Fine-Needle Aspiration Cytology in the Management of Thyroid Nodules: a Preliminary Retrospective Review of 53 Cases at King Faisal Hospital

This is a retrospective review of 50 thyroid nodules investigated by fine-needle aspiration cytology (FNAC). On clinical grounds alone; it is not easy to differentiate between benign and malignant lesions. The use of FNAC in the preliminary investigation of cases assisted in the clinical management of these nodules in ruling out malignancy and in helping to avoid unnecessary open biopsies and surgery. Its cost-effectiveness and rapidity of results and attendant relief of anxiety to the patient make it acceptable to both physician and patient. Materials and Methods: 53 thyroid nodules were evaluated clinically and sampled by FNA using 23G and 25G needles and 10 ml syringes. Ethanol fixed and air-dried methanol -fixed smears were prepared for Papanicolaou and Diff-Quik staining; respectively. Stained preparations were evaluated on the light microscope.Results: Cytodiagnoses included 24 nodular goitres; 19 colloid goitres; 5 cystic lesions; 1 hyperplastic lesion; 1 thyroidifis; and 1 fungal infection. Conclusions: FNAC was useful in ruling out malignancy and avoiding unnecessary surgery. Benign thyroid nodules were more frequent than thyroid carcinoma. Thyroid nodules were more frequent in female patients than male patients with a ratio of 6:1. Further studies are required to unravel any related aetiologic factors; if any

Immunohistochemical Expression of P53; Ebv-Lmpi and Cyclin D1 Proteins in Oesophageal Carcinoma: A Pilot Retrospective Study of 26 Cases

Introduction: The development of oesophageal carcinoma has been attributed to various environmental factors and its incidence varies regionally. The development of this disease is known to occur in recognized histological stages from normal through dysplasia to the malignant stage. Like other cancers; the diagnosis of oesophageal cancer in its premalignant stage would improve the survival. The diagnosis of this cancer on cytomorphology alone is usually done in the late stage of the disease. To be able to diagnose this disease in its early stage; specific tumour markers must be found. The objective of this study was to evaluate p53 tumour suppressor gene protein expression; Epstein-Barr virus latent membrane protein expression and cyclin DI cell cyase protein expression in malignant and normal oesophageal tissues to see whether any variation in their expression in these tissues could be of diagnostic or prognostic value. Methods: 26 archival formalin-fixed paraffin wax embedded tissue blocks of oesphageal carcinoma and 6 of normal oesophagus obtained by endoscopy were studied. 5?m thick tissue sections were cut onto poly-L-Lysine coated microscope slides and dried at 600C for 60 minutes. p53 gene protein expression; EBV-LMPI protein expression and cyclin DI expression were studied immunohisto chemically in these tissue sections. Sections were dewaxed and hydrated to Tris-buffered saline; pH 7.6. Appropriately diluted primary antibodies to p53; EBV-LMPI and Cyclin DI were applied to different sections and incubated overnight at 40OC in a humidity chamber. Sequential applications of other reagents in a three-stage peroxidase antiperoxidase method were applied for chromogen immunoreaction for light microscope visualization. The sections from normal oesophageal tissues were processed with carcinomatous tissues.Results: p53 gene protein was overexpressed in 17 of 26 cases of carcinoma; EBV-LMPI was expressed in 12 of 26 cases of carcinoma; cyclin DI protein was expressed in 14 of the 26 cases of carcinoma; 10 cases of p53 expression were also associated with EBV-LMPI protein expression; 7 cases of p53 protein overexpression did not express EBV-LMPI; 2 cases of EBV-LMPI protein expression did not express p53 protein and 7 cases did not express both p53 and EBV-LMPI proteins. Conclusion: Overexpression of p53 tumour suppressor gene protein in tumour cells of 17 of 26 cases of oesophageal carcinoma while no such expression was demonstrated in normal oesophagus; may have diagnostic and prognostic value. EBV-LMPI expression in tumour cells of 10 of 26 cases of oesophageal carcinoma may also be of value in diagnosis and pathogenesis. Cyclin DI was overexpressed in 14 of the 26 cases and may have diagnostic and prognostic value

Cervical Squamous Intraepitherial Lesions at King Faisal Hospital: A Systematic Review: April 2009 - April 2011

Background: The cervical cancer is the most common cause of mortality with cancer among women in developing countries. Cervical screening tests are used to detect precancerous lesions in various stages of development when they can be treated. Screening for cervical cancer involves women who are at risk for cervical cancer but have no current signs; symptoms or complaints referable to the cervix; or have no previous abnormal Pap smear and have no high risk factors for cervical cancer. This retrospection study was to review cervical smears evaluated in 24 months and squamous intraepithelial lesions detected among the 1;673 cases studied. Methods: Ethanol and spray fixed cervical smears were received by the laboratory from the outpatients department at King Faisal Hospital and from collaborating institutions. The smears were stained by Papanicolaou method and evaluated on the light microscope. 1;673 smears were selected for this study. Results: There were 19 (19/1673) squamous intraepithelial lesions of various grades. 7 (7/19) were low grade squamous intraepithelial (LS1Ls); 11 (11/19) were high grade squamous intraepithelial lesions (HSILs) and 1 (1/19) was adenocarcinoma. 5 (5/19) lesions were associated with human papillomavirus (HPV) infection. Conclusion: This review shows a low incidence of cervical squamous intraepithelial lesions due to the high cost of the test in a high cost health care institution; hence the small number of risky women accessing the test. A bigger study to include a spectrum of all risky women is required

Effusion Cytology at King Faisal Hospital; Kigali: A Review of 151 Cases

Introduction: The clinical management of patients presenting with effusions requires the determination of the cause of the effusion for direction of options of management. The cytologic examination of the effusion is usually required to rule out or confirm malignancy. This is a retrospective review of 151 effusions cytologically investigated at King Faisal Hospital. Methods: One hundred and fifty one effusions collected in EDTA tubes were investigated. The specimens were centrifuged; and from the sediment alcohol-fixed; air-dried smears were prepared for Papanicolaou and Diff-Quik staining; respectively. Results: From the total of 151 effusions; malignant cells were identified in 26 cases as follows: 15 pleural; 8 ascitic and 3 peritoneal malignancies consisted of 15 adenocarcinomas; 5 lymphomas; 3 mesotheliomas 2 myelomas and 1 small cell carcinoma. Conclusions: Malignant effusions constituted 17 percent of all the effusions examined. Adenocarcinomas were the most frequently diagnosed metastatic malignancies in both pleural and ascitic effusions and in both females and males. Primary sites of most of the malignancies could not be determined except for mesotheliomas and small cell carcinoma