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Biomedical subjects

C H Yip

Publications and source records attributed to C H Yip.

At least 19 recordsLinked to original sources

The value of cytology in granulomatous mastitis: a report of 16 cases from Malaysia.

BACKGROUND: Granulomatous mastitis is a rare condition of the breast that can mimic a carcinoma. There are characteristic histological features, the most important of which is a predominantly lobular inflammatory process. It must be differentiated from known causes of granulomatous inflammation, such as tuberculosis. METHODS: In the present paper, the clinical and pathological features of 16 patients with granulomatous mastitis seen over a 3-year period in the University Hospital, Kuala Lumpur, are described. RESULTS: A clinical suspicion of malignancy was present in 10 cases. One of the patients was nulliparous. One had an associated hyperprolactinaemia, while two had systemic lupus erythromatosis. One of the patients was pregnant at the time of presentation. Four patients had localized lumps excised, five were treated conservatively because the lesion was too extensive to resect, and seven patients required drainage procedures for abscess formation. CONCLUSION: Awareness of this condition is important because it mimics a carcinoma, and surgery may not be the best treatment for recurrent disease.

Breast Neoplasms↗

Breast cancer in pregnancy--our experience with six patients in the University Hospital, Kuala Lumpur.

Presentation of breast cancer during pregnancy is a rare situation and one that requires a multidisciplinary approach involving an obstetrician, surgeon and oncologist. Management should be along the same principles as in non-pregnant patients and delay is not justifiable. Mastectomy and axillary clearance is the best option, followed by chemotherapy, which is safe after the first trimester. Radiation if required should be delayed until after delivery of the baby. We present here our experience with 6 patients who presented with breast cancer during pregnancy. Five patients refused any treatment until after delivery, while one underwent only a mastectomy and axillary clearance. The outcome was poor; all of them died between 14 months and 52 months. The poor outcome probably reflects the late stage at presentation in four of the patients (State 3 and 4) rather than the delay in treatment, while delay in treatment in the two who presented with early cancer (Stage 1 and 2) led to a more advanced stage after delivery.

Adult↗

The experience with fine needle aspiration cytology in the management of palpable breast lumps in the University Hospital Kuala Lumpur.

A total of 676 palpable breast lumps seen in the Breast Clinic, University Hospital, Kuala Lumpur from August 1993 to August 1994 were subjected to fine needle aspiration cytology. Fifty-four were reported as inadequate, 501 benign, 95 malignant and 26 suspicious. One hundred and eighty-seven aspirates had histological correlation, while 34 of the malignant aspirates had clinical correlation. The majority of the other 455 patients were followed up for a period of 60 to 72 months without any malignancies becoming apparent. For analysis, only the 221 cases with histological or clinical correlation were included, (the suspicious category was included into the positive group and the inadequate cases were excluded), giving a sensitivity of 91.7%, a specificity of 91.7% and a diagnostic accuracy of 91.7%. Breast cytology was an accurate and rapid method of diagnosis of breast diseases, and in a busy surgical unit with limited operating time, it allowed for the triage of patients with breast complaints in deciding which cases needed early open biopsy. A negative cytology does not exclude the possibility of cancer, as there was a false negative rate of 11%. However by utilising a diagnostic triad of clinical examination, radiological assessment and fine needle aspiration cytology, the risk of missing a malignancy is small.

Biopsy, Needle↗

Cytology of mucinous carcinoma of breast: a report of 28 cases with histological correlation.

Pure mucinous carcinoma (MC) of the breast is a relatively uncommon variant of breast carcinoma with distinctive histological and cytological features. In this study we have analysed fine needle aspiration (FNA) cytological material from 28 cases of MC of breast and correlated the cytomorphological features with histopathology. The 28 patients consisted of 27 females and one male patient. 14 patients were Chinese, 10 were Indian and four were Malay. Their ages ranged from 38 to 90 with a mean at 52 years. The left breast was involved in 17 and the right in 11 cases. The duration of the lump varied from two weeks to 10 years. The cytological picture was characterized by abundant extracellular mucin giving a "sea of mucin" or "whirlpools of mucin" effect, in which were seen floating clusters of tumour cells with relatively bland cytological features. Myxo-vascular fragments were seen in 12 cases. Dissociated tumour cells showed a plasmacytoid appearance with eccentric nuclei. In four cases, the mucin was scanty in amount and the cellularity was high while in two cases, the cellularity was very low. Psammoma bodies were seen in cytological smears in one case. Histological study of excision or mastectomy specimens confirmed all 28 cases to be pure MC. Knowledge of the distinctive cytomorphological appearance of MC would enable correct identification of these lesions as malignant and prompt treatment that could further enhance the survival of these prognostically good breast cancers.

Adenocarcinoma, Mucinous↗

Value of routine 99mTc-MDP bone scintigraphy in the detection of occult skeletal metastases in women with primary breast cancer.

Baseline staging bone scans in 208 women with primary breast cancer in University Hospital Kuala Lumpur from January 1993 to December 1995 were reviewed. A positive bone scan was found in 14.7% of women aged below 50 years, and 9.1% of women aged 50 years and above. No patient with T0/T1, 4.7% with T2, 6.6% with T3 and 35.8% with T4 tumours had a positive scan caused by bone metastases. No patient with clinical Stage 0/1, 4% with Stage 2, 9.5% with Stage 3 and 63% with Stage 4 disease had a positive bone scan. Clinical staging alone was inaccurate in 20.2% of patients. Forty per cent of patients with a positive bone scan did not have bone pain. The false positive rate was 0.5% and the false negative rate was 0.96%. We conclude that a routine bone scan is not required in Stage 1 disease or T1 tumours, is indicated in Stage 3 and 4 disease, or T3 and T4 tumours, and should only be performed in selected women with Stage 2 or T2 cancers.

Journal Article↗

Fine needle aspiration cytology of secretory carcinoma of breast: a case report.

A 39-year-old female presented with a mobile 1.5 cm nodule in the right breast. Fine needle aspiration cytology smears stained with May Grunwald Giemsa were highly cellular with a monotonous population of dissociated and clustered tumour cells that showed a bland cytological appearance with cytoplasmic vacuolation and occasional signet ring forms. Intracellular and extracellular mucus was present. Histological study of the excised breast mass showed a secretory carcinoma. This is a rare breast neoplasm in which cytological features are characteristic enough to permit a specific diagnosis on needle aspirates.

Adult↗

Cytological analysis of breast lesions: a review of 780 cases.

780 breast cytology samples obtained over a one year period at the Breast Clinic of the University Hospital, Kuala Lumpur were reviewed. These included 745 fine needle aspirates (FNA's) and 35 nipple smears. The broad categories of cytodiagnoses were as follows: malignant: 95, suspicious or equivocal: 26, benign: 543, no proliferative lesion: 58 and inadequate: 58. The benign and malignant lesions were also subcategorized on cytological basis. The suspicious or equivocal lesions were subjected to biopsy and 17 of these proved to be malignant. 194 cases that were subjected to histological confirmation and 34 cases that were considered to be undisputably malignant (on the basis of clinical features, recurrences, metastases, etc.) were subjected to statistical analysis (total 228 cases). If the cytologically suspicious/equivocal category was considered as "test positive" the sensitivity of cytodiagnosis was 97.4% and the specificity 92%. The high degree of cytodiagnostic sensitivity and specificity make breast cytology a valuable adjunct in the evaluation of breast lesions.

Adenocarcinoma↗

True hermaphrodite--a case report.

A case report of a male true hermaphrodite with 46XX/46XY karyotype is presented. He was first diagnosed at the age of 9 years when he presented with hypospadias and a left undescended testis. He was lost to follow-up until he presented at the age of 23 years with bilateral gynaecomastia. A hormonal profile showed a low testosterone level, while a seminal assay showed very few sperms. However he claimed to be sexually active. A year later, after he got married, he began to complain of impotence. A review of the condition is presented.

Adult↗

Breast cancer--a comparative study between Malaysian and Singaporean women.

Breast cancer is the leading cause of cancer deaths in Malaysian and Singaporean women. A study done to compare the epidemiology of the disease, as well as to compare the rate of conservative surgery between Malaysian and Singaporean women was carried out. The results show that the median age at presentation was the same in both countries, and the incidence was lower among the Malays. However, there was a significant difference in the stage at presentation and the tumour size; Singaporean women presented at earlier stages and with smaller tumours compared to Malaysian women. This led to a lower rate of conservation surgery in Malaysian women.

Adult↗

The Breast Clinic in University Hospital--a four-month survey.

The breast clinic in the university Hospital Kuala Lumpur was started in August 1993 to cater for the increasing number of women seeking treatment for breast complaints. A four-month survey carried out from January to April 1994 found that Chinese women are more "breast conscious" than Malay and Indian women. The majority of patients were in the reproductive age group. Benign breast diseases form the majority of cases of breast diseases seen. The pick-up rate for new cases of breast cancer was 3.1%. Fine needle aspiration biopsy had a 100% sensitivity during the four-month study, and was a quick method of obtaining a diagnosis.

Adult↗

Meconium ileus--a rare cause of neonatal intestinal obstruction in Malaysia.

Meconium ileus, rare in Malaysia, accounts for 3.7% of all neonatal intestinal obstructions (excluding imperforate anus) seen in the University Hospital, Kuala Lumpur, from 1980-1990. This paper retrospectively reviews our clinical experience with 5 cases of meconium ileus seen over a 12-year period from 1980-1991 in the University Hospital, Kuala Lumpur. Three of the neonates were Malays, and two were Punjabis. Four of them were full-term and one preterm. The birth weights ranged from 1900 to 3700 g, with a mean of 2670 g. One of them also had a sibling with meconium ileus. Two of them were found to have foetal ascites and one had intestinal obstruction, antenatally by ultrasonography. The remaining two were symptomatic soon after birth. Extensive calcification was observed on plain abdominal radiographs in three babies and dilated bowels in the other two. All of them underwent laparotomy and uncomplicated meconium ileus was confirmed in two cases, meconium peritonitis in two and one meconium pseudocyst in addition to meconium peritonitis. There was one intraoperative death, and one long-term survivor who did not have cystic fibrosis. The remaining three did not have additional features suggestive of cystic fibrosis, and finally succumbed to respiratory infection. Sweat test was not done to confirm the diagnosis for logistic reasons. The management of such patients proved to be a challenge to clinicians because of the rarity of this condition.

Female↗

Persistent müllerian duct syndrome--a case report.

An eighteen month old phenotypically and genotypically normal male child was admitted with a left inguinal hernia and a right undescended testis. At operation, he was found to have a uterus, bilateral fallopian tubes, and a vagina in the left hernial sac. Bilateral orchidopexies and excision of the persistent Mullerian duct structures were carried out. This rare case of persistent Mullerian duct syndrome is due to a defect in Mullerian regression, which is in turn controlled by the Mullerian inhibiting substance (MIS). Orchidopexy with excision of the persistent Mullerian duct structures is usually not possible without damage to the vas deferens which is closely adherent to the wall of the uterus. The alternative of leaving the persistent Mullerian duct structures alone and performing a staged or primary orchidopexy has been suggested.

Disorders of Sex Development↗

Cystic neuroblastoma with colonic fistula.

Neuroblastoma is the most common malignant tumour in infancy originating in about 70% of cases in the adrenal gland. Haemorrhage and necrosis is often seen in neuroblastoma but cyst formation is uncommon. Fistulous communication between an adrenal cystic neuroblastoma and the large bowel has never to our knowledge been reported before.

Adrenal Gland Neoplasms↗