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Biomedical subjects

R Chetty

Publications and source records attributed to R Chetty.

At least 37 records · Page 2Linked to original sources
PubMed2001

Spontaneous arteriovenous fistula resulting from HIV arteritis.

Arteriovenous fistulas (AVFs) are uncommon and usually follow trauma or preceding arterial catheterization or puncture. Spontaneous AVFs are rare. A case of spontaneous AVF of the superficial femoral artery and vein in an HIV-infected patient is presented. Histologic examination of the artery showed features similar to those seen in HIV-related large-vessel aneurysms. It would appear that spontaneous AVF are part of the spectrum of macrovascular arteritis related to HIV infection.

Adult↗
PubMed2001

Myxoid invasive papillary urothelial carcinoma of the bladder and urethra.

An unusual case of myxoid transitional cell (urothelial) carcinoma occurring in a 75-year-old man is presented. The primary tumour in the bladder, which was treated by partial cystectomy, consisted of areas of conventional high grade invasive (into the lamina propria) papillary urothelial carcinoma with separate myxoid areas. The latter component accounted for 25% of the tumour. Nine months later, the patient presented with haematuria once again, and a tumour was detected in the urethra. This was excised and histological examination showed only myxoid tumour without any overlying dysplasia or obvious epithelial differentiation. The myxoid areas were positive for epithelial markers and negative for all mesenchymal markers. This case highlights an uncommon variety of papillary urothelial carcinoma that invokes a wide differential diagnosis. Immunohistochemistry is essential in making the correct diagnosis.

Aged↗
PubMed2001

Vasculitides associated with HIV infection.

The manifestations of human immunodeficiency virus (HIV) infection are protean and vasculitides are one of the less common but nonetheless important consequences. A wide range of vasculitides can be encountered, ranging from vasculitis resulting from specific infective agents to a non-specific vasculitis. Among the infective causes, cytomegalovirus and tuberculosis are probably the most common. A polyarteritis nodosa-like vasculitis with important differences to classic polyarteritis nodosa is also described. Hypersensitivity vasculitis resulting in several patterns of vasculitis and angiocentric immunoproliferative vasculitis are well recognised. As part of the immunocompromise caused by HIV, a granulomatous inflammation involving small arteries and veins of the brain surface and leptomeninges, termed a primary angiitis of the central nervous system, is a rare vasculitis associated with high mortality. A recently described large vessel (aorta, femorals, carotids) vasculopathy resulting in either multiple aneurysm formation or occlusive disease is seen in young adults. An infective agent is not found but aetiologically some of these lesions might be the result of a leucocytoclastic vasculitis of vasa vasora or periadventitial vessels. A final group of non-specific vasculitides not fitting into any of the characteristic patterns described accounts for the residue of vasculitides associated with HIV.

Central Nervous System Diseases↗
PubMed2001

Infiltrating ductal carcinoma of the breast with rhabdoid phenotype.

Two cases of ductal cancers of the breast of no special type with a prominent rhabdoid component are presented. The mastectomy specimens showed the tumors to be composed of cells with a characteristic rhabdoid phenotype: Large cells with eccentric nuclei containing large inclusion like nucleoli and abundant eosinophilic cytoplasm. Immunohistochemistry showed typical immunoreactivity with cytoplasmic dot-like accentuation for epithelial markers as well as vimentin. In case 1, although excision margins were clear, tumor recurrence, composed mainly of rhabdoid cells, occurred within 7 months, and the patient died 2 months later. The second case, unfortunately, was lost to follow-up. This report is the second documenting the occurrence of rhabdoid cells in breast cancer. In keeping with other epithelial malignancies that contain rhabdoid cells, aggressive biological behavior is noted. Int J Surg Pathol 9(3):237-239, 2001

Breast Neoplasms↗
PubMed2001

Borderline serous cystadenocarcinoma with coexistent angiosarcoma: an unusual form of ovarian carcinosarcoma.

A 45-year-old woman presented with a short history of abdominal distension and features of intestinal obstruction. Computed tomography examination of the abdomen revealed a solid and cystic mass in the region of the left ovary, but spread within the abdomen was also noted. The ovarian tumor was removed, and an omentectomy was also performed. Microscopic examination of the ovarian tumor and metastases within the omentum showed a carcinosarcoma composed of borderline serous papillary cystadenocarcinoma and angiosarcoma. The angiosarcomatous component was the dominant tumor within the omentum. This case documents an unusual combination of epithelial and sarcomatous elements in an ovarian carcinosarcoma. The tumor behaved aggressively because of the angiosarcomatous component, and since the patient was assessed as having stage IV disease, no further treatment was offered.

Abdominal Neoplasms↗
PubMed2001

Graduates' perceptions of their midwifery training during the four year comprehensive nursing diploma.

Since its inception in 1986, the Comprehensive Nursing Diploma has received many criticisms from registered nurses, who graduated from the pre-existing programmes. This study attempts to examine the perceptions of graduates from this training programme, towards their midwifery education in terms of its adequacy in preparing them for midwifery practice. Twenty-nine graduates of the four year Comprehensive Nursing Programme completed self-administered questionnaires. Data was analysed by means of descriptive and inferential statistics, namely the paired t-test and the Wilcoxon test for matched pairs. Qualitative data was analysed to determine emerging themes and patterns. Differences in competence ratings on entry into midwifery units and those a year later, were significant at p = 0.0001. It was found that graduates appear to have a positive perception of the midwifery component of their training programme. They found the theory aspect to be more than adequate in preparing them for their professional roles. However, with regards to clinical exposure, it was felt that the time period was too short and needed to be extended in order for them to attain clinical proficiency.

Adult↗
PubMed2001

Lymphoepithelioma-like carcinoma of the breast with associated sclerosing lymphocytic lobulitis.

The purpose of this article is to highlight an unusual form of breast carcinoma and discuss its differential diagnosis. A 50-year-old woman underwent wide local excision of a breast lump. Microscopic examination revealed features of a lymphoepithelioma-like carcinoma. Individual tumor cells were present within an abundant lymphoid stroma. Immunohistochemistry revealed the epithelial nature of the cells and excluded a diagnosis of lymphoma. In addition, surrounding nontumorous breast tissue displayed the histologic features of sclerosing lymphocytic lobulitis or lymphocytic mastopathy. This is the second report of a lymphoepithelioma-like carcinoma of the breast, but to the best of our knowledge, it is the first description of coexistent sclerosing lymphocytic lobulitis.

Biomarkers, Tumor↗
PubMed2000

Large artery vasculopathy in HIV-positive patients: another vasculitic enigma.

Human immunodeficiency virus (HIV) infection has impacted on all the systems of the body, and the cardiovascular system is no exception, with small to medium-sized vessel vasculitis being most frequently described. We present 16 HIV-positive patients with large vessel disease consisting of either aneurysms (often multiple) or occlusive disease. Nine men and 7 women ranging in age from 18 to 38 years presented with rupture of aneurysm, transient ischemic attacks, hypertension, ischemia to the lower extremity, or a mass at the site of the aneurysm. Eight patients had 1 aneurysm, 2 had 2 lesions, and the remaining 6 cases had from 3 to 7 aneurysms. Arteries affected included the common carotid, abdominal aorta, common iliac, femoral, and popliteal. Three patients had intercurrent infections, but none had any obvious infective vascular lesion. Only 1 patient had a positive TPHA test for syphilis. Microbiologic culture of both blood and thrombus contents was positive for Staphylococcus aureus in 1 case; no other organisms were cultured. The key histological features were within the adventitia: leukocytoclastic vasculitis of the vasa vasora and periadventitial vessels, proliferation of slit-like vascular channels, chronic inflammation, and fibrosis. There was associated medial fibrosis with loss and fragmentation of muscle and elastic tissue. Intimal changes consisted of duplication and fragmentation of the internal elastic lamina with calcification. Atheroma and marked intimal thickening were not evident We believe that the occurrence of this large vessel vasculopathy (mainly aneurysmal) often with multiple lesions in young HIV-positive patients, is characteristic of possible infective or immune complex origin, with leukocytoclastic vasculitis of vasa vasora and periadventitial vessels being pivotal in many cases.

Adolescent↗
PubMed2000

bcl-2 protein expression in aggressive and non-aggressive basal cell carcinomas.

bcl-2, the well known anti-apoptotic gene, cloned more than a decade ago, promotes cell viability without promoting cell proliferation. With few exceptions, high bcl-2 protein expression is associated with a favourable outcome in epithelial tumours. bcl-2 immunoreactivity in basal cell carcinomas (BCCs) is contradictory, with 67-100% immunopositivity being reported. Although BCCs are traditionally regarded as low-grade, indolent tumours, aggressive BCCs (A-BCCs) are mutilative, locally destructive tumours that often recur. bcl-2 protein expression as a predictor of BCC aggressiveness is poorly documented in the English-language literature. The bcl-2 protein immunoprofile of 50 clinically non-aggressive (NA-BCCs) and 25 clinically A-BCCs was investigated. Of the latter, 17 manifested with one, two or three recurrences. bcl-2 protein expression in each of the recurrences was also evaluated. bcl-2 expression was scored as follows: 0-5% positive cells=negative, 6-25%=1+, 26-50%=2+, 51-75%=3+, >75%=4+. "High" labeling encompassed 3+ or 4+ labeling while "low" labeling referred to 1 + or 2 + labeling. Although bcl-2 positivity was noted in all BCCs, low bcl-2 labeling was a statistically significant feature of A-BCCs (p < 0.01). High bcl-2 labeling of NA-BCCs was a reflection of the bcl-2 labeling of the dominant constituent nodular or superficial subtypes. Micronodular BCCs revealed 2+ or 3+ labeling. Initial and recurrent A-BCCs with a pure or predominantly infiltrative component, demonstrated 1+ or 2+ bcl-2 labeling. The differential bcl-2 expression in the various clinicopathological subtypes of BCCs suggests that, despite the common derivation of these tumours from a primitive basaloid stem cell and a limited potential for metastasis, they form a heterogeneous group of tumours that differ markedly in histologic and biological behaviour. While the superficial and nodular BCCs are indolent slow-growing tumours with high bcl-2 labeling, the aggressive BCCs are infiltrative, desmoplastic tumours with low bcl-2 labeling. In mixed tumours, heterogeneity of labeling is a distinctive feature and is contributed to in part by the labeling trends of the different histological subtypes. The micronodular BCC shows varied bcl-2 labeling but in combined tumours occupies a niche intermediate between the non-aggressive nodular and superficial and the aggressive infiltrative subtypes. The initial and subsequent biopsies of recurrent, adequately excised BCCs share a pure or mixed, predominantly infiltrative, stroma-rich histomorphology with low bcl-2 labeling, reflecting the immunoprofile of a more aggressive growth pattern.

Adult↗
PubMed2000

Transepithelial elimination of cutaneous vulval granuloma inguinale.

BACKGROUND: Transepithelial elimination (TEE), a distinct and well-known entity, is a process during which the skin eradicates undesirable or irritative dermal substances through intact epidermis or follicular epithelium by passive or active means. Although TEE is being described in an increasing number and range of pathological processes, to date, TEE of granuloma inguinale (GI) remains unrecorded in the English-language literature. The aims of this study were: 1) To appraise the light microscopic and ultrastructural morphological epidermal changes that are associated with TEE of cutaneous vulval GI; and 2) To determine the role of intra-epidermal leucocytes and histiocytes in the pathogenesis of TEE of vulval GI. METHODS: This is a retrospective 9-year histopathological review of all cases diagnosed and coded as vulval granuloma inguinale in the Department of Anatomical Pathology, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa. Ultrastructural evaluation was performed on selected cases using a Jeol transmission electron microscope. RESULTS: Of 53 skin biopsies from 47 patients with vulval GI, 43 were suitable for the study. The age range of patients was 15-40 years (mean age=22 years). There were eleven papular, twelve nodular, seven verrucous and thirteen ulcerative lesions. Donovan bodies within macrophages, free-lying Donovan bodies and dense aggregates of neutrophils and plasma cells were seen in the dermis of all biopsies. There was consistent overlying pseudoepitheliomatous hyperplasia. The dermal inflammatory infiltrate hugged the dermo-epidermal junction and appeared entrapped between elongated and acanthotic epidermal rete ridges and pegs. Transepidermal neutrophil microabscesses, histiocytes containing Donovan bodies and neutrophilic and histiocytic fragmentation were present. A variable number of free-lying and intra-histiocytic Donovan bodies and neutrophils were present on the surface of the epidermis. On ultrastructural investigation epidermal spongiosis, intracellular oedema, free-lying, intra-neutrophilic and intra-histiocytic Donovan bodies, and intact and degenerating neutrophils and histiocytes were evident between keratinocytes. The degenerative histiocytes demonstrated marked vacuolation, mitochondrial swelling and bacilli within phagolysosomal vacuoles, bound by intact or disrupted limiting membranes. CONCLUSION: The inflammatory infiltrate at the epitheliomesenchymal interface, pseudoepitheliomatous hyperplasia, intra-epidermal accumulation and disintegration of neutrophils and histiocytes, and the associated release of lytic enzymes, play important contributory roles in TEE of GI. TEE of infectious agents is a poorly recognised mechanism of spread of infectious diseases and represents a public health hazard. In cutaneous vulval GI, TEE is highlighted as a hitherto unrecognised, potential method of spread of Calymmatobacterium granulomatis.

Adolescent↗
PubMed2000

Intercalated duct hyperplasia: possible relationship to epithelial-myoepithelial carcinoma and hybrid tumours of salivary gland.

AIMS: The aims of this study were to ascertain the incidence of intercalated duct hyperplasia in association with cases of epithelial-myoepithelial carcinoma (EMC), and to explore a possible relationship between them and hybrid carcinomas of salivary glands. METHODS AND RESULTS: Seven cases of EMC with sufficient surrounding non-tumour parotid were examined. Three cases contained foci of intercalated duct hyperplasia adjacent to the tumour. One of the cases was a hybrid tumour composed of EMC and mucoepidermoid carcinoma. The hyperplastic intercalated ducts formed multiple foci within the salivary parenchyma and were composed of bland, uniform ducts. Cytological atypia was not identified. CONCLUSIONS: Intercalated duct hyperplasia may be a precursor lesion to EMC. Furthermore, it may also explain why EMC is frequently associated with other salivary gland carcinomas, so-called hybrid tumours, as well as sharing histological features with adenoid cystic carcinoma. Recognition of the latter is of particular importance because adenoid cystic carcinoma carries a poor prognosis.

Actins↗
PubMed2000

Occlusive arterial disease in HIV-infected patients: a preliminary report.

OBJECTIVES: to preliminarily describe the clinical features and management of arterial occlusive disease in human immunodeficiency virus (HIV) infected patients. MATERIALS: twenty HIV positive patients with symptomatic large-vessel arterial occlusion treated by a tertiary vascular unit in a 3-year period. METHODS: retrospective review of clinical case records. RESULTS: patients were noted to be young (median age 37 years), with preponderance of males. Twelve patients had evidence of advanced HIV infection. All patients had critical ischaemia, involving the upper limbs in four and the lower limbs in 16. Coagulation abnormalities were noted in two cases. Operative intervention in 18 patients included revascularisation in seven. Thrombotic occlusion of normal-looking arteries was noted. Arterial biopsy revealed leucoIcytoclastic vasculitis indicative of HIV arteritis in three of five cases examined. CONCLUSIONS: initial experience with large-vessel occlusive disease in HIV positive patients suggests an underlying arteritic aetiology, with clinical and pathological features distinct from atherosclerosis. Further in-depth study is necessary to clarify the pathophysiological basis thereof.

Adolescent↗
PubMed2000

A comparative microsatellite analysis of colorectal cancer in patients <35 years and >50 years of age.

OBJECTIVE: This study was undertaken to investigate microsatellite instability and allelic imbalance in a cohort of young patients (<35 yr) and older patients (>50 yr) with sporadic colorectal carcinomas in the Kwa-Zulu Natal region of South Africa. METHODS: Normal and tumor DNA was isolated from formalin-fixed, paraffin-embedded tissue from 32 patients <35 yr and from 50 patients >50 yr of age. Tumors were staged using the modified Astler-Coller classification. Fluorescent-based DNA technology using an automated DNA sequencer (Alf Express Automated DNA Sequencer) was employed. CY5 labeled primers for microsatellite markers in chromosomes 18, 3, and 2 (DCC, D18S34, D18S58, D3S659, D3S1255, and D2S123) were used. The data were captured and analyzed using the Fragment Manager Software. RESULTS: The informativity of the microsatellite markers ranged from 50% to 71.8%. Microsatellite instability was seen in 44 of 82 cases (53.7%) for at least one of the six markers. Low frequency MSI (MSI-L) was seen in 28 of 82 cases (34.2%) and high frequency MSI (MSI-H) in 16 of 82 cases (19.5%). In the <35-yr age group, MSI-L was seen in six cases (18.8%) and MSI-H in 10 cases (31.3%). In the >50 yr age group, MSI-L was seen in 22 cases (44%) and MSI-H in six cases (12%). Twelve cases showed AI for DCC, seven showed AI for D18S34, and four showed AI for D18S58. MSI was found in 13, 10, and 16 cases for each of these markers, respectively. Allelic imbalance for the D3S659, D2S123, and D3S1255 loci was 3 of 82 cases (3.7%), 10 of 82 cases (12.2%), and 13 of 80 cases (16.3%), respectively. MSI was 14.6% for both D3S659 and D2S123 and was 6.3% for the D3S1255 marker. CONCLUSIONS: Loss of heterozygosity in the region of the DCC locus ranged from 9.3% to 26.7%, and MSI ranged from 12.2% to 19.5% of cases. Allelic imbalance in the region of the repair genes ranged from 6.8% to 27% in the informative cases. MSI, however, ranged from 5% to 12%. These figures are similar to those of other studies done in other parts of the world. Further, no correlation was found between the genetic results and clinicopathological parameters: i.e., tumor stage, grade and clinical parameters of age and gender. However, genetic abnormalities were more common in the younger cohort of patients, and this may translate into the earlier age of presentation. This opens the potential for genetic screening.

Adult↗
PubMed2000

Combined large cell neuroendocrine, small cell and squamous carcinomas of the lung with rhabdoid cells.

Two unusual cases of combined lung carcinoma are presented. Both patients, aged 50 and 53 years, had strong histories of cigarette smoking and presented with lung masses. Microscopic examination revealed an uncommon combination of primary lung cancers. Both cases had a dominant histological picture of large cell neuroendocrine carcinoma. The first case was combined with both squamous and small cell carcinomas in almost equal proportions, while the second consisted of large cell neuroendocrine and squamous carcinomas with a focal area of small cell carcinoma. In addition, both cases contained rhabdoid cells. One of the cases pursued an aggressive clinical course with death in 6 months. The other patient presented with recurrent tumor 12 months after the operation and died shortly thereafter. These cases illustrate two examples of uncommon combined lung cancers: large cell neuroendocrine carcinoma combined with squamous carcinoma and small cell carcinoma. An additional feature was the presence of rhabdoid cells in both cases. It is felt that the rhabdoid component is a reflection of de-differentiation or poor differentiation, and may contribute to the aggressive nature of both tumors.

Biomarkers, Tumor↗
PubMed2000

Gastric adenocarcinoma--a perspective from Durban, KwaZulu-Natal.

KwaZulu-Natal is not a recognised 'hot-spot' for gastric cancer. The purpose of this paper was to ascertain the clinicopathological features of a cohort of cases encountered in the province. Data for 124 cases were collected and analysed for age, gender, race, tumour size, histological type, lymph node status and Helicobacter pylori status. The majority of cancers occurred in the 6th and 7th decades, irrespective of sex and race. More cases were encountered in males than females. The average tumour size was 4.5 cm, two-thirds of cases presented with lymph node metastases, and the vast majority of cases were of the intestinal histological subtype. Only 50 of the 124 cases contained microscopically demonstrable H. pylori organisms. While not as common as in the Western Cape and Japan, gastric cancer in KwaZulu-Natal has similar clinicopathological features to those found in these two high-risk areas.

Adenocarcinoma↗