Biomedical subjects
Publications and source records attributed to V Kasantikul.
A case is presented of a large intrathoracic lymphangiohemangioma in association with spontaneous hemothorax. The lesion was found in a macerated stillborn infant. The precise nature of the tumor was documented histologically.
A case of mixed squamous cell carcinoma and papillary adenocarcinoma of the thyroid in a 75-year-old woman is described. Review of 19 reported adenosquamous carcinoma including the present case revealed that they tended to occur in the sixth and seventh decades of life with an average age of 63.84 years and without sexual predilection. Local invasion and metastases of this highly fatal neoplasm are common.
This study revealed a significant decrease in mortality from injuries sustained by motorcycle accidents following the decree promulgated in 1992 for compulsory use of safety helmets by motorcyclists and pillion riders. The helmets can help only in protection of head injury but do not affect the number of accidents. This safety device can not protect any serious injuries of the neck, chest or internal organs which could result in death or permanent disability. To gain maximum benefit from the law, the helmets should be of standard specification and worn properly. Education to drivers and pillion riders particularly male adolescents is essential in reducing the incidence of motorcycle accidents.
An exceedingly rare intracranial malignant meningioma with papillary and glandular patterns in a 45-year-old man is described. Intracellular mucin production was demonstrated. The nature of the neoplastic cells was verified by immunohistochemical and electron microscopic studies.
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A rare case of adrenocortical adenoma in a 7-month-old female infant with congenital hemihypertrophy of left leg is described. Only 7 similar cases including the present one, are on record. The patients ranged in age from 7 weeks to 45 years. The male:female ratio was 3:4. The adrenal tumors were often detected after CH had become evident. Large functional tumors often produced symptoms of hirsutism, virilization, and precocious puberty. CT and ultrasound are necessary for early detection and prompt treatment.
An 18 year old woman with beta thalassaemia/haemoglobin E developed a large pelvic tumour resulting in bilateral obstructive uropathy. Technetium-99m sulphur colloid marrow image, computed tomographic scan of the abdomen and needle biopsy of the mass confirmed the diagnosis of extramedullary haematopoiesis. Although radiation is the treatment of choice for decompression, the mass in this patient did not respond satisfactorily due to its multiple area of tumour autoinfarction. Obstructive uropathy due to extramedullary erythropoiesis has not to our knowledge been previously described.
Two patients with malignant prolactinoma are reported. The diagnosis of malignancy depends on the demonstration of invasion of brainstem and subarachnoid space and on the presence of marked cellular pleomorphism and mitotic activity. Review of the literature revealed that such malignant tumors were more common in men than in women. The most frequency intracranial sites of metastases were frontal and occipital lobes, and cerebellum. The possibility of radiation-induced carcinomatous transformation is discussed.
Two cases of cerebral abscesses caused by Pseudomonas pseudomallei are reported. The first case, a 51-year-old women had a sudden onset of progressive right hemiparesis and right facial palsy and died within 7 days. Postmortem examination disclosed brain abscess in association with disseminated infection outside the central nervous system. The second case, a 9-year-old boy displayed cerebral abscesses as an isolated manifestation. Recovery occurred after treatment with ceftazidime. Review of the ten case reports of cerebral melioidosis revealed that the lesion occurred in patients of all ages and was more common in men than in women. The frontoparietal lobe was the most common location. Fever, headache, and hemiparesis were frequent clinical manifestations while seizures, ataxia were uncommon. CT scanning, serum antibody titer along with hemoculture were useful investigate tools. The importance of early diagnosis and prompt treatment is emphasized for this fatal but treatable disease.
A 38-year-old woman presented with a 5-month history of a right breast mass after delivery of her second child. The lesion simulated the picture of a carcinoma on clinical grounds. Fine-needle aspiration also reported an erroneous diagnosis of malignancy. At surgery, a discrete granuloma with microabscesses was seen without any causative organisms being identified. Open biopsy or Tru-Cut needle biopsy is recommended to prevent such an error which may result in unnecessary radical surgery.
An 18-year-old woman had unusual clinical manifestations of malignant histiocytosis (MH) including a long duration of massive splenomegaly, absence of lymphadenopathy, and a number of exacerbations characterized by sudden onset of fever. During life, a definite diagnosis could not be established. The antemortem pathology of the marrow and liver was nonspecific and non-diagnostic. The diagnosis of MH was made after postmortem examination by histologic and immunohistochemical studies. The long duration of massive splenomegaly suggests that this patient could represent a chronic form of MH.
We report a case of encephalitis in a 32-year-old woman who initially developed a schizophreniform disorder. The symptoms were further complicated by abnormal movements, dysphagia, progressive weight loss, and aspiration pneumonia. At necropsy, the lesion was noted in various parts of cerebrum and brainstem. Such unusual presentation in patient with encephalitis appears unique and has not been previously reported.
A 35-year-old woman displayed unusual symptoms of progressive bulbar dysfunction. At necropsy, systemic necrotizing vasculitis and small pontine infarcts were demonstrated. The angiographic and magnetic resonance imaging findings are described. The latter investigation is a sensitive method for detecting such pontine lesions. To our knowledge, this case is the first report of magnetic resonance imaging findings of brain stem infarct in a patient with periarteritis nodosa.
A 61-year-old man had an extramedullary subdural meningioma occurring close to the site of an old vertebral traumatic fracture and spinal cord injury. The tumor was discovered 3 years after the spinal trauma. This finding supports the existence of a causal relationship between trauma and subsequent tumor development. A review of the literature disclosed only one other case of intraspinal meningioma after the traumatic fracture of the spine with spinal cord compression.
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A case of adrenal myelolipoma in a 43-year-old woman was incidentally discovered during the investigation of chronic diarrhea due to Giardia lamblia. This tumor can be preoperatively diagnosed by its characteristic appearance on nephrotomogram, ultrasonography, and computerized tomography.
Pituitary tumors from 90 patients were investigated using immunohistochemical study and the results were correlated with clinical records. There were 32 benign prolactinomas and two malignant counterparts, 13 growth hormone positive tumors. 10 corticotropic adenomas, and 10 gonadotropic tumors. Four tumors showed positivity for both prolactin and growth hormone, one prolactin and gonadotropin. An example of mixed, luteinizing hormone, prolactin and growth hormone was observed. Additionally, there was an adenoma composed of two compartments secreting prolactin and growth hormone. One patient had a recurrent gonadotropin adenoma after surgical removal of the original prolactinoma. Fifteen tumors were negative for all hormones and most were nonfunctioning clinically. The clinicopathologic correlations were found to be good for prolactinoma, growth hormone positive tumors and for tumors producing both prolactin and growth hormones causing a combined feature of hyperprolactinemia and acromegaly.