Biomedical subjects
Publications and source records attributed to H L Eng.
We describe a rare case of tuberculous tenosynovitis involving the first dorsal compartment at the wrist mimicking de Quervain's disease. Differentiation between tuberculous infection and de Quervain's disease is important since corticosteroid injection, appropriate in the latter, is detrimental in tuberculous tenosynovitis. Early culture and biopsy in suspicious cases provide accurate diagnosis.
Kimura's disease is a rare benign condition that occurs predominantly in Oriental young people. The patients displayed a variety of manifestations such as painless, tumor-like masses in the head and neck regions, or in the salivary glands with associated lymphadenopathy. They are sometimes initially mistaken for malignant tumors, resulting in improper management. We present four cases of Kimura's disease and a comprehensive review of the literature to increase awareness and alert surgeons and pathologists to consider the possibilities of this disease, especially in Oriental patients having peripheral blood eosinophilia and/or elevated serum IgE.
BACKGROUND: Adjuvant treatment for node-negative breast cancer remains controversial. It is important to pick out the high-risk groups who may benefit from adjuvant systemic therapy and avoid the unnecessary additional therapy for the favorable prognostic groups. METHODS AND MATERIAL: Retrospective study of immunohistochemical staining for HLA-DR on tumor cells from paraffin-embedded tissue specimens of 32 patients with node-negative invasive breast cancer at this hospital from 1986 to 1991 was performed with the aim to investigate its prognostic significance. RESULTS: HLA-DR staining was positive in nine (28%) patients and negative in twenty-three (72%) patients. One (11%) was a recurrence, and no (0%) death occurred in the positive group, compared with nine (39%) recurrences and five (22%) deaths in the negative group. The multivariate analysis failed to show that HLA-DR expression is an independent prognostic factor. However, with univariate analysis, the 5-year disease-free survival rate (87%) of the positive group was significantly better than that (35%) of the negative group (p = 0.04). The 5-year overall survival rate (100%) of the positive group was also better than that (66%) of the negative group, but the difference was not statistically significant. Furthermore, when combination of the HLA-DR expression and estrogen receptor status was used, both the 5-year disease-free and overall survival rate (81% and 100%, respectively) of group A (positive staining for either HLA-DR or estrogen receptor and positive staining for both) were significantly better than those (33% and 58%, respectively) of group B (negative staining for both HLA-DR and estrogen receptor). CONCLUSIONS: We believe HLA-DR expression may be a promising, additive predictive factor to node-negative breast cancer and deserves further investigation based on these preliminary results.
A case of gallbladder adenocarcinoma with gallstone and calcified parasitic ova of Clonorchis sinensis was described. The patient, a 58-year-old Chinese woman, presented with general malaise and jaundice. The gallbladder contained 3 stones in addition to the cancerous lesion. Microscopically, we saw calcified parasitic ova of Clonorchis sinensis associated with the stones. The relationships between Clonorchis sinensis, stones and adenocarcinoma were discussed.
We report three cases of squamous cell carcinoma originating from ovarian dermoid cysts. All patients were postmenopausal with the chief complaints of lower abdominal pain and palpable masses found by themselves. Two of them had diabetes mellitus. The tumor sizes were all more than 10 cm. The diagnoses were made by histological examination of tissues removed at surgery. Two cases were categorized into the FIGO stage IIIc and one in stage Ia. Sonographic findings were characterized by a large adnexal mass with mixed components. An elevated serum squamous cell carcinoma antigen was found in the two cases of advanced stage and one of them also had an elevated serum CA-125 level. All reported cases were unilaterally involved without ascites at laparotomy, while omental lymph nodes metastases were noted in the two cases of advanced stage. One of the patients in the advanced stage died six months after surgery and radiation therapy due to recurrence. The other patient in the advanced stage refused further treatment even though recurrence was found five months after surgery and chemotherapy. There was no evidence of recurrence in the early stage case during the two years of follow-up.
Carcinoid tumors of the thymus are rare. In 1972, Rosai and Higa first described these neoplasms as a distinct entity from thymomas. Clinically, they may be asymptomatic or present with symptoms of a growing mass and/or with ectopic endocrine secretion. Two cases of thymic carcinoid tumor without endocrine manifestations are presented. Microscopically, both tumors showed typical features of carcinoid, such as ribbons, festoons and rosette-like structures. Immunohistochemically, they were immunoreactive for neuron-specific enolase (NSE), chromogranin A and keratin. Electron microscopic examination was performed only in one case and numerous dense core neurosecretory granules were demonstrated. Thymic carcinoid tumors may pursue an aggressive but protracted clinical course. Along with radiotherapy and possibly adjunctive chemotherapy, complete surgical excision remains the best treatment today either for the primary tumor or for subsequent recurrences.
We present a case of lethal short rib-polydactyly syndrome (SRPS) that cannot be categorized into the existing classification. A nosologic discussion is presented. To our knowledge, situs inversus totalis, as in our case, has not been described before in any SRPS.
We have described three patients with primary squamous cell carcinoma of the breast. All three have remained well after modified radical mastectomy. One patient received postoperative radiotherapy. Estrogen receptor status was determined by monoclonal antibody technology in two cases, and the results were negative.
Screening peripheral or cord blood from newborn infants has been used for early detection of alpha-thalassemia conditions. The level of hemoglobin Bart's (Hb Bart's) in the blood correlates with the degree of alpha-gene deletion. Hence, the degree of gene deletion in an alpha-thalassemia carrier state can be estimated. Two thousand cord blood samples collected from the Tainan area were screened with cellulose acetate membrane electrophoresis for Hb Bart's. Ninety-nine of the 2,000 samples (4.95%) were positive for Hb Bart's. Concentrations of Hb Bart's varied from 3.2% to 30.7%. Of the 99 cases with Hb Bart's, 22 had Hb Bart's levels of 3.0% to 9.9%; 54 had Hb Bart's levels of 10.0% to 19.9%; and 23 had Hb Bart's levels of 20% to 40%. Routine cord blood screening by hemoglobin electrophoresis is recommended.
Five cases of intrahepatic cholangiocarcinoma were found among 101 cases of hepatolithiasis. There was no definite sign of cholangiocarcinoma in ERCP and image studies of four cases. The possibility of the existence of occult cholangiocarcinoma should be kept in mind, especially when unusual presentations, such as body weight loss, anemia, palpable abdominal mass, and intractable pain, appear. An intraoperative frozen-section examination should be considered under the following circumstances: (1) whitish nodular mass over liver, (2) mucinous substance within bile duct, and (3) enlarged, firm lymph nodes clustered along the hepatic arteries and/or celiac arteries.
Isolated splenic vein obstruction with left-sided portal hypertension is a rare clinical condition. Owing to the close relationship of the splenic vein and the pancreas, this rare phenomenon is usually secondary to pancreatic inflammation or neoplasm. Acinar cell carcinoma has long been recognized as a distinctive, rare type of pancreatic carcinoma. A case of isolated splenic vein obstruction with left-sided portal hypertension secondary to acinar cell carcinoma of the pancreas, which we are reporting here, is thought to the first documented in the literature.
A laparotomy was performed on a 68-year-old female who, in spite of medical treatment, suffered from uncontrolled upper gastrointestinal bleeding due to ruptured gastric varices. Histological examination of the liver tissue taken during operation revealed tuberculosis. Hepatic tuberculosis, although rare, should be kept in mind as one of the differential diagnosis when there is unexplained, noncirrhotic bleeding gastric varices.
Warthin's tumor is an unusual benign salivary gland tumor. It is predominantly found in Caucasians and is rare in non-Caucasians. The chief affected area of the tumor is the parotid gland. Of all salivary gland neoplasms, Warthin's tumor is the only lesion which is truly multicentric so it may have a second primary lesion, not a recurrence. The peak incidence is in the sixth decade of life. In sexual distribution, there is a male predominance but the incidence of female is progressively increasing. According to Lemelas's study, the increase in female incidence may relate to the increasing population of cigarette smoking of women. Bilateral parotid gland involvement is uncommon. The chief treatment of the tumor is surgical excision. The surgical methods include enucleation, superficial parotidectomy, total parotidectomy. It is very important to protect the facial nerves from injury during surgery. In this paper, we report a case of bilateral metachronous Warthin's tumors with cystic degeneration of parotid glands in a Chinese. Other than literature review and case report, four different methods to protect facial nerves from injury were briefly described.
A cystic tumor was first found in the abdomen of a Taiwanese girl at the age of 9 months. The tumor gradually increased in size and caused no symptoms until the girl was 7 years of age, when surgical removal was carried out. Pathological examination disclosed two "fetuses" within the fibrous sac. The pathogenesis of fetus in fetu and its differentiation from retroperitoneal teratoma are still controversial issues. Further work needs to be done to elucidate whether it is a natural progression of the twinning process to teratoma or the inclusion of a monozygotic diamniotic twin within the bearer.
An unusual case of medullary carcinoma of the thyroid gland with melanin production is described. In addition to typical histologic characteristics, some tumor cells show strong positive reaction for calcitonin by immunohistochemical study. Ultrastructurally dense-core granules and immature melanosomes are found in the same tumor cell. The tumor is thought to arise from a common precursor cell of neural crest origin with both C cell and melanocytic differentiation capable of producing both calcitonin and melanin.
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BACKGROUND: We compared the sonographic characteristics of hepatic adenomas with pathologic findings. METHODS: Information over 10 years was collected on 12 patients (six men, six women; mean age = 47 years) with surgically proven hepatic adenomas. Clinical data, sonographic features, and histopathologic findings were reviewed. RESULTS: The tumors in males were smaller and simpler than those in women (p < 0.05, Fisher's exact test). Four of the six larger tumors (>5 cm) showed mixed-echoic patterns corresponding with pathologically intratumoral hemorrhage and necrosis. Four homogeneously hypoechoic tumors had less change in tumor composition. Three homogeneously hyperechoic tumors had evident fatty changes inside. One isoechoic tumor had a hypoechoic rim, that correlated mostly to the tumor itself and compressed liver parenchyma. Seven of the 12 tumors had thin fibrous capsules that were not seen on sonography. CONCLUSION: Hepatic adenomas have variable sonographic appearances depending on changes in the tumor. Hypoechoic, hyperechoic, and mixed-echoic patterns represent simple adenoma, adenoma with fatty metamorphosis, and hemorrhagic necrosis, respectively, in tumors.
A case of exophytic gastric hemangioma with intratumoral bleeding due to torsion of the tumor pedicle is reported. A radiograph showed a mass without phleboliths. Computed tomography (CT) demonstrated a 14-cm mass with high densities due to hemorrhage, which was contiguous to the stomach and extended to the pelvis. The tumor showed no remarkable enhancement on post-enhanced CT due to torsion of the tumor pedicle.