RESUMO

This study reviewed cases of fatal poisoning in a coroner's autopsy series at the University Hospital of the West Indies and represented the first such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed over the 20-year period January 1980 to December 1999 were reviewed retrospectively; 22 (1.0%) cases were identified and relevant clinical and pathological data analysed. There were 13 males and nine females (M:F ratio 1.4:1) with an age range of 2 - 69 years (mean +/- SD = 27 +/- 16.1 years). The 20 - 29 year group was most commonly affected and five patients (22.7%) were children (< 18 years of age). Pesticides (herbicides/ insecticides) were implicated in nine (41%) cases: paraquat was the most common, found in six (27%) cases. Prescription drugs were the next most prevalent group with six (27%) cases, followed by anti-psychotic drugs in four (18%) cases. Cocaine and ackee were each implicated in two (9%) cases. The manner of death was suicidal in 14 (64%) cases and accidental in eight (36%) cases. Seven patients had documented psychiatric illnesses, six of whom committed suicide. Autopsy findings were largely non-specific. The relatively small number of cases was consistent with the low incidence of fatal poisoning in Jamaica.

Assuntos

RESUMO

This study reviewed the trauma-related deaths in a coroner's (medico-legal) autopsy series at the University Hospital of the West Indies and represents only the second such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed during the 15-year period January 1, 1983 to December 31, 1997 were reviewed retrospectively, and the clinico-pathological characteristics of trauma-related deaths were analysed. Trauma accounted for 470 (28.7%) of the 1,640 coroner's autopsies and the causes of death in descending order of frequency were motor vehicle accidents [MVAs] (44.9%), blunt injuries (17.7%), burns (16.8%), firearm injuries (13.6%) and stab injuries (7.0%). The 21-30 age group was the most commonly affected and the overall male: female ratio was 4:1. The distribution of injuries (excluding burns) by anatomical region was head and neck (43.8%), chest (8.9%), abdomen and pelvis (4.3%), extremities (0.9%) and multiple sites (25.3%). Forty-nine (23.2%) of the victims of MVAs were documented to have been pedestrians. Blunt trauma was most commonly due to accidental falls followed by assaults. Flame burns accounted for 90% of burn cases. There were seven (1.5%) cases of suicide overall. In this series the majority of trauma-related deaths occurred in young males and were due to MVAs. Strategies aimed at reducing trauma-related mortality should therefore emphasize road traffic safety programmes, particularly targeting the young.

Assuntos

RESUMO

Primary clear cell carcinoma of the breast is a rare tumor. The clear cell morphology of the neoplastic population in these tumors has been ascribed to the presence of intracellular lipid, mucin or glycogen, or to myoepithelial, apocrine, or neuroendocrine differentiation. However, a clear cell neoplasm exhibiting evidence of a range of differentiation has not been previously reported. We describe a case of a glycogen-rich primary clear cell breast carcinoma occurring in a 59-year-old woman that showed positivity for apocrine and neuroendocrine markers, as well as possible myoepithelial differentiation. The tumor was a 4-cm mass composed predominantly of periodic acid-Schiff-positive clear cells arranged in a solid, infiltrative pattern. Immunohistochemical staining of the tumor cells was variably positive for cytokeratin, progesterone receptors, gross cystic disease fluid protein-15, neuron specific enolase, chromogranin, and S-100 protein and negative for estrogen receptors, smooth muscle actin, CD31, and CD34. The patient refused any form of further investigation or treatment, but shows no evidence of recurrence or metastatic disease after 18 months of follow-up.

Assuntos

RESUMO

Impalpable breast lesions that are detected during screening mammography for breast cancer must be accurately identified and adequately sampled in biopsy specimens. Open wire-localized breast biopsy using hookwires remains the main method of sampling these lesions in centres without expensive stereotactic facilities. However, the hookwires can shift or become dislodged in the biopsy specimen. We have successfully modified a simple technique for the localization of impalpable lesions in these biopsies. The insertion of a small hypodermic needle into the fixed specimen with the assistance of the compression paddle and crosshairs on the mammography machine resulted in the precise localization of clusters of microcalcifications in 15 of 16 (94%) cases. In contrast, calcifications were identified in sections taken in the plane of the hookwire in only three cases (19%). The rate of detection of malignancy was 50% and the majority of malignant lesions were represented by ductal carcinoma in situ.

Assuntos

RESUMO

Impalpable breast lesions (AU)

Assuntos

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OBJECTIVE: Our aim was to document the distribution of epithelial abnormalities diagnosed on Pap smears in the Department of Pathology, the University of the West Indies (UWI), Mona, Jamaica, and to determine the likelihood of the prescence of clinically significant disease on biopsy for a given cytological diagnosis. METHODS: We reviewed the results of all Pap smears accessioned in the Cytology Unit of the Department of Pathology, over the 3-year period 1997-1999 and collated the epithelial abnormalities using a hybrid cervical intraepithelial neoplasia (CIN)/Bethesda system. We calculated the atypical squamous cells of undetermined significance (ASCUS) rate, the CIN rate and the ASCUS/CIN ratio. Follow-up histology results were obtained from the departmental files. The likelihood ratios (LRs for clinically significant disease on histology for each cytological category were calculated. RESULTS: During the study period a total of 21,144 Pap smears were accessioned, 1,324 (6.3 percent) of which showed epithelial abnormalities. These abnormal Pap smears were most prevalent in the 21-30 year age group (37.5 percent of patients). The distribution of epithelial abnormalities was: ASCUS 34.7 percent, atypical glandular cells of undetermined significance (ASCUS) 1.1 percent, ASCUS/AGUS 0.2 percent, CIN 141.4 percent, CIN II 12.5 percent, CIN III 8.3 percent, sqaumous cell carcinoma (SCC) 1.3 percent, adenocarcinoma (AC) 0.3 percent and vaginal intraepithelial neoplasia (VAIN) II/III 0.2 percent. The CIN rate, ASCUS rate and ASUCS/CIN ratio were 3.9 percent, 2.2 percent and 0.6 respectively. Histological follow-up was available for 477 (36 percent) cases. The LRs for clinically significant disease for the following cytological diagnoses were: AGUS: 0.08, ASCUS: 0.31, CIN I: 1.12, CIN II: 2.01 and CIN III: 3.38. All cases of SCC, AC and VAIN with histological follow-up were shown to be clinically significant. CONCLUSIONS: There was a relatively low incidence of epithelial abnormalities in Pap smears seen at the UWI during the study period with ASCUS and CIN 1 compromising the majority of cases. Biopsy follow-up showed an increasing likelihood for the presence of clinically significnat disease with increasing degrees of epithelial atypia on Pap smear. (AU)

Assuntos

RESUMO

Granulomatous labour mastitis is a rare, benign, inflammatory breast condition of unknown aetiology that can clinically mimic breast cancer. Awareness of this condition is important, as the appropriate specimens must be taken to confirm the diagnosis and to rule out an infectious aetiology. While surgical exclusion has been the traditional therapeutic modality, the most appropriate therapy seems to involve the use of corticosteriods, even in the case of recurrence. (AU)

Assuntos

Assuntos

RESUMO

OBJECTIVE: The aim was to determine the efficacy of the rapid Papanicolaou staining method (RPSM) in fine needle aspiration (FNA) cytology of breast lesions. METHODS: In a prospective study performed between May 1999 and June 2000, FNA specimens were obtained from patients attending the surgical out-patient and breast imaging services of the UHWI for the assessment of breast leisons. One-half of the slides from each specimen were stained by the RPSM, which reduces routine staining time by 80 percent (rapPaps), and the other half stained by the routine Papanicolaou method (routPaps). Specimens that were inadequate based on rapid assessment were immediately repeated. For each group of slides the smear quality, cytologic diagnoses and results of any related biopsy specimens were documented. The concordance between the cytology diagnoses and between the cytologic and histologic diagnoses was determined. RESULTS: One hundred specimens were obtained from 90 patients (M:F = 1:8; average age 42.3 years). RapPaps averaged 2.9 slides per case and routPaps 3.4; 71 percent and 77 percent of rapPaps and routPaps, respectively, had adequate cellular material, and 84 percent and 85 percent of these groups, respectively, displayed satisfactory cellular preservation. There was 83 percent, 52 percent and 56 percent concordance between rapid and routine cytologic diagnoses, rapid and histologic diagnoses, and routine and histology diagnoses, respectively. Non-concordance was due to lack of cellular material in 14/17 (82 percent), 12/23 (52 percent) and 10/21 (48 percent) cases, respectively. Of the remainder, 6 cases represented major diagnostic discrepancies in which atypical cytologic smears were confirmed to be benign lesions on histology. CONCLUSION: These findings show that staining FNA specimens by the rapid Papanicolaou method allows for accurate cytology evaluation of breast leisons at UHWI. The handling of cytologic specimens by this method can be an important cost- and time- saving strategy in the management of patients presenting to the out-patient services. (Au)

Assuntos

RESUMO

Autopsy rates have not been reported at the University Hospital of the West Indies (UHWI) for more than three decades. Declining rates have been documented worldwide, and so we sought to define autopsy rates over the past three decades at UHWI. We conducted a retrospective analysis of the numbers and types of autopsies performed on deaths occuring in the institution, and calculated the relevant autopsy rates. The overall autopsy rate for the study period was 52.7 percent with a statistically significant decline from 65.3 percent in the first decade to 39.3 percent in the third. The non-coroner's autopsy rate showed a concomitant decline from 57.5 percent to 31.5 percent while the coroner's autopsy rate remained stable with a slight increase from 28.1 percent to 29.1 percent. The factors that might have led to the decline of the autopsy are discussed.(AU)

Assuntos