Terminal ileum duplication: an unusual case of small bowel obstruction.

Duplications of the alimentary tract are uncommon congenital anomalies that usually present during infancy and early childhood. The case of an adolescent presenting with small bowel obstruction secondary to a duplication cyst is presented and the challenges in the management described.

Radical prostatectomy outcomes at the University Hospital of the West Indies: 2000-2007.

OBJECTIVES: Prostate cancer is the commonest cancer in Jamaican men with an age-specific incidence of 65.5 per 100 000 and also the commonest cause of male cancer death. This study reports on the oncological outcome and morbidity after radical retropubic prostatectomy. SUBJECTS AND METHODS: The records of 116 patients with clinically localized prostate cancer (cT1c- T2) who underwent radical retropubic prostatectomy at the University Hospital of the West Indies from January 2000 to December 2007 were examined. Preoperative Prostate specific antigen (PSA), clinical stage and Gleason score were recorded. Operative time, blood loss, hospital stay and complications were assessed. Oncological outcome was assessed using biochemical progression. Disease progression was defined by PSA value of 0.4 ng/ml or greater. RESULTS: Mean patient age was 61 (43-75) years. The mean presenting PSA was 10.1 (2-25.1) ng/ml. Mean Gleason score on preoperative biopsy was 6. The commonest clinical stage was T1c (68%). Nodal involvement was seen in only one patient. The positive surgical margin rate was 15.5%. Mean operating time was 246 minutes and mean estimated blood loss was 1.44 L. The mean hospital stay was 6.9 days and 17% of patients developed minor complications, with no treatment or disease related deaths. Five-year biochemical-free survival was 78.4%. CONCLUSIONS: Oncological outcomes after radical retropubic prostatectomy in Jamaica appear to meet global standards with acceptable morbidity.

Body mass index and prostate specific antigen levels in Jamaican men.

OBJECTIVE: To investigate the relationship between body mass index (BMI) and prostate specific antigen (PSA) levels in Jamaican men. METHODS: Men, 40-79 years old, attending public and private urology clinics in Kingston, Jamaica were recruited to a case-control study on the role of dietary and lifestyle factors on prostate cancer. Trained interviewers administered questionnaires and measured weight and height using standardized techniques. Blood samples for PSA were measured at a central laboratory using a micro-particle enzyme immunoassay method. Prostate biopsy was used to confirm prostate cancer. Multivariable linear regression was used to examine the relationship between BMI and PSA separately in the cases and controls. RESULTS: Data from 501 men (233 cases and 263 controls) were assessed. Thirty-five per cent of subjects were overweight and 13% were obese. Among cases, the median PSA was 35.3 ng/dL in normal weight, 26.1 ng/dL in overweight and 14.5 ng/dL in obese men (p = 0.02). For controls, median PSA was 2.0 ng/dL in normal weight, 1.3 ng/dL in overweight and 1.1ng/dl in obese men (p = 0.01). Among cases, BMI was negatively associated with PSA (B(SE) per 5 kg/m2 (BMI difference = -0.51 (0.13); p < 0.01) and remained significant after adjustment for age, sexual activity, smoking, use of statins and tumour grade. For controls, the BMI was also inversely related to the PSA (B(SE) per 5 kg/m2 difference -0.17 (0.07)) but the effect became of borderline significance after adjusting for age. CONCLUSIONS: Prostate specific antigen was inversely related to body mass index in Jamaican men with prostate cancer. Clinicians should consider this association when interpreting PSA results.

Angiomyolipoma of the kidney: the experience at the University Hospital of the West Indies.

OBJECTIVE: Angiomyolipoma (AML) of the kidney is an uncommon tumour that, until recently, was often misdiagnosed preoperatively as renal cell carcinoma (RCC). Newer radiological techniques have allowed more accurate preoperative diagnosis which can facilitate preoperative counselling and planning for conservative therapy. This study reviews the experience with these uncommon tumours at the University Hospital of the West Indies. METHODS: All cases of AML diagnosed during the period 1980 to 2007 were retrospectively identified from the files of the Department of Pathology. From these records, selected data were retrieved and analysed. These included patient demographics, clinical history, clinical diagnosis and pathologic characteristics of the specimen submitted. The total number of primary renal tumours diagnosed in adults during the same period was also determined for comparison. RESULTS: Eleven cases of AML were identified among 149 primary renal tumours in adults. Ten of these cases occurred in women. Amongst these, a single case of tuberous sclerosis was confirmed in a patient with bilateral lesions. Excluding this patient, who was 24-years-old, ages ranged from 24 to 86 years with a mean of 44 years (median 40.5 years) and an equal number of lesions was present on each side. Abdominal or flank pain were the most common clinical symptoms, present in six cases but in three cases, the tumours were discovered incidentally. The correct clinical diagnosis was made pre-operatively in a single case. By contrast, a diagnosis of RCC or other malignant tumour was proffered in eight cases. Pathologically, the maximum dimension of the seven excised tumours, in whom such information was recorded, ranged from 3.5 cm to 12 cm with a median of 7 cm. Spontaneous haemorrhage in the tumour was noted in three cases, all greater than 4.5 cm in maximum dimension. CONCLUSIONS: These data confirm that AML is uncommon at the University Hospital of the West Indies. There was an overwhelming female preponderance and patients presented, most commonly, in the 3rd to 4th decades. Tuberous sclerosis was identified in a solitary case. In this series, symptomatic lesions were > 4.5 cm in maximum dimension and haemorrhage complicated three cases. Most cases were incorrectly diagnosed preoperatively.

A review of granular cell tumours at the University Hospital of the West Indies: 1965-2006.

OBJECTIVE: Granular cell tumours are uncommon lesions that occur in a wide variety of sites. They are usually benign, but as they are infrequently diagnosed preoperatively, they may be confused clinically with malignant lesions. The objective of this study was to assess the relative frequency and the clinicopathologic characteristics of granular cell tumours identified at the University Hospital of the West Indies (UHWI) over a 41-year period. METHODS: The archives of surgical pathology reports in the Department of Pathology at the UHWI from 1965 to 2006 were searched for all cases of granular cell tumour. From these records, a number of demographic and other data were recorded and analyzed. RESULTS: One hundred and thirty cases of granular cell tumours were found in 122 patients. Of these, 99patients were female and 23 male, providing a male:female ratio of l to 4.3. The ages ranged from 5 days to 82 years with a mean age (excluding the 2 youngest cases) of 34.4 years. Lesions ranged in size from 0.2 cm to 10 cm in greatest dimension, the average size being 1.85 cm and were found in a diverse array of anatomic locations, the most common being the vulva, breast and tongue. The correct clinical diagnosis was proffered preoperatively in only one case. In contrast, a malignant diagnosis was suggested in 19 cases. CONCLUSIONS: Compared with other studies, there was a notable difference in the distribution of granular cell tumours in this series. In particular lesions of the tongue accounted for fewer than expected, while lesions of the breast and vulva were considerably increased. The well-recognized female predominance was also substantially higher than in other studies.

Gamna body of the heart.

A patient with cerebral strokes had a cardiac tumour excised. Histologically, it was an infarcted myxoma with features of a Gamna body. Findings are compared with other cardiac Gamna bodies reported in the literature. Most probably represent unusual degenerative changes in a myxoma.

Ruptured saccular pulmonary artery aneurysm associated with persistent ductus arteriosus.

We report a case of rupture of a saccular pulmonary artery aneurysm with fatal hemopericardium in a 29-year-old man who also had persistent ductus arteriosus with severe pulmonary hypertension. Histologic examination of the pulmonary artery showed cystic medionecrosis similar to that observed in patients with ruptured dissecting pulmonary artery aneurysms. The two types of ruptured aneurysms probably only represent different morphological expressions in the same underlying process in which the main contributory factor is pulmonary hypertension.

A cluster of central nervous system defects in Jamaica.

1. Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12-month period between September 1986 and August 1987. 2. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated 54,400 total births. 3. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. 4. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop.

Prostate cancer at the University Hospital of the West Indies in Jamaica. A clinico-pathological profile at the time of needle biopsy diagnosis.

A prospective study of the clinico-pathological features of prostate cancer at the time of needle biopsy diagnosis was conducted in the Department of Pathology at the University Hospital of the West Indies over a one-year period. Ninety cases were diagnosed during this time. The mean age of patients at diagnosis was 72 years and the mean Gleason score of the biopsy, 7.3. Serum prostate-specific antigen levels were markedly elevated in the majority of patients, with a mean value of at least 159.8 ng/ml in the 76 patients for whom this information was available. The significance of these findings and that of other histopathological features examined are discussed, particularly in relation to recognized prognostic factors. It is concluded that the diagnosis of prostate cancer in Jamaica appears to be considerably later than that seen elsewhere. This information should provide support for those who advocate the introduction of a vigorous screening process for prostate cancer in Jamaica.

Soft tissue sarcomas: a ten-year analysis.

Malignant soft tissue tumours are uncommon and the diagnosis is often difficult to make. This study of fifty-nine cases represents a pathological perspective of our experience with these tumours over a 10-year period. Malignant fibrous histiocytoma was the most frequent diagnosis made (36%) and the majority of these occurred in the lower limbs. In 11 (19%) cases, the sarcomas could not be further classified along histogenetic lines. We consider some of the reasons for this and discuss these findings in the light of an increasing trend towards the use of smaller samples for diagnosis.

The pathology of thyroid neoplasms at the University Hospital of the West Indies. A 10-year analysis.

Thyroid neoplasms were diagnosed in 93 patients (79 women and 14 men) between January 1986 and December 1995. 52 tumours were benign and 41 were malignant. An unusual finding was that there were 16 cases each of follicular and papillary carcinomas; that is, more patients with follicular carcinomas than expected. The significance is discussed.

Nodular fasciitis.

A 10-year review of the files of the Department of Pathology revealed 11 cases of nodular fasciitis. The clinicopathologic features of these cases are presented together with a discussion of the pathology of this lesion. The purpose of this study is to enhance both physicians' and pathologists' awareness of this entity.

Tumours and tumour-like lesions of bone. The UHWI experience. University Hospital of the West Indies.

A review of all primary tumours and tumour-like lesions of bone diagnosed in patients who attended the University Hospital of the West Indies over a 10-year period revealed 136 cases comprising 69 benign and 54 malignant tumours, and 13 cases of tumour-like lesions. The prevalence and clinical characteristics of the various lesions are discussed and compared with the findings in other series. The results of this analysis provide demographic data useful in the differential diagnosis of bone lesions locally.

Female adnexal tumour of probable wolffian origin.

We report a case of female adnexal tumour of probable wolffian origin, a rare tumour of the broad ligament, and discuss aspects of its origin, differential diagnosis and behaviour.

Turnaround time in the surgical pathology laboratory.

One measure of the efficiency of a surgical pathology service is the rapidity of reporting the diagnosis to clinicians. The turnaround time (TAT) has been used for this purpose. This study showed that the TAT for 66% of specimens submitted to the surgical pathology laboratory in the University Hospital of the West Indies was within 3 days and for 89% within 6 days. The TAT within 7 days was considered acceptable, but it was shown that it was more than 7 days for 9%, of the specimens submitted. The importance of this information is discussed and recommendations made for identifying more accurately the source of delays in those cases in which the TAT was considered to be unusually prolonged.

Right ventricular cardiomyopathy. A rare and underdiagnosed cause of sudden death in young adults.

We present an example of right ventricular cardiomyopathy, a very uncommon condition which caused sudden death in an adolescent boy. This case report is used to highlight the pathological features of this rare and poorly understood condition, which is often undiagnosed.

Medical students' evaluation of their pathology clerkship experience.

As part of a recent trend among faculties in educational institutions to review and upgrade their courses and teaching methods, the Department of Pathology introduced a questionnaire for assessment of the pathology clerkship experience by the medical students. This was to be completed at the end of their rotation. An evaluation of the results of an entire class indicates that, for the most part, the responses were positive with 82% considering the experience to be of great benefit and 17% of reasonable benefit. The responses were generally more favorable to Anatomical Pathology and Haematology than to Chemical Pathology. The study identified areas where modifications in teaching could be considered, and ways to improve the questionnaire, making it more useful for future assessments.

Meckel-Gruber syndrome. A lethal combination of abnormalities.

We herein describe two cases of Meckel-Gruber Syndrome identified in stillborn infants. Both had all three elements of the classical triad, namely, occipital encephalocele, renal cystic dysplasia and post-axial polydactyly. In addition, many of the other well-known accompanying abnormalities were present. Awareness of this entity in this region is important because of its high risk of recurrence in subsequent pregnancies.

Aortic dissection. An autopsy experience.

Aortic dissection was confirmed in 33 patients at autopsy at the University Hospital of the West Indies between 1975 and 1988. Twenty-five cases were acute and 8 chronic and the diagnosis was made antemortem in 5 cases overall. The high risk of rupture of proximal dissections involving the ascending aorta into the pericardial sac is clear, and the overriding importance of systemic hypertension is once again confirmed. An unusual finding was the higher proportion of females to males. A higher index of suspicion should permit an antemortem diagnosis and appropriate therapy in a larger proportion of patients.

Primary leiomyosarcoma of bone.

Primary leiomyosarcoma of bone is rare. We present the clinicopathological features of a case, the first documented from the Caribbean, seen recently at our institution.