MyMedR

A 10-year experience in the diagnosis and treatment of 92 patients with inflammatory bowel diseases in Kuala Lumpur is described. Tuberculosis (34 cases) was the most common inflammatory bowel disease of surgical importance. The clinical presentation of tuberculous enteritis and Crohn's disease is similar, though tuberculosis is strongly suggested by associated pulmonary disease and radiological evidence of caecal involvement. The finding of 10 cases each of Crohn's disease and ulcerative colitis is in keeping with an increased awareness of these conditions in a developing urban society where facilities exist for thorough investigation of diarrhoeal diseases. Amoebiasis sometimes causes a granulomatous lesion simulating carcinoma. Diverticular disease of the colon as known in the West is of very rare occurrence.

Matched MeSH terms: Crohn Disease/diagnosis; Dysentery, Amebic/diagnosis; Tuberculosis, Gastrointestinal/diagnosis

Fulltext Oral cancer awareness and practice of risk habits and mouth self-examination in high risk indigenous community in Sarawak, Malaysia

Thaddius Herman Maling, Jennifer Geraldine Doss, Low, Wah Yun

International Medical Journal Malaysia, 2017;16(21):19-19.

MyJurnal

This study was to obtain baseline information and its associated factors on oral
cancer awareness, practice of risk habits and mouth self-examination (MSE) among selected highrisk
indigenous community in Sarawak. (Copied from article).

Matched MeSH terms: Diagnosis, Oral

Fulltext Erythema nodosum masking nephrogenic systemic fibrosis as initial skin manifestation

Fuah KW, Lim CTS

BMC Nephrol, 2017 Jul 24;18(1):249.

PMID: 28738858 DOI: 10.1186/s12882-017-0666-7

BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a complication of the gadolinium-based contrast agent used in imaging studies. It is typically characterised by hard, erythematous and indurated skin plaques with surrounding subcutaneous oedema. Distinct papules and subcutaneous nodules can also be seen. Fibrocytes in NSF are immunohistochemically positive for CD34.

CASE PRESENTATION: We present a case of NSF occurred after gadolinium exposure in which the initial presentation mimics an erythema nodosum (EN)-like picture. An initial skin biopsy showed EN. Subsequently the patient developed progressive skin and joints contracture. A repeated skin biopsy done three months later confirmed the diagnosis of NSF. As far as we are aware, this is the second reported case of NSF that mimicked the presentation of EN in the early phase of the disease.

CONCLUSIONS: The appearance of EN-like disease can be one of the early manifestations of NSF. We hope that early recognition of this unusual presentation can alert the physician or nephrologist to the potential diagnosis of NSF.

Matched MeSH terms: Diagnosis, Differential; Erythema Nodosum/diagnosis*; Nephrogenic Fibrosing Dermopathy/diagnosis*

When water is thicker than blood: recognising a systemic cause of haemoptysis

Wedge E, Abrahamson E, Tudor-Williams G, Nadel S, Deal J

Arch Dis Child Educ Pract Ed, 2017 Aug;102(4):210-219.

PMID: 27780827 DOI: 10.1136/archdischild-2015-308957

The case of an 11-year-old child presenting with acute haemoptysis and breathlessness is described. The girl was Malaysian and had recently arrived in the UK. She subsequently deteriorated, developing respiratory failure. The course of the illness is described, with reference to the diagnostic process at each stage. The case demonstrates the importance of having a broad investigatory approach in acute haemoptysis.

Matched MeSH terms: Diagnosis, Differential; Glomerulonephritis/diagnosis*; Hemoptysis/diagnosis*

Primary cutaneous anaplastic large cell lymphoma with lung metastasis

Nor Kamaruzaman Esa, Kahairi Abdullah, Shamim Rahman Abdul Rasheed

Archives of Orofacial Sciences, 2016;11(2):44-48.

MyJurnal

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is relatively a rare tumour of head and
neck region. Without histopathological confirmation, it appears and behaved as like malignant epithelial tumor of
the head and neck region as will be illustrated in the present case. Cutaneous involvement of the tumor with
distant metastasis has made the prognosis unfavorable. This isolated case of head and neck PC-ALCL was
highlighted as it has a tendency to behave aggressively and early diagnosis and treatment is crucial to avoid poor
survival outcome.

Matched MeSH terms: Early Diagnosis

Painful oral and genital ulcers

Ch'ng CC, Wong SM, Lee YY

Cutis, 2017 Jan;99(1):E1-E3.

PMID: 28207013

Matched MeSH terms: Genital Diseases, Male/diagnosis*; Mouth Diseases/diagnosis*; Pemphigus/diagnosis*

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

Melioidosis mimicking miliary tuberculosis

Tan RZ, Mohd Nor F, Shafie S, Tan LJ

Forensic Sci Med Pathol, 2019 03;15(1):151-154.

PMID: 30293222 DOI: 10.1007/s12024-018-0026-3

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a gram-negative intracellular bacillus. Tuberculosis, also an infectious disease, is caused by Mycobacterium tuberculosis, an acid fast bacillus. In both diseases, patients commonly present with fever and respiratory symptoms due to sepsis which might lead to respiratory failure or sudden death if left untreated. Not only are these two entities similar in clinical presentation, but the autopsy findings may mimic each other, giving rise to difficulties in determining the cause of death. We report a case of melioidosis and compare it to a typical case of miliary tuberculosis. Similarities between the cases on gross and histopathological examinations are discussed. In such circumstances, microbiological culture of bodily fluids and internal organs should be performed to ascertain the correct cause of death.

Matched MeSH terms: Diagnosis, Differential; Melioidosis/diagnosis*; Tuberculosis, Miliary/diagnosis

CD56 expression in benign and malignant thyroid lesions

Muthusamy S, Azhar Sha S, Abdullah Suhaimi SN, Kassim N, Mahasin M, Mohd Saleh MF, et al.

Malays J Pathol, 2018 Aug;40(2):111-119.

PMID: 30173227 MyJurnal

INTRODUCTION: Thyroid cancer is the most common endocrine malignancy with more than 95% originating from follicular epithelial cells. Diagnostic dilemma may arise in occasional cases such as when an encapsulated nodule with a follicular growth pattern exhibits clear nuclei with grooves making it difficult to distinguish a follicular adenoma from encapsulated follicular variant papillary thyroid carcinoma. This study aimed to evaluate the diagnostic utility of an immunohistochemical marker, CD56, to distinguish between benign and malignant thyroid lesions.

MATERIALS AND METHODS: We retrospectively studied CD56 expression in 54 benign and 54 malignant thyroid lesions using archival formalin fixed paraffin-embedded tissue blocks for the study period from January 2010 to December 2015, diagnosed in a tertiary hospital.

RESULTS: CD56 was expressed in 52/54 (96.3%) of benign specimens and only 24/54 (44.4%) of malignant ones. The malignant specimens comprised 31 (57.4%) papillary thyroid carcinomas (PTC), 11 (20.3%) follicular carcinomas (FC), seven (13%) medullary thyroid carcinomas (MC), one (1.9%) poorly differentiated carcinoma (PC) and four (7.4%) anaplastic carcinomas (AC). CD56 was not expressed in 28/31 (90.3%) of the PTCs, 1/11 (9.1%) FCs, 1/4 (25%) of ACs while all MCs and the PD were positive. The benign group comprised nodular hyperplasias (29/54), lymphocytic thyroiditis (10/54), follicular adenomas (FA) (14/54) and one hyalinising trabecular tumour. CD56 was expressed in all the benign cases except one FA and one nodular hyperplasia. Thirteen of the 14 FAs were CD56 positive. The difference in expression between benign and malignant tumours was statistically significant as the p value was <0.01.

CONCLUSION: CD56 is a potentially good immunohistochemical marker for differentiating papillary thyroid carcinoma from other benign follicular lesions of the thyroid especially in differentiating follicular variant PTC from FA in equivocal cases.

Matched MeSH terms: Adenoma/diagnosis; Diagnosis, Differential; Thyroid Neoplasms/diagnosis

Fulltext Diagnostic Criteria for Somatosensory Tinnitus: A Delphi Process and Face-to-Face Meeting to Establish Consensus

Michiels S, Ganz Sanchez T, Oron Y, Gilles A, Haider HF, Erlandsson S, et al.

Trends Hear, 2018 9 15;22:2331216518796403.

PMID: 30213235 DOI: 10.1177/2331216518796403

Since somatic or somatosensory tinnitus (ST) was first described as a subtype of subjective tinnitus, where altered somatosensory afference from the cervical spine or temporomandibular area causes or changes a patient's tinnitus perception, several studies in humans and animals have provided a neurophysiological explanation for this type of tinnitus. Due to a lack of unambiguous clinical tests, many authors and clinicians use their own criteria for diagnosing ST. This resulted in large differences in prevalence figures in different studies and limits the comparison of clinical trials on ST treatment. This study aimed to reach an international consensus on diagnostic criteria for ST among experts, scientists and clinicians using a Delphi survey and face-to-face consensus meeting strategy. Following recommended procedures to gain expert consensus, a two-round Delphi survey was delivered online, followed by an in-person consensus meeting. Experts agreed upon a set of criteria that strongly suggest ST. These criteria comprise items on somatosensory modulation, specific tinnitus characteristics, and symptoms that can accompany the tinnitus. None of these criteria have to be present in every single patient with ST, but in case they are present, they strongly suggest the presence of ST. Because of the international nature of the survey, we expect these criteria to gain wide acceptance in the research field and to serve as a guideline for clinicians across all disciplines. Criteria developed in this consensus paper should now allow further investigation of the extent of somatosensory influence in individual tinnitus patients and tinnitus populations.

Matched MeSH terms: Diagnosis, Differential; Tinnitus/diagnosis*; Somatosensory Disorders/diagnosis*

Fulltext To Pace or Not To Pace? A Narrative Review of VIP Syndrome

Khoo CS

Perm J, 2018;22:18-081.

PMID: 30227913 DOI: 10.7812/TPP/18-081

Matched MeSH terms: Diagnosis, Differential; Vertigo/diagnosis*; Syncope, Vasovagal/diagnosis*

Vaginal Brenner tumor with literature review: does this tumour originate from Walthard nests?

Park S, Cho MS

Malays J Pathol, 2017 Apr;39(1):89-93.

PMID: 28413211

Vaginal Brenner tumor is extremely rare. Only five cases have been reported in the English literature to date. Here we report a vaginal Brenner tumor in a 76-year old postmenopausal woman, who presented with a 2.5cm-sized sessile vaginal polyp. Microscopically, it showed characteristic features of Brenner tumor consisting of three components; transitional islands, glands, and dense fibrous stroma. The epithelial tumor cells were positive for GATA-3, p63 and ER, but negative for PAX8. The origin of Brenner tumors in the vagina is unclear, but previous reports suggested of Müllerian origin. However, our case revealed that vaginal Walthard nests could be possible precursor lesions based on their immunohistochemical staining results.

Matched MeSH terms: Brenner Tumor/diagnosis; Ovarian Neoplasms/diagnosis; Vaginal Neoplasms/diagnosis

Nuclear morphometry and texture analysis on cytological smears of thyroid neoplasms: a study of 50 cases

Deka L, Gupta S, Gupta R, Gupta K, Kaur CJ, Singh S S

Malays J Pathol, 2017 Apr;39(1):33-37.

PMID: 28413203

BACKGROUND: Fine needle aspiration cytology (FNAC) is a reliable and reproducible diagnostic technique for thyroid lesions with certain limitations. Computed morphometric methods have been introduced with a view to improve the diagnostic yield of thyroid aspirates. However, a review of the existing literature revealed conflicting reports regarding morphometric parameters in thyroid neoplasms.

MATERIALS AND METHODS: This study included 50 cases of thyroid lesions (20 cases of colloid goitre, 15 of follicular adenoma, 5 of follicular carcinoma and 10 papillary carcinomas). Digital images of cytologic smears of these cases were captured using a dedicated photomicrography system and nuclear profiles traced manually. With self-designed image analysis software, nuclear morphometric measurements, including texture analysis, were performed. Discriminant analysis was performed including the morphometric parameters and percentage of correctly classified nuclei noted.

RESULTS: Nuclear morphometry parameters showed that papillary thyroid carcinoma had the highest perimeter, area, radius and elongation factor compared to other thyroid lesions. Discriminant analysis revealed that altogether 77.9% of cells could be correctly classified to their lesion category based on the nuclear morphometric and textural parameters. Of the neoplastic cases, 84.5% of cells of follicular neoplasms and 72.5% of papillary carcinoma were classified to the respective category.

CONCLUSION: Nuclear morphometry, including texture analysis, can assist in the cytologic diagnosis of thyroid lesions, considering the high degree of accuracy of classification. Further studies and methodological refinements can achieve higher accuracy.

Matched MeSH terms: Carcinoma, Papillary/diagnosis; Thyroid Neoplasms/diagnosis; Adenocarcinoma, Follicular/diagnosis*

Fulltext Renal-limited AL amyloidosis - a diagnostic and management dilemma

Fuah KW, Lim CTS

BMC Nephrol, 2018 11 06;19(1):307.

PMID: 30400895 DOI: 10.1186/s12882-018-1118-8

BACKGROUND: Amyloidosis is a disorder caused by extracellular tissue deposition of insoluble fibrils which may result in a wide spectrum of symptoms depending upon their types, sites and amount of deposition. Amyloidosis can be divided into either systemic or localized disease.

CASE PRESENTATION: We present a case of a middle-aged gentleman who presented with persistent nephrotic syndrome with worsening renal function. Repeated renal biopsies showed the presence of renal-limited AL amyloidosis. Systemic amyloidosis workup was unremarkable apart from a slightly raised band of IgG lambda level with no associated immunoparesis. The nephrotic syndrome and renal histology did not improve over a 3-year period despite being given two courses of chemotherapies.

CONCLUSION: We hope that early recognition of this unusual localised presentation of renal- limited AL Amyloidosis and its poor response to conventional treatment can alert the nephrologist to the potential existence of this rare condition.

Matched MeSH terms: Amyloidosis/diagnosis*; Diagnosis, Differential; Nephrotic Syndrome/diagnosis*

Asymptomatic Balanced Double Aortic Arch Associated With Tetralogy of Fallot

Haranal M, Abdul Latiff HB, Sivalingam S

World J Pediatr Congenit Heart Surg, 2020 01;11(1):130-132.

PMID: 31835984 DOI: 10.1177/2150135119885889

Coexistence of asymptomatic balanced double aortic arch with tetralogy of Fallot (TOF) is extremely rare and represents a surgical dilemma in decision-making due to the lack of consensus on the management of this subset of patients. We report a case of asymptomatic balanced double aortic arch coexistent with TOF in a two-year-old girl.

Matched MeSH terms: Diagnosis, Differential; Heart Defects, Congenital/diagnosis; Tetralogy of Fallot/diagnosis*

Desmoplastic ameloblastoma in Indians: report of five cases and review of literature

Sivapathasundharam B, Einstein A, Syed RI

Indian J Dent Res, 2007 10 17;18(4):218-21.

PMID: 17938502

In the recent World Health Organization classification of odontogenic tumours, desmoplastic ameloblastoma has been characterized as a variant of ameloblastoma, with specific clinical, radiographical, and histological features. Till date, 145 cases have been reported in Japanese, Chinese, Malaysian, Western, and African populations, with very few cases described in Indians. Here, we report five cases in the Indian population. The male to female ratio was 3:2. The mean age at diagnosis was 33.2 years. Four of the tumours were located in the maxilla, in the anterior premolar region. The lone mandibular tumour was located anteriorly, crossing the midline. Three of the tumours had a mixed radiologic appearance with poorly defined borders. Unilocular change was seen in one of them. Two tumours presented as unilocular radiolucencies with specks of radiopacities and well-circumscribed borders. Histologically, irregular odontogenic islands, with a stretched-out 'kite-tail' appearance, were seen in a dense desmoplastic stroma. The peripheral layer of the epithelial islands was made up of flattened cells and the inner core was made up of spindle-shaped and, in some instances, squamous-shaped cells. In two cases, odontogenic epithelium in the form of follicles, typical of solid/multicystic ameloblastoma, was seen and these were typed as 'hybrid' variants. All the cases were treated by resection.

Matched MeSH terms: Ameloblastoma/diagnosis*; Mandibular Neoplasms/diagnosis*; Maxillary Neoplasms/diagnosis*

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