Fibrous Histiocytoma of the Breast

Two Saudi females aged 26 and 14 years presented with giant fibroadenomas. The histology after surgical excision revealed benign fibrous histiocytomas. Patient one remained well with no apparent recurrence after 5 years of the initial excision. However, in patient 2 the benign fibrous histiocytoma recurred with low-grade malignancy after a year of the initial excision. A high-grade recurrence developed after 3 months of the second excision. This was treated by radical wide excision. It was felt later that mastectomy was more appropriate and therefore was performed. The second patient highlights the fact that malignant histiocytoma can occur in the pediatric age group and that the initial surgical treatment of benign fibrous histiocytoma should be aggressive to avoid recurrence and development of malignant changes. We believe that our second patient is the youngest age ever reported in the literature with malignant fibrous histiocytoma

Combined parathyroid adenoma and an occult papillary carcinoma

Although the pathological association of thyroid and parathyroid disease is common, the association of both parathyroid adenoma and thyroid cancer is rare. We report here a case of a 45-year-old Saudi woman who was diagnosed to have primary hyperparathyroidism due to a single parathyroid adenoma as confirmed biochemically and radiologically. At operation, the adenoma was found to be an intrathyroid and therefore a thyroid lobectomy was performed. Histology of the excised lobe revealed in addition to the intrathyroid parathyroid adenoma a concurrent occult thyroid papillary carcinoma. This interesting association is discussed based on a literature review

Concurrent papillary and medullary thyroid carcinomas with mixed metastases to lymph nodes

We report here a rare concurrence of medullary and papillary carcinomas of the thyroid in a 39-year-old Saudi male. He presented with a solitary nodule of the right thyroid lobe and underwent total thyroidectomy based on the cytological diagnosis of papillary carcinoma. Subsequent detailed histopathologic examination of the thyroid revealed 2 different types of malignancies in the 2 lobes papillary cancer in the right and medullary cancer in the left lobe. A single small lymph node showed metastatic replacement by both cancers. The extreme rarity and the interesting pathological features of such combinations are discussed

Pancreatic pseudocyst

Gallstones cause more than two-thirds of the acute pancreatitis episodes in the Kingdom of Saudi Arabia [KSA]. The majority of these attacks are often mild and self-limiting. However, some are associated with complications; most common of which is development of pancreatic pseudocyst. This complication was reported to be rare in some areas of KSA. The author reports his personal experience with pancreatic pseudocysts that he encountered over 9 years of surgical practice in one of the busiest hospitals in the Eastern Province of KSA and discusses various management options

Pigment polyp in the common bile duct

We report here a case of a young female with sickle cell disease and a past history of open cholecystectomy 10 years ago presenting with intermittent upper abdominal pain and jaundice. Abdominal ultrasonography revealed a dilated biliary tree with the possibility of a stone in the proximal common bile duct, but cholangiopancreatography showed a polypoid lesion at the junction of the common hepatic and common bile ducts. Biopsy of the lesion was benign. She underwent bile duct exploration and excision of what proved to be a 'pigment'polyp arising from the cystic duct stump. This is the first reported case of a pigment polyp encountered in sickle a cell disease population

Efficacy of daflon in the treatment of hemorrhoids

To demonstrate the value of Daflon in the management of hemorrhoidal symptoms in Saudi patients attending the Surgical clinic. This is a prospective clinical study of 105 consecutive patients suffering from hemorrhoidal problems including thrombosed piles. Detailed history and proctoscopic examination to determine position, size, and degree of hemorrhoids was conducted in all patients attending the Surgical Clinic at Dammam Central Hospital, Dammam, Kingdom of Saudi Arabia [KSA]. The study was conducted over a 6-months period [December 2000 to May 2001]. All were started on Daflon; 2 tablets twice daily for 4 weeks and were followed up weekly during the study period and proctoscopic examination was conducted at each consultation. The mean age was 35 [range 19-70] years. The majority [77%] suffered congested hemorrhoidal disease and only 8% had thrombosed piles. Previous surgery for piles was noted in 11%. Concomitant medical diseases were present in 10%. The degrees of piles were first degree [23 patients], 2nd degree [73], 3rd degree [9] and 4th degree [0]. There was a statistically significant [p<0.001] improvement in pain, heaviness, bleeding, pruritus, and mucosal discharge from baseline to last visit. There was also a significant [p<0.001] improvement on the proctoscopic appearance. Five patients failed to improve on Daflon; therefore, they underwent surgery. The side effects of Daflon [mainly gastrointestinal symptoms] were encountered in 5 patients but did not force interruption of the medication. Daflon is a very safe and effective drug in the treatment of all hemorrhoidal symptoms in the population of Eastern KSA

Pattern of colo-rectal surgery at Dammam central hospital

This study aims to analyse the patterns of presentation, investigation and surgical management of major colo-rectal diseases admitted to the Department of Surgery, Dammam Central Hospital, one of the major hospitals in the Eastern Province of Saudi Arabia. The case notes of all patients who underwent major colo-rectal procedure [excluding piles and ano-rectal sepsis] over 2-year period [1995 and 1996] were retrospectively reviewed. There were 23 colo-rectal procedures carried out in 21 patients [15 males, 6 females] with mean age of 45 [range 15-75] years during the two year period [1995- 1996]. Fifteen patients [70.4%] were Saudis. The commonest presenting symptoms were: constipation [81%], bleeding per rectum [57%], abdominal pain and discomfort [47.6%], weight loss [42.8%], abdominal mass [19%] and tenesmus [19%]. Ultrasonography was performed in 20 and was informative in 5 cases [mass 3, liver metastases 1 and mesenteric lymphadenopathy in 1]. CT scan was performed in 8 patients and was abnormal in 4. Nineteen patients [90.5%] underwent colonoscopy, which revealed colonic lesions in fifteen patients. Only 3 patients had barium enema that showed malignant lesion in 2. The operations performed were hemicolectomy [eight], anterior resections [four], abdominoperineal resection of rectum [three], Hartmann's procedures [two], reversal of Hartmann's [two], subtotal and total colectomies [three]. Majority of the procedures was carried out for cancer [66.7%], followed by adenoma [9.5%]. There were 4 complications [17%] and 5 deaths [21.7%]; all in patients with cancer. The mean hospital stay was 20 [range 10-67] days. We conclude that colonoscopy is efficiently used at Dammam Central Hospital to investigate large bowel symptoms replacing barium enema. Major colorectal procedures are conducted at a rate of 1 per month. Majority [66.5%] of colonic operations performed were for cancer and that surgery for inflammatory bowel conditions seem to be uncommon