Morphologic, immunphenotypic and clinical discriminators between T-cell / histiocyte-rich large B-cell lymphoma and lymphocyte-predominant Hodgkin lymphoma

Features of T-cell/histiocyte rich large B-cell lymphoma [THRLBCL] overlap with those of lymphocyte predominant Hodgkin lymphoma [LPHL]. The two lymphomas may represent a spectrum of the same disease, and differentiation between the two can sometimes be difficult. We looked at histomorphologic, immunophenotypic and clinical information that may help differentiate the two entities. Cases of THRLBCL and LPHL were blindly reviewed and studied for histological pattern [nodular vs. diffuse], nuclear features and pattern of expression of CD20, CD30, CD57, epithelial membrane antigen [EMA] and Epstein-Barr virus [EBV]. A score encompassing diffuse histology, high nuclear grade, CD20 single-cell pattern, CD30+, CD57-, EMA-, and EBV+ was estimated for the diagnosis of TCHRLBCL. There were 58 cases, including 30 cases of TCHRLBL and 28 cases of LPHL. The median age was 36 years for TCHRLBCL and 21 years for LPHL [P=0.0001]. Three types of nuclei were identified [lymphocytic/histocytic, Reed-Sternberg and centroblast-like]. The latter two high-grade nuclei were suggestive of TCHRLBCL. TCHRLBCL and LPHL, respectively, showed diffuse histology, 90% vs. 4% [P=0.001], single CD20+ cells, 93% vs. 3.5% [P=0.00004], CD30+ cells, 30% vs. 0% [P=0.01], CD57+ cells, 41% vs. 93% [P=0.008], EMA+ cells, 27% vs. 60% [P=0.113], EBV+ cells, 24% vs. 0% [P=0.117], high nuclear grade, 70% vs. 0% [P=0.001], total score 2-7 [mean 4.68] vs. 0-2 [mean 0.72] [P=0.001], high stage, 86% vs. 7% [P=0.0001]. Our findings indicate that a combination of multiple parameters can help differentiate between the two diseases. Two cases originally diagnosed as LPHL were re-assigned the diagnosis of THRLBCL

Palliative care initiative for the eastern mediterranean regions: a proposal

The Eastern Mediterranean Region [EMR], with 22 countries and about half a billion people, has scarce palliative care services that are far from meeting the needs of the region. The authors of this paper believe that the resources and international influence of the World Health Organization could be combined with the excellent palliative care expertise of King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia to establish a collaborative initiative for promotion of palliative care services in the region. This proposal is based on the major components of professional training, development of regional guidelines, integration of palliative care into health plans and polices, and ensuring availability of essential medications. Investment in developing palliative care in the EMR would be expected to relieve the suffering of hundreds of thousands of patients and families in this part of the world

overview of breast cancer

Breast cancer is a major health problem in many parts of the world. Its impact in Saudi Arabia will be more obvious when the national data is released from the National Cancer Registry [NCR] in the future. It is the most common cancer referred to the King Faisal Specialist Hospital and Research Centre [KFSH and RC]. This is a retrospective review of all female breast cancer cases treated at KFSH and RC over a 15-year period. Patients were divided into two groups at the time of their referral to KFSH and RC: metastatic and nonmetastatic. We describe the demographic data, cancer-related information and the treatment offered to all patients. Comparisons were made between Saudi and non-Saudi, and the Saudis were examined in relation to their region of referral and observed to see if any changes occurred during the study period. As well, we tried to compare our results with experience elsewhere. A total of 1584 female breast cancer patients were treated at KFSH and RC between 1975 and 1991. Early breast cancer [Stages I, II] represented 36%, while 64% presented with advanced or metastatic disease [Stages III, IV]. The majority of patients were premenopausal [64%]. For patients with Stage I=III [1005], mastectomy was performed in 85% and lymph node dissection in 93%. Only 30% had no pathologic lymph node involvement and in 49% of the patients, lymph node dissection was adequate [>/= 10 nodes removed]. Estrogen and progesterone receptors were known in 30% of the patients. Sixty-two percent and 72% of patients referred from the central region and the northern region had Stages II and III, respectively. For the non-Saudis, we observed more premenopausal patients [76%] and fewer Stage III, At 15 years, the relapse-free survival in Stages I, II and III was 33%, and 18%, and the overall survival was 80%, 64% and 45%, respectively. Breast cancer in this population affects younger patients [premenopausal] and a higher proportion present with metastatic or locally advanced disease. Management strategies should incorporate conservative surgery when appropriate, and adequate lymph node dissection. This should be coupled with increasing public awareness and education and institution of screening programs. Overall survival is clearly linked to the stage of the disease

Developing palliative care services for terminally ill patients in Saudi Arabia

Palliative Care is an accepted specialty of medicine and nursing which concentrates on the total care of patients suffering from any form of terminal illness. Its development as part of the health care services is a recognition that dying is a normal consequence of living and that the support of health professionals and the use of modern medical technology can relieve much of the distress normally associated with dying of illnesses such as cancer. This article looks at the experience of King Faisal Specialist Hospital and Research Centre in developing a palliative care service for the terminally ill since 1989 in the hope that other institutions in the Kingdom will be encouraged to do likewise

Inflammatory breast carcinoma

Inflammatory breast cancer [IBC] is a distinct clinico-pathological entity. It is a rare tumor which represents less than 5% of all breast cancers. It is known for its aggressive behavior and grave prognosis with high of local and regional recurrence and propensity for distant metastases. The use of induction combination chemotherapy as a part of multimodality treatment in IBC has significantly and favorably altered the natural history of this disease. Approximately 35-50% of IBC patients are now disease free and alive at 5 years when treated by a combined modality approach in sharp contrast to 0-2% survival at 5 years when treated only by local therapy. New strategies such as high dose chemotherapy with autologous bone marrow rescue of growth factor support are being evaluated. This disease still poses many problems in oncology and the optimum management strategy has not yet been defined

Malignant cystosarcoma phyllodes: a review of the clinical experience at King Faisal specialist hospital and research centre

Twelve females with cystosarcoma phyllodes of the breast were referred to King Faisal Specialist Hospital and Research Centre [KFSH and RC] between 1980 and 1990, representing 0.8% of breast cancer patients seen during this period. Median age was 45 years [range 16 to 65 years]. Seven patients [58%] were premenopausal. All patients presented with breast mass, which measured >10 cm in 58% of them. The median duration of symptoms was 15 months [range two to 174]. Neither axillary lymph nodes nor distant metastases were seen at presentation. Surgery was the cornerstone of primary treatment [wide local excision in three and mastectomy in nine]. Two patients received adjuvant chemotherapy and locoregional irradiation. All patients had malignant tumors histologically. Of the four tumors assayed for hormonal receptors, one was positive for estrogen and progesterone receptors. At a median follow-up of 17 months [range two to 77] four patients had relapsed; one died at 19 months and the projected five year survival is 83%. This limited data supports the observation that malignant cystosarcoma phyllodes is a distinctive clinicopathological entity of female breast cancer with a different natural history from carcinoma of the breast. Our survival results are similar to reported experience from the literature