2019 Sep 18;12(9).

PMID: 31537599 DOI: 10.1136/bcr-2019-231516

Florid papillomatosis (FP) of the nipple, or nipple adenoma, is a rare breast tumour, affecting middle-aged group population. A 46-year-old woman presented to us with a cauliflower-like FP of the right nipple with no blood stained discharge or breast lump. FP can be mistaken clinically for Paget's disease and occasionally misinterpreted as invasive ductal or intraductal carcinoma. Extensive intervention, correct diagnosis and prompt treatment are essential. Any breast pathology requires triple assessment including FP of the nipple. Once the diagnosis of ductal carcinoma is excluded, simple complete excision can be undertaken. This is to ensure complete obliteration of disease recurrence and preservation of cosmetic result. We discuss the pathology and psychosocial aspects of FP.

Perforated caecal mass: benign or malignant?

Chan KH, Muhamad A, Hayati F, Azizan N, Andee DZ

ANZ J Surg, 2021 Jul;91(7-8):1620-1622.

PMID: 33351236 DOI: 10.1111/ans.16508

Fulltext Gastric duplication cyst with a red flag presentation: a case report

Alagoo D, Sellappan H, Jayasilan J, Azizan N, Hayati F

Pan Afr Med J, 2021;39:141.

PMID: 34527157 DOI: 10.11604/pamj.2021.39.141.29895

Gastric duplication cyst (GDC) is a rare congenital malformation of the gastrointestinal (GI) tract. Despite being benign in the entity, its complications vary from an asymptomatic abdominal mass to fulminant or massive GI bleeding. A 28-year-old lady presented with unexplained GI haemorrhage, in which the upper endoscopy showed a classic feature of GI stromal tumour. The preoperative diagnosis was also confirmed by the computed tomography. She subsequently underwent surgical resection and the final histopathology was consistent with a benign entity of GDC.

Fulltext Role of co-expression of estrogen receptor beta and Ki67 in prostate adenocarcinoma

Azizan N, Hayati F, Tizen NMS, Farouk WI, Masir N

Investig Clin Urol, 2018 07;59(4):232-237.

PMID: 29984337 DOI: 10.4111/icu.2018.59.4.232

Purpose: To evaluate the expression of estrogen receptor (ER)-beta and Ki67 in prostate cancer and study their relationship.

Materials and Methods: We analyzed 101 cases of prostate adenocarcinoma diagnosed from January 2011 to June 2015 in 100 patients. Immunohistochemical staining of ER-beta and Ki67 was analyzed according to Gleason score categorized into prognostic groups of 1 to 5. Double-immunofluorescent staining of ER-beta and Ki67 was performed in a total of 20 cases to study the co-expression and the relationship between these markers within the same tumor.

Results: A total of 53 of 101 cases (52.5%) were positive for ER-beta expression. There was a positive correlation whereby a high percentage of ER-beta expression was seen in the higher prognostic groups (groups 4 and 5; p=0.007). High Ki67 expression was observed in the higher prognostic group, whereas low Ki67 or negative expression was found in the lower prognostic group (p<0.001). The majority of cases evaluated with double-immunofluorescent staining (14/20) showed co-expression of ER-beta and Ki67 at the individual cell level.

Conclusions: ER-beta and Ki67 are independent tumor markers in high prognostic groups. Hence, co-expression of ER-beta and Ki67 indicates a more aggressive tumor with a poorer prognosis.

An Obstructed Malignant Inflammatory Myofibroblastic Tumour of the Rectum

Zainal Abidin ZA, Azizan N, Hayati F, Mra A, Mohd Azman ZA

Kathmandu Univ Med J (KUMJ), 2018 7 1;16(63):272-274.

PMID: 31719321

Inflammatory myofibroblastic tumour is rare but more common in children. It shows an immunophenotypic features of myofibroblastic differentiation, hence bearing neoplastic potential. The diagnosis is challenging especially if it involves rectum. Surgical resection is the mainstay of treatment if clinically obstructed. A 65-year-old gentleman presented with intestinal obstruction, which then followed by a hartmann's procedure. Final diagnosis is a rare case of inflammatory myofibroblastic tumour of the rectum. We discuss its genetic involvement with a literature review.

Fulltext Spontaneous Omental Infarction: An Unusual Etiology of Abdominal Pain

Khairuddin A, Teng WW, Azizan N, Hayati F, Sahid NA, Kadir F

Kathmandu Univ Med J (KUMJ), 2019 10 1;17(68):347-349.

PMID: 33311048

A 49-year-old lady with previous scars complained of acute abdominal pain for two days. Her right hypochondrium was tender and guarding upon assessment. The laboratory investigations were unremarkable. Due to a diagnostic incongruity, computed tomography of the abdomen was performed showing a suspicious lesion at anterolateral aspect of the ascending colon. Surgical intervention was decided and intraoperative finding was consistent with spontaneous omental infarction. Omentectomy was undertaken and final histology was compatible with the intraoperative diagnosis. Although it is exceptional, omental infarction should be considered as part of the differential diagnoses of right-sided acute abdominal pain with normal laboratory investigations. This case highlights its unexpected discovery and we describe its literature reviews.

Fulltext SARS-CoV-2-induced liver injury: A review article on the high-risk populations, manifestations, mechanisms, pathological changes, management, and outcomes

Payus AO, Mohd Noh M, Azizan N, Muthukaruppan Chettiar R

World J Gastroenterol, 2022 Oct 21;28(39):5723-5730.

PMID: 36338886 DOI: 10.3748/wjg.v28.i39.5723

The novel coronavirus disease 2019 is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was declared a global pandemic with more than 500 million reported cases and more than 6 million deaths worldwide to date. Although it has transitioned into the endemic phase in many countries, the mortality rate and overall prognosis of the disease are still abysmal and need further improvement. There has been evidence that shows the significance of SARS-CoV-2-related liver injury. Here, we review the literature on the various spectrum of SARS-CoV-2 infection-induced liver injury and the possible mechanisms of damage to the hepatobiliary system. This review aimed to illustrate the latest understanding regarding SARS-CoV-2-induced liver injury including the high-risk populations, the characteristic clinical manifestations, the possible pathogenic mechanism, the pathological changes, the current suggestions for clinical treatment for various spectrum of populations, and the prognosis of the condition. In conclusion, SARS-CoV-2 patients with a liver injury warrant close monitoring as it is associated with the more severe and poorer outcome of the infection.

Fulltext Case report: A giant hemorrhagic adrenocortical carcinoma causing cardiorespiratory embarrassment

Yeap BT, Teah KM, Tan JBG, Azizan N

Ann Med Surg (Lond), 2021 Nov;71:102996.

PMID: 34840751 DOI: 10.1016/j.amsu.2021.102996

Background: Adrenocortical carcinoma (ACC) is a rare aggressive tumor that can be hormone or non-hormone secreting. It is usually associated with fatal outcomes due to its physiological hormonal interaction. We report a successful anaesthetic and surgical management for a patient who presented to us with a huge hemorrhagic ACC which was complicated with acute respiratory failure.

Case presentation: A 56-year-old lady presented to us with progressive abdominal distension and right hypochondriac pain for two months. She was anemic with elevated liver enzymes. Urgent computed tomography (CT) of the abdomen and pelvis showed a huge right supra renal mass. She subsequently developed respiratory failure due to splinting of diaphragm, of which successfully underwent an emergency exploratory laparotomy. Subsequent endocrine and histopathological work up showed an adrenocortical carcinoma (ACC).

Discussion: Suprarenal masses usually originate from the adrenal glands. They should be investigated to rule out phaeochromocytoma, which originate from the inner adrenal medulla or outer cortex to form ACC. The latter usually occur in women and of poor prognosis. Huge ACC may cause acute respiratory failure by way of splinting of diaphragm. Both anaesthetic and surgical teams should be well trained in handling patients who undergo adrenal surgeries.

Conclusion: A giant hemorrhagic functional ACC is extremely uncommon with very poor prognosis. Such conditions should be investigated to rule out phaeochromocytoma. Its potential neuro-hormonal interactions and anatomical correlations can cause fatal perioperative cardio-respiratory embarrassment. The anaesthetic and surgical teams should be capable in managing the hemodynamic instabilities that may present during surgical manipulation and resection of a large ACC.

Fulltext Composition and Antibacterial Activity of the Essential Oils of Orthosiphon stamineus Benth and Ficus deltoidea Jack against Pathogenic Oral Bacteria

Azizan N, Mohd Said S, Zainal Abidin Z, Jantan I

Molecules, 2017 Dec 05;22(12).

PMID: 29206142 DOI: 10.3390/molecules22122135

In this study, the essential oils of Orthosiphon stamineus Benth and Ficus deltoidea Jack were evaluated for their antibacterial activity against invasive oral pathogens, namely Enterococcus faecalis, Streptococcus mutans, Streptococcus mitis, Streptococcus salivarius, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Fusobacterium nucleatum. Chemical composition of the oils was analyzed using gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). The antibacterial activity of the oils and their major constituents were investigated using the broth microdilution method (minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC)). Susceptibility test, anti-adhesion, anti-biofilm, checkerboard and time-kill assays were also carried out. Physiological changes of the bacterial cells after exposure to the oils were observed under the field emission scanning electron microscope (FESEM). O. stamineus and F. deltoidea oils mainly consisted of sesquiterpenoids (44.6% and 60.9%, respectively), and β-caryophyllene was the most abundant compound in both oils (26.3% and 36.3%, respectively). Other compounds present in O. stamineus were α-humulene (5.1%) and eugenol (8.1%), while α-humulene (5.5%) and germacrene D (7.7%) were dominant in F. deltoidea. The oils of both plants showed moderate to strong inhibition against all tested bacteria with MIC and MBC values ranging 0.63-2.5 mg/mL. However, none showed any inhibition on monospecies biofilms. The time-kill assay showed that combination of both oils with amoxicillin at concentrations of 1× and 2× MIC values demonstrated additive antibacterial effect. The FESEM study showed that both oils produced significant alterations on the cells of Gram-negative bacteria as they became pleomorphic and lysed. In conclusion, the study indicated that the oils of O. stamineus and F. deltoidea possessed moderate to strong antibacterial properties against the seven strains pathogenic oral bacteria and may have caused disturbances of membrane structure or cell wall of the bacteria.

Fulltext Letter to A rare cause of acute abdomen: Isolated necrosis of the cecum

Hayati F, Dzulkarnaen Zakaria A, Azizan N, Kadir F, Subramaniam S

Turk J Surg, 2021 Jun;37(2):195-196.

PMID: 37275184 DOI: 10.47717/turkjsurg.2021.5115

Fulltext Ectopic Papillary Thyroid Carcinoma of the Posterior Pharynx

Lee CH, Hayati F, Azizan N, Sharif SZ

Iran J Otorhinolaryngol, 2023 Nov;35(131):325-328.

PMID: 38074483 DOI: 10.22038/IJORL.2023.73099.3471

INTRODUCTION: Ectopic thyroid is an uncommon condition resulting from the aberrant development of the normal thyroid gland and is usually found along the thyroglossal tract: lingual, submandibular, thyroglossal cysts, intra-tracheal and mediastinal, or, on rare occasions, in the adrenal gland, gallbladder, gastrointestinal tract, pancreas, and struma ovarii.

CASE REPORTS: We describe a novel case where primary papillary thyroid carcinoma (PTC) was found after a trans-oral excision of a tumor containing ectopic thyroid tissue at the posterior pharynx, an area not known to be a location for ectopic thyroid. Delays due to the COVID-19 pandemic resulted in regional cervical metastases and multifocal PTC. The female patient successfully underwent total thyroidectomy, selective cervical and central lymph node dissection, followed by adjuvant radioactive iodine ablation, with no evidence of distant metastases.

CONCLUSIONS: Ectopic thyroid tissue is uncommon and may be in the posterior pharynx. The principles of management remain those of differentiated thyroid malignancy: complete surgical resection of any tumor focus, total thyroidectomy, and node dissection of involved lymph nodes, followed by adjuvant radioactive iodine in iodine-sensitive tumors.

Examining the evidence between screen time and night eating behaviour with dietary intake related to metabolic syndrome: A narrative review

Sa'ari AS, Hamid MRA, 'Ain Azizan N, Ismail NH

Physiol Behav, 2024 Apr 18;280:114562.

PMID: 38641187 DOI: 10.1016/j.physbeh.2024.114562

Screen time (ST) on digital devices has increased in recent decades due to digital development. Furthermore, constant engagement with digital devices alters sleep patterns, leading to nocturnal eating behaviour among users. These phenomena are therefore of great concern, as digital device addiction and night eating are associated with unhealthy food intake, increasing the metabolic syndrome (MetS) risks. The purpose of this review was to examine the evidence of the influence of ST and night eating behaviour (NEB) on dietary intake and its association with MetS based on previous literature. Prolonged ST and NEB have an association with excessive intake of energy from overconsumption of high-sugar and high-fat foods. However, the relationship between digital content and its influence on food intake is inconsistent. A higher MetS risk was found in individuals with longer ST due to a sedentary lifestyle, while positive energy balance and a shift in circadian rhythm contributed to night eaters. ST and NEB presented with a significant influence on food intake in adults. Additionally, unhealthy food intake due to excessive consumption of empty-calorie foods such as sweet and fatty foods due to addiction to electronic devices and eating at night has a detrimental effect on metabolic function. Therefore, improving food intake by reducing ST and night binges is essential to reduce the risk of MetS.

Fulltext A clinically silent tumour of adrenal myelolipoma: A case report

Azizan N, Myint O, Wynn AA, Thein TT, Hayati F, Nik Lah NAS

Int J Surg Case Rep, 2020;72:63-65.

PMID: 32506033 DOI: 10.1016/j.ijscr.2020.05.056

INTRODUCTION: Adrenal myelolipoma is a rare, non-functional, benign neoplasm which is constituted of mature haematopoietic elements and adipose tissues in various proportions. It is diagnosed accidentally and frequently with the widespread use of imaging modalities.

PRESENTATION OF CASE: We report a 63-year-old lady with incidental findings of adrenal tumour on computed tomography (CT) scan during a routine medical check-up. She underwent tumour resection in view of a large tumour of 7 cm in size.

DISCUSSION: CT scan is sensitive to diagnose adrenal myelolipoma in view of its fat-laden property and useful to monitor the tumour progress. Even previously she opted for conservative management; the decision for surgery was made in view of enlarging tumour and risk of surrounding tissue compression.

CONCLUSION: With increased awareness, the detection rate of this tumour is improving, hence able to prevent the complications of a large tumour such as compression, bleeding and tumour necrosis.

Malignant Subcutaneous Perivascular Epithelioid Cell Tumor of Anterior Abdominal Wall

Gan DEY, Choy RXY, Sellappan H, Hayati F, Azizan N

Oman Med J, 2021 Mar;36(2):e239.

PMID: 33768970 DOI: 10.5001/omj.2021.21

Perivascular epithelioid cell tumors (PEComas) are a family of rare mesenchymal tumors with discrete histological and immunohistochemical characteristics. Even rarer among them are cutaneous and subcutaneous PEComas. We describe a 34-year-old woman who presented with a large anterior abdominal subcutaneous lesion showing intact overlying skin and no obvious invasion of the abdominal musculature. A wide local excision was performed. Histopathology revealed a solitary tumor measuring 75 × 55 × 90 mm with epithelioid cells in nests with thin fibrovascular septa and spindle cells. Resection margins were clear with no invasion to the skin or rectus sheath. Tumor cells were positive for HMB-45 but negative for other markers. This is the largest subcutaneous PEComa reported to date.

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