Frequency of benign and preinvasive breast diseases

The importance of benign proliferative and non-invasive breast lesions as a risk factor preceding the development of invasive mammary carcinoma is well established in the literature. The objective of this study is to estimate the magnitude of benign proliferative diseases as well as mammary intra-epithelial neoplasia in the Western region of the Kingdom of Saudi Arabia [KSA], in order to encourage nationwide breast cancer screening programs for early detection of the high risk proliferative and pre-invasive breast lesions. We reviewed histopathology records [reports and slides of selected cases] of 2129 breast cases including mastectomies and breast biopsies from January 1985 to December 2002 in King Abdul-Aziz University Hospital and King Khalid National Guard Hospital, Jeddah, KSA. All the cases and diagnosis are listed and reclassified using systematized nomenclature of medicine [SNOMED] coding system and then regrouped based on the associated risk factors of developing breast carcinoma. Two thousand one hundred and twenty-nine reports were reviewed and 2343 diagnosis were identified as some cases had more than one diagnosis. The total of benign diagnosis were 1504 after exclusion of malignant diagnosis [558], normal breast tissue, gynecomastia, and non-mammary tissue [281]. All diagnosis [1504] were reclassified based on anatomical prognostic indicators into non-proliferative [1283/1504], proliferative [140/1504], atypical hyperplasia [AH] [8/1504], and carcinoma in situ [CIS] [73/1504]. We compare our findings with the literature and we found that the percentage of benign non-proliferative diagnosis was 85.3% that is higher than the literature 69.7%. Proliferative diseases were 9.3% and atypical hyperplasia was 0.5%, which was lower than the literature 26.2% and 3.6%. On the other hand, CIS diagnosis was 4.9%, which is much higher than the reported literature 1.7%. The study findings could be explained on the basis of higher prevalence of benign breast lesions in our population, or it is related to the number of cases studied, or to the diagnostic criteria followed initially. These findings should encourage us to refine our diagnostic criteria of proliferative diseases, AH and CIS [mammary intraepithelial neoplasia [MIN]]. In addition, we strongly encourage a breast cancer screening program, nationwide

Profile of pop smear cytology in the Western region of Saudi Arabia

Cervical carcinoma is an important womens health problem in the Western countries. There are only few published data on this disease in the Kingdom of Saudi Arabia [KSA]. The aim of this study is to evaluate the abnormal cytological entities detected by cervical Pap smear in Western region of KSA and to discuss the importance of Pap smears screening programs. Retrospective review of all the cervical smears present at the King Abdul-Aziz University Hospital, Jeddah, KSA from 1984 to 2000. The reports of 22089 smears were retrieved from the file of the pathology department. There were 368 [1.66%] abnormal Pap smears out of 22089 smears. Out of these 368 abnormal Pap smears there were 62 [16.8%, mean age 37 year] cervical intraepithelial neoplasia grade 1, 45 [12.2%, mean age 38.5] cervical intraepithelial neoplasia grade 2, 27 [7.3%, mean age 40.5] cervical intraepithelial neoplasia grade 3, 22 [6%, mean age 38.5] positive for malignant cells, 36 [9.8%, mean age 40.5] atypical endocervical cells, 88 [23.9%, mean age 39] atypical squamous cells, 9 [2.4%, mean age 40.5] squamous metaplasia with atypia, 26 [7.1%, mean age 45] squamous cell carcinoma, 6 [1.6%, mean age 36.5] reparative atypia, 2 [5.4% mean age 35] herpes virus changes, 19 [5.1%, mean age 37.5] human papilloma virus changes, 5 [1.4%, mean age 55] adenocarcinoma of endometrium, and 7 [1.9%, men age 43.5] adenocarcinoma of endocervix. Cervical intraepithelial neoplasia and invasive cervical carcinoma are less common in KSA compared to the Western countries, however, cervical screening programs are necessary nationwide to estimate the actual magnitude of cervical carcinoma and its precursor lesions

Analysis of false positive and false negative cytological diagnosis of breast lesions

To study the reasons for interpretive errors in false negative and false positive diagnosis of breast carcinoma on fine needle aspiration cytology material. We reviewed only those cases in which cytohistological discrepancies were found, where the cytologic material was abnormal and to some extent misinterpreted or both. There was only one false negative case [false negative fraction 0.32%] proved histologically as ductal carcinoma and four false positive cases [false positive fraction 1.2%]; 2 fibroadenoma; 1 fibrocystic disease; and 1 stromal fibrosis. Smears of the two false positive fibroadenoma cases showed very high cellularity, overcrowded clusters and frequent stripped nuclei. The fibrocystic case showed tight clusters of apocrine cells and sheets of loosely aggregated macrophages that were over interpreted. Smears of the false negative ductal carcinoma was hypocellular overall, and the cells showed minimal nuclear pleomorphism. Overcrowded clusters and hypercellular smears should be carefully assessed for uniformity of cells and detailed nuclear and cytomorphological features. If the full-blown malignant cytomorphological changes are not visible, a diagnosis of suspicious or inconclusive should be made and frozen section recommended before surgery. Hypocellularity and relatively nuclear monomorphism are the reasons for failure to diagnose malignant breast lesions. Careful attention should be paid to extreme nuclear monomorphism and absence of naked bipolar cells. A cytologically atypical or suspicious diagnosis together with positive radiological and clinical findings should suggest a diagnosis of malignancy

Morphological profile of testicular biopsies associated with infertility

Based on testicular biopsies examined at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, the goal of this retrospective study is identification and systemization of the histopathological patterns of testicular biopsies received especially for investigating male infertility and further more to compare the findings of our study with similar studies in the literature. Our study group consisted of 164 testicular biopsies, which were examined in the Department of Histopathology at King Abdulaziz University Hospital in Jeddah, over a period of 10 years. The data was retrieved and analyzed and the available histopathological results were grouped into 8 different morphological categories. The findings of the biopsies associated with infertility were complied as follows: 45 [27%] showed normal spermatogenesis of which 15% showed active spermatogenesis associated with duct obstruction, 41 [25%] with hypospermatogenesis, 39 [24%] showed end stage tubular sclerosis with interstitial fibrosis, 27 [16.5%] with germ cell aplasia [with or without focal spermatogenesis], 11 [7%] biopsies showed maturation arrest and only on biopsy were associated with karyotpic abnormalities. A higher percentage of hypospermatogenesis and end stage tubular sclerosis with interstitial fibrosis was noticed in this study when compared with the other studies reported from Saudi Arabia. A high percentage [27%] of the biopsies show normal spermatogenesis with or without duct obstruction

Pattern of breast diseases in a teaching hospital in Jeddah, Saudi Arabia

The aim of this case series study is to evaluate the outline and pattern of male and female breast diseases in Saudi Arabia. Also to compare 8 studies of literature discussing the profile of malignant and benign female breast diseases in the Kingdom. We hope that this study will assist us to appreciate the prototype breast diseases in our region. Our study consisted of 1084 consecutive male and female breast lesions. Data on these specimens, received in the time frame of 15 years between January 1984 and March 2000, was retrieved from the records of the laboratory. The outline of breast lesions were tabulated and classified into inflammatory, benign and malignant lesions. In female breasts, benign lesions comprised 57% of all lesions [mean age 28.5], most commonly reported being fibroadenoma 47%, fibrocystic disease 22% and fibroadenosis 14%. Malignant lesions comprised 32.5% of all lesions [mean age 48.49], most commonly reported being ductal carcinoma 88% and lobular carcinoma 4.5%. Inflammatory lesions comprised 11% of all lesions [mean age 35.0], most commonly reported lesion being chronic mastitis 31% and ductectasia 19%. Male benign lesions comprised 55 cases [87%]. Eight cases [13%] of malignant lesions, 6 ductal carcinomas and 2 metastatic adenocarcinomas, were also identified. The rates for female breast lesions varied in different studies but benign fibroadenoma constituted the most common breast lesion and secondly ductal carcinoma. The mean age for malignant lesion in 7 different studies came to be 44.05. In the male breast, carcinomas constituted 3% of all breast carcinomas. Gynecomastia being the most common male breast lesion constituting 54%

Growth of normal urban Saudi schoolboys aged 6-13 years in the southwestern region of Saudi Arabia

The aim of the present study was to establish normal values for height for age and weight for age for elementary schoolboys in an urban southwestern region of Saudi Arabia, and to compare the Saudi values with the USA national center for health statistics [NCHS] standards. A total of 1407 schoolboys representative of all schoolboys aged 6-13 years in the asir region were subjected to weight and height measurements. The values were corrected for age in the form of centile bands and compared with the NCHS standards. Then 5[th], 10[th], 25[th], 50[th], 75[th], 90[th] and 95[th] local percentiles of weight and height were calculated from such values using the frequencies procedure. Saudi boys were significantly shorter [p<0.001] and lighter [p<0.0001] and fell below the NCHS standards. About 38% and 30% of boys fell below the 10[th] centile for weight and height respectively. New national growth standards are needed if growth in schools is to be properly monitored however till the construction of such standards the present study may be used as a source of reference for urban schoolboys in the region