Terminal ileum duplication: an unusual case of small bowel obstruction.

Duplications of the alimentary tract are uncommon congenital anomalies that usually present during infancy and early childhood. The case of an adolescent presenting with small bowel obstruction secondary to a duplication cyst is presented and the challenges in the management described.

Body mass index and prostate specific antigen levels in Jamaican men.

OBJECTIVE: To investigate the relationship between body mass index (BMI) and prostate specific antigen (PSA) levels in Jamaican men. METHODS: Men, 40-79 years old, attending public and private urology clinics in Kingston, Jamaica were recruited to a case-control study on the role of dietary and lifestyle factors on prostate cancer. Trained interviewers administered questionnaires and measured weight and height using standardized techniques. Blood samples for PSA were measured at a central laboratory using a micro-particle enzyme immunoassay method. Prostate biopsy was used to confirm prostate cancer. Multivariable linear regression was used to examine the relationship between BMI and PSA separately in the cases and controls. RESULTS: Data from 501 men (233 cases and 263 controls) were assessed. Thirty-five per cent of subjects were overweight and 13% were obese. Among cases, the median PSA was 35.3 ng/dL in normal weight, 26.1 ng/dL in overweight and 14.5 ng/dL in obese men (p = 0.02). For controls, median PSA was 2.0 ng/dL in normal weight, 1.3 ng/dL in overweight and 1.1ng/dl in obese men (p = 0.01). Among cases, BMI was negatively associated with PSA (B(SE) per 5 kg/m2 (BMI difference = -0.51 (0.13); p < 0.01) and remained significant after adjustment for age, sexual activity, smoking, use of statins and tumour grade. For controls, the BMI was also inversely related to the PSA (B(SE) per 5 kg/m2 difference -0.17 (0.07)) but the effect became of borderline significance after adjusting for age. CONCLUSIONS: Prostate specific antigen was inversely related to body mass index in Jamaican men with prostate cancer. Clinicians should consider this association when interpreting PSA results.

Actinomycosis of the colon with invasion of the abdominal wall: An uncommon presentation of a colonic tumour.

Actinomycosis is an uncommon chronic suppurative infectious disease that is caused by Actinomycetes organisms, which are gram-positive, microaerophilic, anaerobic bacteria. The most common type causing disease in humans is Actinomyces israelii. This organism is a commensal of the human mouth and is seldom pathogenic. When it does cause disease, however, three main clinical types of involvement are recognized including cervico-facial, thoracic and abdominal actinomycosis.Herein, we present the case of a 79-year-old male patient who underwent surgical exploration following presentation with abdominal pain and an abdominal mass, initially thought to be a malignancy. Pathologic examination confirmed this as a case of abdominal actinomycosis. This diagnosis should always be included in the differential diagnosis of patients who present with an infiltrative abdominal mass.

Angiomyolipoma of the kidney: the experience at the University Hospital of the West Indies.

OBJECTIVE: Angiomyolipoma (AML) of the kidney is an uncommon tumour that, until recently, was often misdiagnosed preoperatively as renal cell carcinoma (RCC). Newer radiological techniques have allowed more accurate preoperative diagnosis which can facilitate preoperative counselling and planning for conservative therapy. This study reviews the experience with these uncommon tumours at the University Hospital of the West Indies. METHODS: All cases of AML diagnosed during the period 1980 to 2007 were retrospectively identified from the files of the Department of Pathology. From these records, selected data were retrieved and analysed. These included patient demographics, clinical history, clinical diagnosis and pathologic characteristics of the specimen submitted. The total number of primary renal tumours diagnosed in adults during the same period was also determined for comparison. RESULTS: Eleven cases of AML were identified among 149 primary renal tumours in adults. Ten of these cases occurred in women. Amongst these, a single case of tuberous sclerosis was confirmed in a patient with bilateral lesions. Excluding this patient, who was 24-years-old, ages ranged from 24 to 86 years with a mean of 44 years (median 40.5 years) and an equal number of lesions was present on each side. Abdominal or flank pain were the most common clinical symptoms, present in six cases but in three cases, the tumours were discovered incidentally. The correct clinical diagnosis was made pre-operatively in a single case. By contrast, a diagnosis of RCC or other malignant tumour was proffered in eight cases. Pathologically, the maximum dimension of the seven excised tumours, in whom such information was recorded, ranged from 3.5 cm to 12 cm with a median of 7 cm. Spontaneous haemorrhage in the tumour was noted in three cases, all greater than 4.5 cm in maximum dimension. CONCLUSIONS: These data confirm that AML is uncommon at the University Hospital of the West Indies. There was an overwhelming female preponderance and patients presented, most commonly, in the 3rd to 4th decades. Tuberous sclerosis was identified in a solitary case. In this series, symptomatic lesions were > 4.5 cm in maximum dimension and haemorrhage complicated three cases. Most cases were incorrectly diagnosed preoperatively.

A review of granular cell tumours at the University Hospital of the West Indies: 1965-2006.

OBJECTIVE: Granular cell tumours are uncommon lesions that occur in a wide variety of sites. They are usually benign, but as they are infrequently diagnosed preoperatively, they may be confused clinically with malignant lesions. The objective of this study was to assess the relative frequency and the clinicopathologic characteristics of granular cell tumours identified at the University Hospital of the West Indies (UHWI) over a 41-year period. METHODS: The archives of surgical pathology reports in the Department of Pathology at the UHWI from 1965 to 2006 were searched for all cases of granular cell tumour. From these records, a number of demographic and other data were recorded and analyzed. RESULTS: One hundred and thirty cases of granular cell tumours were found in 122 patients. Of these, 99patients were female and 23 male, providing a male:female ratio of l to 4.3. The ages ranged from 5 days to 82 years with a mean age (excluding the 2 youngest cases) of 34.4 years. Lesions ranged in size from 0.2 cm to 10 cm in greatest dimension, the average size being 1.85 cm and were found in a diverse array of anatomic locations, the most common being the vulva, breast and tongue. The correct clinical diagnosis was proffered preoperatively in only one case. In contrast, a malignant diagnosis was suggested in 19 cases. CONCLUSIONS: Compared with other studies, there was a notable difference in the distribution of granular cell tumours in this series. In particular lesions of the tongue accounted for fewer than expected, while lesions of the breast and vulva were considerably increased. The well-recognized female predominance was also substantially higher than in other studies.

Infective endocarditis at the University Hospital of the West Indies. A revisit.

Many countries have reported a change in the profile of infective endocarditis (IE) over the past three decades. The objective of this study was to evaluate the characteristics of IE from the autopsy service of the University Hospital of the West Indies (UHWI) during the last 15 years and to compare the results with that of an earlier study. There were 26 cases of IE during the period under review with a M:F ratio of 1.2:1. The ages ranged from 15 days to 74 years with a mean of 36.4 +/- 24.57 years. The largest number of cases (n = 7) occurred in the 10 to 19-year-age group. Cardiac predisposing factors were identified in 14 patients; nine with rheumatic heart disease, four with prosthetic valves and one with a bicuspid aortic valve. All vegetations were located on valves, the aortic being the most frequently involved followed by the mitral. Streptococcus species were the most common causative organisms followed by Staphylococcus aureus. Compared with the profile seen 15 years ago, there have been only minor changes in the characteristics of IE cases observed in the autopsy service at the UHWI.

Infective endocarditis at the University Hospital of the West Indies. A revisit

Many countries have reported a change in the profile of infective endocarditis (IE) over the past three decades. The objective of this study was to evaluate the characteristics of IE from the autopsy service of the University Hospital of the West Indies (UHWI) during the last 15 years and to compare the results with that of an earlier study. There were 26 cases of IE during the period under review with a M:F ratio of 1.2:1. The ages ranged from 15 days to 74 years with a mean of 36.4 +/- 24.57 years. The largest number of cases (n = 7) occurred in the 10 to 19-year-age group. Cardiac predisposing factors were identified in 14 patients; nine with rheumatic heart disease, four with prosthetic valves and one with a bicuspid aortic valve. All vegetations were located on valves, the aortic being the most frequently involved followed by the mitral. Streptococcus species were the most common causative organisms followed by Staphylococcus aureus. Compared with the profile seen 15 years ago, there have been only minor changes in the characteristics of IE cases observed in the autopsy service at the UHWI

Heart weight and heart weight/body weight ratio in a Jamaican adult autopsy population. A preliminary study.

The heart weight and heart weight/body weight (HW/BW) ratio were assessed in an adult autopsy population and compared with commonly used reference values. Examination of 127 adult post-mortem cases (80 males and 47 females, aged 17 to 91 years) revealed that the mean heart weight and the HW/BW ratios of both genders were significantly greater than the reference values, particularly so in the hypertensive patients. These findings suggest that the Jamaican adult heart is significantly heavier than values used from reference tables. In both genders, heart weight was significantly and positively correlated with body weight and body mass index but not height, for non-hypertensive and hypertensive subjects. The present data are preliminary and not comprehensive enough to establish definitive reference values for the Jamaican population. However, this information needs to be taken into consideration when making pathologic diagnoses using heart weight as a criterion in post-mortem diagnosis.

Heart weight and heart weight/body weight ratio in a Jamaican adult autopsy population. A preliminary study

The heart weight and heart weight/body weight (HW/BW) ratio were assessed in an adult autopsy population and compared with commonly used reference values. Examination of 127 adult post-mortem cases (80 males and 47 females, aged 17 to 91 years) revealed that the mean heart weight and the HW/BW ratios of both genders were significantly greater than the reference values, particularly so in the hypertensive patients. These findings suggest that the Jamaican adult heart is significantly heavier than values used from reference tables. In both genders, heart weight was significantly and positively correlated with body weight and body mass index but not height, for non-hypertensive and hypertensive subjects. The present data are preliminary and not comprehensive enough to establish definitive reference values for the Jamaican population. However, this information needs to be taken into consideration when making pathologic diagnoses using heart weight as a criterion in post-mortem diagnosis

Multiple endocrine neoplasia type 2B. A case report and review of the syndrome

This paper presents a case of the very rare multiple endocrine neoplasia Type 2B syndrome. It highlights that because of the presence of superficial neuromas in this condition, there is the possibility for early diagnosis. Recent knowledge of the molecular genetics of this syndrome and the ability to screen family members is also stressed since early thyroidectomy is now recommended to prevent the development of thyroid carcinoma which is the main determinant of prognosis

Prostate cancer at the University Hospital of the West Indies in Jamaica. A clinico-pathological profile at the time of needle biopsy diagnosis.

A prospective study of the clinico-pathological features of prostate cancer at the time of needle biopsy diagnosis was conducted in the Department of Pathology at the University Hospital of the West Indies over a one-year period. Ninety cases were diagnosed during this time. The mean age of patients at diagnosis was 72 years and the mean Gleason score of the biopsy, 7.3. Serum prostate-specific antigen levels were markedly elevated in the majority of patients, with a mean value of at least 159.8 ng/ml in the 76 patients for whom this information was available. The significance of these findings and that of other histopathological features examined are discussed, particularly in relation to recognized prognostic factors. It is concluded that the diagnosis of prostate cancer in Jamaica appears to be considerably later than that seen elsewhere. This information should provide support for those who advocate the introduction of a vigorous screening process for prostate cancer in Jamaica.

Prostate cancer at the University Hospital of the West Indies in Jamaica. A clinico-pathological profile at the time of needle biopsy diagnosis

A prospective study of the clinico-pathological features of prostate cancer at the time of needle biopsy diagnosis was conducted in the Department of Pathology at the University Hospital of the West Indies over a one-year period. Ninety cases were diagnosed during this time. The mean age of patients at diagnosis was 72 years and the mean Gleason score of the biopsy, 7.3. Serum prostate-specific antigen levels were markedly elevated in the majority of patients, with a mean value of at least 159.8 ng/ml in the 76 patients for whom this information was available. The significance of these findings and that of other histopathological features examined are discussed, particularly in relation to recognized prognostic factors. It is concluded that the diagnosis of prostate cancer in Jamaica appears to be considerably later than that seen elsewhere. This information should provide support for those who advocate the introduction of a vigorous screening process for prostate cancer in Jamaica.

Multiple endocrine neoplasia type 2B. A case report and review of the syndrome.

This paper presents a case of the very rare multiple endocrine neoplasia Type 2B syndrome. It highlights that because of the presence of superficial neuromas in this condition, there is the possibility for early diagnosis. Recent knowledge of the molecular genetics of this syndrome and the ability to screen family members is also stressed since early thyroidectomy is now recommended to prevent the development of thyroid carcinoma which is the main determinant of prognosis.

Nodular fasciitis.

A 10-year review of the files of the Department of Pathology revealed 11 cases of nodular fasciitis. The clinicopathologic features of these cases are presented together with a discussion of the pathology of this lesion. The purpose of this study is to enhance both physicians' and pathologists' awareness of this entity.

Medical students' evaluation of their pathology clerkship experience.

As part of a recent trend among faculties in educational institutions to review and upgrade their courses and teaching methods, the Department of Pathology introduced a questionnaire for assessment of the pathology clerkship experience by the medical students. This was to be completed at the end of their rotation. An evaluation of the results of an entire class indicates that, for the most part, the responses were positive with 82% considering the experience to be of great benefit and 17% of reasonable benefit. The responses were generally more favorable to Anatomical Pathology and Haematology than to Chemical Pathology. The study identified areas where modifications in teaching could be considered, and ways to improve the questionnaire, making it more useful for future assessments.

Nodular fasciitis

A 10-year review of the files of the Department of Pathology revealed 11 cases of nodular fasciitis. The clinicopathologic features of these cases are presented together with a discussion of the pathology of this lesion. The purpose of this study is to enhance both physicians' and pathologists' awareness of this entity.

Medical students' evaluation of their pathology clerkship experience

As part of a recent trend among faculties in educational institutions to review and upgrade their courses and teaching methods, the Department of Pathology introduced a questionnaire for assessment of the pathology clerkship experience by the medical students. This was to be completed at the end of their rotation. An evaluation of the results of an entire class indicates that, for the most part, the responses were positive with 82 considering the experience to be of great benefit and 17 of reasonable benefit. The responses were generally more favorable to Anatomical Pathology and Haematology than to Chemical Pathology. The study identified areas where modifications in teaching could be considered, and ways to improve the questionnaire, making it more useful for future assessments.

Complete non-puerperial uterine inversion as a result of a uterine sarcoma.

Complete non-puerperial uterine inversion is rare and when present is usually associated with a prolapsed submucous fibroid. The inversion in this case was associated with a uterine sarcoma in an 88 year old diabetic patient, gravida 13, who presented with a four month history of intermittent vaginal bleeding. She was successfully managed with a total abdominal hysterectomy and some of the difficulties with diagnosis and management are highlighted.