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Xu X, Seet JE, Yap QV, Chao SS, Thong MKT, Wang DY, Ong YK. Latent class analysis of structured histopathology in prognosticating surgical outcomes of chronic rhinosinusitis with nasal polyps in Singapore. Rhinology 2023:3079. [PMID: 37219028 DOI: 10.4193/rhin22.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Structured histopathology profiling is recommended when reporting chronic rhinosinusitis with nasal polyp (CRSwNP) tissue. The objective of this study is to identify features in structured histopathology that predict outcome after functional endoscopic sinus surgery (FESS) in a cohort of CRSwNP patients from Singapore. METHODS Latent class analysis was performed on structured histopathology reports of 126 CRSwNP patients who had undergone FESS. Outcome measures were polyp recurrence, need for systemic corticosteroids, revision surgery or biologics, and disease control at 2 years post-FESS. RESULTS Three classes were identified. Class 1 was characterised by mild, predominantly lymphoplasmacytic inflammation. Class 2 comprised of 100 eosinophils/HPF, hyperplastic seromucinous glands, mucosal ulceration and mucin containing eosinophil aggregates and Charcot-Leyden crystals. Classes 2 and 3 were significantly associated with uncontrolled disease at 2 years post-FESS. Class 3 was additionally associated with the need for systemic corticosteroids. CONCLUSIONS Eosinophil count, degree of inflammation, predominant inflammatory type, hyperplastic seromucinous glands, mucosal ulceration and mucin containing eosinophil aggregates and Charcot-Leyden crystals predicted need for systemic corticosteroids and uncontrolled disease at 2 years post-FESS. The presence of >100 eosinophils/HPF should be reported, as this subset of tissue eosinophilia was associated with less favourable outcomes after FESS.
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Affiliation(s)
- X Xu
- Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore
| | - J E Seet
- Department of Pathology, National University Hospital, Singapore
| | - Q V Yap
- Department of Pathology, National University Hospital, Singapore
| | - S S Chao
- Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore
| | - M K T Thong
- Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore
| | - D Y Wang
- Department of Otolaryngology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y K Ong
- Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore
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Chia DKA, Sundar R, Kim G, Ang JJ, Lum JHY, Nga ME, Goh GH, Seet JE, Chee CE, Tan HL, Ho J, Ngoi NYL, Lee MXW, Muthu V, Chan GHJ, Pang ASL, Ang YLE, Choo JRE, Lim JSJ, Teh JL, Lwin A, Soon Y, Shabbir A, So JBY, Yong WP. ASO Visual Abstract: Outcomes of a Phase II Study of Intraperitoneal Paclitaxel Plus Systemic Capecitabine and Oxaliplatin (XELOX) for Gastric Cancer with Peritoneal Metastases. Ann Surg Oncol 2022; 29:8608-8609. [PMID: 36207480 DOI: 10.1245/s10434-022-12043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Daryl K A Chia
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Guowei Kim
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jia Jun Ang
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jeffrey H Y Lum
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Giap Hean Goh
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Je Ee Seet
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Hon Lyn Tan
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Natalie Y L Ngoi
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Matilda X W Lee
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Vaishnavi Muthu
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Gloria H J Chan
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Angela S L Pang
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Yvonne L E Ang
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Joan R E Choo
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Joline S J Lim
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Jun Liang Teh
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Aung Lwin
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Yuen Soon
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Asim Shabbir
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Jimmy B Y So
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore.
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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Yong CW, Lum JL, Makmur A, Seet JE, Lim AAT. Unusual metastatic presentations of a primary right parapharyngeal acinic cell adenocarcinoma. Int J Oral Maxillofac Surg 2019; 49:564-568. [PMID: 31668783 DOI: 10.1016/j.ijom.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/30/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022]
Abstract
Acinic cell adenocarcinoma (ACA) is a malignant epithelial neoplasm of the salivary glands. The patient reported herein presented with an unusual case of a metastatic ACA originating from the right parapharyngeal region, which eventually metastasized to the ipsilateral cavernous sinus and the contralateral mandibular ramus. The trigeminal nerve may have served as a channel for the spread of the cancer from the right parapharyngeal region to the cavernous sinus, and subsequently to the left mandibular ramus. The widening of the left inferior alveolar nerve canal was an early sign of metastasis in this case.
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Affiliation(s)
- C W Yong
- Discipline of Oral Maxillofacial Surgery, Faculty of Dentistry, National University Centre for Oral Health, Singapore
| | - J L Lum
- Discipline of Oral Maxillofacial Surgery, Faculty of Dentistry, National University Centre for Oral Health, Singapore
| | - A Makmur
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - J E Seet
- Department of Pathology, National University Hospital, Singapore
| | - A A T Lim
- Discipline of Oral Maxillofacial Surgery, Faculty of Dentistry, National University Centre for Oral Health, Singapore.
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Abstract
Pseudogout, also known as calcium pyrophosphate deposition disease, is a rheumatological condition arising from accumulation of calcium pyrophosphate dihydrate crystals in connective tissues. We present a case of a 56-year-old Bangladeshi woman who underwent focused right inferior parathyroidectomy for primary hyperparathyroidism from a right inferior parathyroid adenoma. On the first post-operative day, she complained of left elbow painful swelling with redness and warmth. Arthrocentesis of left elbow was done due to suspicion of septic arthritis. Two weeks prior to this surgery, she had sudden bilateral knee swelling was diagnosed in her home country of bilateral knee osteoarthritis with effusion and arthrocentesis showed no crystals. Aspiration of left elbow showed calcium pyrophosphate crystals, associated with post parathyroidectomy hypocalcemia, hypomagnesemia confirming pseudogout. Her uric acid level was normal. Bilateral wrist x-rays showed triangular fibrocartilage complex chondrocalcinosis. The patient's condition improved with colchicine and naproxen, as well as calcium and magnesium replacement. Her left elbow swelling and pain resolved. Pseudogout flare is a rare but known sequelae after parathyroidectomy. Early recognition and expeditious treatment is essential.
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Affiliation(s)
- C H Tai
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, Department of Surgery, National University Health System , Singapore
| | - H B Oh
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, Department of Surgery, National University Health System , Singapore
| | - J E Seet
- Department of Pathology, National University Health System , Singapore
| | - K Y Ngiam
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, Department of Surgery, National University Health System , Singapore
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Venkatesh SK, Wang G, Seet JE, Teo LLS, Chong VFH. MRI for transformation of preserved organs and their pathologies into digital formats for medical education and creation of a virtual pathology museum. A pilot study. Clin Radiol 2012; 68:e114-22. [PMID: 23246024 DOI: 10.1016/j.crad.2012.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/25/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
AIM To evaluate the feasibility of magnetic resonance imaging (MRI) for the transformation of preserved organs and their disease entities into digital formats for medical education and creation of a virtual museum. MATERIALS AND METHODS MRI of selected 114 pathology specimen jars representing different organs and their diseases was performed using a 3 T MRI machine with two or more MRI sequences including three-dimensional (3D) T1-weighted (T1W), 3D-T2W, 3D-FLAIR (fluid attenuated inversion recovery), fat-water separation (DIXON), and gradient-recalled echo (GRE) sequences. Qualitative assessment of MRI for depiction of disease and internal anatomy was performed. Volume rendering was performed on commercially available workstations. The digital images, 3D models, and photographs of specimens were archived into a workstation serving as a virtual pathology museum. RESULTS MRI was successfully performed on all specimens. The 3D-T1W and 3D-T2W sequences demonstrated the best contrast between normal and pathological tissues. The digital material is a useful aid for understanding disease by giving insights into internal structural changes not apparent on visual inspection alone. Volume rendering produced vivid 3D models with better contrast between normal tissue and diseased tissue compared to real specimens or their photographs in some cases. The digital library provides good illustration material for radiological-pathological correlation by enhancing pathological anatomy and information on nature and signal characteristics of tissues. In some specimens, the MRI appearance may be different from corresponding organ and disease in vivo due to dead tissue and changes induced by prolonged contact with preservative fluid. CONCLUSIONS MRI of pathology specimens is feasible and provides excellent images for education and creating a virtual pathology museum that can serve as permanent record of digital material for self-directed learning, improving teaching aids, and radiological-pathological correlation.
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Affiliation(s)
- S K Venkatesh
- Department of Diagnostic Radiology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Ng HH, Narasaraju T, Phoon MC, Sim MK, Seet JE, Chow VT. Doxycycline treatment attenuates acute lung injury in mice infected with virulent influenza H3N2 virus: involvement of matrix metalloproteinases. Exp Mol Pathol 2012; 92:287-95. [PMID: 22421441 DOI: 10.1016/j.yexmp.2012.03.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/20/2012] [Accepted: 03/01/2012] [Indexed: 12/15/2022]
Abstract
Acute respiratory distress syndrome, a severe form of acute lung injury (ALI), is a major cause of death during influenza pneumonia. We have provided evidence for the involvement of recruited neutrophils, their toxic enzymes such as myeloperoxidase and matrix metalloproteinases (MMPs), and neutrophil extracellular traps in aggravating alveolar-capillary damage. In this study, we investigated the effects of doxycycline (DOX), an inhibitor of MMPs, on influenza-induced ALI. BALB/c mice were infected with a sublethal dose of mouse-adapted virulent influenza A/Aichi/2/68 (H3N2) virus, and administered daily with 20mg/kg or 60 mg/kg DOX orally. The effects of DOX on ALI were determined by measuring inflammation, capillary leakage, and MMP activities. Furthermore, levels of T1-α (a membrane protein of alveolar type I epithelium) and thrombomodulin (an endothelial protein) in the bronchoalveolar lavage fluid were evaluated by Western blot analysis. Our results demonstrate significantly decreased inflammation and protein leakage in the lungs after DOX treatment. Levels of MMP-2 and MMP-9 activity, T1-α and thrombomodulin were also diminished in the DOX-treated group. These findings were corroborated by histopathologic analyses, which demonstrated significant reduction in lung damage. Although DOX treatment reduced ALI, there were no effects on virus titers and body weights. Taken together, these results demonstrate that DOX may be useful in ameliorating ALI during influenza pneumonia. Further studies are warranted to determine whether DOX can be used in combination with anti-viral agents to alleviate severe influenza pneumonia.
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Affiliation(s)
- H H Ng
- Infectious Diseases Program, Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
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Fox PA, Seet JE, Stebbing J, Francis N, Barton SE, Strauss S, Allen-Mersh TG, Gazzard BG, Bower M. The value of anal cytology and human papillomavirus typing in the detection of anal intraepithelial neoplasia: a review of cases from an anoscopy clinic. Sex Transm Infect 2005; 81:142-6. [PMID: 15800092 PMCID: PMC1764665 DOI: 10.1136/sti.2003.008318] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Previous studies have reached differing conclusions about the utility of anal cytology as a screening tool for anal intraepithelial neoplasia (AIN). There is a need also to establish whether HPV typing offers a useful adjunct to screening. METHODS We analysed data from 99 consecutive homosexual/bisexual male patients (89 HIV-1 positive) who underwent high resolution anoscopy. Follow up visits for these patients were also included, giving a total of 160 anoscopic procedures. Comparison was made between results of anal cytology using the sampling method of Palefsky, and histological findings of biopsies taken from abnormal areas seen on high resolution anoscopic examination of the anal canal. Swabs taken concurrently with the cytology were analysed for the presence of human papillomavirus (HPV) DNA and compared with the cytological and histological findings. RESULTS The sensitivity of the cytology was 83%, and the specificity 38% when compared with histology. At screening of 34 asymptomatic men, 83% had anal cytological dysplasia and 78% had AIN. There were no significant differences in the prevalence of hrHPV genotypes between different cytological or histological grades of abnormalities. CONCLUSION Anal cytology by the Palefsky method is simple to undertake, has a sensitivity and specificity comparable with cervical cytology, and can therefore be used as the basis of a pilot screening project in centres with large cohorts of HIV positive homosexual men who have a high risk of developing anal carcinoma. HPV genotyping is not a useful adjunct to cytological screening.
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Affiliation(s)
- P A Fox
- Department of HIV and Genitourinary Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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