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Fine-needle aspiration cytology in Kimura's disease

Jayaram G, Peh KB

Diagn Cytopathol, 1995 Nov;13(4):295-9.
PMID: 8599911

Three patients presenting with parotid, submandibular, and/or lymph node masses were subjected to fine-needle aspiration cytology. Smears showed dissociated and clustered endothelial cells, eosinophils, lymphocytes, and Warthin Finkeldey giant cells. In two cases a diagnosis of Kimura's disease was suggested from the FNA cytologic smears. In the third case the presence of mononucleate cells with prominent nucleoli led to a suspicion of Hodgkin's disease. Excision biopsy and histopathologic study established a diagnosis of Kimura's disease in all three cases.
High expression of LC3A, LC3B, and p62/SQSTM1 autophagic proteins in human colonic ganglion cells

Awi NJ, Armon S, Peh KB, Peh SC, Teow SY

Malays J Pathol, 2020 Apr;42(1):85-90.
PMID: 32342935

INTRODUCTION: Autophagy is a mechanism that degrades large damaged organelles and misfolded proteins to maintain the homeostasis in all cells. It plays double-faceted roles in tumourigenesis and prevention of various cancers. In our side observation of investigating the prognostic value of autophagy in colorectal cancer (CRC), we found high expression of autophagy proteins (LC3A, LC3B, and p62/SQSTM1) in the colonic ganglion cells. To our best understanding, this is the first paper reporting such finding.
MATERIALS AND METHODS: Formalin-fixed paraffin-embedded (FFPE) CRC tissues blocks were retrieved and confirmed by haematoxylin & eosin (H&E) staining. Immunohistochemistry (IHC) targeting autophagy proteins (LC3A, LC3B, and p62/SQSTM1) was then performed followed by pathological examination.
RESULTS: All three autophagy proteins were present in both normal and tumour tissues of CRC patients. Interestingly, high expression of autophagy proteins in colonic ganglion cells was consistently seen regardless of tissue type (normal or cancer) or tumour site (caecum, ascending, transverse, descending, sigmoid colon and rectum).
CONCLUSIONS: This work highlights the high autophagic activities in human colonic ganglion cells.
Fulltext Retroperitoneal extragonadal germ cell tumor with duodenal infiltration: A challenging endo-luminal tissue diagnosis

Qua CS, Peh KB, Kannan S, Goh KL

JGH Open, 2022 Feb;6(2):152-154.
PMID: 35155826 DOI: 10.1002/jgh3.12711

A 32-year-old Malay male was referred to our hospital for a second opinion. An abdominal and pelvic CT scan at the previous medical facility showed a large retroperitoneal tumor, which was subjected to ultrasound-guided fine-needle aspiration cytology (FNAC) with a provisional diagnosis of malignant lymphoma. However, after reviewing the existing results, a repeat biopsy was deemed necessary and this was performed endoluminally via gastroduodenoscopy in view of the close proximity of the tumor and the third part of the duodenum. The first biopsy failed to detect any abnormal cells, but a repeat biopsy with supporting evidence from other laboratory results led to a final diagnosis of extragonadal germ cell tumor (GCT) with duodenal infiltration.
Fulltext Vitamin D deficiency causing eosinophilic esophagogastroenteritis and ascites: a rare association

Qua CS, Peh KB, Saravannan K, Goh KL

BMJ Case Rep, 2021 Feb 04;14(2).
PMID: 33541947 DOI: 10.1136/bcr-2020-240039

A 54-year-old Chinese man presented with ascites for 2 weeks. He had a preceding 2-year history of intermittent dysphagia, lethargy and general malaise. Blood investigations revealed leucocytosis with eosinophilia of 26.5%, whereas paracentesis showed turbid fluid with high protein content (45 g/L) and a high white blood cell count of 5580/µL, predominantly eosinophils (90%). An incidental assay of vitamin D showed a very low level of 13.5 ng/mL. No other cause of ascites was found. Gastroscopy was normal except for duodenitis. However, biopsies from lower oesophagus confirmed the presence of eosinophilic infiltration. Following vitamin D replacement, the patient experienced marked improvement in symptoms of dysphagia within 2 weeks and no recurrence of ascites after 3 months. The reason for the patient's vitamin D deficiency remains unclear. The marked improvement in the patient's health indicates a causative role of vitamin D deficiency in causing eosinophilic esophagogastroenteritis and associated eosinophilic ascites.
Association between autophagy and KRAS mutation with clinicopathological variables in colorectal cancer patients

Awi NJ, Yap HY, Armon S, Low JSH, Peh KB, Peh SC, et al.

Malays J Pathol, 2021 Aug;43(2):269-279.
PMID: 34448791

Autophagy is a host defensive mechanism responsible for eliminating harmful cellular components through lysosomal degradation. Autophagy has been known to either promote or suppress various cancers including colorectal cancer (CRC). KRAS mutation serves as an important predictive marker for epidermal growth factor receptor (EGFR)-targeted therapies in CRC. However, the relationship between autophagy and KRAS mutation in CRC is not well-studied. In this single-centre study, 92 formalin-fixed paraffin-embedded (FFPE) tissues of CRC patients (42 Malaysian Chinese and 50 Indonesian) were collected and KRAS mutational status was determined by quantitative PCR (qPCR) (n=92) while the expression of autophagy effector (p62, LC3A and LC3B) was examined by immunohistochemistry (IHC) (n=48). The outcomes of each were then associated with the clinicopathological variables (n=48). Our findings demonstrated that the female CRC patients have a higher tendency in developing KRAS mutation in the Malaysian Chinese population (p<0.05). Expression of autophagy effector LC3A was highly associated with the tumour grade in CRC (p<0.001) but not with other clinicopathological parameters. Lastly, the survival analysis did not yield a statistically significant outcome. Overall, this small cohort study concluded that KRAS mutation and autophagy effectors are not good prognostic markers for CRC patients.
Association of Fusobacterium nucleatum infection with the clinicopathological characteristics in colorectal cancer patients

Pang SW, Armon S, Chook JB, Chew J, Peh KB, Lim WW, et al.

Mol Biol Rep, 2024 Jan 16;51(1):124.
PMID: 38227097 DOI: 10.1007/s11033-023-09150-5

BACKGROUND: Colorectal cancer (CRC) is a global health problem. The gut microbiome is now recognized as an important underlying factor to the initiation and progression of CRC. Fusobacterium nucleatum (FN) is one of the most studied bacteria in the aetiology of CRC. This study provided cohort evidence on the association of FN infection with clinicopathologic features in CRC patients.
METHODS: We analysed the cancerous and adjacent non-cancerous formalin-fixed paraffin embedded (FFPE) tissue of 83 CRC patients from a single medical centre in Malaysia. TaqMan probe-based qPCR targeting the 16S rRNA gene was used to detect the presence of FN in the extracted FFPE DNA. The differences in FN expression between cancer and non-cancer tissues were evaluated. Association studies between FN infection in the tumour and relative FN abundance with available clinical data were conducted.
RESULTS: FN was more abundant in the cancerous tissue compared to non-cancerous tissue (p = 0.0025). FN infection in the tumour was significantly associated with lymph node metastasis (p = 0.047) and cancer staging (p = 0.032), but not with other clinicopathologic variables. In double-positive patients where FN was detected in both cancerous and non-cancerous tissue, the expression fold-change of FN, calculated using 2-ΔΔCT formula, was significantly higher in patients with tumour size equal to or greater than 5 cm (p = 0.033) and in KRAS-mutated patients (p = 0.046).
CONCLUSIONS: FN is enriched in CRC tumour tissue and is associated with tumour size, lymph node metastasis, cancer staging, and KRAS mutation in this single-centre small cohort study.