Concomitant urothelial cancer and renal tuberculosis.

We report a case of coexisting urothelial cancer and renal tuberculosis in the same kidney. The patient is a 72-year-old female with a remote history of treated pulmonary tuberculosis who presented with haematuria, initial investigation of which elucidated no definitive cause. Almost 1 year later, a diagnosis of metastatic urinary tract cancer was made. The patient received chemotherapy for advanced collecting duct type renal cell carcinoma, based on histological features of renal biopsy. Subsequent confirmatory immunostains however led to a revised diagnosis of urothelial cancer, necessitating a change in chemotherapy regimen. A diagnosis of ipsilateral renal tuberculosis was made based on TB-PCR testing of renal biopsy tissue and anti-TB therapy was coadministered with chemotherapy. The patient died 9 months after diagnosis of metastatic urothelial cancer.

Chronic inflammatory demyelinating polyneuropathy in a patient infected with human T lymphotropic virus type I.

A 32-year-old Afro-Caribbean woman presented with a 1-year history of slowly progressive sensory and motor symptoms initially affecting the legs and later involving the arms. Clinical examination demonstrated a mainly distal pattern of weakness with little objective sensory impairment. The clinical features suggested the possibility of chronic inflammatory demyelinating polyneuropathy. This diagnosis was supported by neurophysiological testing and examination of the cerebrospinal fluid and confirmed by sural nerve biopsy as well as by exclusion of other causes of neuropathy. Seropositivity for human T lymphotropic virus type I (HTLV-I) was demonstrated. The clinical significance of this finding in an area with a high HTLV-I endemicity, as well as its possible aetiological relevance to the diagnosis of chronic inflammatory demyelinating polyneuropathy, is discussed.

Struma cordis in a Jamaican woman.

A case of ectopic thyroid within the right ventricle (struma cordis) occurring in a middle-aged Jamaican woman is described. This rare and fascinating condition is curable utilizing standard open-heart surgical techniques. Investigations to rule out primary thyroid or ovarian malignancy, as well as the presence of remaining normal thyroid tissue or other ectopic thyroid rests are important in the management of these patients.

Malignant meningioma with extension into the neck

One per cent of all brain tumours and twenty per cent of meningiomas eventually develop an extracranial extension. The least common site is the neck. We report a case of malignant meningioma with extension into the neck of a 39-year-old male.

Tuberculous encephalopathy: a rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.

Tuberculous encephalopathy. A rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.(Au)

Malignant meningioma with extension into the neck

One per cent of all brain tumours and twenty per cent of meningiomas eventually develop an extracranial extension. The least common site is the neck. We report a case of malignant meningioma with extension into the neck of a 39-year-old male.(Au)

Granulosa-theca cell tumour of the ovaries. A late metastasizing tumour

Granulosa-theca cell tumours are ovarian neoplasms of low malignancy with hormone secreting potential, accounting for 2-3 percent of all ovarian cancers. They have an uncertain clinical course and a potential for late recurrence aftet surgical removal. Clincal features of a patient presenting with pulmonary metastases 21 years after removal of the primary tumour are described, along with a review of the management options.(AU)

Orbital psuedotumour with intracranial extension

Inflammatory pseudotumour of the orbit is an unusual condition of unknown aetiology which rarely extends beyond the orbit. To our knowledge 19 cases with intracranial extension have been reported, one of which involved the pituitary fossa or sphenoid sinus. Most required cytotoxic agents, surgery or radiotherapy in addition to corticosteroids. We present a case of orbit pseudotumour with extension into the pituitary fossa, sphenoid sinus and cavernous sinuses with vascular compression. Marked clinical improvement occurred on steroid therapy alone.(AU)

Major causes of death in diabetic patients at the University Hospital of the West Indies: an autopsy study

Diabetes mellitus is one of the more common chronic diseases in Jamaica. To determine the major causes of death in diabetics, a retrospective autopsy study was undertaken, as autopsy reports provide the most precise explanation of the cause of death. At the University Hospital of the West Indies (UHWI) between January 1991 and July 1997, autopsies were performed on 1695 patients, of which 142 (8.4 percent) had diabetes mellitus. There were 61 males (43 percent) and 81 females (57 percent), ranging in age from 25 to 93 years. The major causes of death in these diabetics were infection (34.5 percent), and vascular diseases (19.7 percent), which included cardiovascular diseases (11.3 percent), cerebrovascular diseases (5.6 percent), and other vascular disorders (2.8 percent). Biochemical derangement accounted for 15.5 percent of deaths, comprising uncontrolled diabetes with or without ketoacidosis or coma (13.4 percent) and uraemia (2.1 percent). Pulmonary thromboembolism (6.3 percent), gastrointestinal diseases (6.3 percent), trauma/homicide/suicide (3.5 percent), neoplasms (2.8 percent), acute pancreatitis (2.1 percent), and liver disease (0.7 percent) were other causes. In 12 caes, the cause of death was undetermined.(AU)

Angiomyofibroblastoma - a rare but distinct entity

A case of angiomyofibroblastoma of the vulva in a 23-year-old woman is presented. Clinical, histological and immunohistochemical features as well as the differential diagnosis and prognosis of this rare but distinct entity are discussed. Only about 65 cases are documented in the literature and to our knowledge this is the first case to be reported from the Caribbean(AU)

An appraisal of smear diagnosis in neurosurgical biopsies - abstract

The neurosurgeon needs rapid tissue diagnosis during surgery to plan the extent of the operation if the exact nature of the lesion is known, to take additional specimens if a previous attempt has failed to be diagnostic and to decide on management if the lesion is non-neoplastic. Rapid tissue diagnosis is mostly offered by frozen sections in various fields of surgery. However, neuro-surgical biopsies are generally multiple, tiny fragments of gelatinous tissue, mostly inappropriate for frozen sections. Smear technique for tissue diagnosis has been in use since 1930 and is routinely used for neurosurgical diagnosis in many European centres. It was started at the University Hospital of the West Indies in 1981. To evaluate the accuracy of the technique we analyzed smear diagnoses and compared them with paraffin section diagnoses. The results were compared with similar studies from other parts of the world. One hundred and forty-four biopsies, comprising 133 intracranial and 11 spinal biopsies, were analyzed. The correct diagnosis was made in 93 percent of cases. The conditions encountered were mainly neoplastic. In 10 cases, there were discrepancy between smear and paraffin section diagnosis. In 8 of the 10 cases, the error was in properly classifying the tumour and did not have any immediate significance on the management. Only in two cases could the error have had a management implication. There was no false negative and only one false positive when a meningioma was diagnosed on superficial biopsy material and on subsequent analysis of more specimen proved to be an inflammatory pseudo-tumour. The diagnostic accuracy (93 percent) was in keeping with similar studies from Europe and North America. The technique is simple, rapid, sensitive, accurate and appropriate for rapid diagnosis of neurosurgical biopsies. (AU)

Correlation between clinical and autopsy diagnosis at the University of the West Indies

Autopsies help in the understanding of the disease process, check the accuracy of clinical diagnosis and provide reliable data for the epidemiologist. Although the number of comparative autopsy studies is very limited, the rate of discrepancy between clinical and autopsy ranges from 4 to 68 per cent. To determine the discrepancy between clinical and autopsy diagnoses, and to find out the major disease groups where the errors are most frequently made, a preliminary study was undertaken. One hundred and seventy-eight consecutive autopsies at the University Hospital of the West Indies over an eighteen month period were analysed and the results were compared with similar studies from other institutions. The overall rate of major discrepancy was 16 percent. The most frequently missed diagnoses were thromboembolism (40 percent), followed by malignancies (25 percent) and infection (22 percent). Sickle-cell disease made a special group. In the majority of the sicklers there was no anatomical cause of death, neither was there a clinical diagnosis as to the cause of death. The overall discrepancy rate and the rate of error in major groups in this study is lower than in other similar studies (AU)

Metastatic carcinoma of the penis

Metastic carcinoma of the penis is uncommon. The primary tumour is most commonly reported to be in the genitourinary or gastrointestinal tract. A case of metastatic carcinoma of the penis, secondary to a primary carcinoma of the prostate gland, is described

Metastatic carcinoma of the penis

Metastic carcinoma of the penis is uncommon. The primary tumour is most commonly reported to be in the genitourinary or gastrointestinal tract. A case of metastatic carcinoma of the penis, secondary to a primary carcinoma of the prostate gland, is described (AU)

Malignant triton tumour of the spine

A malignant triton tumour is a malignant schwannoma with rhabdomyoblastic differentiation, and is a very rare occurrence. We describe the case of a 33-year-old man with neurofibromatosis type 1 who presented with paraplegia. Pathological examination of an intradural, extramedullary tumour excised at lumbar laminectomy demonstrated a malignant schwannoma with rhabdomyoblastic differentiation. We believe this is the first documented case of a malignant triton tumour of the spine

Plexiform neurofibroma: a rare cause of obstructive jaundice

A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed

Plexiform neurofibroma: a rare cause of obstructive jaundice

A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed (AU)

Malignant triton tumour of the spine

A malignant triton tumour is a malignant schwannoma with rhabdomyoblastic differentiation, and is a very rare occurrence. We describe the case of a 33-year-old man with neurofibromatosis type 1 who presented with paraplegia. Pathological examination of an intradural, extramedullary tumour excised at lumbar laminectomy demonstrated a malignant schwannoma with rhabdomyoblastic differentiation. We believe this is the first documented case of a malignant triton tumour of the spine (AU)

Identification of human T-cell leukemia/lymphoma virus type I antibodies, DNA, and protein in patients with polymyositis

OBJECTIVE: To investigate a possible association between human T cell leukemia/lymphoma virus type I (HTLV-I) and polymyositis (PM). METHODS: Sera and muscle biopsy samples from 9 Jamaican PM patients were compared with specimens from American HTLV-I positive PM patients and normal controls. Sera were evaluated for HTLV antibodies by enzyme-linked immunosorbent assay and Western blot. The biopsy samples were analyzed for HTLV-I/II DNA by polymerase chain reaction and were also immunohistochemically stained for HTLV gp46 envelope protein. RESULTS: Seven of the 8 Jamaican PM patients from whom sera were available were HTLV-I seropositive. The muscle biopsies of all 9 Jamaican patients demonstrated severe lymphocytic infiltration, cellular degeneration, myofiber atrophy, and fibrosis. Each muscle biopsy specimen contained HTLV-I DNA. Two of 6 samples demonstrated intense staining for HTLV-I gp46 in many of the invading mononuclear cells and weak staining for HTLV-I gp46 in many of the other specimens were weakly positive for gp46 in rare mononuclear cells. All controls specimens were negative for the presence of HTLV-I DNA and protein. CONClUSION: HTLV-I is associated with an inflammatory muscle disease characterized by direct invasion of the affected muscle by HTLV-I-infected mononuclear cells.(AU)