MyMedR

Fulltext An Infratemporal Meningioma: A Diagnostic Dilemma

Kaur A, Ali R, Omar E, Hashim H

J Radiol Case Rep, 2021 Jan;15(1):1-10.

PMID: 33717402 DOI: 10.3941/jrcr.v15i1.3898

A 46-year-old male presented with painless, recurrent bilateral ear discharge and an enlarging right temporal swelling. There were no neurological deficits. Imaging revealed an enhancing, soft tissue mass at the right infratemporal region involving the right temporalis muscle with a small, enhancing intradural component and associated hyperostosis of the greater wing of the right sphenoid bone. Tumour debulking of the right temporalis tumour was performed. Tumour invasion of the right temporalis muscle was noted intraoperatively. Histopathological result was consistent with fibrous meningioma WHO Grade 1 involving surgical resection margins. Follow-up MRI revealed residual right temporal extracranial component. Thus, plans were made for a second stage tumour debulking, however at time of writing, surgery had not been performed. This case highlights the differing appearances of the common meningioma occurring extracranially with elaboration of its differential diagnosis and management.

Matched MeSH terms: Diagnosis, Differential

Conservative management of juvenile spongiotic gingivitis: a series of ten cases

DeSeta M, Baldwin D, Siddik D, Hullah E, Harun N, Yee R, et al.

Br Dent J, 2020 09;229(5):287-291.

PMID: 32918012 DOI: 10.1038/s41415-020-2023-7

Introduction This case series highlights the condition juvenile spongiotic gingivitis; how to recognise it, where it lies in a list of differential diagnoses and why conservative management is the authors' recommended treatment.Case series The authors present ten cases that were successfully managed conservatively on the Joint Oral Medicine Paediatric Dentistry Clinic at Guy's and St Thomas' NHS Foundation Trust over a six-year period. Follow-ups reached up to 5 years and 11 months to date, with no adverse outcomes observed in any of the cases.Conclusion The pathogenesis of this benign condition and its ideal management is not well understood. Recurrence can occur after surgical treatment and the condition is likely to spontaneously resolve or regress with age. Therefore, particularly in asymptomatic cases, conservative management is recommended.

Matched MeSH terms: Diagnosis, Differential

Metastatic follicular thyroid carcinoma: a case report

Sathasivam H, Loh YM, Saw CL, Khalid N

Gerodontology, 2017 Jun;34(2):276-279.

PMID: 27384017 DOI: 10.1111/ger.12240

OBJECTIVE: A case of oral metastatic follicular thyroid carcinoma is presented.

BACKGROUND: Metastatic tumours are more frequent in older individuals and can be the only sign/symptom of an undiagnosed primary malignancy.

CASE REPORT: A 69-year-old lady presented with an enlarging mandibular swelling. Incisional biopsy and imaging studies were suggestive of metastatic follicular thyroid carcinoma.

CONCLUSION: Metastatic tumours should be considered in the differential diagnosis of mandibular swellings especially in older individuals.

Matched MeSH terms: Diagnosis, Differential

X-ray diagnosis in urinary tract infection

Devadason I

Med J Malaysia, 1975 Dec;30(2):114-20.

PMID: 1228376

Matched MeSH terms: Diagnosis, Differential

An Expansile Well-defined Radiolucency in Anterior Mandible: Case Presentation with Treatment Approach and Literature Update

Arora S, Urs AB, Choudhary Z

Gulf J Oncolog, 2017 Jan;1(23):77-81.

PMID: 28272008

A 15-year-old Indian male patient presented with a history of pain and swelling in left mandible. Imaging studies revealed a well-defined unilocular radiolucency in the body of the mandible. Patient also gave the past history of the surgery of the jaws, which was histopathologically diagnosed as dentigerous cyst. Following this patient underwent incisional biopsy and later excisional biopsy. The histopathologic diagnosis for incisional biopsy was unicystic ameloblastoma but final diagnosis was dentinogenic ghost cell tumor for the excised tissue. To the best of our knowledge, this appears o be the first case of dentigerous cyst transforming into dentinogenic ghost cell tumor. The clinical presentation of the case, differential diagnosis and treatment modalities are being discussed.

Matched MeSH terms: Diagnosis, Differential

Evaluation of a Rapid Kit for Detection of IgM against Leptospira in Human

Rao M, Amran F, Aqilla N

Can J Infect Dis Med Microbiol, 2019;2019:5763595.

PMID: 30881530 DOI: 10.1155/2019/5763595

Introduction: Leptospirosis is an acute febrile illness, known for its protean clinical manifestations and the challenge in differentiating from other infectious diseases. Standardized confirmatory test is antibody dependent and not accessible by the suburban community. This study measures efficiency of an immune-chromatographic assay, Leptocheck WB, in detecting acute leptospirosis.

Methods: A total of 142 sera were used for kit evaluation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by comparing rapid kit results with gold standard laboratory, microscopic agglutination test (MAT).

Results: We found this rapid kit to have a sensitivity and specificity of 66.6% and 78.9%, respectively, whereas the PPV and NPV of the kit appeared to be 73.3% and 73.2%, respectively.

Discussion: Test efficiency of this rapid kit is reasonable. It is specific in detecting leptospiral antibody and assures clinician of accurate diagnosis by having higher PPV and NPV. It is prompt and efficient in comparison with conventional methods in assisting differential diagnosis. High sensitivity and specificity leptospirosis rapid test is indeed a crucial measure to assist the diagnosis of acute undifferentiated febrile illnesses.

Matched MeSH terms: Diagnosis, Differential

Biofluid Markers of Equine Neurological Disorders Reviewed From Human Perspectives

Mayaki AM, Abdul Razak IS, Noraniza MA, Mazlina M, Rasedee A

J Equine Vet Sci, 2020 03;86:102907.

PMID: 32067661 DOI: 10.1016/j.jevs.2019.102907

Neurological disorders (NDs) are often fatal to horses. Thus, symptoms of equine NDs commonly indicate euthanasia. Current diagnostic approaches for equine NDs is based on clinical signs, differential diagnoses, analysis of cerebrospinal fluid (CSF), assessment of histopathological lesions, and imaging. However, advances in biofluid biomarkers in the diagnosis of human neurological diseases can potentially be applied to equine NDs. In this review, we described the established human blood and CSF neurobiomarkers that could potentially be used to diagnose equine NDs.

Matched MeSH terms: Diagnosis, Differential

Fulltext Giant submandibular sialolipoma masquerading as huge goitre: a case report

Subramaniam S, Johan S, Hayati F, Ng CY, Azizan N, Chuah JA, et al.

BMC Surg, 2020 Jun 11;20(1):130.

PMID: 32527309 DOI: 10.1186/s12893-020-00787-8

BACKGROUND: Sialolipoma is a rare tumour which may arise from both major and minor salivary glands and has recently been described as a variant of salivary gland lipomatous lesions.

CASE PRESENTATION: We report a 54-year-old male who presented with a 7-year history of large right anterior neck swelling. He was clinically euthyroid and had no compressive or infiltrative symptoms. He sought medical attention due to the discomfort exerted by the weight of the mass and was keen for excision. The swelling appeared like a goitre but physical examination proved otherwise. Imaging was suggestive of a benign tumour arising from the right parapharyngeal fossa. The mass was surgically excised and was noted to be adherent to part of the submandibular gland. Histopathological examination revealed a new variant of benign adipocytic tumour of salivary gland or sialolipoma arising from the submandibular gland. Besides being the largest sialolipoma to be reported, there are also no reports of giant submandibular sialolipomas masquerading as a huge goitre in appearance.

CONCLUSION: Submandibular sialolipomas can present in really large sizes and appear as a giant goitre. It is important to differentiate between benign lipomas from liposarcomas and tailor the management accordingly. Surgical enucleation is the preferred choice of treatment for these benign tumours with low recurrence rates.

Matched MeSH terms: Diagnosis, Differential

Fulltext At the heart of the problem: congestive cardiac failure as a cause of ascites: A narrative review

Goh ZNL, Teo RYL, Chung BK, Wong AC, Seak CJ

Medicine (Baltimore), 2022 Aug 05;101(31):e29951.

PMID: 35945724 DOI: 10.1097/MD.0000000000029951

Heart failure leading to cardiac ascites is an extremely rare and underrecognized entity in clinical practice. Recognizing cardiac ascites can be difficult, especially since patients presenting with ascites may have more than 1 etiology. Various biomarkers are available to aid in the diagnosis of cardiac ascites, though with differing sensitivities and specificities. Such biomarkers include serum albumin, ascitic albumin and protein, as well as serum N-terminal pro-brain natriuretic peptide (NT-proBNP). While serum NT-proBNP is a powerful biomarker in distinguishing the etiology of ascites and monitoring treatment progression, its cost can be prohibitive in low-resource settings. Clinicians practicing under these circumstances may opt to rely on other parameters to manage their patients. We go on further to report a series of 3 patients with cardiac ascites to illustrate how these biomarkers may be employed in the management of this patient population. Clinicians should always keep in mind the differential diagnosis of cardiac failure as a cause of ascites. The resolution of cardiac ascites may serve as a surrogate clinical marker for response to antifailure therapy in lieu of NT-proBNP at resource-scarce centers.

Matched MeSH terms: Diagnosis, Differential

Nasopharyngeal Respiratory Epithelial Adenomatoid Hamartoma-Master of Masquerade

D'Oliveiro JJ, Chong AW

Ann Otol Rhinol Laryngol, 2023 Nov;132(11):1483-1486.

PMID: 36941748 DOI: 10.1177/00034894231159325

OBJECTIVES: To highlight a case of nasopharyngeal Respiratory Epithelial Adenomatoid Hamartoma (REAH) in a female patient with chronic nasal block.

METHODS: A single case report of a female patient with the diagnosis of REAH, detailing her presenting symptoms, clinical findings, management and follow up.

RESULTS: Histopathological assessment of the excised nasopharyngeal polyp was consistent with a diagnosis of REAH with a discussion on the disease and its current literature reviews.

CONCLUSION: The incidence of REAH within the nasopharynx remain rare with only few cases described in literature, especially in females.

Matched MeSH terms: Diagnosis, Differential

A typical clinical manifestation of atypical underlying diagnosis: Answers

B N, Cj NA, Mk AM, I MI

Pediatr Nephrol, 2023 Nov;38(11):3615-3617.

PMID: 37160459 DOI: 10.1007/s00467-023-05967-1

Matched MeSH terms: Diagnosis, Differential

Giant Urinary Bladder in a Woman with Down Syndrome: A Case Report

Padzel S, Ariffin F, Mohd Yusuf SY, Mohamad Ali ND

Am J Case Rep, 2024 Jul 24;25:e944260.

PMID: 39044396 DOI: 10.12659/AJCR.944260

BACKGROUND Non-neurogenic neurogenic bladder involves fluctuating flow rates due to involuntary muscle contractions during voiding in those with normal neurological function. The diagnostic challenge lies in distinguishing between massive urinary bladder distension and ovarian tumors. While various pathologies mimicking ovarian tumors are documented, cases of a massively distended urinary bladder, known as giant urinary bladder, posing as such are notably scarce. CASE REPORT This case report presents the unique clinical scenario of a 31-year-old woman with Down syndrome who was initially misdiagnosed with an ovarian tumor due to progressive abdominal distention, reduced appetite, and weight loss. On presentation, she appeared dehydrated, with an abnormal renal profile. Despite hydration, the renal profile worsened. Initial ultrasound showed a large, uniloculated cystic lesion measuring 11×15 cm in the pelvis. Due to the size of the cyst, which appeared to be ovarian in origin, ovarian tumor was suspected. However, tumor markers were normal. A computed tomography scan subsequently showed a massively distended urinary bladder measuring 11.6×13.6×17.6 cm causing bilateral obstructive uropathy, with moderate hydronephrosis and hydroureter. Needing intermittent catheterization at first, the patient subsequently passed urine on her own following behavioral modification. CONCLUSIONS This rare case of non-neurogenic neurogenic bladder causing a giant urinary bladder in a patient with Down syndrome highlights the importance of an awareness of this condition for effective assessment and patient treatment.

Matched MeSH terms: Diagnosis, Differential

Fulltext About clinicopathological conference and its' practice in the School of Medical Sciences, USM

Hassan S

Malays J Med Sci, 2006 Jul;13(2):7-10.

PMID: 22589598

The clinicopathological conference, popularly known as CPC primarily relies on case method of teaching medicine. It is a teaching tool that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients. The process involves case presentation, diagnostic data, discussion of differential diagnosis, logically narrowing the list to few selected probable diagnoses and eventually reaching a final diagnosis and its brief discussion. The idea was first practiced in Boston, back in 1900 by a Harvard internist, Dr. Richard C. Cabot who practiced this as an informal discussion session in his private office. Dr. Cabot incepted this from a resident, who in turn had received the idea from a roommate, primarily a law student.

Matched MeSH terms: Diagnosis, Differential

THE ISOLATION OF HISTOPLASMA CAPSULATUM FROM A PATIENT IN A CHEST HOSPITAL

PONNAMPALAM JT

Med J Malaysia, 1964 Mar;18:201-4.

PMID: 14157186

Matched MeSH terms: Diagnosis, Differential*

Chronic haemolytic anaemia; a report of three cases of Cooley's anaemia and five cases of acholuric jaundice seen in Malaya with a discussion on the differential diagnosis

FIELD CE, TAN EE

Med J Malaya, 1955 Sep;10(1):60-82.

PMID: 13287496

Matched MeSH terms: Diagnosis, Differential*

Fulltext The Value of H3K27me3 Immunohistochemistry in Differentiating Malignant Peripheral Nerve Sheath Tumour with Its Histologic Mimickers

Mustapar N, Zawawi MSF, Tuan Sharif SE

Asian Pac J Cancer Prev, 2020 Mar 01;21(3):699-705.

PMID: 32212796 DOI: 10.31557/APJCP.2020.21.3.699

BACKGROUND: Diagnosis of malignant peripheral nerve sheath tumor (MPNST) is rather challenging due to its divergent morphologic heterogeneity and lack of specific ancillary test. The emergence of H3K27 trimethylation (H3K27me3) as a new immunohistochemistry (IHC) marker for MPNST have recently available to assist pathologists in differentiating MPNST from other histologic mimics. We aim to study the expression pattern of H3K27me3 in MPNST and its histologic mimickers and their association with the clinicopathological data.

METHODOLOGY: A total of 59 benign and malignant spindle cell tumours (18 MPNST and 41 of its histologic mimickers which included 10 schwannoma, 13 neurofibroma, 4 synovial sarcoma, 3 fibrosarcoma, 2 gastrointestinal stromal tumour (GIST), 4 leiomyosarcoma, 1 spindle cell liposarcoma, 1 solitary fibrous tumour, 2 low grade fibromyxoid sarcoma and 1 unclassified spindle cell sarcoma), diagnosed from January 1998 to April 2018 in Hospital Universiti Sains Malaysia (HUSM) were tested for H3K27me3 by IHC. The MPNST histological grade was assessed based on the French Fe'de' ration Nationale des Centres de LutteContre le Cancer (FNCLCC) for 3 tiers system (low grade, intermediate grade and high grade). The clinicopathological data were retrieved from the patients' record.

RESULTS: A total of 61.1% (11/18 MPNST) showed loss of H3K27me3 expression which is statistically significant as compared to its histologic mimics (p<0.001). Similar findings (p=0.026) were also observed in high grade MPNST (81.8%), intermediate grade MPNST (100%) and 0% in low grade MPNST.

CONCLUSION: H3K27me3, combined with other panel of markers, is useful in MPNST diagnosis to differentiate it from the histological mimickers.

Matched MeSH terms: Diagnosis, Differential*

Fulltext Current diagnostic approaches to detect two important betacoronaviruses: Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Chong ZX, Liew WPP, Ong HK, Yong CY, Shit CS, Ho WY, et al.

Pathol Res Pract, 2021 Sep;225:153565.

PMID: 34333398 DOI: 10.1016/j.prp.2021.153565

Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are two common betacoronaviruses, which are still causing transmission among the human population worldwide. The major difference between the two coronaviruses is that MERS-CoV is now causing sporadic transmission worldwide, whereas SARS-CoV-2 is causing a pandemic outbreak globally. Currently, different guidelines and reports have highlighted several diagnostic methods and approaches which could be used to screen and confirm MERS-CoV and SARS-CoV-2 infections. These methods include clinical evaluation, laboratory diagnosis (nucleic acid-based test, protein-based test, or viral culture), and radiological diagnosis. With the presence of these different diagnostic approaches, it could cause a dilemma to the clinicians and diagnostic laboratories in selecting the best diagnostic strategies to confirm MERS-CoV and SARS-CoV-2 infections. Therefore, this review aims to provide an up-to-date comparison of the advantages and limitations of different diagnostic approaches in detecting MERS-CoV and SARS-CoV-2 infections. This review could provide insights for clinicians and scientists in detecting MERS-CoV and SARS-CoV-2 infections to help combat the transmission of these coronaviruses.

Matched MeSH terms: Diagnosis, Differential*

Fulltext Kimura's disease of the parotid: A complete clinical-radiological-pathology report

Ragu R, Eng JY, Azlina AR

Med J Malaysia, 2014 Aug;69(4):199-201.

PMID: 25500854

Kimura's disease is rare chronic inflammatory disease with a distinct clinicopathological entity. It has three major components; inflammatory, vascular and fibrosis. It has to be considered as a differential diagnosis in young patient presenting with head and neck swelling. Although of unknown aetiology many hypothesis has been postulated. Inflammation is the most prominent and predominating characteristic in this disease. Although reported to be predominant in Asian literature regarding this disease is scanty. We report a complete clinical-radiological and pathological picture of this disease.

Matched MeSH terms: Diagnosis, Differential

Fulltext Post-operative immunohistochemical diagnosis of two synchronous primary non-small cell lung cancers in a single lobe

Sachithanandan A, Nor Y

Med J Malaysia, 2013 Apr;68(2):175-6.

PMID: 23629571 MyJurnal

Synchronous primary non-small cell lung cancers (NSCLC) are rare and may be discovered unexpectedly following lung resection. Discrimination from intrapulmonary metastases is important to guide treatment and prognosis but is difficult solely on clinical or radiological findings. Histopathological evaluation with immunohistochemistry (IHC) markers can prove decisive and should feature in the diagnostic algorithm of such patients. We report a rare case of two synchronous primary NSCLCs diagnosed post operatively following pathological examination of the resected lobe, highlighting the value of IHC and discuss the management of such patients.

Matched MeSH terms: Diagnosis, Differential

Fulltext Symptomatic intra-articular ganglion cyst of the knee

Aminudin CA, Samsudin OC, Hyzan MY, Hamzaini AH, Zahiah M

Med J Malaysia, 2004 Dec;59 Suppl F:57-9.

PMID: 15941165

We are reporting a case of a patient with a symptomatic intra-articular ganglion of the knee arising from infrapatellar fat pad. Plain radiograph and Magnetic Resonance (MR) images were correlated with arthroscopic examination and histological findings. The cyst was removed and post operatively patient regained full extension.

Matched MeSH terms: Diagnosis, Differential

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