1.Endocrine mucin-producing sweat gland carcinoma - newly described skin appendageal tumours
The Malaysian Journal of Pathology 2020;42(1):111-114
Introduction: Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a recently described adnexal tumour with a predilection for the face particularly the eye-lids. Considered to be a precursor lesion of mucinous adenocarcinoma, it may represent part of a morphological spectrum. We described a case of this entity, which we believe is the first case to be reported in Malaysia. Case report: A 59-year-old Chinese male presented with a slow-growing cystic lesion over the left lower lateral canthal region. The lesion became progressively larger and nodular within the last 6 months. Histologically, the lesion is a well-circumscribed intradermal tumour with pushing borders extending into the subcutaneous tissue. The tumour cells were arranged in lobules of solid, papillary and cribriform architecture. The cells displayed uniform, medium-sized, round to oval nuclei with stippled chromatin pattern and ample eosinophilic granular cytoplasm. Intracellular mucin (as highlighted by mucicarmine stain) was observed in areas with focal extracellular mucin seen. Mitotic figures were not particularly impressive. By immunohistochemistry study, the tumour cells expressed ER, PR, CK7, GCDFP-15, mammaglobin and EMA diffusely. Chromogranin A and synaptophysin highlighted a significant number of tumour cells. Discussion: The morphology and immunohistochemical profile similarities between EMPSGC and solid papillary carcinoma of the breast (SPCOTB) makes the former considered as the cutaneous analogue of the latter. In fact, one should rule out the possibility of metastatic SPCOTB before considering the diagnosis of EMPSGC.
2.Lipoma Arborescens of the Knee: A Case Report of Rare Entity
Malaysian Journal of Medicine and Health Sciences 2018;14(3):60-63
Lipoma arborescens is a non-neoplastic, reactive condition due to chronic synovial inflammation and irritation, characterized by frond-like or villous proliferation of mature adipose tissue covered by hyperplastic synovium. The knee is the most commonly affected site particularly the suprapatellar pouch. We report a case of lipoma arborescens affecting the right knee of an elderly Chinese gentleman associated with bilateral knee and hand osteoarthritis. He presented with progressive worsening of right knee swelling and pain. Partial synovectomy of the right knee was performed and no lesion recurrence was noted at one year post-operation. The clinical and imaging findings, pathological features, together with differential diagnoses were discussed.
Lipomatous lesions
3.Hypertension in the absence of urinary abnormalities - An unusual presentation of anaphylactoid purpura
Pui Ling Thong ; Kang Nien How ; Ikmal Hisyam Bakrin
The Medical Journal of Malaysia 2020;75(4):436-438
Henoch-Schonlein Purpura (HSP) or anaphylactoid purpura,
currently named IgA vasculitis is the most common form of
systemic vasculitis in children. In adults and young infants,
HSP tends to have atypical presentations with higher rates of
severe gastrointestinal problems and delayed renal
complications. While hypertension is a known complication of
HSP nephritis, it is rarely seen in individuals with normal renal
function and urinary findings. We report a case of a 7-year-old
boy with HSP, who presented with abdominal pain and severe
hypertension without other features of glomerulonephritis.
4.Intradermal Naevi of External Auditory Canal: Unusual location with a unique presentation
Yatiee Swany LAHURI ; Mohd Khairi Md Daud ; Md Salzihan Md. Salleh ; Ikmal Hisyam BAKRIN
The Medical Journal of Malaysia 2018;73(2):121-122
The incidence of intradermal nevus in the externalauditory canal is uncommon. We herein are describing acase of 60-year-old lady who presented with foreign bodysensation in the right external ear canal (EAC) with milddiscomfort and ear bleed during ear picking. Otoscopicexamination revealed hyperpigmented mass on the floorof the outer two third of EAC. Complete excisional biopsyof the mass resulted in histopathology findings ofintradermal nevus. Despite the fact that the disease is notalarming, the possibilities of benign melanocytic nevitransformation into malignant lesions such as melanomaneed to be ruled out.
5.A Case Report of Pityriasis Lichenoides-Like Mycosis Fungoides in Children: A Challenging Diagnosis
Siti Noorfadhilah MOHD AMIN ; Rosediani MUHAMAD ; Wan Noor Hasbee WAN ABDULLAH ; Maryam MOHD ZULKIFLI ; Ikmal Hisyam BAKRIN ; Teebah TANGAM
Korean Journal of Family Medicine 2021;42(4):334-338
Primary cutaneous lymphomas are rare diseases among the general population, and even rarer in children. Mycosis fungoides (MF) is the most commonly diagnosed form in childhood. Several atypical clinical variants of MF have been reported, and pityriasis lichenoides-like MF (PL-like MF) is a recently described subtype. We report about a rare case of PL-like MF in an 11-year-old Malay boy with a 2-year history of multiple scaly erythematous papules associated with progressive and generalized hypopigmentation. This case report illustrates the significant dilemma in the diagnosis of the disease, particularly in the early stages, because its symptoms can mimic those of many common childhood inflammatory skin disorders. Later, the widespread hypopigmentation obscured the characteristic lesions, leading to misdiagnosis. Moreover, due to unfamiliarity of the disease, the diagnosis of PL-like MF was missed and delayed until only 2 years after the onset of the dermatosis. Therefore, primary care practitioners must have a high index of suspicion for this cutaneous neoplasm in children with persistent or worsening skin lesions, not responding to standard therapy, to ensure timely referral, diagnosis, and treatment.
6.A Case Report of Pityriasis Lichenoides-Like Mycosis Fungoides in Children: A Challenging Diagnosis
Siti Noorfadhilah MOHD AMIN ; Rosediani MUHAMAD ; Wan Noor Hasbee WAN ABDULLAH ; Maryam MOHD ZULKIFLI ; Ikmal Hisyam BAKRIN ; Teebah TANGAM
Korean Journal of Family Medicine 2021;42(4):334-338
Primary cutaneous lymphomas are rare diseases among the general population, and even rarer in children. Mycosis fungoides (MF) is the most commonly diagnosed form in childhood. Several atypical clinical variants of MF have been reported, and pityriasis lichenoides-like MF (PL-like MF) is a recently described subtype. We report about a rare case of PL-like MF in an 11-year-old Malay boy with a 2-year history of multiple scaly erythematous papules associated with progressive and generalized hypopigmentation. This case report illustrates the significant dilemma in the diagnosis of the disease, particularly in the early stages, because its symptoms can mimic those of many common childhood inflammatory skin disorders. Later, the widespread hypopigmentation obscured the characteristic lesions, leading to misdiagnosis. Moreover, due to unfamiliarity of the disease, the diagnosis of PL-like MF was missed and delayed until only 2 years after the onset of the dermatosis. Therefore, primary care practitioners must have a high index of suspicion for this cutaneous neoplasm in children with persistent or worsening skin lesions, not responding to standard therapy, to ensure timely referral, diagnosis, and treatment.
7.Molecular Detection of Cryptococcus from Formalin-fixed Paraffin-embedded Tissue Sample - A Noncultural Approach for Diagnosis of Primary Pulmonary Cryptococcosis
Syarifah Mohd Rahim ; Amizatul Aini Salleh ; Ikmal Hisyam Bakrin ; Tengku Zetty Maztura Tengku Jamaluddin ; Siti Norbaya Masri
Malaysian Journal of Medicine and Health Sciences 2020;16(SP 1, September):47-49
Despite pulmonary cryptococcosis showing good response to antifungal treatment, making accurate diagnosis in a timely manner remains a challenge. Tissue for fungal culture is less sensitive, nonspecific, and time-consuming to allow for prompt diagnosis. We herein report a case of 31-year-old woman with no known medical illness but
presented with history of cough and haemoptysis for two months. The chest X-ray and bronchoscopy revealed left lung mass. While tuberculosis showed negative result and no growth observed in the tissue culture, the
histopathological examination (HPE) finding was suggestive of fungal infection. The formalin-fixed
paraffin-embedded (FFPE) tissue was sent for molecular testing, which revealed Cryptococcus neoformans.
This report emphasises on the advantages and limitations of polymerase chain reaction (PCR) as an alternative
method to confirm the diagnosis in cases of culture-negative fungal infection.
8.Paraneoplastic Bullous Pemphigoid Masquerading as Hand-foot Syndrome: A Case Report of Rare Entity
Subhatharshni Mohan ; Nazatul Shima Abdul Rahim ; Amizatul Aini Salleh ; Hasni Mahayidin ; Ikmal Hisyam Bakrin
Malaysian Journal of Medicine and Health Sciences 2020;16(Supp 9, November):127-130
Bullous pemphigoid (BP) is a chronic and the most frequent immune-mediated subepidermal blistering
disorder which mainly affects elderly individuals. The autoantibodies produced following
T-cell dysregulation are directed against BP180 (BPAg2) and BP230 (BPAg1), hemidesmosomal proteins
located in the basement membrane zone (BMZ) of the epidermis. BP may present with polymorphic
dermatological features including non-bullous manifestations and blisters. Therefore, a wide range
of differential diagnoses such as eczema, urticaria, pemphigus and the differentials for subepidermal
blister with eosinophils such as epidermolysis bullosa acquisita (EBA) and bullous drug eruptions should
be considered in such cases. The associations of solid organ internal malignancies and BP are quite rare and
vary between studies. Here, we present a case of paraneoplastic bullous pemphigoid (PNBP) in a patient
with underlying renal cell carcinoma who was initially diagnosed with worsening hand-foot syndrome (HFS)
which has led to withdrawal of his oral chemotherapy treatment.
9.Diagnostic Pitfall in Fine Needle Aspiration Cytology of Pilomatrixoma with Unusual Clinical Presentation
Omar Alzallal ; Anani Aila Mat Zin ; Hasni Mahayidin ; Ikmal Hisyam Bakrin
Malaysian Journal of Medicine and Health Sciences 2021;17(No.4):416-418
Pilomatrixoma (PMX) is a benign skin adnexal tumour with matrical differentiation. It frequently presents as a painless and slow growing solitary skin nodule primarily at the head, face and neck regions. Although there is increasing
understanding on the clinical presentations and morphological features of PMX, difficulties are still expected in establishing the clinical and cytological diagnosis. We report a young girl who presented with a painless post-auricular
swelling for one year with sudden increased in size. Computed Tomography (CT) scan and fine needle aspiration
cytology (FNAC) findings were suggestive of a malignancy. Diagnosis of PMX was established and confirmed by tissue histopathological examination. The purpose of this study is to demonstrate the diagnostic pitfall of PMX in FNAC
specimens, especially in patients with unusual clinical presentations.
10.Correlation of E-Cadherin Expression with Clinicopathological Parameters and Its Outcomes among Prostate Cancer Patients in Hospital Kuala Lumpur
Siti Farah Sophia Mohd Nasir ; Ikmal Hisyam Bakrin ; Norhafizah Mohtarrudin ; Rosna Yunus
Malaysian Journal of Medicine and Health Sciences 2020;16(No.4):101-107
Introduction: Aberrant expression of E-cadherin has shown to have correlation with advanced disease of prostate
cancer. In this study, we evaluated the potential of E-cadherin as a prostate cancer prognostic marker and determined
its correlation with patient outcomes. Method: 46 prostate cancer specimens in the form of paraffin-embedded tissue
blocks were retrieved from the Histopathology Unit, Department of Pathology, Hospital Kuala Lumpur. The expression patterns of E-cadherin were determined by immunohistochemistry staining. The E-cadherin expression was
evaluated and scored as positive (3+) and negative or loss of expression (2+ and 1+). The correlations of E-cadherin
expression with patient outcomes which included biochemical failure, disease-free, metastasis and local recurrence
were determined. Correlations of E-cadherin expression with the currently used traditional clinicopathological parameters were also evaluated. Results: There were significant correlations between E-cadherin expression with biochemical failure (p=0.005) and local recurrence (p=0.003). However, there were no significant correlations between
E-cadherin expression with disease-free (p=0.864) and tumour metastasis (p=0.430). Comparing the correlation of
E-cadherin expression with the traditional clinicopathological parameters, there were significant correlations between E-cadherin expression with pathological staging (p=0.001), Gleason score (p=0.004) and perineural invasion
(p=0.001). However, there was no significant correlation between E-cadherin expression with positive tumour margin (p=0.320). Conclusion: These results support the potential use of E-cadherin as a prognostic tool for prostate
cancer as well as an additional marker along the currently available traditional clinicopathological parameters.