Renal cell carcinoma in childhood.
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Biomedical subjects
Publications and source records attributed to T A Junaid.
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A recurrent dermatofibrosarcoma protuberans (storiform fibrocytic histiocytoma) in the parotid gland of a 50-year-old Nigerian male is reported. Recent knowledge of the histiogenetic origin of the tumor is mentioned.
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OBJECTIVES: To prospectively study the prevalence of nosocomially acquired Clostridium difficile, a major cause of diarrhoea in hospitalized patients, in the intensive care units (ICUs) and burn unit (BUs) of three teaching hospitals in Kuwait. METHODS: During a 1-year prospective study, stool/rectal swabs were obtained from 344 patients admitted into the ICUs of Mubarak Hospital (ICU-1), the Kuwait Cancer Control Centre (ICU-2), and the BU of Ibn Sina Hospital. The presence of C. difficile and/or its toxin was detected by serially culturing the specimens on differential, selective and enriched media and the use of TOX-A/B test, on admission and at subsequent 1-weekly interval until discharge. RESULTS: Out of the 344 patients admitted into these units, over a study period of 1 year, only 263 (77%) were evaluable. All of them had negative stool culture/toxin on admission. Overall, 25 (9.5%) of these 263 patients acquired C. difficile during their hospitalization. Thirteen (7%) of 187 patients acquired C. difficile in ICU-1, 9 (36%) of 25 on ICU-2 and 3 (5.9%) of 51 patients in BU. Eight (32%) developed diarrhoea attributable only to C. difficile and/or toxin, and the remaining 17 (68%) were asymptomatic: none had pseudomembranous colitis. The diarrhoea in these patients was associated with antibiotic use, the main trigger-antibiotics being the third-generation cephalosporins. Acquisition occurred within 4-53 days of admission, with the majority occurring in the first 15 days. CONCLUSION: Overall, the prevalence of hospital-acquired C. difficile infection/colonization was less than 10%. The use of third-generation cephalosporins was high and was related to the development of diarrhoea. Once acquired, diarrhoea developed in about one third of C. difficile-positive cases, an indication that C. difficile infection/colonization endemic in the hospital ICUs studied is usually transmitted among the hospitalized patients.
OBJECTIVES: To study the clinicopathological and immunohistochemical features of gastrointestinal stromal tumors (GISTs) in Kuwait. MATERIALS AND METHODS: Hematoxylin- and eosin-stained sections of primary gastrointestinal mesenchymal tumors were reviewed. Immunohistochemical staining was performed using a panel of antibodies to determine muscle and neural differentiation, the incidence of CD117 and CD34 expression, as well as bcl-2 and cytokeratin expression. Each stain was interpreted as negative or positive. The staining intensity of positive cases was graded as weak, moderate or strong. RESULTS: The age range was 25-80 with an average age of 54 and a male:female ratio of 3:2. The stomach was the most common site for these tumors, followed by the small intestine. Histologically, 46% were classified as malignant and 54% were benign. Most of the malignant tumors occurred in males, particularly in the stomach or small intestine. There was no significant difference in patient age between malignant and benign tumors. The most sensitive markers were muscle-specific actin for muscle differentiation and glial fibrillary acidic protein for neural differentiation. CD117 expression was seen in 81% and CD34 in 54% of all tumors. CONCLUSIONS: The results of this study show that the stomach is the most common site for these tumors, that malignant tumors are more likely to occur in the small intestine than in the stomach, and that there is no difference between benign and malignant tumors with regard to age. Our findings are comparable to those of other workers, although our male:female ratio was slightly higher.
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Seventeen cases of chemodectomas seen in the University College Hospital, Ibadan, are presented. Eight of them (48%) are carotid body tumors, while six (36%) are glomus jugulare. The rest are subglottic, abdominal and multicentric. The sex distribution for the two major types is equal for males and females; but they all seem to appear in younger age groups. Operative mortality has been exclusive to carotid body tumors (50% for this group), while bleeding is the leading postoperative complication in all the cases. The embryology, pathophysiology and clinical presentation of chemodectomas are discussed and it is suggested that, in the management of this condition, the advantages of operation should be weighed against morbidity and mortality risks.
A retrospective review of 186 transrectal needle biopsies of the prostate has revealed that repeated use of the TruCutTM needle until it is ineffective does not affect its accuracy. A diagnostic correlation of 96% between the clinically malignant prostate and histopathologic diagnosis was achieved. This correlation was 10.5% with benign prostatic hypertrophy associated with a suspected malignant nodule. Minimal rectal haemorrhage complicated the procedure in 5.9% of cases. No other complication was documented.
A prospective study of 101 Nigerian infants with conjugated hyperbilirubinaemia seen over 6 years shows that extrahepatic biliary tract obstruction, idiopathic hepatitis, and bacterial infections were the common causes. A firm diagnosis was based on clinical, biochemical and histological features when the patient presented early. However, most of the infants presented late and the superimposed features of prolonged cholestasis made differentiation of the probable causes difficult. Erythrocyte peroxide haemolysis test and laparatomy aided diagnosis in these cases. Seventy five per cent of the patients with sepsis treated with antibiotics, and 70% of those with hepatitis treated symptomatically, recovered. Surgery was successful in only 15% of the patients with biliary tract obstruction. These were those who had either diverticulum of the common bile duct, localized atresia or stenosis or in whom biliary obstruction was due to viscid bile.
Sixty-nine patients with primary osteosarcoma of the bone are reviewed. There were 50 males and 19 female; a male predominance of 2.6:1. The patients presented in advanced stages. In agreement with other authors, we found a peak incidence in the second decade. No associated Paget's disease was found in any of the elderly patients. The long bones of the lower limbs were the most frequently affected. Treatment with amputation was not acceptable to the great majority of our patients.
OBJECTIVE: To study the fine needle aspiration (FNA) cytologic features of male breast lesions and to determine the efficacy of FNA cytology in the diagnosis of these lesions. STUDY DESIGN: During a five-year period (July 1988-June 1993), 188 males with breast lesions were investigated by fine needle aspiration cytology (FNAC). Slides were available for review in 185 of these cases. RESULTS: Gynecomastia was the most common lesion (132 cases), followed by benign tumors and cysts (16 cases), carcinoma (6 cases) and inflammatory lesions (5 cases). In 26 cases the smears were considered inadequate. The cytologic features of gynecomastia included cohesive sheets of bland cells (100.0% of cases), bipolar bare nuclei (76.5%) and columnar cells (38.6%). Mild nuclear atypia was observed in seven cases. The cytologic features consisted of dyshesive groups of ductular cells with moderate to severe nuclear atypia and absence of bare nuclei as well as columnar cells. The benign tumors and cysts included lipomatous lesions (10 cases), spindle cell tumors (3 cases) and epidermal inclusion/pilar cysts (3 cases). Histology was done in 25 cases. Diagnostic accuracy of FNAC for gynecomastia, benign tumors and malignancy was 100.0%, 100.0% and 66.7%, respectively. The only discrepant case was a carcinoma, diagnosed as highly suspicious on the cytologic specimen.
A 46-year-old woman presented with a mass in the left breast and left axillary lymphadenopathy. Five years earlier she had received a renal transplant from an unrelated donor because of end-stage renal failure secondary to adult polycystic kidney disease. She was on immunosuppression therapy in the form of cyclosporine, azathioprine and prednisolone. Fine needle aspiration cytology of the breast mass showed a metaplastic (sarcomatoid) carcinoma, whereas the axillary lymph node aspirate suggested carcinosarcoma. Immunocytochemical studies revealed dense positivity for vimentin in the sarcomatous component and positivity for epithelial membrane antigen in the epithelial component. Rare cells were positive for cytokeratin. The cytodiagnosis was confirmed by excision biopsy of axillary lymph nodes. The patient died on the fourth postoperative day following left mastectomy and axillary clearance. The histopathology report of the breast tumor showed sarcomatoid carcinoma.