MyMedR

Fulltext Giant epidermal cyst with intramuscular extension: a rare occurrence

Low SF, Sridharan R, Ngiu CS

BMJ Case Rep, 2015 Feb 06;2015.

PMID: 25661748 DOI: 10.1136/bcr-2013-202534

An epidermal cyst is the most common type of cyst to occur in subcutaneous tissue. When its size is greater than 5 cm, it is recognised as a giant epidermal cyst. A subcutaneous giant epidermal cyst with intramuscular extension is extremely rare. The authors report a case of a 74-year-old man who presented with a painless, slow-growing left gluteal mass of 6-month duration. Examination revealed a large left gluteal mass that was fixed to the underlying structures. A small epidermal cyst with visible punctum was noted at the medial aspect of the mass. MRI demonstrated a large, lobulated left gluteal lesion measuring 20 cm×16 cm×10 cm. The lesion was partly within the gluteal maximus muscle and partly within the subcutaneous tissue. MRI and ultrasound features of the lesion were consistent with a giant epidermal cyst with intramuscular extension. The lesion was excised and histology confirmed the diagnosis.

An interesting finding in a patient with chronic diarrhoea

Marwan AA, Ngiu CS, Periyasamy P

Ann Acad Med Singap, 2013 Feb;42(2):97-8.

PMID: 23515696

Fulltext Camurati-engelmann disease association with hypogonadism and primary hypothyroidism

Low SF, Abu Bakar N, Ngiu CS

Iran Red Crescent Med J, 2014 Aug;16(8):e9481.

PMID: 25389497 DOI: 10.5812/ircmj.9481

INTRODUCTION: Camurati-Engelmann disease (CED) is a rare autosomal dominant disease with various phenotypic expressions. The symptoms usually develop during childhood. The hallmark of the disease is bilateral symmetric diaphyseal hyperostosis of the long bones with progressive involvement of the metaphysis. The epiphysis is strictly spared. The common clinical symptoms are pain of the extremities, muscle wasting, waddling gait, and lethargy. CED is rarely seen in conjunction with hypogonadism. CED-associated hypothyroidism has not been reported yet. Clinical assessment and skeletal survey are important to make the diagnosis.

CASE PRESENTATION: Hereby we reported a case of CED with concomitant hypogonadism and hypothyroidism. Serial plain radiographs of the patient showed classic and progressive diaphyseal cortical hyperostosis of the long bone.

CONCLUSIONS: Hyperostosis of the skull was observed in the present case. The characteristic osseous changes of CED were highlighted and the differential diagnoses were discussed.

Juvenile spondyloarthropathy: an important clinical lesson to remember

Sridharan R, Ngiu CS, Shaharir SS, Said MS

BMJ Case Rep, 2015;2015.

PMID: 26677159 DOI: 10.1136/bcr-2015-213220

Spondyloarthropathy (SpA) is a group of inflammatory conditions that include spondylitis, sacroiliitis, asymmetrical peripheral arthritis and enthesitis. This condition is known as juvenile SpA when the diagnosis is made in patients up to 16 years of age. Enthesitis is a highly specific feature that occurs more often in juvenile SpA than in the adult form. In contrast to adult onset SpA, the initial manifestation of juvenile SpA rarely presents as inflammatory back pain. Peripheral arthritis is the more common presenting feature. We report a case of a 12-year-old boy who presented with a 1-year history of progressive low back pain, gluteal pain and thigh pain. There were no clinical symptoms of arthropathy of the distal extremities. MRI of the whole spine was performed twice, which, unfortunately, was unyielding. Finally, MRI of the sacroiliac joints revealed asymmetric sacroiliitis as well as enthesitis of the hips and pelvis. Further laboratory data showed negative rheumatoid factor and positive human leucocyte antigen (HLA) B27. A diagnosis of juvenile SpA with sacroiliitis and enthesitis was made. The imaging characteristics of juvenile SpA are highlighted.

Fulltext Osseous haemophilic pseudotumour and concurrent primary hyperparathyroidism: a diagnostic conundrum

Low SF, Sridharan R, Ngiu CS, Haflah NH

BMJ Case Rep, 2014;2014.

PMID: 24729114 DOI: 10.1136/bcr-2013-203282

Pseudotumours are rare, occurring in 1-2% of severe haemophiliacs. Osseous locations are far less frequent than soft tissue location. We report a case of a 43-year-old man with haemophilia A, who presented with a gradually enlarging left thigh mass for 8 months. There were no constitutional symptoms. Plain radiograph showed an expansile lytic lesion with 'soap-bubble' appearance arising from the left femur diaphysis. On MRI, it appeared as a non-enhancing, multilobulated lesion expanding the medullary and subperiosteal spaces. The mass exhibited concentric ring sign with heterogeneous intermediate signal intensity in the core lesion, reflective of chronic haematoma with blood degradation products of different stages. A diagnosis of haemophilic pseudotumour was made. Hypercalcaemia, however, raised a diagnostic dilemma as bone malignancy needed to be considered. An open excisional biopsy and subsequent amputation confirmed the diagnosis of osseous haemophilic pseudotumour. Nuclear medicine study later revealed a concurrent parathyroid adenoma.

Fulltext Midgut malrotation with congenital peritoneal band: a rare cause of small bowel obstruction in adulthood

Low SF, Ngiu CS, Sridharan R, Lee YL

BMJ Case Rep, 2014;2014.

PMID: 24717859 DOI: 10.1136/bcr-2013-202690

Midgut malrotation commonly presents in the neonatal period, and rarely manifests its symptoms in adulthood with an estimated incidence of 0.2-0.5%. Nevertheless, the symptoms are non-specific with no strong pointers towards the clinical diagnosis. Consequently, the diagnosis is usually disclosed with imaging or surgery. We report a case of small bowel obstruction secondary to a congenital peritoneal band with underlying midgut malrotation in a 48-year-old man.

Abu Bakar A, Ngiu CS, Mohamad Said MS, Periyasamy P

Ann Acad Med Singap, 2011 Oct;40(10):467-8.

PMID: 22206056

Fulltext Nocardiosis in a patient with rheumatoid arthritis treated with rituximab and a summary of reported cases

Ngiu CS, Said MS, Periyasamy P, Low SF

BMJ Case Rep, 2010;2010.

PMID: 22778377 DOI: 10.1136/bcr.11.2009.2421

Rituximab is a B-cell-depleting monoclonal anti-CD20 antibody. It is widely used in haematology and rheumatology. However, usage of rituximab in immunosupressed patient has been associated with various opportunistic infections. The authors reported a case of refractory rheumatoid arthritis treated with rituximab, which later presented with non-resolving pneumonia with pulmonary nodule. Percutaneous computer tomogram guided lung biopsy was arranged to confirm the suspicion of tuberculosis, but did not yield conclusive results. Later, she presented left-chest abscess and underwent incision and drainage. The pus culture and sensitivity confirmed pulmonary nocardiosis with chest wall dissemination. She was treated with 2-week course of trimethoprim sulfamethoxazole and responded. The authors also reviewed published cases of nocardiosis post-rituximab.

Fulltext A CASE OF INFILTRATING LOBULAR CARCINOMA OF THE BREAST WITH GASTRIC METASTASIS 22 YEARS AFTER INITIAL SURGERY

Hanafiah M, Sidek S, Low SF, Ngiu CS

Acta Clin Croat, 2021 Mar;60(1):136-140.

PMID: 34588734 DOI: 10.20471/acc.2021.60.01.20

Gastric metastasis from breast carcinoma is uncommon and rarely encountered in our daily practice. We report a case of late gastric metastasis from previous infiltrating lobular carcinoma of the breast. The patient had extended disease-free interval of 22 years prior to metastasis. Gastroscopy and fluoroscopy showed changes appearing like linitis plastica of the body of the stomach. Computed tomography of the thorax and abdomen demonstrated pulmonary metastasis and mediastinal lymphadenopathy. Biopsy of the mediastinal lymph node and stomach lesion confirmed metastatic adenocarcinoma from breast carcinoma based on immunohistochemistry staining. Immunohistochemistry staining of both specimens revealed strong positivity for cytokeratin 7 and negative for cytokeratin 20.

Abdominal wall necrotising fasciitis: A rare but devastating complication of the percutaneous endoscopic gastrostomy procedure

Mohd Said MR, Abdul Rani R, Raja Ali RA, Ngiu CS

Med J Malaysia, 2017 02;72(1):77-79.

PMID: 28255151 MyJurnal

Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long term enteral feeding. Even though the procedure is relatively safe, it is associated with various complications such as peritonitis or even death.1 We presented a case of a 54-year-old gentleman with underlying ischemic stroke and pus discharges from a recently inserted PEG tube. Computed Topography (CT) scan confirmed abdominal wall necrotising fasciitis complicated with hyperosmolar hyperglycaemia state (HHS) and later succumbed after 48 hours of admission. Our case illustrated the rare complication related to the insertion of PEG tube; abdominal wall necrotising fasciitis that was associated with mortality.

It's not just a heartburn and reflux disease: a case report of distal oesophageal spasm and review of literature

Nawawi KNM, Wong Z, Ngiu CS, Raja Ali RA

Med J Malaysia, 2019 12;74(6):540-542.

PMID: 31929483

Distal oesophageal spasm is a rare condition that affects the motility of the oesophagus. It can be diagnosed by highresolution oesophageal manometry and the diagnosis is supported by other modalities such as barium swallow and esophagogastroduodenoscopy examinations. Treatment options include pharmacological therapy, endoscopy and surgical interventions. We described a case of distal oesophageal spasm in an elderly patient who presented with chronic dyspepsia.

Gastrointestinal: Solitary fibrous tumor from lesser omentum: An elderly from Malaysia with an unusual huge painful intra-abdominal mass

Ng CS, Luqman M, Wong ZQ, Ngiu CS, Raja Affendi RA

J Gastroenterol Hepatol, 2017 Oct;32(10):1664.

PMID: 28948703 DOI: 10.1111/jgh.13721

Fulltext A case of Hashimoto encephalopathy in a Malay woman with Graves disease

Ngiu CS, Ibrahim NM, Yahya WN, Tan HJ, Mustafa N, Basri H, et al.

BMJ Case Rep, 2009;2009.

PMID: 21709844 DOI: 10.1136/bcr.01.2009.1501

Hashimoto encephalopathy (HE) is a poorly recognised steroid-responsive encephalopathy, with prominent neuropsychiatric features. Diagnosis is often difficult due to its heterogeneous clinical presentation, especially since the thyroid status or anti-thyroid antibody titres may not be related to the disease state. Here, the case of a 23-year-old Malay woman with Graves disease who presented with progressive encephalopathy diagnosed as HE is presented. She responded dramatically to high dose intravenous and then oral corticosteroid. A month after the initiation of treatment, she regained full independency.

Fulltext Non Secretory Multiple Myeloma With Extensive Extramedullary Plasmacytoma: A Diagnostic Dilemma

Low SF, Mohd Tap NH, Kew TY, Ngiu CS, Sridharan R

Iran J Radiol, 2015 Jul;12(3):e11760.

PMID: 26528383 DOI: 10.5812/iranjradiol.11760v2

Multiple myeloma (MM) is characterized by progressive proliferation of malignant plasma cells, usually initiating in the bone marrow. MM can affect any organ; a total of 7 - 18% of patients with MM demonstrate extramedullary involvement at diagnosis. Non-secretory multiple myeloma (NSMM) is a rare variant that accounts for 1 - 5% of all cases of multiple myeloma. The disease is characterized by the absence of monoclonal gammopathy in serum and urine electrophoresis. Our case report highlights the diagnostic challenge of a case of NSMM with extensive extramedullary involvement in a young female patient who initially presented with right shoulder pain and bilateral breasts lumps. Skeletal survey showed multiple lytic bony lesions. The initial diagnosis was primary breast carcinoma with osseous metastases. No monoclonal gammopathy was found in the serum or urine electrophoresis. Bone marrow and breast biopsies revealed marked plasmacytosis. The diagnosis was delayed for a month in view of the lack of clinical suspicion of multiple myeloma in a young patient and scant biochemical expression of non-secretory type of multiple myeloma.

Diffuse hepatic haemangiomatosis: A case report and review of literature

Rao R, Naidu J, Muhammad Nawawi KN, Wong ZQ, Ngiu CS, Mohammed F, et al.

Med J Malaysia, 2018 12;73(6):436-438.

PMID: 30647226

Hepatic haemangioma is a solitary liver lesion and prevalent among the female patients. We report a case of diffuse hepatic haemangiomatosis in a 62-year-old man, who was referred for an incidental finding of multiple liver nodules. History and physical examinations were unremarkable. Computed tomography and magnetic resonance imaging of the liver were performed and showed multiple haemangiomatosis. In view of the rarity of this condition in men, a liver biopsy was done and confirmed haemangiomas. Available published literature on diffuse hepatic haemangiomatosis was reviewed.

Fulltext The effects of different postures and provocative swallow materials on the normative Chicago 3.0 metrics in a healthy Asian population

Mohd Said MR, Wong Z, Abdul Rani R, Ngiu CS, Raja Ali RA, Lee YY

J Gastroenterol Hepatol, 2021 May;36(5):1244-1252.

PMID: 33002243 DOI: 10.1111/jgh.15284

BACKGROUND AND AIM: Variations in the Chicago 3.0 normative metrics may exist with different postures and with different provocative swallow materials in a healthy Asian population.

METHOD: Eligible healthy Malay volunteers were invited to undergo the high-resolution esophageal manometry (inSIGHT Ultima, Diversatek Healthcare, Milwaukee, WI, USA). In recumbent and standing positions, test swallows were performed using liquid, viscous, and solid materials. Metrics including integrated relaxation pressure 4 s (IRP-4 s, mmHg), distal contractile integral (DCI, mmHg s cm), distal latency (DL, s), and peristaltic break (PB, cm) were reported in median and 95th percentile.

RESULTS: Fifty of 57 screened participants were recruited, and 586 saline, 265 viscous, and 261 solid swallows were analyzed. Per-patient wise, in the recumbent position, 95th percentile for IRP-4 s, DCI, DL, and PB were 16.5 mmHg, 2431 mmHg s cm, 8.5 s, and 7.2 cm, respectively. We observed that with each posture, the use of viscous swallows led to changes in DL, but the use of solid swallows led to more changes in the metrics including DCI and length of PB. Compared with a recumbent posture, anupright posture led to lower IRP-4 s and DCI values. Both per-patient analysis and per-swallow analyses yielded almost similar results when comparing the different postures and types of swallows. No major motility disorders were observed in this cohort of asymptomatic population. However, more motility disorders were reported in the upright position.

CONCLUSIONS: Variations in metrics can be observed in different postures and with different provocative swallow materials in a healthy population. The normative Chicago 3.0 metrics are also determined for the Malay population.

P031 Identification of alternative splicing in transcript isoforms in patients with ulcerative colitis: effects of disease duration

Low EN, Wong Z, Ngiu CS, Nazefah AH, Rafiz AR, Mokhtar N, et al.

J Crohns Colitis, 2017 Feb 01;11(suppl_1):S94-S95.

PMID: 28172430 DOI: 10.1093/ecco-jcc/jjx002.157

Fulltext High resolution impedance manometry: a necessity or luxury in esophageal motility disorder?

Boo HS, Chik I, Ngiu CS, Lim SY, Jarmin R

Am J Case Rep, 2018 Aug 23;19:998-1003.

PMID: 30135416 DOI: 10.12659/AJCR.909717

BACKGROUND The esophagus can be affected by a variety of disorders that may be primary or secondary to another pathologic process, but the resulting symptoms are usually not pathognomonic for a specific problem, making diagnosis and further management somewhat challenging. High resolution impedance manometry (HRiM) has established itself as a valuable tool in evaluating esophageal motility disorder. HRiM is superior in comparison with conventional water perfused manometric recordings in delineating and tracking the movement of functionally defined contractile elements of the esophagus and its sphincters, and in distinguishing the luminal pressurization of spastic esophageal contraction from a trapped bolus. Making these distinctions can help to identify achalasia, distal esophageal spasm, functional obstruction, and subtypes according to the latest Chicago Classification of Esophageal Motility Disorders version 3.0. CASE REPORT We report a case series of 4 patients that presented with dysphagia; and with the ancillary help of the HRiM, we are able to diagnose esophageal motility disorder and evaluate its pathogenetic mechanism. This approach aids in tailoring each management individually and avoiding disastrous mismanagement. CONCLUSIONS From the series of case reports, we believe that HRiM has an important role to play in deciding appropriate management for patients presenting with esophageal motility disorders, and HRiM should be performed before deciding on management.

Conventional versus Doxorubicin-Eluting Beads Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: a Tertiary Medical Centre Experience in Malaysia

Rahman FA, Naidu J, Ngiu CS, Yaakob Y, Mohamed Z, Othman H, et al.

Asian Pac J Cancer Prev, 2016;17(8):4037-41.

PMID: 27644658

BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer that is frequently diagnosed at an advanced stage. Transarterial chemoembolisation (TACE) is an effective palliative treatment for patients who are not eligible for curative treatment. The two main methods for performing TACE are conventional (c-TACE) or with drug eluting beads (DEB-TACE). We sought to compare survival rates and tumour response between patients undergoing c-TACE and DEB-TACE at our centre.

MATERIALS AND METHODS: A retrospective cohort study of patients undergoing either treatment was carried out from January 2009 to December 2014. Tumour response to the procedures was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Kaplan-Meier analysis was used to assess and compare the overall survival in the two groups.

RESULTS: A total of 79 patients were analysed (34 had c-TACE, 45 had DEB-TACE) with a median follow-up of 11.8 months. A total of 20 patients in the c-TACE group (80%) and 12 patients in the DEB-TACE group (44%) died during the follow up period. The median survival durations in the c-TACE and DEB-TACE groups were 4.9 ± 3.2 months and 8.3 ± 2.0 months respectively (p=0.008). There was no statistically significant difference noted among the two groups with respect to mRECIST criteria.

CONCLUSIONS: DEB-TACE demonstrated a significant improvement in overall survival rates for patients with unresectable HCC when compared to c-TACE. It is a safe and promising approach and should potentially be considered as a standard of care in the management of unresectable HCC.

Unexplained ascites, a sign for neuroendocrine carcinoma

Mohd Kamil MK, Ngiu CS, Md Isa N, Yaacob Y Y, Deborah Chew CH, Wong ZQ, et al.

Med J Malaysia, 2018 02;73(1):60-62.

PMID: 29531208 MyJurnal

Neuroendocrine neoplasm is an epithelial neoplasm with predominant neuroendocrine differentiation that can arise from many organs in the body. We reported a rare case of gastric neuroendocrine carcinoma which accounts for less than 1% of all gastric tumours that is associated with poor prognosis. The recognition of this rare tumour in early stage is challenging and high suspicious into it might bring to early detection and so forth might improve the prognostication.

Displaying publications 1 - 20 of 21 in total