Hepatitis B associated nephrotic syndrome in Jamaican children: a 12 year review

Between December 1984 and November 1996, 171 children under 12 years of age presented to the University Hospital of the West Indies with nephrotic syndrome. Of these, 10 were diagnosed hepatitis B surface antigen (HbsAg) positive on routine screening. Their clinicopathological data were analyzed and renal histology documented. Eight of the ten children had membranous nephropathy (MN), while the remainder had mesangial proliferative glomerulonephritis (MesN) and minimal change nephrotic syndrome (MCNs). The young ages and steroid sensitivity of these two children suggested that hepatitis B virus (HBV) infection was coincidental rather than causative. Steroids were ineffective in inducing remission in any of the 4 MN patients so treated. At a mean follow-up of 36 months, 7/10 patients had experienced complete or partial remission and 3 had persistent nephrotic syndrome. None was in renal failure and 60 percent had asymptomatic biochemical hepatitis. Remission occurred in the MN group either 2 to 9 months from the onset of oedema whether or not steroids were administered. Our data suggest that the prevalence of HBV infection in Jamaica may be intermediate rather than low and that the route of transmission may be horizontal. It is recommended that hepatitis B vaccination be a part of the regular immunization in Jamaica, and that all children with nephrotic or atypical glomerular disease be screened for HbsAg as HBV nephropathy is usually clinically indistinguishable from idiopathic renal disease.(AU)

Thyroid papillary carcinoma arising in a branchial cleft cyst

We describe the clinico-pathological features and discuss the possible pathogenetic mechanism of thyroid papillary carcinoma arising in a branchial cleft cyst. This has been described only once previously in the literature.

Thyroid papillary carcinoma arising in a branchial cleft cyst

We describe the clinico-pathological features and discuss the possible pathogenetic mechanism of thyroid papillary carcinoma arising in a branchial cleft cyst. This has been described only once previously in the literature. (AU)

Idiopathic foca and segmental glomerulosclerosis in Jamaica: a 10 year review

Idiopathic focal and segmental glomerulosclerosis (IFSGS) in a predominantly black population does not appear to behave any differently than in Caucasian patients. Response to steroid therapy and cyclophosphamide had favourable prognostic significance. There may be a subgroup of IFSGS which responds more slowly to steroids. The duration of steroid therapy should extend beyond four months

Idiopathic foca and segmental glomerulosclerosis in Jamaica: a 10 year review

Idiopathic focal and segmental glomerulosclerosis (IFSGS) in a predominantly black population does not appear to behave any differently than in Caucasian patients. Response to steroid therapy and cyclophosphamide had favourable prognostic significance. There may be a subgroup of IFSGS which responds more slowly to steroids. The duration of steroid therapy should extend beyond four months (AU)

Glomerulonephritis after human parvovirus infection in homozygous sickle-cell disease

Glomerulonephritis with proteinuria of sufficient degree to manifest the nephrotic syndrome followed aplastic crises induced by human parvovirus (B19) in seven patients with homozygous sickle-cell disease, within 7 days in five patients and 6-7 weeks in two. Segmental proliferative glomerulonephritis was found in all four patients who underwent acute renal biopsies and focal segmental glomerulosclerosis was found in the fifth patient who had a biopsy 4 months later. One patient recovered completely, one died in chronic renal failure after 3 months, and the others had impaired creatinine clearance, four with continuing proteinuria (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 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)

Nephrotic syndrome and human parvovirus infection in homozygous sickle-cell disease: a temporal association - abstract

Proteinuria of sufficient severity to manifest the nephrotic syndrome and renal impairment has been associated with human parvovirus (B19) infection in 7 patients with homozygous sickle-cell (SS) disease. In most patients, the proteinuria resolved but renal impairment remained. The glomerular histology showed evidence of segmental proliferative glomerulonephritis in 4 out of 5 biopsies. Most events occurred within 2 weeks of B19 associated aplastic crisis, and the mechanism is at present unknown. This association may add to the pathogenic significance of B19 infection in SS disease (AU)

Outcome of solid renal tumours in children at the University Hospital of the West Indies

Of the twenty-nine children with solid tumours treated at the University Hospital of the West Indies (UHWI) between January, 1972 and December, 1991, there were twenty-eight cases of nephroblastoma and one of mesoblastic nephroma. Peak incidence was between the ages of two and four years. Twenty-five children had radical nephrectomy while one had bilateral partial nephrectomy. In thirteen cases, pre-operative chemotherapy and radiotherapy was used. Post-operative chemotherapy and radiotherapy were used in 24 and 13 cases, respectively. Stage of the tumour was the most decisive factor influencing the outcome. Whereas there was 100 per cent cure rate in Stages I and II, Stage III had only a 55.5 per cent survival rate and non of the Stage IV survived. Bilateral (Stage V) tumours are curable if individual tumours are localised, as in one of the two cases. The benign mesoblastic nephroma, in a one-month-old infant, was cured by nephrectomy alone. While the present therapy of radical nephrectomy along with combination chemotherapy is satisfactory for early stages, more aggressive adjuvant therapy is needed for improving the results in Stages III and IV

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)

Outcome of solid renal tumours in children at the University Hospital of the West Indies

Of the twenty-nine children with solid tumours treated at the University Hospital of the West Indies (UHWI) between January, 1972 and December, 1991, there were twenty-eight cases of nephroblastoma and one of mesoblastic nephroma. Peak incidence was between the ages of two and four years. Twenty-five children had radical nephrectomy while one had bilateral partial nephrectomy. In thirteen cases, pre-operative chemotherapy and radiotherapy was used. Post-operative chemotherapy and radiotherapy were used in 24 and 13 cases, respectively. Stage of the tumour was the most decisive factor influencing the outcome. Whereas there was 100 percent cure rate in Stages I and II, Stage III had only a 55.5 percent survival rate and non of the Stage IV survived. Bilateral (Stage V) tumours are curable if individual tumours are localised, as in one of the two cases. The benign mesoblastic nephroma, in a one-month-old infant, was cured by nephrectomy alone. While the present therapy of radical nephrectomy along with combination chemotherapy is satisfactory for early stages, more aggressive adjuvant therapy is needed for improving the results in Stages III and IV (AU)

Adult T-cell leukemia/lymphoma in a renal transplant recipient

A 42 year old man with chronic renal failure and homograft transplantation developed adult T-cell lymphoma in one native kidney. The role of transfusion in the acquisition of human T-lymphotropic virus type 1 and its role in the early development of adult T cell lymphoma, particularly on the background of chronic immunosuppression, are discussed. To our knowledge, this is the first such case. (AU)

Renal pathology in diabetes mellitus - abstract

The morphological changes in both insulin-dependent and non-insulin-dependent diabetes mellitus (IDDM and NIDDM) are indistinguishable. The earliest pathological changes are enlarged glomeruli due to hypertrophy seen mainly in IDDM patients. There is also an increase in total volume of both basement membrane (BM) and capillary lumen. A second peak of glomerular hypertrophy occurs late in the disease when overt pathological changes are established. At this, many glomeruli are comprised and the open, functioning glomerulii will show a three-fold increase in size. The pathognomonic change in diabetic nephropathy is nodular glomerulosclerosis or nodular intercapillary glomerulosclerosis (Kimmelstiel-Wilson lesion) which is characterised by enlargement of mesangium due to increase in mesangial matrix. This is associated with diffuse thickening of the capillary wall which is due to increased BM material. A diffuse lesion may be considered specific after ruling out all the other causes of thickened BM, i.e. immune-complex glomerulonephritis, anti-glomerular basement membrane antibody disease, etc. The exudative and capsular drop lesions are not specific for diabetes mellitus but can be considered to be highly suggestive lesions. There is hyaline arteriolosclerosis, involving both afferent and efferent arterioles. The only pathognomonic tubular lesion (Armanni-Ebstein lesion) is a rare finding, and is found in the straight portion of the proximal convoluted tubules in which tubular cells contain glycogen. The patients with the nephropathic syndrome may show lipid-filled proximal tubules. In the late stages, there are non-specific atrophic changes with thickening of the basement membrane. There are no specific gross features of the kidney in diabetes mellitus. It may be enlarged, normal or granular contracted. The subscapular surface may either be finely or coarsely granular with focal depressed scars. The cut surface may show thinning of the cortex, loss of the corticomedullary junction and prominent blood vessels. Papillary necrosis is uncommon (AU)

Solid renal tumours in children at the University Hospital of the West Indies - abstract

Between January 1972 and December 1991, twenty-nine children with solid renal tumours were treated at the UHWI. Twenty-eight of these were nephroblastomas and one was a mesoblastic nephroma. Peak incidence was between the ages of two and four years. Abdominal distension, mass and pain were the common presenting features. A palpable mass was present in all, which could be confirmed by intravenous urogram and/or ultrasound to be of renal origin. Chest X-ray revealed metastic lesions in six cases. Twenty-five children had radical nephrectomy while one had bilateral partial nephrectomy. In thirteen cases, pre-operative chemotherapy ñ radiotherapy was used. Post-operative chemotherapy and radiotherapy were used in twenty-four and thirteen cases, respectively. Stage of the tumour was the most decisive factor influencing the outcome. Whereas there was a 100 per cent cure rate in Stages I and II, Stage III had only 55.5 per cent survival rate and none of the Stage IV survived. The histology or size of the tumour were not critical factors. While the present therapy of radical nephrectomy along with the combination chemotherapy is unsatisfactory for early stages, more aggressive chemotherapy and improved radiotherapy are needed for improving the results in Stages III and IV. Bilateral (Stage V) tumours are curable if individual tumours are localised, as in one of two cases. The benign mesoblastic nephroma, in a one-month old infant, was cured by nephrectomy alone (AU)

Thyroid-Gonad relationship in systemic lupus erythematosus

Thirty women with systemic lupus erythematosus (SLE) were examined to assess the thyroid-gonad relationship. Significant decreases in mean serum tri-iodo-thyronine and testerone levels and increases in mean serum estradiol and luteinizing hormone levels were observed in SLE patients as compared to control subjects. The serum levels of thyroxine, thyrotropin, tri-iodo-thyronine uptake, free thyroxine index and prolactin were, however, not significantly different in both groups. The interpretation of these findings is unclear but SLE could be regarded as one of the nonthyroidal systematic illness since low serum tri-iodo-thyrotropin levels were observed in our patients. Furthermore, high levels of estradiol and low levels of testosterone in our female patients may indicate involvement of sex steroids in the pathogenesis of SLE. (AU)

Warthin's tumour in Jamaica: incidence, electron microscopy and immunoenzyme studies

Warthin's tumour has traditionally had a strong male association, and has been said to be rare in Blacks. Current studies describe a newtrend; a rise in females, strongly linked to cigarette smoking. The tumour has eosinophilic epithelial cells packed with distinctive mitochondria, and a lymphoid stroma. Immunological investigations have demonstrated polyclonal B cells and macrophages. Views differ as to whether B or T cells predominate. Between 1958 and 1989, the Jamaica Cancer Registry recorded 491 benign and malignant salivary gland tumours. There were 18 cases of Warthin's tumour (3.7 percent), with a male:female ratio of 5:1. The low proportion of females is similar to the trend for female lung cancer in Kingston & St. Andrew. A case of Warthin's tumour was studied by light and electron microscopy and immunoenzyme methods. The epithelial cells contained numerous mitochondria with stacked cristae, as previously described. Similar morphology occurs in oncocytic tumours; riboflavin-deficient rats and mice; rats given non-lethal doses of hypoglycin; dogs treated with annatto extracts; and hibernating or starving frogs. The mitochondrial changes may be an adaptive response. The immunoenzyme studies utilized newly available monoclonalantibodies: UCHLI, L26, 4KB5, MT1 and LN2. The reaction patterns indicate a distribution of B and T cells in a manner expected in a lymph node. The interaction between mitochondrial changes adaptive metabolic pathways, the immune cells and tobacco raises some interesting questions (AU)

Fine needle aspiration biopsy in the diagnosis of breast cancer

A prospective study if 176 fine needle aspiration biopsy (FNAB) in 172 patients was carried out to assess the accuracy of FNAB in diagnosing breast cancer at the University Hospital of the West Indies. The results showed 99 per cent and 97 per cent accuracy and sensitivity rates, respectively. There were no false positives and a one per cent false negative rate. FNAB provides a rapid, safe and cheap method of accurately diagnosing breast cancer (AU)

Warthin's tumour in Jamaica: incidence, electron microscopic and immunoenzyme studies - abstract

Warthin's tumour has traditionally had a strong male association, and has been said to be rare in Blacks. Current studies describe a new trend: a rise in females, strongly linked to cigarette smoking. The tumour has eosinophilic epithelial cells packed with distinctive mitochondria, and lymphoid stroma. Immunological investigation has demonstrated polyclonal B-cell, T-cells and macrophoages. Views differ as to whether B or T cells predominated. Between 1958 and 1989, the Jamaican Cancer Registry recorded 491 benign and malignant salivary gland tumours. There were 18 cases of Warthin's tumour (3.7 per cent), with a male:female ratio of 5:1. The low proportion of females is similar to the trend for female lung cancer in Kingston and St. Andrew. A case of Warthin's tumour was studied by light and electron microscopy and immunoenzyme methods. The epithelial cells contained numerous mitochondria with stacked cristae, as previously described. Similar morphology occurs in oncocytic tumours; riboflavin-deficient rats and mice; rats given non-lethal doses of hypoglycin; dogs treated with annatto extracts; and starving frogs. The mitochondrial changes may be an adaptive response. The immunoenzyme studies utilized newly available monoclonal antibodies: UCHL1, L26, 4KB5, MT1 and LN2. The reaction patterns indicate a distribution of B and T cells in a manner expected in a lymph node. The interaction between mitochondrial changes, adaptive metabolic pathways, the immune cells and tobacco, raises some interesting questions (AU)