Biomedical subjects
Publications and source records attributed to P Jayalakshmi.
A 21-year-old lady was admitted with a one year history of painless swelling in the neck. The clinical features and radiological findings suggested a thyroglossal duct cyst. Histology of the excised duct cyst showed papillary carcinoma. Ultrasound examination of the thyroid gland was normal. The patient is on regular follow-up and is well two years following surgery.
Schistosomiasis is a widely prevalent disease in the world and usually involves the gastro-intestinal and urinary tract. The involvement of the female genital tract has been well-established in S. haematobium infections and is rare with S. japonicum infections. This case involves a Filipino female who was admitted to the University Hospital Kuala Lumpur for right iliac fossa pain and was diagnosed initially as acute appendicitis. Ultrasound showed a multi-septated pelvic cyst leading to a provisional diagnosis of ovarian torsion. Intraoperatively a right parovarian cyst was detected and removed. Histology revealed a congested cyst wall with areas of haemorrhage with several viable and calcified eggs of S. japonicum measuring 85 microns x 62 microns. Within the cystic cavity blood admixed with eggs were seen. Confirmation was carried out by using the indirect haemagglutination (IHA) test. This is a first report of upper genital schistosomiasis mimicking an ovarian tumour.
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Squamous metaplasia (SM) of thyroid follicular epithelium is known to occur in a variety of non-neoplastic lesions as well in thyroid neoplasms, notably papillary carcinoma (PC). In follicular thyroid tumors, on the other hand, SM is very rare. This case describes cytological and pathological findings in a follicular adenoma (FA) that presented as a cystic lesion with extensive SM. The fine needle aspiration (FNA) cytology sample in this case yielded only necrotic material from the cystic area and squamous cells, which being mostly of immature type, were not recognised as squamous in the cytological smears. The needle missed the solid (neoplastic) component of the lesion and on the whole the cytological picture was considered to be equivocal. FA can now be added to the spectrum of thyroid lesions that can show SM. Awareness of this will enable cytopathologists to consider non-papillary lesions in the differential diagnosis of thyroid nodules that yield squamous cells.
We report a rare tumour of the nasopharynx- papillary adenocarcinoma. This is usually of low grade and certainly in out patient it behaved so. It is even rarer to have this tumour in a patient with Turner's syndrome in whom there is a high incidence of gynaecological malignancy. It has not previously been documented and the occurrence in this patient is probably coincidental.
Sudden maternal death from amniotic fluid embolism is a rare but serious complication which usually occurs during late pregnancy, often during labour or shortly after, with more than 80% mortality. Such a death causes immense stress to both the relatives and the attending doctors as it is sudden and unexpected. Three such deaths are discussed here. Traditionally, it was believed that this complication usually occurred in prolonged and difficult labour, but there is evidence contrary to this, and it is not possible to predict when and where this fatal complication will occur. Current views and various pathophysiologic mechanisms leading to the fatal outcome are also discussed.
A review of consecutive biopsies of adnexal tumours from 112 patients, received by the Department of Pathology, University of Malaya, over a 13-year period was undertaken. The age range of the patients was from 1 to 84 years, with a mean of 29.8 years. Thirty-three (32%) patients were under 20 years of age. There were 68 females with a male to female ratio of 1.0:1.5. In 105 cases (93.7%), the neoplasm was solitary. The tumour measured less than 2 cm in the largest dimension in 103 cases (92%). The common sites of occurrence were the head and neck region (59%) and extremities (25%). Neoplasms of hair follicle origin accounted for 63.4% (71 cases) of all lesions. Intra-tumour deposition of amyloid was noted in one of the 14 cases of trichoepithelioma.
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Explore the source record for details and available documents.
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Leprosy is a chronic infectious disease and is still a public health problem in Malaysia. In 1926, the Leper Enactment Act was established which required compulsory notification and isolation of leprosy patients. As a result, the National Leprosy Control Centre (NLCC) was built in Sungai Buloh, Selangor. In 1969, the National Leprosy Control programme was launched with the objective of early case finding and decentralisation of treatment of leprosy. The treatment of leprosy patients is integrated with basic Medical and Health services in Malaysia. With the implementation of multiple drug therapy in 1985, the National prevalence rate of leprosy has reduced from 5.7 per 10,000 in 1983 to 1.7 per 10,000 in 1992. The Research Unit in NLCC was established in 1950, where cultivation of Mycobacterium leprae using mouse foot-pad technique is done. This technique is used for assessment of efficacy of chemotherapeutic agents in leprosy. Research activites are also done in collaboration with the Institute for Medical Research in Kuala Lumpur such as isolation of Mycobacterium leprae antigen using T cell clones and phenolic glycolipid antigen.
Fifty-nine cases of tuberculous cervical lymphadenitis were analysed histologically. Characteristic epithelioid cell granulomas were seen in all the cases with central areas of caseation necrosis in 96.6% (57/59) of these cases. The diagnosis of tuberculosis was further established by the demonstration of acid-fast bacilli (AFB) in the tissue sections in 29 cases. These AFB, although occasional, were found more frequently within the epithelioid cells as compared with other zones of the granuloma. There was no significant association between necrosis and bacillary content. We conclude that light microscopical assessment is still a useful screening method to diagnose tuberculosis in cases of cervical lymphadenopathy.
A retrospective histological analysis of colonic biopsies received by the Department of Pathology, University of Malaya during the 4-year-period between 1990 and 1993 revealed nine cases of microscopic colitis (MC). The ages of the patients ranged from 18 to 53 years. Seven patients were females with a female to male ratio of 3.5 :1. The main clinical symptom was chronic diarrhoea of duration varying from 4 months to 5 years. None of the patients had any systemic illness or were on any prior medication. Colonoscopy and barium enema observations in all the subjects were essentially normal. Colonic biopsies showed diffuse plasmacytic infiltration of the lamina propria, intraepithelial lymphocytic infiltration and normal crypt pattern. To the best of our knowledge, this is the first documented report on MC from Malaysia. It is envisaged that better recognition of this condition by histopathologists would reduce the numbers in the often diagnosed category of "nonspecific colitis".
The simultaneous occurrence of carcinoma of the cervix in pregnancy is uncommon. In a prospective study of 397 patients undergoing type III radical hysterectomy for early invasive cancer of the cervix, 18 were pregnant at the time of surgery; 4 of these were operated after delivery elsewhere. Two others had a type I extrafascial hysterectomy. The incidence was 1 in 4077 deliveries. The clinical and histological characteristics of these patients are presented. Routine speculum examination and cervical cytology in all pregnant patients early in pregnancy are vital for early diagnosis. Bleeding in pregnancy should not automatically be assumed to be caused by pregnancy-related conditions. The strategies in surgical management are discussed. Radical hysterectomy in pregnancy is safe. No major complications were encountered; the mean blood loss was 1.4 liters. The incidence of pelvic node metastases was similar to that seen in nonpregnant patients. The overall 5-year survival rate was 77.7%. Of the 4 patients who died, 3 presented in the puerperium; all succumbed within 27 months. Poor histological prognostic features contributed to the significantly poorer survival in the puerperal patients (P = 0.0445). The 5-year survival in those presenting during the antepartum period (92.8%) was, however, similar to that in the nonpregnant patients. Metastases to the placenta or fetus were not encountered.
A 1 year review of 529 cases of acute appendicitis, treated at the University Hospital in 1990, was performed. Perforation rate was 23.7% and delay in diagnosis was found to be significant. Patients above 50 years of age were particularly at risk. Diagnostic error was 19.3% and it was a problem not only in young women but also in children. Temperature and rectal examinations were not found to be helpful in the diagnosis in contrast to leukocytosis. Waiting time for operation was long (median 7 hours), be it for a perforated or a nonperforated appendicitis.
Histopathological features in 89 cases of Stage 1B and early 2A invasive carcinoma of the cervix who underwent Wertheim radical hysterectomy and pelvic lymphadenectomy were studied. Depth of tumour invasion and lymphatic/vascular space permeation by tumour cells were significantly associated with lymph node metastases. The other features such as tumour type, and stromal leucocytic reaction showed no significant relationship to the presence of lymph node metastases.
Nine cases of histologically diagnosed chromoblastomycosis are reported from Malaysia. All the patients were males and ranged in age from 56 to 65 years. The duration of symptoms varied from 5 months to 13 years. All the lesions were noted in the lower limbs. Malignancy was suspected clinically in 5 cases. The diagnosis was established by finding characteristic brown muriform cells in the tissue sections.