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Displaying publications 21 - 29 of 29 in total

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Heterotopic ossification in psammomatous spinal meningioma: a diagnostic controversy

Wong YP, Tan GC, Mukari SAM, Palaniandy K

Int J Clin Exp Pathol, 2021;14(5):627-632.
PMID: 34093948

Heterotopic ossification (HO), a synonym for osseous metaplasia, is a pathological phenomenon, characterized by abnormal bone formation outside the skeletal system observed commonly in various neoplastic and non-neoplastic diseases. HO occurring in meningioma is exceptionally rare. We reportherein an unusual case of spinal meningioma containing numerous calcified psammoma bodies and extensive HO in a 75-year-old woman, who presented with progressive worsening bilateral lower limb weakness and numbness. The presence of remarkable bone formation within a meningioma is controversial among pathologists; while some regard them as psammomatous meningioma as the primary diagnosis, others prefer osteoblastic meningioma, a form of metaplastic meningioma. There is compelling molecular data to advocate that HO is an active disease process involving metaplastic (osseous) differentiation of meningioma stroma mesenchymal stem-like cells, but not the meningothelial-derived tumor cells. Henceforth, the term "metaplastic meningioma" may not be appropriate in this context. A plausible designation as "psammomatous meningioma with osseous metaplasia" defines this entity more accurately. This paper highlights the need for a unifying nomenclature to reduce diagnostic controversy caused by conflicting terms in the literature. The possible pathogenesis of this intriguing phenomenon is discussed.

Matched MeSH terms: Pathologists
Fulltext Exophytic Verrucous Hyperplasia of the Oral Cavity – Application of Standardized Criteria for Diagnosis from a Consensus Report

Zain RB, Kallarakkal TG, Ramanathan A, Kim J, Tilakaratne WM, Takata T, et al.

Asian Pac J Cancer Prev, 2016 01 09;17(9):4491.
PMID: 27865210 DOI: 10.7314/APJCP.2016.17.(9).4491

Verruco-papillary lesions (VPLs) of the oral cavity described in the literature involve a spectrum of conditions
including squamous papilloma, verruca vulgaris, focal epithelial hyperplasia, condyloma, proliferative verrucous
leukoplakia and verrucous carcinoma. A majority of the VPLs are slow growing, benign in nature and have a
viral aetiology. Virus associated benign mucosal outgrowths are not too difficult to diagnose either clinically or
by microscopy. Apart from virus-associated lesions, VPLs harboring malignant potential or behaviour such as
verrucous carcinoma, proliferative verrucous leukoplakia, oral verrucous hyperplasia (OVH), oral papillary
squamous cell carcinoma (PSCC) and oral conventional squamous cell carcinoma with papillary features (CSCC)
need to be further clarified for better understanding of their predictable biologic behavior and appropriate
treatment. Current understanding of potentially malignant VPLs is perplexing and is primarily attributed to
the use of confusing and unsatisfactory terminology. In particular, the condition referred to as oral verrucous
hyperplasia (OVH) poses a major diagnostic challenge. OVH represents a histopathological entity whose clinical
features are not well recognised and is usually clinically indistinguishable from a verrucous carcinoma and a
PSCC or a CSCC. A consensus report published by an expert working group from South Asia as an outcome of
the ‘First Asian Regional Meeting on the Terminology and Criteria for Verruco-papillary Lesions of the Oral
Cavity’ held in Kuala Lumpur, Malaysia, recognised the clinical description of these OVH as a new entity named
‘Exophytic Verrucous Hyperplasia’. Previously described clinical features of OVH such as the ‘blunt’ or ‘sharp’
variants; and the ‘mass’ or ‘plaque’ variants can now collectively fall under this newly described entity. This paper
discusses in detail the application of the standardized criteria guidelines of ‘Exophytic Verrucous Hyperplasia’
as published by the expert group which will enable clinicians and pathologists to uniformly interpret their pool
of OVH cases and facilitate a better understanding of OVH malignant potential.

Matched MeSH terms: Pathologists
Fulltext Distribution pattern of brain tumour in a tertiary hospital in East Coast, Malaysia

Nurul Balqis Md Dzali, Mohd Nizam Zahary, Nor Hidayah Abu Bakar, Hasnan Jaafar, Wan Rohani Wan Taib

Malaysian Journal of Public Health Medicine, 2017;17 Special(2):41-48.

Brain tumour occurrence in Malaysia demonstrates an increasing trend from year to year among adults and the second most common cancer among children. Thus, the expansion of numerous research for novel therapy and treatment are necessary. The distribution of brain tumour in a specific population is important to provide substantial information about the current trends for developing new diagnostic technique and research. Consequently, this study is opted to provide descriptive data of brain tumour in Hospital Universiti Sains Malaysia (USM). 217 brain tumour cases were collected from the hospital record between 2011 and 2014. The brain tumour cases were confirmed by pathologists according to WHO classification and grading. Descriptive analysis was evaluated by using Microsoft Excel and IBM SPSS version 22. Gender preponderance in this study shows very little difference. The most common adult primary brain tumour in this study was meningioma (32.7%) followed by glioblastoma (7.8%), a type of diffuse astrocytic tumour. According to age factor, brain tumour distribution pattern shows an increasing trend as the age increases and meningioma is the most common among the elder patients. Secondary tumour takes more than 10% from overall percentage of brain tumour cases. In conclusion, the descriptive data presentation in this study is very helpful to provide baseline information on the current brain tumour occurrence in this region.

Matched MeSH terms: Pathologists
ALK-positive anaplastic large cell lymphoma with a monomorphic small-cell pattern masquerading as inflammatory gastric lesions

Lee JS, Choi SJ, Kim L, Park IS, Han JY, Kim JM, et al.

Malays J Pathol, 2019 Aug;41(2):213-222.
PMID: 31427559

INTRODUCTION: Anaplastic lymphoma kinase-positive (ALK+) anaplastic large cell lymphoma (ALCL) with a non-common pattern can be diagnostic challenging. Pathologists can be unavoidably and unintentionally blind to non-descript tumor cells in a lymphohistiocytic- (LH) or small-cell (SC)-pattern. We report a case of primary systemic ALK+ ALCL with a SC pattern that presented as secondary gastric lesions with a mixed LH and SC pattern that was masqueraded as inflammatory lesions.
CASE REPORT: A 34-year-old woman with intractable epigastric pain was referred to have repeated endoscopy with biopsy. She was found to multiple gastric erosions and nodules that were diagnosed as inflammatory lesions both endoscopically and histologically. Meanwhile, she developed an acute onset of severe back pain associated with a pathologic compression fracture in the T3 thoracic vertebral body. Imaging studies disclosed a disseminated systemic disease involving abdominopelvic lymph nodes and cervical and thoracic vertebral bodies. The needle biopsy of the pelvic lymph node disclosed diffuse proliferation of monomorphic small round cells that were diffusely positive for CD30 and ALK. A diagnosis of ALK+ ALCL with a monomorphic SC pattern was rendered.
DISCUSSION: A retrospective review of the gastric biopsies with the aid of immunohistochemistry enabled us to recognise the presence of lymphomatous infiltrates with a mixed LH and SC pattern in every piece of gastric biopsies that were repeatedly misdiagnosed as inflammatory lesions. This case illustrates a significant diagnostic pitfall of the LH- and SC-patterns in ALK+ ALCL, in which the tumour cells featuring lymphoid, plasmacytoid or histiocytoid appearance can be masqueraded as inflammatory cells.

Matched MeSH terms: Pathologists
Fulltext Immune Checkpoint Inhibitors in Urothelial Carcinoma: Recommendations for Practical Approaches to PD-L1 and Other Potential Predictive Biomarker Testing

Lopez-Beltran A, López-Rios F, Montironi R, Wildsmith S, Eckstein M

Cancers (Basel), 2021 Mar 20;13(6).
PMID: 33804698 DOI: 10.3390/cancers13061424

Immuno-oncology (IO) agents (anti-programmed cell death 1 (PD-1) and anti-programmed cell death-ligand 1 (PD-L1)) are approved as first- and second-line treatments for metastatic UC. PD-L1 expression levels in UC tumors help clinicians determine which patients are more likely to respond to IO therapies. Assays for approved IO agents use different antibodies, immunohistochemical protocols, cutoffs (defining "high" vs. "low" PD-L1 expression), and scoring algorithms. The robust control of pre-analytical and analytical standards is needed to obtain high-quality PD-L1 results. To better understand the status and perspectives of biomarker-guided patient selection for anti-PD-1 and anti-PD-L1 agents in UC, three workshops were held from December 2018 to December 2019 in Italy, Malaysia, and Spain. The primary goal was to develop recommendations for best practice approaches to PD-L1 testing in UC. Recommendations pertaining to the interpretation and reporting of the results of PD-L1 assays from experienced pathologists and oncologists from around the globe are included. A test request form for pathology laboratories was developed as a critical first step for oncologists/urologists to encourage communication between clinicians and pathologists, ensuring fast and high-quality test results. In this era of personalized medicine, we briefly discuss novel biomarkers being evaluated for IO agents in UC.

Matched MeSH terms: Pathologists
Metastatic leiomyosarcoma of the thyroid: A rare entity

Che Jalil NA, Rama Chandran P, Samsudin AHZ, Yahya MM, Wan Abdul Rahman WF

Malays J Pathol, 2021 Apr;43(1):69-73.
PMID: 33903308

Cancer metastasis to the thyroid gland from non-thyroid sites is a rare presentation in clinical practice. The most frequent primary cancers that metastasise to the thyroid are renal cell carcinoma, followed by colorectal, lung and breast. We report a case of a 64-year-old Malay lady who presented with anterior neck swelling 4 years after an initial diagnosis of uterine leiomyosarcoma. She had undergone a hysterectomy procedure four years ago. Fine needle aspiration cytology of the thyroid mass suggested undifferentiated thyroid carcinoma. After multi-disciplinary discussion, the patient underwent thyroidectomy and the final histopathological diagnosis was metastatic leiomyosarcoma of the thyroid. The diagnosis was aided by an immunohistochemistry panel of positive myogenic markers, negative epithelial markers as well as the previous medical history of uterine leiomyosarcoma. Metastatic leiomyosarcoma of the thyroid may mimic primary undifferentiated (anaplastic) thyroid carcinoma (UTC) with a sarcomatoid pattern, medullary thyroid carcinoma (MTC) with spindle cells morphology and spindle cell tumour with thymus-like differentiation (SETTLE). Hence, a multidisciplinary approach must be practised by pathologists, surgeons and radiologists to consider metastatic lesions of the thyroid gland, especially when a previous history of cancer exists or is suspected.

Matched MeSH terms: Pathologists
Fulltext Evaluation of sHLA-G levels in serum of patients with prostate cancer identify as a potential of tumor marker

Heidari MH, Movafagh A, Abdollahifar MA, Abdi S, Barez MM, Azimi H, et al.

Anat Cell Biol, 2017 Mar;50(1):69-72.
PMID: 28417057 DOI: 10.5115/acb.2017.50.1.69

Prostate cancer is the most common cancer type in men and is the second cause of death, due to cancer, in patients over 50, after lung cancer. Prostate specific antigen (PSA) is a widely used tumor marker for prostate cancer. Recently, PSA is discovered in non-prostatic cancer tissues in men and women raising doubts about its specificity for prostatic tissues. PSA exists in low serum level in healthy men and in higher levels in many prostate disorders, including prostatitis and prostate cancer. Thus, a supplementary tumor marker is needed to accurately diagnose the cancer and to observe the patient after treatment. Recently, soluble human leukocyte antigen-G (sHLA-G) has been introduced as a new tumor marker for different cancer types, including colorectal, breast, lung, and ovary. The present descriptive-experimental study was carried out including patients with malignant prostate tumor, patients with benign prostate tumor, and a group of health men as the control group, as judged by an oncologist as well as a pathologist. After sterile blood sampling, sHLA-G was measured by enzyme-linked immunosorbent assay in each group. The data was then analyzed using one-way ANOVA. P≤0.05 was considered as statistically significant. The results showed that the mean of sHLA-G level was high in patients. Also, it was found that there was a significant difference in sHLA serum level between the three groups. The data revealed that sHLA-G can be a novel supplementary tumor marker in addition to PSA to diagnose prostate cancer.

Matched MeSH terms: Pathologists
Fulltext The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body

Hasmi AH, Khoo LS, Koo ZP, Suriani MUA, Hamdan AN, Yaro SWM, et al.

Forensic Sci Med Pathol, 2020 09;16(3):477-480.
PMID: 32500339 DOI: 10.1007/s12024-020-00270-z

During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. The craniotomy box technique was tested on a confirmed COVID-19 positive body where a full postmortem examination was performed by a team of highly trained personnel in a negative pressure Biosafety Level 3 (BSL-3) autopsy suite in the National Institute of Forensic Medicine (IPFN) Malaysia. This craniotomy box is a custom-made transparent plastic box with five walls but without a floor. Two circular holes were made in one wall for the placement of arms in order to perform the skull opening procedure. A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics.

Matched MeSH terms: Pathologists*
Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action

Horton S, Sullivan R, Flanigan J, Fleming KA, Kuti MA, Looi LM, et al.

Lancet, 2018 05 12;391(10133):1953-1964.
PMID: 29550030 DOI: 10.1016/S0140-6736(18)30460-4

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.

Matched MeSH terms: Pathologists