Publications by authors named "Nornazirah Azizan"

24 Publications

  • Page 1 of 1

Gastric duplication cyst with a red flag presentation: a case report.

Pan Afr Med J 2021 18;39:141. Epub 2021 Jun 18.

Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

Gastric duplication cyst (GDC) is a rare congenital malformation of the gastrointestinal (GI) tract. Despite being benign in the entity, its complications vary from an asymptomatic abdominal mass to fulminant or massive GI bleeding. A 28-year-old lady presented with unexplained GI haemorrhage, in which the upper endoscopy showed a classic feature of GI stromal tumour. The preoperative diagnosis was also confirmed by the computed tomography. She subsequently underwent surgical resection and the final histopathology was consistent with a benign entity of GDC.
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http://dx.doi.org/10.11604/pamj.2021.39.141.29895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418179PMC
June 2021

Development and validation of a structured survey questionnaire on knowledge, attitude, preventive practice, and treatment-seeking behaviour regarding dengue among the resident population of Sabah, Malaysia: an exploratory factor analysis.

BMC Infect Dis 2021 Aug 31;21(1):893. Epub 2021 Aug 31.

Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Malaysia.

Background: Several studies have reported a significant association of knowledge, attitude and preventive practice (KAP) regarding dengue infection among community's resident in endemic areas. In this study we aimed to assess and develop a reliable and valid KAP survey on the subject of dengue that is suitable for the resident population of Sabah, Malaysia.

Methods: A community-based cross-sectional study was conducted from October 2019 to February 2020 involving 468 respondents. Information on the socio-demographic characteristics of the participants (six items), their KAP (44, 15 and 18 items on knowledge, attitude and practice, respectively) and treatment-seeking behaviour (five items) towards dengue was collected using a structured questionnaire. Data analysis was performed using SPSS and R software in the R Studio environment. The knowledge section was analysed by two-parameter logistic item response theory (2-PL IRT) using ltm package. The construct validity and reliability of items for sections on attitude, practice and treatment-seeking behaviour were analysed using psy package.

Results: For the knowledge section, only 70.5% (31/44) of items were within or close to the parameter acceptable range of -3 to + 3 of difficulty. In terms of discrimination, 65.9% (29/44) of items were within or close to the acceptable range of 0.35 to 2.5, and 24 items (54.5%) failed to fit the 2-PL IRT model (P < 0.05) after assessing by goodness-of-fit analysis. Only eight items were reliable and retained in the attitude section with a Kaiser-Meyer-Olkin (KMO) test value of > 0.7, while based on the communalities, 11 items in the attitude section were excluded due to very low h2, factor loading values and low correlation with the total (< 0.5). The practice section was found suitable for factor analysis because the KMO value was > 0.7. The communalities of the practice section showed that seven items had low h2 values (< 0.3), which were therefore excluded from further analysis, and only 11 items were retained.

Conclusions: The KAP items retained in the final version of the survey were reliable and valid to be use as a questionnaire reference when conducting future similar studies among the population of Sabah.
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http://dx.doi.org/10.1186/s12879-021-06606-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406825PMC
August 2021

The Value of Preoperative Diagnosis in Leiomyosarcoma of the Vulva.

Oman Med J 2021 Mar 31;36(2):e256. Epub 2021 Mar 31.

Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu,
Sabah, Malaysia.

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http://dx.doi.org/10.5001/omj.2021.68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082599PMC
March 2021

Different Domains of Dengue Research in Malaysia: A Systematic Review and Meta-Analysis of Questionnaire-Based Studies.

Int J Environ Res Public Health 2021 04 23;18(9). Epub 2021 Apr 23.

Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia.

This review provided a systematic overview of the questionnaire-related dengue studies conducted in Malaysia and evaluated their reliability and validity used in the questionnaires. An extensive literature search was conducted using various electronic databases, including PubMed, EMBASE, Medline, and ScienceDirect. Systematic reviews and meta-analysis (PRISMA) were selected as the preferred item reporting method. Out of 88 identified dengue-related, 57 published from 2000 to April 2020 met the inclusion criteria and were included. Based on the meta-analysis, a poor mean score was obtained for knowledge (49%), attitude (44%), and preventive practice (55%). The study showed that the level of knowledge on cardinal signs and modes of transmission for dengue virus were highest among health care workers, followed by students (international and local) and lastly community residents. In treatment-seeking behaviours, only half of the respondents (50.8%) would send their child to the nearest health clinics or hospitals when a child became restless or lethargic. The acceptance rate for dengue vaccine, bacteria (Wolbachia), as a vector for dengue control and self-test diagnostic kit for dengue showed considerably high (88.4%, 70%, and 44.8%, respectively). Health belief model (HBM) constructs, such as perceived barriers, perceived severity, perceived susceptibility, self-efficacy, and perceived benefit influence prevention practices. Lastly, only 23 articles (40.3%) had piloted or pretested the questionnaire before surveying, in which three reported Cronbach's alpha coefficient (0.70-0.90). A need for active participation of communities and healthcare personnel, promotion of awareness, and safe complementary medicines, as well as assessment of psychometric properties of questionnaire use in dengue surveys in Malaysia, in order for assessing dengue reliably and valid.
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http://dx.doi.org/10.3390/ijerph18094474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122824PMC
April 2021

Re: Perforated descending colon adenocarcinoma manifesting as necrotizing fasciitis.

ANZ J Surg 2021 04;91(4):763-764

Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

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http://dx.doi.org/10.1111/ans.16536DOI Listing
April 2021

The challenges and risk of laboratory handling on a histology specimen during COVID-19 pandemic.

Ann Med Surg (Lond) 2021 Apr 26;64:102242. Epub 2021 Mar 26.

Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia.

The Coronavirus Disease 2019 (COVID-19) pandemic has taken the world into turmoil by surprise. The rapid spreading of this virus has led to an exponential increase in the number of cases. It has created a public health disaster, causing a collapse of the health system in every part of the world. Many sectors in the health area are affected, including histopathology services. The challenges and risk of viral transmission can come from various aspects and levels. For COVID-19 tests, there are even cases of no direct contact with the specimens; the specimens received infection from individuals of unknown status. The fixatives used for histopathology specimens are believed to be inactivated viruses, which can be an inactivate coronavirus. Even so, precautions have to be put in place to prevent the spread of infection to laboratory personnel, especially to those handling underfixed and fresh frozen cytology samples. Precautions must also be taken when dealing with histopathology services, by wearing full personal protective equipment and by executing other standard safety measures. The purpose of this review is to highlight the challenges faced in managing histopathology services in our centre during the COVID-19 pandemic.
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http://dx.doi.org/10.1016/j.amsu.2021.102242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997141PMC
April 2021

Malignant ulcer: a great mimicker of gastric plasmablastic lymphoma.

Clin J Gastroenterol 2021 Aug 1;14(4):1027-1030. Epub 2021 Apr 1.

Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

Plasmablastic lymphoma (PBL) is an uncommon human immunodeficiency virus (HIV)-associated lymphoma, with a predilection to develop in the oral cavity. It usually has a plasmablastic morphology with weak or no expression of B cell-associated markers. Among non-HIV patients, it tends to occur in the gastrointestinal (GI) tract, lymph nodes, and skin. We experience a 74-year-old male who presented with abdominal discomfort, altered bowel habit, loss of weight, and loss of appetite with a palpable abdominal mass. Upper endoscopy revealed multiple dish-like and raised nodular mass with a central ulcer in the stomach and duodenum. The histology was consistent with high-grade lymphoma of the plasmablastic type. The immunohistochemistry was positive for plasma cells marker of CD38 and CD138, but negative for the lymphocytic marker of CD45, as well as mature T and B cell marker of CD3 and CD20. Unfortunately, the patient succumbed due to sepsis without completion of his investigations and treatments.
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http://dx.doi.org/10.1007/s12328-021-01409-3DOI Listing
August 2021

Malignant Subcutaneous Perivascular Epithelioid Cell Tumor of Anterior Abdominal Wall.

Oman Med J 2021 Mar 23;36(2):e239. Epub 2021 Mar 23.

Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

Perivascular epithelioid cell tumors (PEComas) are a family of rare mesenchymal tumors with discrete histological and immunohistochemical characteristics. Even rarer among them are cutaneous and subcutaneous PEComas. We describe a 34-year-old woman who presented with a large anterior abdominal subcutaneous lesion showing intact overlying skin and no obvious invasion of the abdominal musculature. A wide local excision was performed. Histopathology revealed a solitary tumor measuring 75 × 55 × 90 mm with epithelioid cells in nests with thin fibrovascular septa and spindle cells. Resection margins were clear with no invasion to the skin or rectus sheath. Tumor cells were positive for HMB-45 but negative for other markers. This is the largest subcutaneous PEComa reported to date.
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http://dx.doi.org/10.5001/omj.2021.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988466PMC
March 2021

Re: Rare case of wandering spleen causing intra-thoracic megacolon.

ANZ J Surg 2021 01;91(1-2):214

Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

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http://dx.doi.org/10.1111/ans.16380DOI Listing
January 2021

Perforated caecal mass: benign or malignant?

ANZ J Surg 2021 Jul 22;91(7-8):1620-1622. Epub 2020 Dec 22.

Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

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http://dx.doi.org/10.1111/ans.16508DOI Listing
July 2021

Huge Retroperitoneal Cyst Masquerading as Ovarian Tumour: A Case Report.

Front Surg 2020 22;7:585411. Epub 2020 Oct 22.

Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Malaysia.

Retroperitoneal cystic mass is a rare surgical condition that is often misdiagnosed preoperatively. Here, we report a case of a 56-year-old woman who presented with abdominal swelling for a 1-year duration, which was associated with lower abdominal pain for 6 months. Her abdominal radiograph showed a huge radiopaque lesion, and contrast-enhanced computed tomography scan of the abdomen reported it as a left ovarian serous cystadenoma causing local mass effect to the left ureter leading to mild left hydronephrosis. She underwent exploratory laparotomy and noted there was a huge retroperitoneal cystic mass. The histopathological assessment finding was consistent with a benign retroperitoneal cyst. This case report aims to share the rare case of primary retroperitoneal lesions, which can cause a diagnostic challenge preoperatively to all clinicians despite advanced achievement in medical imaging.
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http://dx.doi.org/10.3389/fsurg.2020.585411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642373PMC
October 2020

An oncological curiosity of a male patient with a huge leiomyoma of the terminal ileum.

Oxf Med Case Reports 2020 Oct 23;2020(10):omaa086. Epub 2020 Oct 23.

Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

Leiomyoma is a smooth muscle tumour that can arise in any part of the body especially the uterus. Even though it is traditionally linked with hormonal influence, it can also develop in extrauterine organs with a slight female predominance. It is indistinguishable with gastrointestinal stromal tumour (GIST) histologically. We report a case of a 30-year-old gentleman who presented with a huge painful mass in the right iliac fossa. Computed tomography revealed a 10 × 10 cm homogeneous mass arising from the terminal ileum; he subsequently underwent an open right hemicolectomy. Histology showed a well-circumscribed lesion composed of interlacing bundles of smooth muscle fibres of the submucosa with positive smooth muscle actin and H-Caldesmon stains but negative for DOG-1 and CD117 (c-kit) stains which were consistent with leiomyoma. Despite its rarity, this hormone-related tumour needs to be considered regardless of gender. Immunohistochemistry is paramount as it is histologically identical to GIST.
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http://dx.doi.org/10.1093/omcr/omaa086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583423PMC
October 2020

Vanek's tumor causing ileoileal intussusception in a middle-aged man.

Oxf Med Case Reports 2020 Jul 24;2020(7):omaa050. Epub 2020 Jul 24.

Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Intestinal obstruction is a common surgical emergency requiring urgent intervention. Small bowel obstruction secondary to intussusception is rarely encountered especially when inflammatory fibroid polyp (IFP) is the lead point. A 41-year-old gentleman with intestinal intussusception secondary to IFP presented to us with a classic symptom of intestinal obstruction. Computed tomography revealed a target or sausage-shaped soft tissue mass with a layering effect, which was confirmed by intraoperative findings. Histopathology was consistent with IFP and supported by immunoreactivity of CD34 and negative immunostaining for CD117. He recovered without any surgical complication or recurrence. Even intussusception can be managed via non-surgical technique in children; surgery is the mainstay of treatment in adults.
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http://dx.doi.org/10.1093/omcr/omaa050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376978PMC
July 2020

Huge Pulsatile Sternal Mass.

Oman Med J 2020 May 30;35(3):e137. Epub 2020 Jun 30.

Breast and Endocrine Unit, Queen Elizabeth Hospital II, Ministry of Health Malaysia, Lorong Bersatu, Off Jalan Damai, Kota Kinabalu, Sabah, Malaysia.

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http://dx.doi.org/10.5001/omj.2020.55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325478PMC
May 2020

Incidental hepatic tuberculosis during planned resection of locally advanced ampullary carcinoma: a case report.

BMC Surg 2020 Jun 30;20(1):145. Epub 2020 Jun 30.

Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

Background: Tuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems.

Case Presentation: A 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB.

Conclusions: A high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma.
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http://dx.doi.org/10.1186/s12893-020-00806-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325297PMC
June 2020

Giant submandibular sialolipoma masquerading as huge goitre: a case report.

BMC Surg 2020 Jun 11;20(1):130. Epub 2020 Jun 11.

Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.

Background: Sialolipoma is a rare tumour which may arise from both major and minor salivary glands and has recently been described as a variant of salivary gland lipomatous lesions.

Case Presentation: We report a 54-year-old male who presented with a 7-year history of large right anterior neck swelling. He was clinically euthyroid and had no compressive or infiltrative symptoms. He sought medical attention due to the discomfort exerted by the weight of the mass and was keen for excision. The swelling appeared like a goitre but physical examination proved otherwise. Imaging was suggestive of a benign tumour arising from the right parapharyngeal fossa. The mass was surgically excised and was noted to be adherent to part of the submandibular gland. Histopathological examination revealed a new variant of benign adipocytic tumour of salivary gland or sialolipoma arising from the submandibular gland. Besides being the largest sialolipoma to be reported, there are also no reports of giant submandibular sialolipomas masquerading as a huge goitre in appearance.

Conclusion: Submandibular sialolipomas can present in really large sizes and appear as a giant goitre. It is important to differentiate between benign lipomas from liposarcomas and tailor the management accordingly. Surgical enucleation is the preferred choice of treatment for these benign tumours with low recurrence rates.
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http://dx.doi.org/10.1186/s12893-020-00787-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291645PMC
June 2020

A clinically silent tumour of adrenal myelolipoma: A case report.

Int J Surg Case Rep 2020 1;72:63-65. Epub 2020 Jun 1.

Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

Introduction: Adrenal myelolipoma is a rare, non-functional, benign neoplasm which is constituted of mature haematopoietic elements and adipose tissues in various proportions. It is diagnosed accidentally and frequently with the widespread use of imaging modalities.

Presentation Of Case: We report a 63-year-old lady with incidental findings of adrenal tumour on computed tomography (CT) scan during a routine medical check-up. She underwent tumour resection in view of a large tumour of 7 cm in size.

Discussion: CT scan is sensitive to diagnose adrenal myelolipoma in view of its fat-laden property and useful to monitor the tumour progress. Even previously she opted for conservative management; the decision for surgery was made in view of enlarging tumour and risk of surrounding tissue compression.

Conclusion: With increased awareness, the detection rate of this tumour is improving, hence able to prevent the complications of a large tumour such as compression, bleeding and tumour necrosis.
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http://dx.doi.org/10.1016/j.ijscr.2020.05.056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283099PMC
June 2020

Counter response to Response from Dr Yagnik and Dr Yagnik to Gangrenous giant Meckel's diverticulitis masquerading acute appendicitis: a surgical conundrum.

ANZ J Surg 2020 01;90(1-2):190

Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia.

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http://dx.doi.org/10.1111/ans.15571DOI Listing
January 2020

Florid papillomatosis of the nipple.

BMJ Case Rep 2019 Sep 18;12(9). Epub 2019 Sep 18.

Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.

Florid papillomatosis (FP) of the nipple, or nipple adenoma, is a rare breast tumour, affecting middle-aged group population. A 46-year-old woman presented to us with a cauliflower-like FP of the right nipple with no blood stained discharge or breast lump. FP can be mistaken clinically for Paget's disease and occasionally misinterpreted as invasive ductal or intraductal carcinoma. Extensive intervention, correct diagnosis and prompt treatment are essential. Any breast pathology requires triple assessment including FP of the nipple. Once the diagnosis of ductal carcinoma is excluded, simple complete excision can be undertaken. This is to ensure complete obliteration of disease recurrence and preservation of cosmetic result. We discuss the pathology and psychosocial aspects of FP.
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http://dx.doi.org/10.1136/bcr-2019-231516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754673PMC
September 2019

Giant Preputial Calculus: The First Reported Case in Malaysia.

Case Rep Surg 2018 18;2018:4606259. Epub 2018 Sep 18.

Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Preputial calculus is a relative surgical rarity. It usually happens in elderly men with poor hygiene and uncircumcised penis complicated with phimosis. In the paediatric group, it is usually secondary to phimosis and other urologic and/or neurologic anomalies. Surgical treatment is the mainstay of treatment. Herein, we report a 27-year-old gentleman with preputial stone presented with obstructive uropathy and was successfully treated with surgical intervention. To the best of our knowledge, this is the first reported case of the largest preputial stone in Malaysia.
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http://dx.doi.org/10.1155/2018/4606259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167587PMC
September 2018

Role of co-expression of estrogen receptor beta and Ki67 in prostate adenocarcinoma.

Investig Clin Urol 2018 07 18;59(4):232-237. Epub 2018 Jun 18.

Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

Purpose: To evaluate the expression of estrogen receptor (ER)-beta and Ki67 in prostate cancer and study their relationship.

Materials And Methods: We analyzed 101 cases of prostate adenocarcinoma diagnosed from January 2011 to June 2015 in 100 patients. Immunohistochemical staining of ER-beta and Ki67 was analyzed according to Gleason score categorized into prognostic groups of 1 to 5. Double-immunofluorescent staining of ER-beta and Ki67 was performed in a total of 20 cases to study the co-expression and the relationship between these markers within the same tumor.

Results: A total of 53 of 101 cases (52.5%) were positive for ER-beta expression. There was a positive correlation whereby a high percentage of ER-beta expression was seen in the higher prognostic groups (groups 4 and 5; p=0.007). High Ki67 expression was observed in the higher prognostic group, whereas low Ki67 or negative expression was found in the lower prognostic group (p<0.001). The majority of cases evaluated with double-immunofluorescent staining (14/20) showed co-expression of ER-beta and Ki67 at the individual cell level.

Conclusions: ER-beta and Ki67 are independent tumor markers in high prognostic groups. Hence, co-expression of ER-beta and Ki67 indicates a more aggressive tumor with a poorer prognosis.
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http://dx.doi.org/10.4111/icu.2018.59.4.232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028465PMC
July 2018

Gangrenous giant Meckel's diverticulitis masquerading acute appendicitis: a surgical conundrum.

ANZ J Surg 2019 09 25;89(9):E379-E380. Epub 2018 Apr 25.

Department of Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia.

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http://dx.doi.org/10.1111/ans.14503DOI Listing
September 2019

Giant Mediastinal Germ Cell Tumour: An Enigma of Surgical Consideration.

Case Rep Surg 2016 11;2016:7615029. Epub 2016 Oct 11.

Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.

We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour.
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http://dx.doi.org/10.1155/2016/7615029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078647PMC
October 2016
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