Fatal poisoning in Jamaica: a coroner's autopsy study from the University Hospital of the West Indies.

This study reviewed cases of fatal poisoning in a coroner's autopsy series at the University Hospital of the West Indies and represented the first such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed over the 20-year period January 1980 to December 1999 were reviewed retrospectively; 22 (1.0%) cases were identified and relevant clinical and pathological data analysed. There were 13 males and nine females (M:F ratio 1.4:1) with an age range of 2 - 69 years (mean +/- SD = 27 +/- 16.1 years). The 20 - 29 year group was most commonly affected and five patients (22.7%) were children (< 18 years of age). Pesticides (herbicides/ insecticides) were implicated in nine (41%) cases: paraquat was the most common, found in six (27%) cases. Prescription drugs were the next most prevalent group with six (27%) cases, followed by anti-psychotic drugs in four (18%) cases. Cocaine and ackee were each implicated in two (9%) cases. The manner of death was suicidal in 14 (64%) cases and accidental in eight (36%) cases. Seven patients had documented psychiatric illnesses, six of whom committed suicide. Autopsy findings were largely non-specific. The relatively small number of cases was consistent with the low incidence of fatal poisoning in Jamaica.

Androgen and vitamin D receptor expression in archival human breast tumors.

BACKGROUND: The present study was undertaken for quantitation of androgen (AR) and vitamin D (VDR) receptor expression in human male and female breast tumors by flow cytometry. METHODS: Nuclei isolated from sections of paraffin-embedded tumors by pepsin digestion were treated for antigen unmasking and incubated with antibodies to AR and VDR. Flow cytometric analysis was used to determine the percentage of receptor-positive nuclei with fluorescence greater than 95% of the isotype nuclei. Mean log fluorescence channel values were used for comparing antigen density of the isotype and the antibody-treated nuclei. RESULTS: Six of 23 female breast tumors had aneuploid DNA content. Nineteen of 20 estrogen receptor-positive female tumors by immunohistochemical analysis (IHC) were also AR positive by flow analysis. Aneuploid subpopulations had higher percentages of AR-positive nuclei than did diploid populations. Eight of 33 male breast tumors had aneuploid DNA content. Twenty-three of 33 male breast tumors were AR positive by flow analysis compared with six that were AR positive by IHC. Six AR-positive (IHC) male tumors were also AR positive by flow analysis. VDR expression was higher in diploid female tumors than in aneuploid tumors. CONCLUSIONS: Lack of a strong correlation between IHC and flow analysis may be due to differences in criteria used for identification of receptor-positive and -negative tumors by the two methods.

Traumatic deaths in Jamaica: a coroner's (medico-legal) autopsy study from the University Hospital of the West Indies.

This study reviewed the trauma-related deaths in a coroner's (medico-legal) autopsy series at the University Hospital of the West Indies and represents only the second such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed during the 15-year period January 1, 1983 to December 31, 1997 were reviewed retrospectively, and the clinico-pathological characteristics of trauma-related deaths were analysed. Trauma accounted for 470 (28.7%) of the 1,640 coroner's autopsies and the causes of death in descending order of frequency were motor vehicle accidents [MVAs] (44.9%), blunt injuries (17.7%), burns (16.8%), firearm injuries (13.6%) and stab injuries (7.0%). The 21-30 age group was the most commonly affected and the overall male: female ratio was 4:1. The distribution of injuries (excluding burns) by anatomical region was head and neck (43.8%), chest (8.9%), abdomen and pelvis (4.3%), extremities (0.9%) and multiple sites (25.3%). Forty-nine (23.2%) of the victims of MVAs were documented to have been pedestrians. Blunt trauma was most commonly due to accidental falls followed by assaults. Flame burns accounted for 90% of burn cases. There were seven (1.5%) cases of suicide overall. In this series the majority of trauma-related deaths occurred in young males and were due to MVAs. Strategies aimed at reducing trauma-related mortality should therefore emphasize road traffic safety programmes, particularly targeting the young.

Clear cell carcinoma of the breast with immunohistochemical evidence of divergent differentiation.

Primary clear cell carcinoma of the breast is a rare tumor. The clear cell morphology of the neoplastic population in these tumors has been ascribed to the presence of intracellular lipid, mucin or glycogen, or to myoepithelial, apocrine, or neuroendocrine differentiation. However, a clear cell neoplasm exhibiting evidence of a range of differentiation has not been previously reported. We describe a case of a glycogen-rich primary clear cell breast carcinoma occurring in a 59-year-old woman that showed positivity for apocrine and neuroendocrine markers, as well as possible myoepithelial differentiation. The tumor was a 4-cm mass composed predominantly of periodic acid-Schiff-positive clear cells arranged in a solid, infiltrative pattern. Immunohistochemical staining of the tumor cells was variably positive for cytokeratin, progesterone receptors, gross cystic disease fluid protein-15, neuron specific enolase, chromogranin, and S-100 protein and negative for estrogen receptors, smooth muscle actin, CD31, and CD34. The patient refused any form of further investigation or treatment, but shows no evidence of recurrence or metastatic disease after 18 months of follow-up.

Marking of wire-localized breast biopsies for mammographically detected microcalcifications.

Impalpable breast lesions that are detected during screening mammography for breast cancer must be accurately identified and adequately sampled in biopsy specimens. Open wire-localized breast biopsy using hookwires remains the main method of sampling these lesions in centres without expensive stereotactic facilities. However, the hookwires can shift or become dislodged in the biopsy specimen. We have successfully modified a simple technique for the localization of impalpable lesions in these biopsies. The insertion of a small hypodermic needle into the fixed specimen with the assistance of the compression paddle and crosshairs on the mammography machine resulted in the precise localization of clusters of microcalcifications in 15 of 16 (94%) cases. In contrast, calcifications were identified in sections taken in the plane of the hookwire in only three cases (19%). The rate of detection of malignancy was 50% and the majority of malignant lesions were represented by ductal carcinoma in situ.

Marking of wire-localized breast biopsies for mammographically detected microcalcifications

Impalpable breast lesions (AU)

Abnormal Papanicolaou (PAP) smears at UWI, 1997-1999 [abstract]

OBJECTIVE: Our aim was to document the distribution of epithelial abnormalities diagnosed on Pap smears in the Department of Pathology, the University of the West Indies (UWI), Mona, Jamaica, and to determine the likelihood of the prescence of clinically significant disease on biopsy for a given cytological diagnosis. METHODS: We reviewed the results of all Pap smears accessioned in the Cytology Unit of the Department of Pathology, over the 3-year period 1997-1999 and collated the epithelial abnormalities using a hybrid cervical intraepithelial neoplasia (CIN)/Bethesda system. We calculated the atypical squamous cells of undetermined significance (ASCUS) rate, the CIN rate and the ASCUS/CIN ratio. Follow-up histology results were obtained from the departmental files. The likelihood ratios (LRs for clinically significant disease on histology for each cytological category were calculated. RESULTS: During the study period a total of 21,144 Pap smears were accessioned, 1,324 (6.3 percent) of which showed epithelial abnormalities. These abnormal Pap smears were most prevalent in the 21-30 year age group (37.5 percent of patients). The distribution of epithelial abnormalities was: ASCUS 34.7 percent, atypical glandular cells of undetermined significance (ASCUS) 1.1 percent, ASCUS/AGUS 0.2 percent, CIN 141.4 percent, CIN II 12.5 percent, CIN III 8.3 percent, sqaumous cell carcinoma (SCC) 1.3 percent, adenocarcinoma (AC) 0.3 percent and vaginal intraepithelial neoplasia (VAIN) II/III 0.2 percent. The CIN rate, ASCUS rate and ASUCS/CIN ratio were 3.9 percent, 2.2 percent and 0.6 respectively. Histological follow-up was available for 477 (36 percent) cases. The LRs for clinically significant disease for the following cytological diagnoses were: AGUS: 0.08, ASCUS: 0.31, CIN I: 1.12, CIN II: 2.01 and CIN III: 3.38. All cases of SCC, AC and VAIN with histological follow-up were shown to be clinically significant. CONCLUSIONS: There was a relatively low incidence of epithelial abnormalities in Pap smears seen at the UWI during the study period with ASCUS and CIN 1 compromising the majority of cases. Biopsy follow-up showed an increasing likelihood for the presence of clinically significnat disease with increasing degrees of epithelial atypia on Pap smear. (AU)

Granulomatous lobular mastitis. A case report and review of the literature

Granulomatous labour mastitis is a rare, benign, inflammatory breast condition of unknown aetiology that can clinically mimic breast cancer. Awareness of this condition is important, as the appropriate specimens must be taken to confirm the diagnosis and to rule out an infectious aetiology. While surgical exclusion has been the traditional therapeutic modality, the most appropriate therapy seems to involve the use of corticosteriods, even in the case of recurrence. (AU)

The use of the rapid papanicolaou staining method in fine needle aspiration cytology of the breast at the University Hospital of the West Indies

OBJECTIVE: The aim was to determine the efficacy of the rapid Papanicolaou staining method (RPSM) in fine needle aspiration (FNA) cytology of breast lesions. METHODS: In a prospective study performed between May 1999 and June 2000, FNA specimens were obtained from patients attending the surgical out-patient and breast imaging services of the UHWI for the assessment of breast leisons. One-half of the slides from each specimen were stained by the RPSM, which reduces routine staining time by 80 percent (rapPaps), and the other half stained by the routine Papanicolaou method (routPaps). Specimens that were inadequate based on rapid assessment were immediately repeated. For each group of slides the smear quality, cytologic diagnoses and results of any related biopsy specimens were documented. The concordance between the cytology diagnoses and between the cytologic and histologic diagnoses was determined. RESULTS: One hundred specimens were obtained from 90 patients (M:F = 1:8; average age 42.3 years). RapPaps averaged 2.9 slides per case and routPaps 3.4; 71 percent and 77 percent of rapPaps and routPaps, respectively, had adequate cellular material, and 84 percent and 85 percent of these groups, respectively, displayed satisfactory cellular preservation. There was 83 percent, 52 percent and 56 percent concordance between rapid and routine cytologic diagnoses, rapid and histologic diagnoses, and routine and histology diagnoses, respectively. Non-concordance was due to lack of cellular material in 14/17 (82 percent), 12/23 (52 percent) and 10/21 (48 percent) cases, respectively. Of the remainder, 6 cases represented major diagnostic discrepancies in which atypical cytologic smears were confirmed to be benign lesions on histology. CONCLUSION: These findings show that staining FNA specimens by the rapid Papanicolaou method allows for accurate cytology evaluation of breast leisons at UHWI. The handling of cytologic specimens by this method can be an important cost- and time- saving strategy in the management of patients presenting to the out-patient services. (Au)

Autopsy rates at the University Hospital of the West Indies, 1968-1997

Autopsy rates have not been reported at the University Hospital of the West Indies (UHWI) for more than three decades. Declining rates have been documented worldwide, and so we sought to define autopsy rates over the past three decades at UHWI. We conducted a retrospective analysis of the numbers and types of autopsies performed on deaths occuring in the institution, and calculated the relevant autopsy rates. The overall autopsy rate for the study period was 52.7 percent with a statistically significant decline from 65.3 percent in the first decade to 39.3 percent in the third. The non-coroner's autopsy rate showed a concomitant decline from 57.5 percent to 31.5 percent while the coroner's autopsy rate remained stable with a slight increase from 28.1 percent to 29.1 percent. The factors that might have led to the decline of the autopsy are discussed.(AU)

Autopsy rates at the University Hospital of the West Indies, 1968-1997

Autopsy rates have not been reported at the University Hospital of the West Indies (UHWI) for more than three decades. Declining rates have been documented worldwide, and so we sought to define autopsy rates over the past three decades at UHWI. We conducted a retrospective analysis of the numbers and types of autopsies performed on deaths occuring in the institution, and calculated the relevant autopsy rates. The overall autopsy rate for the study period was 52.7 percent with a statistically significant decline from 65.3 percent in the first decade to 39.3 percent in the third. The non-coroner's autopsy rate showed a concomitant decline from 57.5 percent to 31.5 percent while the coroner's autopsy rate remained stable with a slight increase from 28.1 percent to 29.1 percent. The factors that might have led to the decline of the autopsy are discussed.

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.(AU)

Testicular metastases from carcinoma of the prostate

Secondary testicular tumours are uncommon and most originate from prostatic carcinoma. A retrospective study of the clinico-pathological features of prostatic carcinoma metastatic to the testes was conducted in the Department of Pathology, University of the West Indies, Jamaica, for the period June 1958 to January 1998. Metastatic prostatic carcinoma was seen in 1.4 percent of the 284 orchiectomy specimens examined. A brief review of the literature related to this entity was undertaken.(AU)

Beyond fibrocystic disease: the evolving concept of pre-malignant breast cancer

There is a broad spectrum of benign and pre-malignant breast disease that may be diagnosed on biopsy. Some of these conditions place affected women at significantly increased risk for breast cancer, particularly the atypical hyperplasias. All health care workers should be aware of recent developments in this important aspect of breast disease. The classification, criteria for diagnosis, associated risks for cancer development and various controversies related to these benign and borderline breast diseases are discussed.(AU)

Massive ascites secondary to severe endometriosis

Massive ascites is an unusual association with endometriosis. This case report is of such a condition in an Afro-Jamaican woman. The diagnosis was made at laparotomy and conservative treatment was adopted allowing for retention of reproductive function. Postoperative therapy was Goserelin, a Gonadotropin Releasing Hormone (GnRH) agonist, for six months. This relieved all of her symptoms. However, long term follow-up is needed, as recurrence is possible.(AU)

Malignant lymphoma of gastric mucosa-associated lymphoid tissue in Jamaica

The recently appreciated concept of Mucosa-Associated Lymphoid Tissue (MALT) and the characteristics of the lymphomas arising therein are discussed with reference to the clinical, histological and immunohistochemical features of the first four cases of gastric MALT lymphomas diagnosed at the University Hospital of the West Indies. These tumours are low-grade B-cell lymphoas, which may undergo high-grade transformation. They are aetiologically associated with Helicobacter pylori (H pylori) infection in the stomach and may be cured in the early stages with antibiotics. Our cases were diagnosed from gastrectomy specimens removed for suspected carcinoma. All were high-grade, and associated with H pylori; 3 cases presented as advanced disease. Documentation of the features of these lymphomas will increase awareness and earlier recognition (AU)