Primary gastric yolk sac tumour

Primary gastric yolk tumours are extremely rare. We report a 52-year-old male who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 after having undergone a gastrectomy abroad due to a suspected poorly-differentiated adenocarcinoma. The patient subsequently returned to Oman to receive chemotherapy. However, while undergoing chemotherapy, an abdominal computed tomography scan revealed a lobulated mesenteric mass. Microscopic examination of the resected lesion confirmed a diagnosis of a yolk sac tumour. The mass was diffusely positive for á-fetoprotein [AFP] and a gastric carcinoma stain was negative. Gastrectomy slides from the patient's previous surgery were examined retrospectively. The morphology was typical for a yolk sac tumour and was negative for epithelial markers. An AFP stain showed diffuse immunoreactivity. Thus, the patient was deemed to have had a primary gastric yolk sac tumour which had later metastasised to the mesocolon. Germ cell tumour protocols were initiated and the patient responded well to treatment

Unveiling cancer

This article narrates a multifaceted educational journey undertaken by a medical student through a weekly SCRAPS [surgery, clinical disciplines, radiology, anatomy, psychiatry and laboratory sciences] clinicopathological meeting held in the College of Medicine and Health Sciences at Sultan Qaboos University in Muscat, Oman. Through a presentation titled 'Unveiling Cancer', the multidisciplinary and interprofessional audience witnessed a simulated interaction between a medical student, a technologist peer and tutors in medicine, pathology and radiology. The presentation was based on the complexities of presentation, diagnosis and management of a patient with anaplastic large cell lymphoma, a rare type of non-Hodgkin lymphoma, in the aftermath of a bone marrow transplantation. After describing the case, the student shared with the audience a spectrum of learning objectives, which included integration in the complex world of contemporary medicine, insight into the triumphs and travails of technology [immunohistochemistry] and peer collaboration, communication and mentorship

Histomorphological spectrum of papillary carcinoma of thyroid in oman

Thyroid cancer is the commonest endocrine malignancy and is the second most common cancer affecting young females in Oman. The diagnosis of Papillary Thyroid Carcinoma [PTC] is based primarily on histologic architecture and nuclear morphology in routine Haematoxilin and Eosin [H and E] stained slides. Whenever in doubt, immunohistochemistry may be helpful. This retrospective study included 115 cases of PTC diagnosed at a tertiary care center in Oman over 10 years period, from 2001 to 2010. Slides and blocks of these cases were retrieved from the pathology laboratory. Ninety five [95] were females and 20 were males. Papillary Thyroid Carcinoma [PTC]was most commonly seen in the 20 - 50 years of age. The commonest morphologic variant seen in this population was classical papillary variant in 44/115 [38%] followed by papillary micro-carcinoma [n=30/115, 26%] and follicular variant of papillary carcinoma [n=18/115, 15.6%]. Out of the 30 micro-carcinoma cases, 18 were diagnosed incidentally in thyroids operated for multi-nodular goiter. Immunohistochemical marker CK-19 was positive in 29/31, HBME-1 and HMW-CK in 15/15 cases; CEA was in one case where it was reported negative. Immunohistochemical stains were useful in cases with atypical /doubtful morphology

Diagnostic utility of endoscopic ultrasound guided aspiration cytology in evaluation of pancreatic masses

To determine the sensitivity and specificity of endoscopic ultrasound [EUS] guided fine needle aspiration cytology [FNAC] in the evaluation of pancreatic masses. Analytical study. Department of Pathology, Shaukat Khanum Cancer Hospital and Research Centre, from January 2006 to June 2011. Patients of either gender aged above 18 years who underwent EUS guided FNAC of pancreatic masses detected on abdominal CT, were included in the study. Biphasic abdominal CT scans were carried out for all the patients, followed by EUS guided FNAC. All material aspirated for cytologic evaluation was assessed for sample adequacy on-site, followed by formal examination for diagnostic purposes. The mean age of patients tested was 58.94 +/- 12.84 years with age ranging from 23 to 78 years. Regarding gender 23/42 [54.76%] patients were male and 19/42 [45.24%] were female. Out of 42 cases, 27 [64%] cases were diagnosed as adenocarcinoma, 4 [9.5%] as benign, 4 [9.5%] as mucinous cystic neoplasm, 2 [4.7%] as chronic pancreatitis, 2 [4.7%] as non-diagnostic, 2 [4.7%] as atypical cells seen and 1 [2.38%] as non-Hodgkin's lymphoma. The results were in full concordance with radiologic findings. EUS guided FNA is an excellent procedure for evaluation of pancreatic masses. The overall sensitivity of this procedure is 89% and the specificity is 67%

Multiple enteric duplication cysts in a twin fetus

Enteric duplication cysts are rare congenital anomalies of the gastrointestinal tract. These can be suspected if cystic lesions are noted in the fetal abdomen during an antenatal ultrasonogram. The differential diagnoses of fetal intra-abdominal cystic lesions include fetal omental cysts, fetal mesenteric cysts, meconium pseudocysts and fetal ovarian cysts. We report an antenatally diagnosed enteric duplication cyst in one of a set of twin fetuses which was managed successfully

Carcinosarcoma of the esophagus

Carcinosarcoma of the esophagus is a rare neoplasm characterized histologically by presence of carcinomatous and sarcomatous elements. Case report of Carcinosarcoma of the esophagogastric junction whose morphological and immunohistochemical features makes it quite distinctive from other tumours is presented. It was an ulcerated lesion diagnosed in an elderly Afghan lady located 34 cms from the incisor teeth. The patient was a smoker

Minimally invasive papillary carcinoma of the extrahepatic bile ducts

Invasive papillary carcinomas of the Extrahepatic Bile Ducts [EBD] are uncommon [4-5%]. The course is less aggressive than conventional adenocarcinomas of the extrahepatic bile ducts. Non-invasive and minimally invasive papillary carcinomas are even rarer, behave as in-situ carcinomas and are associated with excellent long-term prognosis. A variety of lesions of the EBD that show papillary architecture should be distinguished from papillary carcinoma. Here, we report a case of papillary carcinoma of the common bile duct showing minimal invasion. Separation of invasive from non-invasive or minimally invasive papillary carcinoma is critical in estimating the patient outcome

Bart's syndrome: a case report

Bart's syndrome is defined as congenital localized absence of skin [CLAS] associated with epidermolysis bullosa [EB]. It may be associated with any type of EB but is mostly reported with dominant dystrophic epidermolysis bullosa [DEB dominant]. Clinically it is characterized by raw beefy areas of denuded skin on trauma-prone areas of body e.g. hands and feet. Diagnosis is obvious clinically but requires ultrastructural microscopy for proper classification of the disease. Treatment suffices to palliative measures. We describe here a case of newborn baby who presented with rich-red areas of denuded skin on the hands and feet. Clinical appearance was sufficiently distinct to suggest the diagnosis of Bart's syndrome. We repot this case because of its rarity