Malay Gentleman Research Articles

A Rare Presentation of Carcinosarcoma in a Long Standing Parotid Mass

A Rare Presentation of Carcinosarcoma in a Long Standing Parotid Mass Introduction: Parotid tumours represent one of common tumours seen in the field of Otorrhinolaryngology. Common benign tumours include pleomorphic adenoma and warthins tumour while most common malignant parotid gland tumour is mucoepidermoid carcinoma. This case, however, highlights a rare parotid tumour in a long standing parotid mass. Objective: To present a rare case of parotid carcinosarcoma ex pleomorphic adenoma. Clinical Report: A 35 year old Malay gentleman with no prior medical illness first presented on 22nd October 2013 with history of left parotid swelling for more than 10 years in which he had not seeked treatment before. He was compelled to seek treatment after a drastic increase in size within 2 weeks prior to swelling. Patient has been an active smoker past 20 years. Examination revealed a large, lobulated left parotid mass measuring 10 cm x 9 cm x 8 cm which was hard, not tender and fixed to overlying skin. There were no palpable neck nodes and facial nerve was intact. Fine needle aspiration cytology revealed mucoepidermoid carcinoma ex pleomorphic adenoma. He underwent tracheostomy, left extended total parotidectomy, left supraomohyoid neck dissection with soft tissue reconstruction with free fasciocutaneous anterolateral thigh (ALT) flap on 11th March 2014. Histopathological examination of the parotid mass revealed carcinosarcoma ex pleomorphic adenoma. Conclusion: This case report highlights a rare malignant transformation of a long standing parotid mass to form carcinosarcoma of the parotid gland.

High dose steroid and acute visual loss: case report and discussion on acute central serous chorioretinopathy in elderly

Central serous chorioretinopathy (CSCR) is one of sight-threatening side effects of systemic steroids. Although it is uncommon, CSCR seriously threatens the patient’s vision and it has the potential for permanent visual morbidity. This article reports about a 54-year-old Malay gentleman who developed central vision loss after received a course of oral prednisolone 50 mg/day for a month period for the treatment of multifocal motor neuropathy. His vision recovered 1 year after cessation of steroid as the CSCR resolved. However, subjectively the visual quality is poor. Steroids in any route of administration can induce CSCR and it must be used with precaution especially in the elderly. Although resolutions are usually spontaneous after cessation of steroid, chronic and recurrent CSCR can lead to irreversible visual impairment. Judicious use of systemic steroids, early detection and prompt co-management with the treating physician can help prevent permanent visual disturbance.

A Rare Presentation of Carcinosarcoma in a Long Standing Parotid Mass

A Rare Presentation of Carcinosarcoma in a Long Standing Parotid Mass Introduction: Parotid tumours represent one of common tumours seen in the field of Otorrhinolaryngology. Common benign tumours include pleomorphic adenoma and warthins tumour while most common malignant parotid gland tumour is mucoepidermoid carcinoma. This case, however, highlights a rare parotid tumour in a long standing parotid mass. Objective: To present a rare case of parotid carcinosarcoma ex pleomorphic adenoma. Clinical Report: A 35 year old Malay gentleman with no prior medical illness first presented on 22nd October 2013 with history of left parotid swelling for more than 10 years in which he had not seeked treatment before. He was compelled to seek treatment after a drastic increase in size within 2 weeks prior to swelling. Patient has been an active smoker past 20 years. Examination revealed a large, lobulated left parotid mass measuring 10 cm x 9 cm x 8 cm which was hard, not tender and fixed to overlying skin. There were no palpable neck nodes and facial nerve was intact. Fine needle aspiration cytology revealed mucoepidermoid carcinoma ex pleomorphic adenoma. He underwent tracheostomy, left extended total parotidectomy, left supraomohyoid neck dissection with soft tissue reconstruction with free fasciocutaneous anterolateral thigh (ALT) flap on 11th March 2014. Histopathological examination of the parotid mass revealed carcinosarcoma ex pleomorphic adenoma. Conclusion: This case report highlights a rare malignant transformation of a long standing parotid mass to form carcinosarcoma of the parotid gland.

Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula

Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Giant Inguino-scrotal Hernia: Repair and Management

An 84-year-old Malay gentleman presented with signs of intestinal obstruction secondary to obstructed right giant inguinoscrotal hernia. He was subjected for emergency inguinal hernia repair with intra- operative findings of multiple loop of dilated bowel with thickened omentum within the sac. Repair of the hernia defect with strengthening of the posterior wall was carried out. Post-operatively the patient was managed in ICU due to development of intra-abdominal hypertension. The presentation and management of giant inguino- scrotal hernia will be further discussed.

Impaction of Durian Seed in the Larynx

Common foreign bodies in adults include fish bones and improperly chewed meat A 72-year-old Malay gentleman was brought in by his son to the emergency department after he was seen gasping at home. The patient has an underlying history of stroke with neurological deficit include his gag reflex. According to family members, the patient had the symptom a day after he had allegedly consumed a piece of durian without removing its seed. Patient was then admitted to Intensive care Unit (ICU) for monitoring. His blood gas normalized and was extubated after 2 days in ICU before discharged home the next day.

Mandibular Metastasis from Nasopharyngeal Carcinoma

Objective: To describe a case of mandibular metastasis from nasopharyngeal carcinoma and review the literature.
 Methods:
 Design: Case Report
 
 Setting: Tertiary Public University Hospital
 
 Patient: One
 
 Result: A 42 year-old Malay gentleman underwent concurrent chemoradiotherapy (CCRT) for T4N2M0 (Stage IVa) nasopharyngeal carcinoma (NPC) non-keratinizing type (WHO II). Upon completion of CCRT, he developed metastasis to the left body of the mandible that increased in size despite 3 cycles of adjuvant intravenous chemotherapy. Hemi-mandibulectomy was deferred due to recent irradiation and a further 15 fractions of boost radiotherapy reduced the mandibular metastasis in size, but it has remained the same after six months follow up.
 Conclusion: Nasopharyngeal carcinoma (NPC) is a common malignancy in Oriental Asia and the South East Asian regions. It has the highest rates of nodal and distant metastases among all head and neck cancers. Distant metastasis to bone is common, but we could find no previous report of mandibular bone involvement in the literature. Radiotherapy remains the main treatment modality and combination with chemotherapy has been shown to improve survival of patients. There are studies on nasopharyngeal carcinoma tumour markers for diagnosis and disease process follow up, but these are still inconclusive.
 Keywords: Nasopharyngeal carcinoma, Bones, Mandible, Metastasis.

Endogenous endophthalmitis and Horner's syndrome secondary to brain abscess in HIV patient

A 39–year-old Malay gentleman was presented with sudden onset of blurring of vision, associated with pain, redness and partial ptosis in the left eye (LE) for 2 weeks. It was also associated with headache and drowsiness that were progressively worsened. On examination, the vision was hand movement LE. There was partial upper lid ptosis with injected conjunctiva and mild anterior chamber reaction. The view of the posterior segment was hazy on LE. The right eye was essentially normal. On investigation, B-scan ultrasound was suggestive of LE vitreous opacity. CT scan and MRI of the orbit and brain showed multiple enhancing brain lesions. Toxoplasma IgG, anti-HCV and anti-HIV were reactive and the patient was treated with toxoplasma infection.

A case of persistent vomiting

A 34-year-old Malay gentleman presented with colicky abdominal pain and bilious vomiting. He was recently diagnosed with metastatic non-small …

Liver Abscess Caused by Tuberculosis and Melioidosis

We report an unusual co-existence of Burkholderia pseudomallei and acid fast bacilli in a young Malay gentleman with liver abscess. He was treated with antibiotics and surgical drainage. This phenomenon has not been reported in previous literature and the dilemma of its management is discussed.

Scleral melting 16 years after pterygium excision with topical Mitomycin C adjuvant therapy

Purpose To report a case of scleral melting noted 16 years after pterygium excision with postoperative adjuvant topical Mitomycin C (MMC). Method Case report. Results A 61-year-old Malay gentleman underwent right nasal pterygium excision using bare sclera technique followed by topical MMC 0.1% for a week, 16 years ago. He was noted to have a right nasal scleral thinning with calcified plaque and granuloma. He was successfully treated conservatively without further progression of the scleral melting. Conclusion Long-term complication of pterygium excision with adjuvant topical Mitomycin C may occur. The case shows that early detection and recognition of the complication can be sight saving.