case report: aggressive fibromatosis in a one-year old child

Aggressive fibromatosis, also defined as desmoid tumor, is an uncommon tumor. A review of literature detected less than 100 cases that have been reported of pediatrics aged 16 years or younger with aggressive fibromatosis in the head and neck. In this study we report a 1-year old girl who presented with an oral mass. The clinical, radiological, the histopathological features, and treatment are discussed

Pattern of cervical smear abnormalities using the revised Bethesda system in a tertiary care hospital in western Saudi Arabia

To evaluate Pap smear [PS] diagnoses at a tertiary care hospital using the revised Bethesda system, and to compare the results with other similar studies. We designed a retrospective study to review all PS from the Cytopathology Department of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from January 2005 to December 2009. Of the 7297 cases reviewed, 1254 cases [17.3%] had epithelial cell abnormalities. The categories included: atypical squamous cell of undetermined significance [ASC-US] found in 9.3%, atypical squamous cell, cannot exclude high squamous intraepithelial lesion [ASC-H] in 0.8%, low grade squamous intraepithelial lesion [LSIL] in 2.7%, and high grade squamous cell lesion [HSIL] in 0.9%. The mean age incidence [MAI] was 40 years for ASC-US, 42 years for ASC-H, 47 years for LSIL, and 45 years for MAI. Squamous cell carcinoma [SCC] was found in 0.06% with mean age incidence of 46 years. In the atypical glandular cell category, there was 3.2% atypical glandular cell of undetermined clinical significance not otherwise specified, 0.1% atypical glandular cells favoring neoplasm, and 0.08% atypical endometrial cells favoring neoplasm. The incidence of abnormal PS has increased from previously 4.7%, to 17.3% in the present study. The ASC-US among total PS examined has also significantly increased. The increase in the number of positive PS raises concerns of whether the new BS results are an artificial increase in the prevalence and the predictive value of cytology to some extent.

Cervical cancer screening with pattern of pap smear. Review of multicenter studies

To estimate the frequency of abnormal cervical smears and to compare the findings with earlier reported data from Saudi Arabia. The study was divided into 2 parts. The prospective part was conducted at King Abdul-Aziz University Hospital and a private laboratory by using the Bethesda System criteria and diagnostic entities in evaluating all the pap smears that were received during the period of January 2000 to December 2004. All reliable published literature on pap smear performed at different hospitals from 1990-2004, from the Western and Abha regions of Saudi Arabia were retrospectively evaluated. A total of 5132 cases were evaluated in the prospective part of the study. The percentage of abnormal pap smears was 4.7%. The significant categories were atypical squamous cell of undetermined significance [2.4%], low grade squamous intraepithelial lesion [0.6%], high grade squamous intraepithelial lesion [0.4%] and atypical glandular cells of undetermined significance [1.1%]. The malignant categories were squamous cell carcinoma [0.08%], adenocarcinoma of cervix in situ [0.02%] and invasive [0.04%]. Other malignancies were 0.04% and neuroendocrine carcinoma was 0.02%. In the second part of the study, the total number of cases reported in the literature were 45596. The percentage of abnormal pap smear was 1.4%. The total cases evaluated in the current study and the previous published studies were 50, 728 and the frequency of abnormal pap smear was 1.6%. The percentage of abnormal pap smear was higher in the prospective part of this study than the previously reported results. Unified national programs for diagnosing cervical precancerous lesions should be established covering different region of the Kingdom to evaluate the magnitude of the problem

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

Breast Cancer Screening

Breast cancer is a very common health problem in Saudi females that can be reduced by early detection through introducing breast cancer screening. Literature review reveals significant reduction in breast cancer incidence and outcome after the beginning of breast cancer screening. The objectives of this article are to highlight the significance of breast cancer screening in different international societies and to write the major guidelines of breast cancer screening in relation to other departments involved with more emphasis on the Pathology Department guidelines in tissue handling, diagnostic criteria and significance of the diagnosis. This article summaries and acknowledges major work carried out before, and recommends similar modified work in order to meet the requirement for the Saudi society

Histopathological and Immunohistochemical Characteristics of Primary Renal Primitive neuroectodermal Tumor

We report a 32-year-old male who presented with huge [17x10.5x5 cm] right kidney with metastasis in the liver and retroperitoneal lymph nodes. Histological, detailed immunohistochemical studies and electron microscopic examinations were performed. Microscopy revealed small to intermediate sized cells with hyperchromatic nuclei, scanty cytoplasm, abundant mitosis with no pseudorossete formation. Immunohistochemical study revealed positive staining of the tumor cells for S100, neurofilaments, neuron specific enolase, vimentin and myoglobin. Primitive neuroectodermal tumors are rare malignant round cell tumors of the kidney. A correct diagnosis can be made on light microscopic features, and by immunohistochemically positive staining for more than one neural marker. This neoplasm should be differentiated from other renal neoplasms composed of small round cells

Histopathology of adenoid cystic carcinoma of the larynx and adenocarcinoma hybrid

A 35-year-old Saudi female presented to the Ear, Nose and Throat clinic complaining of hoarseness of voice. Examination revealed subglottic mass, which proved to be adenoid cystic carcinoma of the larynx with adenocarcinoma hybrid. In this paper we discuss the pathological features and electron microscopy of adenoid cystic carcinoma in detail, including its differential diagnosis, prognosis and treatment

Hepatocellular carcinoma

To establish the most common pathological criteria to diagnose hepatocellular carcinoma, and to identify the high-risk patients for further investigation in order to detect hepatocellular carcinoma in its early stages. A retrospective study was carried out at King Khalid National Guard Hospital including 60 cases diagnosed as hepatocellular carcinoma cytologically and histopathologically. Further investigations were performed by special staining and immunohistochemical staining on 42 blocks including Periodic acid-schiff, PAS-D, Reticulin, Iron and Alpha Fetoprotein, hepatitis B surface antigen, hepatitis B core antigen and p53 antibodies. It was found that pleomorphism, followed by presence of prominent nucleoli and nuclear pseudoinclusion were the most frequent finding in hepatocellular carcinoma. While considering other studies, reticulin framework, glycogen and iron content of the hepatocellular carcinoma were markedly diminished as compared to non-malignant liver tissue. Antibodies against tumor suppressor gene was applied on paraffin section [p53], it was positive in 52% of cases and 53% of them were having anti hepatitis B surface antigen positivity, detected in their serum and 23% were having hepatitis C antibodies positive. Hepatocellular carcinoma is a common malignancy that can be detected by certain defined pathological parameters and should be suspected in high-risk patient

rare metastasis from Hepatocellular carcinoma

Primary hepatocellular carcinoma is the second most common gastrointestinal cancer [GIT] in the Kingdom Skin metastasis occur mainly in advanced cases. Using Medline Search only 48 cases of skin metastasis from hepatocellular carcinoma have been reported in the world literature in the past 10 years, with no report from Saudi Arabia