Colonic Lipomas at the University Hospital of the West Indies

Lipomas of the colon are uncommon but cause diagnostic difficulty when they are symptomatic. The clinical and pathological features of 17 cases of colonic lipomas diagnosed at the University Hospital of the West Indies between 1970 and 1999 are reported. Ten cases were symptomatic, two of these being diagnosed with adult intussusception. Six patients had incidental lipomas in bowel resected for other patholgoy while one lipomas was diagnosed an sigmoidoscopy. Increased awareness of these lesions will enhanced pre-operative diagnostic accuracy.(Au)

Splenic cysts - a Jamaican experience

A total of eleven (11) cases of non-parasitic splenic cysts have been studied at the University Hospital of the West Indies by routine haematoxylin and eosine and immunohistochemcial staining, using epithelial markers (cytokeratin, low molecular weight keratin and epithelial membrane antigen). The majority (eight of eleven) were found to epithelial or true cysts. This is in contrast to findings previously reported in the literature, based on light microscopic examination, that the majority of splenic cysts are non-epithelial in origin. We therefore suggest that immunohistochemical studies should be used routinely to accurately define the nature of all splenic cysts.

Splenic cysts - a Jamaican experience

A total of eleven (11) cases of non-parasitic splenic cysts have been studied at the University Hospital of the West Indies by routine haematoxylin and eosine and immunohistochemical staining, using epithelial markers (cytokeratin, low molecular weight keratin and epithelial membrane antigen). The majority (eight of eleven) were found to epithelial or true cysts. This is in contrast to findings previously reported in the literature, based on light microscopic examination, that the majority of splenic cysts are non-epithelial in origin. We therefore suggest that immunohistochemical studies should be used routinely to accurately define the nature of all splenic cysts. (AU)

Inflammatory pseudotumour of the spleen: report of a case and review of the literature

A case of inflammatory pseudotumour of the spleen in a 34-year-old female patient is described. We have briefly reviewed the literature on the subject and discussed aetiopathogenesis, pre-operative differential diagnosis and treatment modalities.

Splenic cysts: a Jamaican experience

Epithelial cysts of the spleen are common and comprises approximately 10 percent of all non-parasitic cystic lesions. They are more common in females and are usually found in children and young adults. They are considered to be congenital in origin but the actual pathogenetic mechanism is not known. However, it is said to be due to metaplasia of the celomic epithelium or heterotopic endodermal inclusions within the spleen. It is also believed to be due to an embryonic defect in the aggregation of the mesodermal island. These cysts are usually large, unilocular or multilocular with fibrous trabeculation of the wall which is lined at least in part by stratified squamous epithelium. They are filled with yellow and brownish hemorrhagic or clear straw colour fluid. They vary in size. This communication describes eight such cases, one of which was reported in 1961 by Gore and Harland, found in the files of Pathology Department between 1953 to 1991. The age ranges between 10 - 31 years with 62 percent of it being females. The size of the spleen varies between 230 gm to 2,300 gm. Immunohistochemical methods were used to demonstrate the epithelial nature of the lining of the cysts in some cases. Clinical presentation, pathological findings, pathogenesis and treatment are discussed. (AU)

Inflammatory pseudotumour of the spleen: report of a case and review of the literature

A case of inflammatory pseudotumour of the spleen in a 34-year-old female patient is described. We have briefly reviewed the literature on the subject and discussed aetiopathogenesis, pre-operative differential diagnosis and treatment modalities (AU)

Solitary rectal ulcer syndrome

Solitary rectal ulcer syndrome (Rectal prolapse syndrome) is an uncommon and imperfectly understood entity which, however, should be included in the differential diagnosis of ano-rectal symptoms. This article reports on the nine cases so far diagnosed at the University Hospital of the West Indies (UHWI), and offers a brief review of the condition (AU)

Acute acalculous cholecystitis

Acute acalculous cholecystitis is now well recognised but is almost certainly not an homogeneous entity. The recognition of at least two sub-groups would appear to enhance the clinical perspective of this problem and facilitate on-going study and discussion. Two cases representing one of these sub-sets are reported, and both varieties are described. (AU)

Chronic pancreatitis in Jamaica

Thirty-five patients with chronic pancreatitis (CP) treated with over a 15-year period were studied. There were 29 men and 6 women with a mean age of 47 years (range 21-67). Twenty-seven (77 percent) were chronic alcoholics, two (6 percent) had gallstones, one had stenosis of the Ampulla of Vater and in five (14 percent) no obvious cause was found. Thirty patients (86 percent) presented with abdominal pain. Chronic diarrhoea was present in 8 (23 percent), and steatorrhoea was documented in 6 of these. Fifteen (43 percent) had pancreatic calcifications. Five developed pseudocysts and 16 (46 percent) developed diabeted mellitus. Twelve patients required surgery. Three continue to have severe recurrent relapses of pain but the majority (91 percent) have had a relatively stable course with medical management. (AU)

Appendicectomy at the University Hospital of the West Indies (1984-1988): A retrospective review

The pathological records of appendicectomy specimens from patients with suspected acute appendicitis at the University Hospital of the West Indies during the 5-year period 1984-1988 were studied. The numbers of cases, their ages, sex and seasonal incidence were similar to those of other studies. The over-all false positive diagnosis rate was 25 percent (16 percent in males, 38 percent in females). The main diagnostic difficulty was in young females in whom surgery for suspected appendicitis often proved unnecessary. (AU)

Evaluation of thyroid nodules by fine needle aspiration cytology: a prospective study

A prospective study of 200 fine aspiration cytology specimens from 194 patients with thyroid nodules at the University Hospital of the West Indies in Jamaica showed a 95 percent accuracy when the results were compared with histopathology reports of the subsequent thyroidectomy surgical specimens in 86 patients. The false negative rate was 3 percent (for neoplasia), and there was a false positive rate of 10.5 percent. Fine needle aspiration cytology thus proves to be an accurate, specific and sensitive method of assessment of thyroid nodules which ultimately reduces unnecessary surgical intervention (AU)

Evaluation of thyroid nodules by fine needle aspiration cytology - abstract

A prospective pilot study was undertaken to correlate the results of fine needle aspiration cytology (FNAC) and routine histology, in cases of nodular goitre, in order to assess the reliability of FNAC, as a diagnostic tool. Forty-eight patients with nodular (clinically single or multi-nodular) goitres had FNAC performed by standard technique under general anaesthesia just before the operation. Cytological evaluation of the aspirate compared with the histology as reported independently by the duty staff pathologist. Of the 48 cases, 13 smears were reported as "inadequate for diagnosis" (most of these near the start of the study) and 3 smears as "inconclusive". The FNAC positive and negative predictive values were respectively 0.75 and 0.72. The FNAC false positive rate of 6 out of 25 (24 percent) is high, but this still means that 19 out of 25 patients with hyperplasia might have been spared surgery. Of more importance is the FNAC false negative rate of 2 out of 7 as this would be the rate of missing a neoplasm and inducing surgical delay. Our results do not compare well with most large series; although FNAC could become, in our hands, a technique reliable enough to guide clinicians in selecting those nodular goitres which should be explored and thereby decrease the rate of unnecessary thyroid surgery, it is a technique requiring experience before reliable results are obtained (AU)

Ileo-colic volvulus

Three cases of volvulus of the right colon are presented, and the current literature is reviewed. Prompt diagnosis based on clinical suspicion and plain abdominal radiographs can be made. Urgent operative treatment is mandatory. If gangrene has already occurred or if the volvulus cannot be untwisted, primary resection or a Mikulicz procedure should be performed depending on the patient's condition after applying soft clamps to the bowel proximally and distally. In non-gangrene cases, simple detortion is inadequate. Right hemicolectomy may be performed in the fitter patients but caecopexy of the peritoneal flap type has been shown to be promising, and appears to be as effective and perhaps safer in less experienced hands. (AU)