Changing trends of obesity and lipid profiles among Bangkok school children after comprehensive management of the bright and healthy Thai kid project.

BACKGROUND: Cardiovascular diseases are the world's leading cause of death. Children in Thailand are currently facing obesity, hyperlipidemia, and high atherogenic indices. This study aimed to assess the success of the Bright and Healthy Thai Kid project in reducing obesity and high lipid profiles among Bangkok school children. METHODS: A community-based, intervention (participatory action) with pre-post comparison of anthropometric and lipid profile data was conducted in five randomly selected Bangkok primary schools. The participatory action involved teachers, students, and parents. Data collection on anthropometric measurements, dietary intake, physical activity, and fasting blood samples of three generations of students was carried out during July-August (midterm months in Thailand) in the years 2004, 2017, and 2019. SPSS for Windows, version 16 was used for data analysis. RESULTS: Comparing the data from 2004, 2017, and 2019, obesity rates of 19.3 in 2004 gradually declined to 16.9 and 15.6 in 2017 and 2019 (P <  0.001). High serum total cholesterol, triglyceride, LDL-C, and atherogenic indices decreased significantly (p <  0.001). CONCLUSIONS: We believe that the great time and effort expended for a campaign to reduce rates of obesity and hyperlipidemia in school children does work to prevent future cardiovascular diseases. Long-term investment in national programs is required to achieve whole societal involvement in improving knowledge and skills related to health, nutrition, and healthy food choices.

Clinicopathological features of dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans (DFSP) is a superficial cutaneous tumor of low malignant potential characterized by a high rate of local recurrence. The histopathological appearance shows uniform spindle neoplastic cells arranged in a predominantly storiform pattern, typically with positive staining for cluster of differentiation (CD)34 and vimentin on immunohistochemistry. A minority of cases of DFSP have areas of sarcomatous transformation. Wide surgical excision is the cornerstone of treatment for DFSP. The objective of the present study was to determine the clinicopathological features of DFSP. Pathological records were searched for cases of DFSP in the database of the Department of Pathology, Faculty of Medicine Ramathibodi Hospital (Mahidol University, Bangkok, Thailand) between 1994 and 2013. The results showed 68 cases with DFSP. The mean age at diagnosis was 40 years (range, 3-86 years). Among this group of patients, 26 cases (38.2%) experienced local recurrence and 6 (8.8%) exhibited sarcomatous transformation of DFSP. The factors that predict the recurrence of DFSP are an incorrect first pathological diagnosis and an inadequate surgical margin. The factors that predict the sarcomatous transformation of DFSP are a larger tumor size and an incorrect first pathological diagnosis. In patients who have tumors with spindle cells arranged in a storiform pattern, CD34 immunohistochemical staining provides the definitive diagnosis. Exact histopathological categorization is important to select the appropriate treatment and predict the clinical outcome.

Paget's disease of bone in ethnic Thai presented with urologic symptoms and misleading as metastatic prostate cancer: report of a case with a review of the literature.

Paget's disease of bone is common in some parts of Europe and in countries inhabited by European emigrants. In Western Countries, Paget's bone disease is one of the priorities in differential diagnosis for elderly patients who present osteoblastic lesions, so it is unlikely to be overlooked, even though patients may present symptoms unrelated to bone lesions. However in Asian countries where Paget's disease is rare, metastatic prostate cancer appears to be the most common cause for osteoblastic lesions, thus, the Paget's disease is unlikely to be of much concern. This may lead to undue emphasis on investigations to support the diagnosis of prostate cancer. In this report, a 69 year-old man presented pain in the right leg and difficulty urinating. The plain film showed osteoblastic lesions of the right pelvic bone and lumbar spine. The pertinent routine laboratory findings revealed increased levels of serum alkaline phosphatase 125 U/L (normal 27-86). Metastatic prostate cancer was highly suspected and investigations focused upon this, including a serum prostate specific antigen assay, a transurethral cystoscopic examination, an intravenous pyelogram, and an ultrasonogram of the prostate gland. However all of these investigations failed to support prostate cancer. Bone biopsy was performed twice, resulting in a report supporting Paget's disease of bone. The patient was treated with alendronate for three months. Radiologic findings, six months later, showed signs of improvement. He died one year later of heart failure that could plausibly had been a cardiovascular complication of Paget's disease. Better awareness of Paget's disease in Thailand and other Asian countries should reduce the incidence of unnecessary investigations and avoid a misleading diagnosis, which could lead to inappropriate treatment for metastatic prostatic cancer and undesirable psychological impact associated with being misinformed regarding malignancy.

Determination of asbestos bodies in bronchoalveolar lavage fluids in Thailand.

OBJECTIVE: Asbestos bodies (AB), ferroprotein-coated asbestos fiber may be present in bronchoalveolar lavage fluid (BALF) of asbestos exposed persons. The present study was conducted to evaluate the prevalence and number of asbestos bodies in the BALF of tenable asbestos exposed workers compare to general population in Thailand. MATERIAL AND METHOD: Thirty workers of cement pipe and roof tile factories using chrysotile asbestos and 30 unexposed patients that underwent diagnostic bronchoscopy were included in this study. Determination of asbestos bodies was made by membrane filtration method as described in earlier reports. RESULTS: The findings were positive in six workers and in one control subject (0.1-3.6 vs. 0.2 AB/ml of BALF, p = 0.449). CONCLUSION: AB was identified in workers more often than in pulmonary disease patient. Two of workers had more than 1 AB/ml of BALF.

Radiological findings in 31 patients with chondroblastoma in tubular and non-tubular bones.

INTRODUCTION: This study aimed to evaluate radiological findings in patients with chondroblastoma (CB) in tubular and non-tubular bones (NTBs). METHODS: We retrospectively reviewed the medical records of patients with CB. Data collected included patients' gender and age, type, size and location of bone involved, and imaging findings regarding border, lobulation, calcification, trabeculation, cortical expansion and destruction, periosteal reaction, soft tissue component and fractures. Magnetic resonance imaging and/or multidetector computed tomography were used to determine the presence of any internal cystic space or secondary aneurysmal bone cyst that may have affected the radiological appearance of CB. RESULTS: All 31 lesions (18 tubular bones, 13 NTBs) exhibited geographic bone destruction and did not involve the adjacent joints. Univariate analysis showed that NTB lesions were found in older patients and were associated with thin trabeculation (p < 0.01) and well-defined margins (p < 0.05), whereas tubular bone lesions correlated with thick trabeculation and partially ill-defined margins. On multivariate analysis, age and type of bone involvement were significantly correlated. An increase in age by one year reduced the risk of having tubular bone involvement by about 27% when compared with NTBs (p = 0.011). Thin trabeculation was also significantly correlated with NTB lesions. CONCLUSION: Age was the most significant parameter, as increased age was found to reduce the risk of tubular bone involvement. Patients with NTB lesions were significantly older than those with tubular bone lesions. Based on imaging alone, thin trabeculation showed significant correlation with CB occurring in NTBs on both univariate and multivariate analyses.

Parosteal ossifying lipoma of the fibula: a case report with contrast-enhanced MR study and a review of the literature.

This report describes a rare case of parosteal ossifying lipoma of the fibula. Very few reports have described the magnetic resonance (MR) imaging features with gadolinium enhancement of this neoplasm. In this case, low-signal-intensity strands within the lipomatous mass on T1-weighted image with varying degrees of enhancement were detected. Thus, parosteal ossifying lipoma should be included within the group of gadolinium-enhanced benign lipomatous tumours that may mimic liposarcoma on MR imaging. However, the characteristic radiographic appearance, together with computed tomography or MR imaging features, should aid in the correct diagnosis of this condition.

Asymptomatic Paget's bone disease in ethnic Thais: a series of four case reports and a review of the literature.

Paget's bone disease is quite common in some parts of Europe and countries inhabited by European emigrants, but it is rare in Asia. There have been only 13 reported cases in Southeast Asia, including one reported case from Thailand. Half of the previously reported cases had bone symptoms and the other half were asymptomatic, but were incidentally discovered when patients were being investigated for other medical problems. Here are reported cases of four asymptomatic patients who presented elevation of serum alkaline phosphatase during routine annual medical checkups. All patients were of Chinese descent and all cases were proven by biopsy. Based on this experience, we are of the opinion that a substantial number of unrecognized cases of Paget's disease exist among ethnic Thais. We feel that they would be revealed if clinicians were alerted of its presence and if they included it as a possible diagnosis together with metastasis and osteoporosis when examining bone lesions or when results for elevated serum alkaline phosphatase are detected during routine checkups. We also anticipate that a higher prevalence of this disease may occur in future Thai generations due to the addition of offspring from Asian-European intermarriages to offspring of Chinese descent in the ethnic Thai population.

Extraskeletal giant cell tumor of the larynx: case report and review of the literature.

Giant cell tumors of the larynx typically arise within the laryngeal skeleton. We report a case of a laryngeal tumor in a 29-year-old man that clearly originated outside the laryngeal cartilage. It was identified as a soft-tissue giant cell tumor. To the best of our knowledge, an extraskeletal laryngeal giant cell tumor has not been previously reported.

Double check up of malignancy biopsy specimens for patient safety.

BACKGROUND: The diagnostic of malignancy in biopsy specimens is very important because it guides to selected treatment option and prognostic prediction. However biopsy specimens usually have small pieces leading to variations of the interpretation by anatomical pathologists. OBJECTIVE: To detect and correct the errors or the significant discrepancies in the diagnosis of biopsy specimens before sign-out and to determine the frequency of anatomic pathology significant discrepancies. DESIGN: The application of the mutually agreed work instructions (record) for the detection of errors or the significant discrepancies and their process of sign-out. The record of biopsy specimen that received a secondary check (1959 cases, 2005-2007) was analyzed. RESULTS: After a secondary check, 53 cases of non-malignancy for any reason by a second pathologist were included. However when using our definition on significant discrepancies, only 37 cases were considered. Another seven cases with the opinions with malignancy that were of different cell types that do harm to the patients were added. Therefore, 44 cases (2.25%) had truly significant discrepancies. CONCLUSION: The truly significant discrepancy frequency was 2.25% during the process of pre-sign-out secondary check of malignancy of biopsy specimens. The project has been applied as a routine daily work. It can be an innovative safety program for patient in Thailand.

Epithelioid hemangioma involving three contiguous bones: a case report with a review of the literature.

An epithelioid hemangioma involving three contiguous bones in continuity has, to the best of our knowledge, not been reported in the literature. A case of a 48-year-old man presented with radiating pain to the lower thoracic region for two years. A radiograph and CT scan revealed both permeative osteolytic and multiple trabeculated lesions involving the left posterior part of the 10th rib as well as the 9th and 10th vertebral bodies in continuity and was misled as a malignant or infectious lesion. The histopathology and immuno-histochemistry of the lesion confirmed the diagnosis of an epithelioid hemangioma. The lesion was still stable as of three years after surgery.

Presacral fibrosarcoma in childhood: a case report.

Presacral fibrosarcoma is a rare malignant tumor in childhood. Because of its rarity in the presacral region, it is often missed from the differential diagnosis of presacral mass in childhood. The authors present a case of large presacral fibrosarcoma involving spinal canal, with an initial presentation of back pain and abnormal gaiting.

Inflammatory myofibroblastic tumor ofabdomen: computerized tomographic (CT) and pathological findings.

Inflammatory Myofibroblastic Tumor (IMT) is the recent name of Inflammatory pseudotumor which was in intermediate group of fibrous-origin tumor. The authors retrospectively reviewed such cases in Ramathibodi Hospital from January 2001 to December 2005. There were 115 cases of fibrous-origin tumor which was IMT in 17 cases. Nine cases occurred in the abdomen and only 3 of these had complete computerized tomographic (CT) imaging. One was hypodense liver mass with thick rim enhancement. Another one in the liver presented as a liver abscess which appeared as multiloculated hypodense mass with enhanced septum. The third case was a large malignant-looking retroperitoneal mass and having a small accompanying hepatic lesion which rapidly grew in the follow up study at nine months. IMT in the abdomen was scanty. The diagnosis was done with difficulty because of different signs and symptoms such as fever and palpable abdominal mass. The laboratory findings were nonspecific or within normal limits. Tissue biopsy was the way of definite diagnosis. We reported 3 cases of abdominal IMT with variable imaging findings that may lead to inappropriate treatment. Recognization of such findings will help achieve correct diagnosis.

Including MIR of a primary bone leiomyosarcoma that radiologically mimics a giant cell tumor.

The authors present a case of a 42-year-old female who developed a leiomyosarcoma of the right proximal tibia that appeared radiologically similar to a giant cell tumor Histology revealed spindle cells running in whorl-like fashion with focal atypia and low mitotic figures. The immuno-stains revealed positive reactivity for alpha-smooth muscle (SMA), muscle actin and cytokeratin (AE1/AE3). The authors rendered a diagnosis of low-grade leiomyosarcoma of bone. The lesion was considered a primary lesion since the patient did not have other leiomyomatous tumors. The MRI showed hypo- to iso- signal intensity on T1-weighted imaging and heterogeneous intensity on T2-weighted imaging. This was likely due to admixed fibrotic tissue in the lesion. The tumor cells were not positive for Ebstein-Barr virus by in-situ hybridization as seen in leiomyomatous tumors in immunodeficiency patients.

A descriptive study of 36 cases of solitary soft tissue cysticercosis at Ramathibodi Hospital from surgical specimens during 1990-2006.

We present a study of 36 cases of solitary soft tissue cysticercosis retrieved from pathological reports and medical records during 1990-2006. The soft tissue was the most common organ affected by cysticercosis in our study accounting for 75% of all affected cases. The brain was the second most common, and accounted for 15%. The most common location for the soft tissue lesions was upper extremities which accounted for 33% of cases, and the least common sites were the back, eyelid, buttock and cheek, which accounted for 3% each. Preoperative diagnoses of the lesions were as follows: lipoma, masses of undetermined nature, cysts, abscesses, fat necrosis and lymphadenitis. The mean size of lesions was 1.5 cm; the minimum and maximum sizes were 0.3 and 3 cm, respectively. The mean age of the patients was 33.5 years and the range was 9 to 68 years. The ratio of males to females was 1 to 5, which may reflect differences in eating habits and social life between males and females in our society. Our findings indicated that none of the cases in our study were diagnosed as cysticercosis preoperatively. Therefore, clinicians should include cysticercosis in the differential diagnosis of soft tissue cystic nodules or masses. Data regarding the sizes of lesions should be helpful in differentiating this entity from other soft tissue lesions in clinical practice and on magnetic resonance imaging.

An intramuscular cysticercosis, a case report with correlation of magnetic resonance imaging and histopathology.

The authors report a case of a solitary intramuscular cysticercosis in a 47-year-old female who presented with a mass in the right elbow for five years. The magnetic resonance imaging (MRI) findings revealed a cystic mass of 1.5 cm. in size located at the periphery of the pronator teres muscle; the T1-weighted MRI showed hypointensity mass with internal content that was more obviously seen on T2-weighted image and T1-weighted with fat suppression after gadolinium administration. The authors could not recognize perilesional edema in the MRI that corresponded with the histological findings of chronic inflammatory process in combination with foreign body giant cell reaction. The scolex could not be seen in the imaging but could be identified in the histopathological sections.

Giant cell reparative granuloma concurrent with squamous cell carcinoma of the temporal bone: a case report and review of the literature.

A case of giant cell reparative granuloma concurrent with squamous cell carcinoma of the right temporal bone in a 44-year-old man with clinically presenting otorrhea from the mass of the right acoustic canal with hearing loss is reported. The histopathological examination of the lesion characterizes by multinucleated giant cells with in a fibroblastic stroma and area of keratinizing squamous cell carcinoma. GCRG may have been a local reaction provoked by the squamous cell carcinoma. Clinical and pathological features with briefly reviewed relevant literatures of temporal GCRG describing 24 cases are discussed. The patients have the mean age of 34.8 years. The ages of the patients ranged from 4 months to 72 years old. Temporal bone GCRG shows a male predilection of approximately 3:1. The frequently presenting symptoms of temporal bone GCRG are hearing loss, mass, tinnitus, otalgia, otorrhea, vertigo, headache, facial weakness, and diplopia. This is the first reported description in the literature of temporal bone GCRG concurrent with squamous cell carcinoma.

Invasive fungal infection in Ramathibodi Hospital: a ten-year autopsy review.

OBJECTIVE: Determine the clinicopathological findings in autopsy cases with invasive fungal infection. MATERIAL AND METHOD: The autopsy and medical records with invasive fungal infection in Ramathibodi Hospital between January 1997 and December 2006 were analyzed. The criterions for the diagnosis of invasive fungal infection were the evidence of fungal elements from histopathological section. The age, gender underlying predisposing risk factors for the disease, clinical manifestations, extent of systemic organ involvement documented morphologically at autopsy, and fungal culture were analyzed RESULTS: There were 155 autopsy cases (73 male, 82 female; mean age 45.3 years, range 3 months to 87 years) with the diagnosis of invasive fungal infection. The common clinical presentations were fever (55.5%), and dyspnea (26.5%). The invasive fungal infection was associated with hematologic malignancy in 31%. The common mycoses were aspergillosis and candidiasis, which were observed in 88 and 80 cases, respectively. There were 32 cases (20.6%) of mixed fungal infection. Cultures from autopsy materials were positive for fungus in 80 cases out of 99 cases (80.8%). The most frequent site of fungal infection was in the lungs (74.8%), followed by gastrointestinal tract (28.4%), and brain (26.5%). Invasive fungal infection was diagnosed intravitally in 63.9% of total cases. CONCLUSION: A diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompromised patients who presented with prolonged fever Clinical specimens must be sent for histopathology and fungal culture for a definite diagnosis and an appropriate management. Therefore, the physician should inform the laboratory if invasive fungal infection is suspected because special media are necessary for the best recovery of fungi. In addition, the present study underscores the significance of autopsy as a diagnostic method and means of medical quality control.

Normal internal organ weight of Thai adults correlated to body length and body weight.

OBJECTIVE: Examine the relationship between the internal organ weight with body weight and body length. MATERIAL AND METHOD: Analysis of data from 250 autopsies from the Ramathibodi Hospital from August 2003 to February 2005. The cases were from sudden unnatural death including accident, homicide and suicide and excluded decomposed bodies, fire related deaths and cases where medical treatment had been given. The age ranged from 15 to 88 years and there were 51 females and 199 males. Parson's correlation coefficient was used to examine the relationship between the internal organ weight with body weight and body length. RESULTS: The mean+/-standard deviation (SD) were represented by males and females respectively; Brain 1339+/-160/1165+/-184 gm, heart 311+/-66/278+/-160 gm, lung 910+/-347/675+/-255 gm, liver 1439+/-365/ 1214+/-275 gm, spleen 103+/-46/92.9+/-48 gm, kidney 260+/-68/230+/-42 gm. CONCLUSION: The relationship between internal organ weight and body weight showed each internal organ significantly correlated with body weight in males at p-value < 0.05, whereas in females it only correlated to liver, kidney and spleen at p-value < 0.05. For the correlation between internal organ weight and body length, it showed only brain, lung, liver and kidney correlated to the body length in males at p-value < 0. 05, but not in females.

Epstein-Barr virus associated lymphoepithelial carcinoma of the parotid gland; a clinicopathological report of three cases.

Lymphoepithelial carcinoma is a relatively uncommon malignant tumor of the salivary gland demonstrating malignant epithelial cells with dense lymphoid stroma. The authors report three cases of lymphoepithelial carcinoma associated with Epstein-Barr virus of the right parotid gland with clinically presenting as painless, gradual enlargement of the preauricular mass. The histopathologic examination of the parotid gland is characterized by malignant epithelial cells with dense lymphoid stroma. Immunohistochemical stains show positive reactivity to cytokeratin and p53 in malignant epithelial cells. In situ hybridization of the Epstein-Barr virus-encoded Ribonucleic acid shows positivity in malignant epithelial cells. Clinical and pathologic features with relevant literatures are discussed. These are the first reported cases of primary parotid lymphoepithelial carcinoma associated with Epstein-Barr virus infection in Thailand and Southeast Asia.

Soft tissue telangiectatic osteosarcoma in a young patient: imaging and immunostains.

Telangiectatic osteosarcoma of the soft tissue is rare and generally affects adults older than 50 years of age. We present the case of a 17-year-old male who developed a mass in the right thigh. The CT and MRI findings suggested a malignant hemorrhagic tumor without discernable osteoid matrix. Differential diagnosis included various hemorrhagic mesenchymal tumors. Histology revealed large multiple cysts lined with septae and filled with numerous giant cells, pleomorphic spindle cells, and occasionally an osteoid-like substance. Immunostaining for osteocalcin was positive in the cytoplasm of both stromal mononucleate and multinucleate giant cells. Surgery and adjuvant chemotherapy were applied and the patient survives to the time of writing after 30 months of follow-up without recurrence or metastasis.