Introduction: Development of renal cell carcinoma (RCC) is a life threatening complication of long- term haemodialysis. Studies have shown that approximately one third or more of patients on long-term haemodialysis of more than three years will develop acquired cystic kidney disease (ACKD), and 20- 50% of patients with ACKD, particularly with complex cysts of Bosniak types IIF, III and IV, may even- tually transform into RCC. This study looks at the incidence of haemodialysis related RCC in Brunei Da- russalam. Material and Methods: Cases of RCC registered in the Department of Pathology registry from January 2000 to December 2010 were identified and retrospectively reviewed. Results: A total number of 5,287 malignancies were reported during this period of which 74 were RCC, giving an overall incidence of 1.4%. Out of these 74 cases, 6.8% (n=5) was found to be RCC transformed from ACKD associated with long-term haemodialysis. There was a male preponderance (4:1), four Malay men and one Chinese lady with a median age of 51 years (37-66) at diagnosis. The duration of haemodialysis prior to the development of RCC ranged from 4 to 16 years. The common presenting signs and symp- toms were cystic mass in kidney 60% (n=3), haematuria and metastatic RCC in urinary bladder 20% (n=1), metastasis to the neck glands 20% (n=1). The right kidney was affected in four (80%) and one on the left (20%). Conclusion: Our study showed that ACKD associated RCC accounted for 6.8% of all RCC, and the duration to RCC development ranged from four to 16 years. There was a preponderance in males. Radiological screening may need to be considered for patients at risk.

Myxomas are the most common type of primary cardiac tumour with 86% occurring in the left atrium. Right atrial myxomas is far less common. Patients usually present with progressive dyspnoea, fever, weight loss, right-sided heart failure, or pulmonary embolisation. We report the case of a 55-year-old man who presented with progressive dyspnoea and signs of right heart failure secondary to a large right atrial myxoma, which was diagnosed with a bedside transthoracic echocardiogram. This was successfully removed surgically.
Atrial Myxoma ; Dyspnea ; Heart Failure ; Treatment Outcome

Stroke or cerebrovascular accident is common and is most commonly embolic or haemorrhagic. A common source of embolism is the heart and as such echocardiogram is an essential investigation. However, clinicians need to be aware of rare sources of embolism. We report a rare and interesting case of a 61-year-old Caucasian man who presented with stroke and on evaluation was found to have a large thrombus coiled striding over a patent foreman ovale into the right and left atrium consistent with a 'thrombus in transit'. The origin of the thrombus was later confirmed to be from the left saphenous vein. This case highlights an interesting case of 'thrombus in transit'.
Stroke ; Myxoma ; Foramen Ovale, Patent ; Embolism, Paradoxical

A 35-middle-aged female with history of recent travel to the Indian Subcontinent, presented with features of malabsorption. Blood chemistry revealed low serum albumin and low serum Vitamin B12 levels. Upper gastrointestinal endoscopy was done and was reported as normal. The duodenal biopsy sent for histopathologic examination and is shown (Panel). What is the diagnosis? Answer: refer to page 186

(Refer to page 164) Answer: Giardiasis. The slide shows duodenal biopsy with pear shaped protozoa of Giardia lamblia on the luminal surface of the villi. Giardia lamblia is a pear-shaped, flagellated protozoan that causes a wide variety of gastro-intestinal complaints. Giardia is possibly the most common parasite of humans worldwide and the second most common in the United States after pinworm.

Cervical glial polyps or gliosis of uterine cervix are rare. These are rare polypoidal mesenchymal tumours and usually manifest with vaginal bleeding, post-coital bleeding or cervical discharge. Microscopically these polyps show heterotopic glial tissue with varying degree of gliosis. Immunoperoxidase staining with Glial fibrillary acidic protein (GFAP) confirms the glial nature of the polyp. Controversies remain regarding the origin. Some consider them to be foetal implants following termination of pregnancy whilst others consider them to be metaplastic in nature. We report a rare case of cervical gliosis that was diagnosed after histological examination of the resected specimen in a 32-year-old lady who presented with irregular per vagina bleeding.

Malignant cystic lesions of the lateral side of the neck are usually due to metastasis and are rarely primary carcinoma. The most common is metastatic cystic squamous cell carcinoma arising from a primary site at the Waldeyer's ring. However, they can arise from papillary carcinoma of thyroid, lung and mediastinum but very rarely from the abdominal and pelvic organs without regional lymph node involvement. Therefore, accurate diagnosis is very important for appropriate management. We report two cases of cystic squamous cell carcinoma of the lateral neck; cystic metastasis from an occult squamous cell carcinoma of the tongue and a primary branchiogenic carcinoma. We emphasize the importance of meticulous search for the primary malignant lesions in cases of cystic carcinoma of the neck.
Branchioma ; Carcinoma ; Cysts ; Metastasis

Lymphangioma of the ovary is an extremely rare lesion. There are only 19 cases reported in the literature. Lymphangioma is usually unilateral and asymptomatic, presenting as an incidental finding during routine gynaecologic procedures. It is composed of aggregates of lymphatic spaces in ovarian stroma and the endothelial cells lining these spaces stain positively with CD-31 and CD-34 on immunostaining. The main differential diagnosis is an adenomatoid tumour which can be differentiated from the lymphangioma by immunohistochemical studies. We report this rare lesion in a 42-year-old Malay lady diagnosed after total abdominal hysterectomy and right salpingo-oophrectomy. A literature review is presented and the histological and immunohistological findings along with differential diagnosis are discussed.