Prawat Nitiyanant

Tuberculous infection of the hand and wrist

The authors report on 23 patients treated for tuberculosis of the hand and wrist during the past 20 years. Duration of symptoms prior to diagnosis ranged from several months to years. Swelling and pain on motion were common symptoms, as was increased sedimentation rate. Granulomatous inflammation was seen on paraffin section in most of the patients, however tissue cultures were positive for Mycobacterium tuberculosis in only 6 patients in this study. Treatment of these patients was divided into medical and surgical treatments. The incisional biopsy and antituberculous drug were carried out and administered in the medical-treated group for 2 years. The surgical synovectomy as well as debridement and administration of antituberculous drugs were carried out on the surgical group. The results showed no recurrence in this study. Most of the patients showed improved symptoms and an increased range of motion. In conclusion, this treatment resulted in good recovery of function with low morbidity.Visuthikosol V, Kruavit A, Nitiyanant P, Siriwongpairat P. Tuberculous infection of the hand and wrist.

Primary hepatic clear cell myomelanocytic tumor

A case of hepatic clear cell myomelanocytic tumor in a 31‐year‐old woman presenting clinically with abdominal pain is reported. Histopathologic examination showed a lesion characterized by a population of large epithelioid cells with clear or eosinophilic granular cytoplasm, rich in glycogen. Immunohistochemically, the tumor cells were positive for HMB‐45, Melan‐A and muscle‐specific actin, but negative for epithelial markers, desmin, S‐100 protein, and neuroendocrine markers. Ultrastructurally, the tumor cells had abundant glycogen, well‐developed rough endoplasmic reticulum, microtubules and aberrant melanosomes. Clinical and pathologic features with a brief review of the relevant literature for hepatic CCMMT as a variant of perivascular epithelioid cell tumor (PEComa) are discussed.

Salvage treatment for sarcomas of the hand.

We report 6 patients (1 male and 5 females; age range, 13–77 years) with hand sarcoma. The lesions were located between the digits and the distal end of the radius. A painless mass was the common manifestation in these patients. An incisional biopsy was performed on every patient, and histology revealed two low-grade malignant sarcomas and four high-grade malignancies. A surgical salvage procedure was performed. The 4 patients with high-grade malignancy underwent adjuvant therapy such as radiotherapy and/or chemotherapy. Four patients are still alive and exhibit acceptable function in the affected hand. Our surgical procedure is presented.

Oropharyngolaryngeal Sarcocystosis and Histoplasmosis Co-Infection in a Patient with Systemic Lupus Erythematosus

Sarcocystosis is an uncommon zoonotic coccidian protozoal infection caused by Sarcocystis spp. Muscular sarcocystosis have been detected in patients with various types of cancer but co-infection with histoplasmosis has never been reported. We report a 39-year-old woman with active lupus nephritis who presented with hoarseness for eleven months. Physical examination and magnetic resonance imaging revealed an irregular exophytic mass at the left oropharynx and the left true vocal cord. The histopathologic diagnosis was oropharyngolaryngeal sarcocystosis and histoplasmosis. She was treated with oral itraconazole for histoplasmosis. The authors briefly review the clinicopathologic features and pathogenesis of oropharyngolaryngeal sarcocystosis and histoplasmosis and conclude the possibility of co-infection of oropharyngolaryngeal sarcocystosis and histoplasmosis, especially in immunocompromised patient.

Granulocytic sarcoma of the breast: a case study in LAO PDR

Granulocytic sarcoma (GS) also called, myeloid sarcoma, chloroma, myeloblastoma or extra medullary myeloid tumor is an extra medullary hematopoietic neoplasm composed of immature myeloid cell (myeloblasts). GS may occur in leukemia, myeloproliferative disorder. GS can occur in any site of the body; common sites of involvement include bone, CNS, soft tissue, lymph nodes and skin, but breast is very rare. GS of breast have been reported both before and after hematological diagnosis. Primary, isolate or non-leukemic GS of breast was described when bone marrow biopsy to confirm as no other hematologic malignancy. Depending on review of all Medline cases reported, only 24 cases of primary were commonly in unilateral site, and only 4 cases were bilateral site. The incidence of GS of breast is 2/1,000,000 in adults and ages ranged from 16–72 years (mean 31 years). The histology was composed of homomorphous of eosinophil cytoplasm of immature cell with single or multiple nucleoli. The malignant cells were positive for myeloperoxidase (MPO), CD43, CD34, TDT, CD 117, CD68 and negative for CD20, CD30, CD3, CD56, CD79 and ULH1.The differential diagnosis included lymphoma and poorly differentiated carcinoma. The prognosis was very poor. We report a case of granulocytic sarcoma (GS) in the left breast of a 33-year-old woman who presented with breast mass, which was diagnosed as diffuse lymphoma, large cell type on H&E histopathology without any special straining, immunohistochemical and very limited of patient information such as echography, CBC, FNA or biopsy of breast or bone marrow tissue. The final diagnosis was made by additional immunohistochemical study.