Thyroid cancer presenting as an incidentaloma detected on F-18 FDG PET/CT imaging: A case report.

The authors report a woman with a history of malignant B-cell lymphoma (MALT lymphoma) at the lower lobe of the left lung status post left lower lobe lobectomy who underwent F-18 FDG PET/CT whole-body imaging for evaluation of any suspicious new pulmonary lesion. The study incidentally found abnormal focal hypermetabolic activity, called incidentaloma, at the right thyroid lobe, which was pathologically proven to be papillary thyroid carcinoma. She was further treated with radioiodine therapy after a total thyroidectomy had been done.

Chorioretinal biopsy in an immunocompromised patient with subretinal mass.

A 59-year-old woman with autoimmune diseases presented with rapidly decreased vision in the left eye. Clinical examination and investigations were inconclusive. Pars plana vitrectomy and chorioretinal biopsy were performed. The histopathologic examination revealed acute branching, septate hyphae morphologically consistent with Aspergillus spp. The infection responded to systemic and intravitreous voriconazole. The subretinal mass gradually subsided but eventually the eye became blind. Chorioretinal biopsy is a valuable diagnostic procedure which, in some cases, may be the only way to provide a definite diagnosis and specific treatment of patients with progressive chorioretinal lesions of unknown etiology. In the presented case, although the vision cannot be recovered, we can avoid unnecessary enucleation and prevent the spread of infection that may threaten patient’s life.

Prevalence of prostate cancer in aging males receiving PSA (prostate specific antigen) screening test (A campaign for celebration of Siriraj Established Day).

Prostate cancer is a potential men's health problem. The prevalence of prostate cancer continues to rise. Serum PSA (Prostate Specific Antigen) can be used as a screening tool for detection of early prostate cancer However, a screening program for prostate cancer has not yet been accepted as cost-effective and long term survival benefits have not been shown. Nevertheless, some doctors request PSA testing in men who present with lower urinary tract symptoms (LUTS) to detect prostate cancer OBJECTIVE: To study for prevalence of prostate cancer in healthy men seeking medical check-up for prostate cancer. MATERIAL AND METHOD: During the anniversary celebration of Siriraj established day (26/07/1888), a cohort study of Prevalence of prostate cancer in aging males using PSA Screening Test was carried out, 200 men over 45 years of age were invited to PSA testing and prostate glands check-up including, IPSS (international prostatic symptoms score), QOL (quality of life score) and DRE (digital rectal examination). Patients with elevated PSA were advised to undergo transrectal-ultrasound-guided-biopsy of the prostate (TRUS-biopsy). Cancer detection rate was calculated according to symptoms described by patients, IPSS and age groups. Data was compared using Chi-Square test. RESULTS: Median values from data of men's ages, IPSS, QOL and PSA were 63 years, 11, 2, and 1.23 ng/ml, respectively. 9 of 200 patients (4.5%) were found to have prostate adenocarcinoma on biopsy. Most of the cancer cases showed a localized lesion. Prostate cancer was found more common in patients who described themselves as having abnormal urination. There was no prostate cancer found in patients with a mild degree of LUTS (IPSS less than 8). Prostate cancer tended to be more common in men with high IPSS. CONCLUSION: Screening prostate cancer by PSA testing detected the cancer in 4.5%. Most cancers were found on symptomatic patients. Patients with LUTS should be made aware of prostate cancer and PSA testing may be offered in such patients. However screening of prostate cancer in all men regardless of symptoms must wait for a larger study looking at long term survival benefit, cost-effectiveness of screening, and lastly, quality of life of patients on a screening program.

Pathological findings in influenza A (H5N1) infection.

This report includes pathological findings in the two patients who died of avian flu infection in Thailand. One of them was the first confirmed human case of H5N1 infection reported in Thailand. The other was the first case that was probably infected by person-to-person transmission. The most affected organ systems are respiratory and reticuloendothelial systems. Both cases revealed diffuse alveolar damage, which is the major cause of death. The former also showed superimposed pulmonary fungal infection.

Alveolar echinococcosis : An unusual liver mass in a Thai Patient.

We report herein the case of a 40-year-old Thai woman who developed a hepatic tumor like lesion suspected to be cholangiocarcinoma. The patient underwent hepatic surgery and the heptatic mass was sent for a histopathological examination. The gross section of the hepatic mass demonstrated alveolar echinococcosis, which showed the specfic rostellar hooks of Echinococcus multilocularis metacestodes. As our patient had been record, it was highly likely that this alveolar echinococcosis had been contacted foreign country. The laboratory tests showed no eosinophilia. After surgery, the patient was treated with albendazole which led to improvement of went of the disease. To our knowledge this is the first described case of alveolar echinococcosis (AE), as the diagnosis of this disease is usually found in the to chronic phase. This study also reviewed comparative echinococcosis and previously reported cases in Thailand. The alveolar echinococcosis is outlined with respect to this helminthic infection a long with recent contributions in areas of parasitology, pathology, diagnosis and transmission.

Time needed for rinsing the decalcification specimen by tap water.

Objectives: To determine a proper time for neutralizing the decalcified specimen by rinsing with tap water. Methods: Fix pork from fresh market in routine fixative for 24 hours, put into 5% nitric acid for 24 hours to 7 days. Then rinse in running tap water for 1-48 hours. Process and cut the specimens into slide, attain with H&E stain. Distribute to three pathologists to evaluate the quality of staining and microscopic detail. Results: Neutralizing for 2 hours or longer yields similar microscopic to the specimen that soaked in acid for 72 hours or less. The histologic feature is not recovered in the soaked in acid longer than 72 hours, no matter how long it is neutralized. Discussion: The result shows no benefit in rinsing the decalcified specimen longer than 2 hours, and soaking in acid longer than 72 hours causes permanent artifact.

Nasal granuloma gravidarum presenting with recurrent massive epistaxis.

Nasal granuloma gravidarum is a rare condition associated with pregnancy and minor trauma. This condition presents with a nasal mass with varying degree of bleeding and obstruction. We report a patient with nasal granuloma gravidarum in the third trimester of pregnancy. Surgical excision is the definite treatment for this condition in order to stop the vicious cycle of recurrent massive bleeding. Possible etiology, clinical features and management are discussed.

Ewing's sarcoma arising in prostate gland: A case report.

An 18-year-old Thai male presented with weight loss and urinary retention. Physical examination revealed an enlarged prostate gland. Serum prostate specific antigen (PSA) level was 0.3ng/ml. Histologic section demonstrated a small round cell tumor with intracytoplasmic glycogen. Immunohistochemical and ultrastructural studies were compatible with Ewing's sarcoma. Since no other osseous or extraosseous lesions of the same tumor were found in this patient, we concluded that this was a case of primary extraskeletal Ewing's sarcoma of the prostate gland. Case follow-up after one year revealed a good response to chemotherapy.

Pathological study of pigmented dermatofibrosarcoma protuberans.

In this paper we performed morphological studies of Bednar tumor, which is a rare pigmented variant of dermatofibrosarcoma protuberans (DFSP) for evidence of histogenetic origin. Presence of melanosome-containing cells is the only histologic criterion of Bednar tumor, which is different from the ordinary DFSP. Immunohistochemical and ultrastructural examinations revealed that the melanosome-containing cells gave positive reactivity to antibodies to vimentin and S-100 protein, but negative to HMB-45, CD38, Factor VIII, NSE, and KP-1. The melanosomes are in Stage II, III, and IV, suggesting that the pigment was produced within the cell rather than phagocytosed from other cells. The rest of the tumor had similar pattern of immunoreactivity to DFSP such as positivity for CD34 and vimentin, indicating that Bednar tumor and DFSP originated from the same cell line. The ultrastructural feature of non-pigmented cells was similar to perineural cells in the first group and similar to fibroblasts in the second group. DNA flow cytometry in our cases revealed diploid cells with low to intermediate S-phase fraction and no aneuploid cells which were reported in a previous study.

Bronchioloalveolar carcinoma presenting with obstructive jaundice: A case report.

An unusual case of bronchioloalveolar carcinoma of the lung presented with chronic cough and obstructive jaundice in an adult Thai male, who subsequently died after having undergone palliative treatment with percutaneous transhepatic biliary drainage (PTBD). Autopsy finding included typical bronchioloalveolar carcinoma diffusely distributed in both lungs and its metastatic tumors at paratracheal nodes, both adrenal glands, spleen, liver and soft tissue around common bile duct that caused obstruction of biliary tract mimicking hepato-biliary cancer, clinically. In addition to histopathologic evaluation, the ultrastructural finding of dense bodies reminiscent of lamella bodies, and the identical DNA index of near diploid aneuploid cell cycle of the tumors in the lung and liver, confirmed the bronchioloalveolar carcinoma of the lung as the primary tumor that had a widespread metastasis.

DNA analysis of hepatocellular carcinoma.

Specimens from 13 cases of resectable hepatocellular carcinoma (HCC) were studied using flow cytometry. The correlation between histological features and ploidy distribution showed those with higher histological grading (HCC grade III or IV) to display an increased tendency towards aneuploidy and polyploidy than those with low grade (HCC grade II and clear cell type of HCC). Along with the tumor’s increased tendency towards aneuploidy and polyploidy, the percent DNA distribution in the S- and G2 – phase was also found increased. The same applied to the DNA index, we also detected a strong correlation between proliferation index and ploidy pattern of HCC.

Immunohistochemical and ultrastructural studies of myofibroblasts in hepatocellular carcinoma.

Sections from 13 hepatocellular carcinomas (HCCs) were examined to determine the myofibroblasts (MFBs) in tumour fibrous stroma and cirrhotic fibrous stroma, using monoclonal antibodies to specific actins HHF-35, 1A4 and sarcomeric actin. Histological grading of tumours with the expression of a labelling index using monoclonal antibodies to proliferative cell nuclear antigen (PC-10) were correlated with the amount of MFBs. The results showed a statistically significant increase in the amount of MFBs in tumour fibrous stroma. However, no significant correlation was found between the amount of MFBs with histological grading or the labelling index. However, a good correlation with statistically significant differences between the histological grading of HCC with the labelling index was shown. In conclusion, MFBs found in the tumour fibrous septa of HCC were a response by the stromal reaction or a desmoplastic reaction intended to limit the tumour size by contraction.