1.Food for thought: Chocolate.
The Malaysian Journal of Pathology 2013;35(2):109-
No abstract available.
2.Cytokeratin immunoreactivity in Ewing sarcoma/ primitive neuroectodermal tumour.
Elbashier, Sha ; Nazarina, Ar ; Looi, Lm
The Malaysian Journal of Pathology 2013;35(2):139-45
Ewing sarcoma (ES)/ primitive neuroectodermal tumour (PNET) is an aggressive malignant neoplasm affecting mainly children and young adults. The tumour is included with other primitive neoplasms under the category of small round cell tumour. Cytokeratin expression in ES/PNET has been described in sporadic case reports as well as a few systemic series. We studied this feature in Malaysian patients diagnosed in University Malaya Medical Centre on the basis of typical morphology and immunohistochemical assays. Immunohistochemical staining for AE1/AE3 and MNF116 were performed in 43 cases. Cytokeratin was expressed in 17 cases (39.5%) in focal, intermediate or diffuse patterns. There was no significant association between cytokeratin immunoreactivity and the following parameters: patient age, sex, skeletal and extraskeletal primary location as well as primary, metastastic or recurrent tumours or chemotherapy treatment. A significant association between cytokeratin and neuron specific enolase (NSE) expression was demonstrated. Our study supports evidence of epithelial differentiation in ES/PNET and emphasizes that the expression of cytokeratin does not exclude ES/PNET in the differential diagnosis of small round cell tumours.
3.Phyllodes tumours of the breast: retrospective analysis of a University Hospital’s experience
Toh YF ; Cheah PL ; Looi LM ; Teoh KH ; Tan PH
The Malaysian Journal of Pathology 2016;38(1):19-24
Taking cognizance of the purported variation of phyllodes tumours in Asians compared with Western
populations, this study looked at phyllodes tumours of the breast diagnosed at the Department of
Pathology, University of Malaya Medical Centre over an 8-year period with regards to patient
profiles, tumour parameters, treatment offered and outcome. Sixty-four new cases of phyllodes
tumour were diagnosed during the period, however only 30 (21 benign, 4 borderline and 5 malignant)
finally qualified for entry into the study. These were followed-up for 4-102 months (average = 41.7
months). Thirteen cases (8 benign, 3 borderline, 2 malignant) were Chinese, 9 (all benign) Malay,
7 (4 benign, 1 borderline, 2 malignant) Indian and 1 (malignant) Indonesian. Prevalence of benign
versus combined borderline and malignant phyllodes showed a marginally significant difference
(p=0.049) between the Malays and Chinese. Patients’ ages ranged from 21-70 years with a mean of
44.9 years with no significant difference in age between benign, borderline or malignant phyllodes
tumours. Except for benign phyllodes tumours (mean size = 5.8 cm) being significantly smaller
at presentation compared with borderline (mean size = 12.5 cm) and malignant (mean size = 15.8
cm) (p<0.05) tumours, history of previous pregnancy, breast feeding, hormonal contraception and
tumour laterality did not differ between the three categories. Family history of breast cancer was
noted in 2 cases of benign phyllodes. Local excision was performed in 17 benign, 2 borderline and
3 malignant tumours and mastectomy in 4 benign, 2 borderline and 2 malignant tumours. Surgical
clearance was not properly recorded in 10 benign phyllodes tumours. Six benign and all 4 borderline
and 5 malignant tumours had clearances of <10 mm. Two benign tumours recurred locally at 15
and 49 months after local excision, however information regarding surgical clearance was not
available in both cases. One patient with a malignant tumour developed a radiologically-diagnosed
lung nodule 26 months after mastectomy, was given a course of radiotherapy and remained well
8-months following identification of the lung nodule.
4.Correlation of p16INK4a immunoexpression and human papillomavirus (HPV) detected by in-situ hybridization in cervical squamous neoplasia
Cheah PL ; Koh CC ; Nazarina AR ; Teoh KH ; Looi LM
The Malaysian Journal of Pathology 2016;38(1):33-38
Persistence and eventual integration of high-risk HPV (hrHPV) into the cervical cell is crucial
to the progression of cervical neoplasia and it would be beneficial to morphologically identify
this transformation in routine surgical pathology practice. Increased p16INK4a (p16) expression is a
downstream event following HPV E7 binding to pRB. A study was conducted to assess the correlation
between hrHPV detection using a commercial in-situ hybridization assay (Ventana INFORM HPV
ISH) and p16 immunoexpression (CINtec Histology Kit) in cervical squamous intraepithelial lesions
and squamous carcinoma. 27 formalin-fixed, paraffin-embedded cervical low-grade squamous
intraepithelial lesions (LSIL), 21 high-grade squamous intraepithelial lesions (HSIL) and 51 squamous
carcinoma (SCC) were interrogated. hrHPV was significantly more frequent in HSIL (76.2%) and
SCC (88.2%) compared to LSIL(37.0%). p16 expression was similarly more frequent in HSIL
(95.2%) and SCC (90.2%) compared to LSIL(3.7%). That the rates of hrHPV when compared with
p16 expression were almost equivalent in HSIL and SCC while p16 was expressed in only 1 of the
10 LSIL with hrHPV, are expected considering the likelihood that transformation has occurred in
HSIL and SCC but does not occur in majority of LSIL.
5.Subacute measles encephalitis: A case of long term survival with follow-up MR brain scans
HT Chong ; Norlisah Ramli ; KT Wong ; LM Looi ; T Iwasaki ; N Nagata ; Vimalan Ramasundram ; CT Tan
Neurology Asia 2007;12(1):121-125
Measles virus causes three distinct neurological syndromes: acute disseminated encephalomyelitis,
subacute sclerosing panencephalitis and the rare subacute measles encephalitis, or inclusion body
measles encephalitis. There is a current debate of whether subacute measles encephalitis is an
opportunistic infection or a subacute infection caused by a mutated measles strain. There is also no
report of long term MRI of survivor. We reported a young Chinese girl with a history of relapsed acute
lymphoblastic leukaemia and subacute measles encephalitis confirmed by brain biopsy who survived.
Serial magnetic resonance imaging of the brain showed cortical and basal ganglial involvement in
the initial phase, and generalized cerebral atrophy in the subsequent scan four and a half years later.
The patient recovered from subacute measles encephalitis with substantial neurological deficits with
the cessation of maintenance chemotherapy without specific antiviral treatment. This suggested that
reconstitution of host immunity was adequate in effecting the clearance of the virus, and supporting
the hypothesis that subacute measles encephalitis is primarily an opportunistic infection.