Bilateral subepidermal calcified nodules of the eyelid

A subepidermal calcified nodule [SCN] is an uncommon benign lesion, which usually develops in early childhood and is typically solitary. A rare form of this lesion has been reported in the eyelid. We report here a case of a 12-year-old girl with bilateral nodules of the right upper eyelid and a left lower eyelid simulating epidermal cyst. The histopathologic examination of the excised nodule confirmed the diagnosis. To our knowledge, this may be the first bilateral case of eyelid SCN reported in the literature

Jaffe-campanacci syndrome

This case report describes the clinical, radiological and histopathological features of the Jaffe-Campanacci syndrome as seen in a 6-year-old Qatari male patient who was initially misdiagnosed as a case of systemic neurofibromatosis. Our case has all the diagnostic stigmata of Jaffe-Campanacci syndrome as described in the literature and these include cafe au lait macules, skeletal deformities and multiple histologically confirmed non-ossifying fibromas of the long bones

Propionic acidemia and zinc deficiency presenting as necrolytic migratory erythema

Necrolytic migratory erythema was first described in 1942 in a patient with pancreatic islet cell carcinoma. The disease can, however, have other etiologies including nutritional dermatoses. Here, we describe the clinicopathological picture of a 7-year-old female patient who presented with necrolytic migratory erythema which we believe is secondary to a rare combination of zinc deficiency and propionic acidemia

Interdigitating dendritic cell tumor

Interdigitating dendritic cell tumor is an extremely rare neoplasm that mainly occurs in lymph nodes. In this case report, we describe the histopathological and clinical features of a typical interdigitating dendritic cell case in a 30-year-old Saudi female who presented with a painless unilateral left neck mass. Microscopically, the lesional tissue in the affected lymph node showed whorls and fascicles of spindle cells intermingling with small lymphocytes. The neoplastic cells were strongly and diffusely positive for S-100 protein, vimentin and alpha 1-antichemotrypsin and focally for macrophages marker [CD68]. The combined morphological features and immunohistochemical results were diagnostic of interdigitating dendritic cell tumor

Endobronchial inflammatory pseudotumor of the lung

Inflammatory pseudotumor [also called plasma cell granuloma, histiocytoma and x-anthofibroma] is a benign, slow growing lesion which may present with cough, dyspnea, hemoptysis and unresolving pneumonia or can be discovered radiographically as a localised lesion. It has been reported in individuals up to 70 years old, but approximately two-thirds have developed in individuals under 30 years of age. The sex incidence is approximately equal. Inflammatory pseudotumors of the lung are usually peripheral lesions but may occasionally be endobronchial. We report the case of an endobronchial inflammatory pseudotumor in a 17-year-old girl who presented with unresolving right-sided pneumonia. Appropriate radiological, bronchoscopic and histopathological investigations lead to accurate pre-operative diagnosis and early complete surgical resection through a limited right main bronchus incision [bronchotomy]. The patient made good postoperative recovery and an excellent prognosis is anticipated

Morphologic patterns of male infertility in Saudi Arabia

To determine the predominant histopathological patterns seen in the testicular biopsies taken during the investigation of male infertility and to compare the obtained histopathological findings with those seen in other similar studies. This is a retrospective study performed on 230 testicular biopsies which were examined in the Department of Pathology at King Khalid University Hospital in Riyadh over a period of 10 years. The histopathological findings were grouped into 8 different morphologic categories. We have utilized a classification that is principally morphologic but that uses known or suspected clinical associations in the case of karyotypic abnormalities and excurrent duct obstruction. Of the total of 230 testicular biopsies studied, 72 cases showed normal spermatogenesis, of which 50 cases were suspected to be associated with excurrent duct obstruction. Germinal cell aplasia with and without focal spermatogenesis was found in about 90 cases. Thirty cases showed hypospermatogenesis, 25 cases showed maturation arrest and 12 cases showed end stage tubular sclerosis with interstitial fibrosis. Only one case was noted to show features associated with karyotypic abnormalities. A higher percentage of germinal cell aplasia was noted in this study when compared with other similar investigations including one previous local study. Possible causes of these discrepancies may be related to several factors including environmental effects. The design of the different studies and the criteria used for patient selection or both could also explain the cause of these observed differences

Prevalence of intratubular germ cell neoplasia of the testis

Intratubular germ cell neoplasia has been described as a premalignant state with the potential to progress to invasive carcinoma of the testis. We determined the prevalence of intratubular germ cell neoplasia in relation to the associated pathology in testicular biopsies from infertile men and in orchidectomies performed for both neoplastic and non-neoplastic conditions. We reviewed all testicular biopsies performed for the investigation of infertility and orchidectomy specimens of non-neoplastic conditions and testicular tumors seen during a period of 10 years at King Khalid University Hospital. Histopathological examination of all specimens to determine the presence of intratubular germ cell neoplasia was carried out. Immunohistochemistry for placenta alkaline phosphatase was performed on formalin-fixed and Bouin's-fixed specimens with intratubular germ cell neoplasia, positive and negative controls were also stained for comparison. The review included a total of 548 male patients. The incidence of intratubular germ cell neoplasia in 244 testicular biopsies from infertile men was 0.82%. The percentage of intratubular germ cell neoplasia seen in 17 orchidectomies performed for invasive germ cell tumors was, however, 47%. Intratubular germ cell neoplasia was not detected in 109 of the orchidectomies performed for maldescended testes and in 2 cases of the androgen insensitivity syndrome. All cases of intratubular germ cell neoplasia identified in this review were not described at the time of primary pathological examination of the biopsies and orchidectomy specimens. Awareness of this clinicopathological entity is essential to describe and detect this form of testicular cancer at the preinvasive state. The prevalence of intratubular germ cell neoplasia is low in Saudi patients particularly in the high risk group of patients with cryptorchidism. Furthermore, our results do not support the need for routine biopsy of the testis of infertile or cryptorchid patients unless sampling is indicated in preparation of assisted fertilization technique or orchidopexy

Silica particles as a possible aetiological factor of esophageal carcinoma in the qassim region of Saudi Arabia; a pilot study

To determine the causative relation between the high levels of silica content in local wheat and salt and the reported increased incidence of esophageal carcinoma in the Qassim region of Saudi Arabia The wheat and natural salt produced in the Qassim province of Saudi Arabia are analyzed using the "ash-weight-method" in order to determine their content of silica. At the same time, the acid insoluble particles of silica isolated from esophageal squamous epithelium surrounding the tumor-bearing site are assessed using a filtration method for extraction. The particles are subsequently observed by a scanning electron microscope and the elements measured by an x-ray analyzer. The results obtained from the experimental and control specimens are tabulated and compared. The resected esophageal segments of four Saudi patients who were diagnosed to have esophageal carcinoma and have been resident in the Qassim province formed test group number I [group I]. Group II [the control tissue specimen] consisted of equal weight of mucosal samples obtained from four normal esophageal segments taken during necropsies performed in Riyadh Central Hospital. The results of this retrospective pilot study showed that the wheat and natural salt produced in the Qassim province contain significantly higher levels of silica when compared with that of other countries like United Arab Emirates and Australia: 130 [6.5%], 74 [3.7%] and 34 mg [1.7%] of silica per 2000 mg of wheat respectively and 14 mg [0.12%] only of silica per 2000 mg of sample. A comparison between the mean values of the counts and weight of silica granules in carcinomatous esophageal specimens and that of control samples show a significant increase in the levels of silica in the resected esophageal segments, Table 1. This pilot study suggests a previously unconsidered possible aetiological relation between the significant silica contents in the wheat and salt and the increased reported incidence of oesophageal carcinoma among the local population of Qassim's province. It is possible that the putative sharp-edged silica particles cause repeated local injury during their passage down the esophagus and also during the time they spend buried in the mucosa. This repeated injury may lead to cellular proliferation and subsequent neoplastic change

Intra-operative cytology and frozen sections of breast lesions: a comparison from a Saudi teaching hospital

Evaluate the usefulness of intraoperative cytology in providing rapid and accurate diagnosis for various breast lesions and to compare its diagnostic yield with that of frozen and paraffin sections. Setting: All surgically excised breast lesions submitted to the Histopathology and Cytology Department at King Khalid University Hospital [KKUH], Saudi Arabia during a period of 18 months [May 1993 till October 1994]. Subjects: Fifty Saudi female patients admitted to the surgical wards at KKUH because of breast-related clinical complaints and who have had subsequent surgical excision of their breast lesions. Design: Touch imprints and scalpel blade scrapes were made from the cut surfaces of 50 different breast lesions. The cytological preparations were stained using the "Diff-Quick" method. Frozen sections were also performed on all cases. There were 28 benign and 22 malignant lesions. There were three cases of significant discrepancies between the intra-operative cytology and frozen section diagnosis. Our findings indicate that intra-operative cytology alone gave the correct diagnoses in 94% of the cases examined. Intraoperative cytology is a reliable and cost-effective technique which can be used as an adjunct to frozen section of breast lesions. The histopathologist should, however, be aware of the patient's clinical details, mammographic findings and the macroscopic appearances of the lesions examined

Hypersensitivity reaction to carbamazepine presenting with angioimmunoblastic lymphadenopathy generalized dermatitis and bone marrow granulomas

A 29-year-old Saudi woman was admitted to the medical unit at King Khalid University Hospital with a history of generalized erythematous and vesicular skin rash, lymphadenopathy and hepatosplenomegaly. She was a known epileptic receiving carbamazepine treatment for the last 2 years. The lymph node biopsy showed features of angioimmunoblastic lymphadenopathy. The bone marrow trephine biopsy revealed the presence of small non-caseating epitheloid granulomas and her skin showed features of exfoliative and vesicular dermatitis. The histological features are described and discussed in addition to a detailed review of the literature and a comparison with other reported cases is made