Lupus Vulgaris in a Maltese patient

Introduction The incidence of cutaneous tuberculosis (TB) in the developed world has fallen, in parallel with the decline of other forms of TB. Nevertheless cases still occur and their diagnosis may be difficult. We report a case of lupus vulgaris in a Maltese patient who went on to have an excellent response to antituberculous chemotherapy.peer-reviewe

Solitary fibrous tumour of the nose and nasopharynx

A case of solitary fibrous tumour of the nasal cavity is reported. These tumours, rare in the nose, are believed to be similar to fibrous mesotheliomas of the pleural cavity. The main presenting symptom is that of unilateral nasal obstruction and diagnosis is made on histological examination of the lesion. These tumours have to be distinguished from other spindle-cell tumours of the nasal cavity and sinuses.peer-reviewe

The menstruating bladder, an unusual cause of haematuria

A 39 year old lady presented with flank pain and haematuria. Radiological investigations showed unilateral hydronephrosis and a serum creatinine of 102?mol/l. At cystoscopy, a soft tissue mass was found in the region of the left ureteric orifice and was causing obstruction of the ureter. A resection biopsy of this lesion was taken. A CT scan and DTPA renogram showed a non-functioning left kidney secondary to chronic obstruction by a soft tissue mass at the left vesico-ureteric junction. Histological analysis of the endoscopic resection specimen showed that the mass contained tubal-type epithelium compatible with a diagnosis of endosalpingiosis (a rare variant of Mullerianosis of the urinary tract). In view of persistent symptoms, it was decided to proceed to surgery. A hysterectomy, bilateral salpingo-oophorectomy and partial cystectomy were performed. The patient has recovered well and is currently asymptomatic. Formal histology of the resection specimen showed the presence of endometriosis.peer-reviewe

Endoscopic snare polypectomy of a pedunculated adenocarcinoma of the duodenal bulb arising from a hyperplastic polyp

Primary non-ampullary adenocarcinoma of the duodenum is a rare occurrence, arising mainly from adenomatous polyps [1].We report the first case of a pedunculated adenocarcinoma of the duodenal bulb, arising from a hyperplastic polyp, treated with endoscopic snare polypectomy.peer-reviewe

A second vestigial umbilical vein : a case report

A healthy female infant was found to have two umbilical arteries and two umbilical veins at the cut surface of the cord at birth. Detailed inspection of the cord showed the second vein to represent a short segment vestigial vessel that, moreover, was not associated with any other congenital anomaly as is often found in infants with umbilical vein anomalies.peer-reviewe

Giant gastric folds in a patient with hypoalbuminaemia

A 70-year-old man presented with a 3-month history of persistent epigastric pain, 8 kg weight loss and lower limb swelling. Examination revealed a normal abdomen and bilateral lower limb oedema. Blood results were unremarkable except for hypoalbuminaemia (23 g/l) and peripheral eosinophilia (1.06×109/l). Urinalysis and CT of the abdomen were negative. An oesophagogastroduodenoscopy (OGD) revealed large gastric folds involving the fundus and the body of the stomach (figure 1), and a small antral polyp. Histology showed marked reactive mucosal changes, pronounced foveolar hyperplasia and cystic dilatation (figure 2), compatible with a diagnosis of Ménétrier’s disease. Helicobacter pylori was absent and the antral polyp was adenomatous. He was given omeprazole and prednisolone (20 mg daily), which was tailed down after 2 months. Subsequently, his symptoms improved significantly. He regained 10 kg in weight and his albumin levels normalised. OGD done post therapy and 1 year later still showed prominent, but less pronounced, gastric folds, and histological evidence of hyperplastic gastropathy.peer-reviewe

Phospho-Akt expression is high in a subset of triple negative breast cancer patients

The most commonly used biomarkers to predict the response of breast cancer patients to therapy are oestrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2). Patients positive for these biomarkers are eligible for specific therapies such as anti-oestrogen therapy in the event of ER and PgR positivity, and trastuzumab, a monoclonal antibody, in the case of HER2 positive patients. Patients who are negative for all these three biomarkers, the so-called triple negatives, however, derive little benefit from such therapies. The PI3K/Akt pathway is activated in triple negative breast cancer cases, providing a possible target for therapy. The activation of Akt was investigated in Maltese triple negative breast cancer cases using an antibody detecting Akt phosphorylated at serine 473 (anti-Akt pS473). The study showed that 26\% of triple negative breast cancer patients had an elevated level of Akt (pS473). Furthermore, FTY720, a pharmacological activator of the phosphatase PP2A, was shown to block Akt activation at a concentration of 1\textmu M, in HCC1937 cells subjected to insulin-like growth factor 1 (IGF-1). Our data defined a subset of triple negative breast cancer patients based on high activity of AKT (pS473). This subset would be eligible for treatment using therapies which target the PI3K/Akt pathway, such as kinase inhibitors or phosphatase activators. In support of this, the BRCA1 mutant cells (HCC1937) were sensitive to the PP2a activator, FTY720. This suggests that FTY720 is a potential drug for use in adjuvant therapy in breast cancer cases having a high Akt (pS473).peer-reviewe

Laryngeal lymphoma : the high and low grades of rare lymphoma involvement sites

The larynx is an extremely rare site of involvement by lymphomatous disease.We present two cases of isolated laryngeal high-grade and another low-grade lymphoma, together with a literature review of laryngeal lymphoma management.peer-reviewe

Clinical outcome of pediatric collagenous gastritis : case series and review of literature

Collagenous gastritis (CG) is characterized by patchy subepithelial collagen bands. Effective treatment and the clinical and histological outcome of CG in children are poorly defined. The aim of this study is to summarize the published literature on the clinical outcome and response to therapy of pediatric CG including two new cases. We performed a search in Pubmed, OVID for related terms; articles including management and clinical and/or endo-histologic follow up information were included and abstracted. Reported findings were pooled in a dedicated database including the corresponding data extracted from chart review in our patients with CG. Twenty-four patients were included (17 females) with a mean age of 11.7 years. The clinical presentation included iron deficiency anemia and dyspepsia. The reported duration of follow up (in 18 patients) ranged between 0.2-14 years. Despite most subjects presenting with anemia including one requiring blood transfusion, oral iron therapy was only documented in 12 patients. Other treatment modalities were antisecretory measures in 13 patients; proton pump inhibitors (12), or histamine-2 blockers (3), sucralfate (5), prednisolone (6), oral budesonide in 3 patients where one received it in fish oil and triple therapy (3). Three (13%) patients showed no clinical improvement despite therapy; conversely 19 out of 22 were reported with improved symptoms including 8 with complete symptom resolution. Spontaneous clinical resolution without antisecretory, anti-inflammatory or gastroprotective agents was noted in 5 patients (4 received only supplemental iron). Follow up endo-histopathologic data (17 patients) included persistent collagen band and stable Mononuclear cell infiltrate in 12 patients with histopathologic improvement in 5 patients. Neither collagen band thickness nor mono-nuclear cell infiltrate correlated with clinical course. Intestinal metaplasia and endocrine cell hyperplasia were reported (1) raising the concern of long term malignant transformation. In summary, CG in children is a chronic disease, typically with a variable clinical response and an indolent course that is distinct from the adult phenotype. Long term therapy usually inclused iron supplementation but cannot be standardized, given the chronicity of the disease, variability of response and potential for adverse events.peer-reviewe

Parathyroid carcinoma : clinical course, diagnosis and management

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism often resulting in severe hypercalcaemia. It tends to follow a rather aggressive course with a high propensity for locoregional spread and distant metastasis. En bloc resection is the mainstay of treatment, with surgery also playing a role in the palliation of hypercalcaemia for recurrent and metastatic disease. While adjuvant chemotherapy and radiotherapy have shown disappointing outcomes, bisphosphonates and calcimimetic agents are effective in the management of recalcitrant hypercalcaemia in parathyroid carcinoma. We report a case of parathyroid carcinoma in a lady who initially presented with a neck mass, severe hypercalcaemia, a bony swelling over the shin and elevated parathyroid hormone levels. The diagnosis was confirmed histologically following a thyroid lobectomy, isthmectomy and parathyroidectomy. In the three years which followed the patient received two courses of palliative radiotherapy, two thoracotomies for pulmonary metastatectomy, an extensive neck re-exploration and fashioning of a tracheostomy for aggressive local recurrence with invasion of the larynx.peer-reviewe