Paragangliomas of the head and neck: A retrospective review at Siriraj Hospital.

Objective: To analyze the distribution and radiological findings of paragangliomas of the head and neck region at Siriraj Hospital. Methods: The cases with pathological proven of paragangliomas in the head and neck from January 1996 to December 2003 at Siriraj Hospital were retrospectively reviewed. Clinical presentation and radiologic findings in term of location, size, number, pattern of enhancement, vascularity and bony destruction were analyzed. Results: There were 26 tumors among 22 patients which were 12 females and 10 males, with an average age of 47 years old. By locations, paragangliomas were found as carotid body tumor in 46.2%, glomus tympanicum in 11.5%, glomus vagale in 11.5%, glomus jugulare in 3.8%, glomus jugulotympanicum in 7.6% and rare locations in 19.2%. The unusual locations included sinonasal cavity, sphenoid sinus, supraglottic larynx, thyroid gland and posterior fossa. The presenting symptoms were neck mass in 53.8%, tinnitus in 26.9%, cranial nerve palsy in 19.2%, epistaxis in 3.8%, hoarseness of voice in 3.8%, severe headache in 3.8%. Multicentricity was found in 18%. Aggressive pattern was documented in 15.4 %. The radiological findings of paragangliomas in usual locations were all characteristic homogeneous intensely enhanacement or hypervascularity (100%). Those in rare locations had also central necrosis (60%). Bony destruction was shown in 9.5% of usual locations and 40% of unusual locations. No any of lesions in rare locations had multicentricity. Conclusion: Carotid body tumor is the most common paragangliomas in the head and neck region. Clinical presentation of a paraganglioma is related to location of the tumor. On the basis of the locations and radiographic characteristics, in common locations, imaging findings are characteristics and they may provide definite diagnosis, but in rare locations the radiological findings are not characteristics, and should be differentiating from other head and neck lesions.

A two-phase study model for the standardization of HER2 immunohistochemical assay on invasive ductal carcinoma of the breast.

OBJECTIVES: To develop and verify a standardized protocol for HER2 immunohistochemical assays on invasive ductal carcinoma of the breast in Thailand. MATERIAL AND METHOD: A two-phase study approach was employed. In the Phase One, after verifying the proposed protocol that adopted the HercepTest procedure using readily available primary antibodies, CB11 and A0485, Lab 1 performed the HER2 immunohistochemical staining for 137 cases of invasive ductal carcinoma twice with two types of the antibody. Nine pathologists from 8 centers independently examined and scored all the 2 x 137 stained slides that were blinded for antibody type. Interobserver reliability was calculated using pair-wise kappa. Following discussion of the results, the Phase Two study was planned. Lab 2 and Lab 3 independently performed the HER2 staining according to the protocol for 60 invasive breast carcinoma cases. The same group of pathologists scored 2 x 60 stained slides that were masked for laboratories. Interobserver reliability and interlaboratory agreement from each pathologist were calculated using kappa statistics. Three interpreted categories--namely negative, equivocal and positive tests were used in the analyses. RESULTS: Phase One study showed interobserver agreement between pairs varied from kappa 0.75 (95%CI, 0.68-0.82) to 0.06 (95%CI, 0-0.14) while Phase Two study obtained pair-wise kappa scores ranged from 0.84 (95%CI, 0. 80-0.89) to 0. 65 (95%CI, 0.59-0.71). Interlaboratory kappa for each pathologist was 0.67 (95%CI, 0.61-0.73). CONCLUSION: The standardization of HER2 immunohistochemical assay was achieved through this two-phase study model. It had added benefits of improving pathologists' expertise and verifying the HER2 testing protocol to be used in Thailand.

Glucagonoma presenting with obstructive jaundice : A case report.

A case report of a 2-cm glucagonoma at head of pancreas in 48-year old woman presented with obstructive jaundice. She had no manifestation of the glucahonoma syndrome. She underwent bylorus preserving pancreaticoduodenectomy (PPPP). Immunohistochemical studies revealed that this tumor was a malignant glucagonoma. She made an uneventful recovery after the operation and was discharged from the hospital without complication. Six months later, she was found to have multiple liver metastases which did not response to chemotherapy and died 11 months after the operation with liver failure.

Value of liver biopsy findings in AIDS patients.

From the year 1997 to 2000, 146 liver biopsies were performed in 140 AIDS patients, admited to Bamrasnaradura hospital with prolonged fever (73.6%), hepatomegaly (71.4%) and abnormal liver function test (69.3%) being the principle indications. The findings of liver biopsies included TB (18), MAC (14), Cryptococcosis (10), Histoplasmosis (6), Penicillosis (4), CMV (2) and 7 granulomas in which no organism was identified. Opportunistic infections were found in 61 of 146 biopsies (41.8%). Neoplasm was seen in 22 biopsies (15.1%); the most common neoplasm was hepatocellular carcinoma, found in 16 biopsies (11%). Other findings included chronic active hepatitis (3), cirrhosis (3) and alcoholic hepatitis (1). The liver biopsy is a helpful diagnostic tool in AIDS patients with prolonged fever, hepatomegaly or abnormal liver function tests.

Intestinal parasitic infections in HIV and non-HIV infected patients with chronic diarrhea in Thailand.

Chronic diarrhea is a common problem in AIDS patients, and enteric parasites are re-cognized as important causes. This study determined the prevalence of parasitic infections in HIV infected patients with chronic diarrhea. Ninety-one patients with AIDS who presented with chronic diarrhea and 103 patients who were HIV negative were enrolled in the study. Detection of stool parasites was made by microscopy of simple smear, formalin-ether concentration method, modified acid-fast and modified trichrome staining techniques. Species identification of microsporidia spores was made by transmission electron microscopy (TEM). Cases in which serial fecal examinations were negative were subjected to gastroduodenoscopy and/or colonoscopy. Parasitic infections were found in 51 (56%) AIDS patients with chronic diarrhea and in 18 (17%) non-HIV cases (p < 0.001). Microsporidia and Cryptosporidium parvum were the most common parasites found in HIV infected patients and were also significantly more prevalent than in non-HIV infected cases [29% vs 0% for microsporidia, (p < 0.001), and 25% vs 1% for C. parvum, (p < 0.001)]. Species identification of microsporidia spores in 26 patients using TEM revealed Enterocytozoon bieneusi in 19 cases. This study indicated that microsporidia and C. parvum are important pathogenic causes of chronic diarrhea in AIDS patients in Thailand.

Systemic fungal infection: A study of 138 autopsies.

A study of 138 autopsy cases with deep fungal infections out of a total of 3328 autopsy cases during the period 1980 to 1985 was carried out when the causal organisms were determined, 160 infections were found: 10 were caused by pathogenic fungi (Crytococcus neoformans) and the other 10 were caused by opportunistic fungi including aspergillus, candida, mucor and penicillium. A combination of more than one fungus was noted in 21 cases. The central nervous system was most likely to be affected by crytococcus, whereas the respiratory and alimentary systems were infected by aspergillus and candida, respectively. In this study, males were somewhat more commonly affected than females. Fungal infections were common in those who had underlying diseases, internal malignancies, diabetes mellitus as well as in patients with a history of prolonged use of antibiotics and corticosteroids. Compared with a previous study in the same hospital, the incidence definitely increased, although the other patterns of the systemic fungal infections showed no significant change.

Paratesticular rhabdomyosarcoma : Report of a case.

Rhabdomyosarcoma is one of the most common soft tissue sarcomas in childhood and adolescent. It usually involves the orbital and pelvic portions of the genitourinary tract and less commonly, the paratesticular tissue. Our report here is of a Thai male who complained of a painless slow growing mass in the left testicular region for 2 years. This mass was noted to have rapidly increased in size within 2 months prior to admission. Only left orchidectomy was performed and the pathological diagnosis was paratesticular embryonal rhabdyosarcoma.