Steroid resistant nephrotic syndrome in pediatric patients: histopathological patterns at King Hussein Medical Center

Objective: to analyze the histopathological pattern of steroid resistant nephrotic syndrome in pediatric age group at King Hussein Medical Center

Method: a retrospective study of record review was carried out at King Hussein Medical Center during the period from January 2007 to September 2014 for all pediatric patients with steroid resistant nephrotic syndrome who underwent percutaneous kidney biopsy. Medical records were reviewed for age, sex, symptoms treatment and histopathological diagnosis

Results: one hundred children with the diagnosis of steroid resistant nephrotic syndrome were included in the study. 54% were males. The age ranges between 1-14 years. The most frequent symptom was puffiness of the eyes and lower limbs swelling. Focal segmental glomerulosclerosis was the most common histopathological pattern [54%], followed by minimal change disease [25%]. Alport syndrome was found in [2%]; however minimal change disease accounted only for [12%] after the age of 10 years

Conclusion: focal segmental glomerulosclerosis is the most common cause of steroid resistant nephrotic syndrome; which emphasize the importance of histopathological diagnosis in steroid resistant nephrotic syndrome for both treatment and prognosis

Immunophenotypic profile of acute leukemia cases using multicolor flow cytometry; three year experience at king Hussein medical center

To study the immunophenotypic profile of acute leukemia cases, using multicolor flow cytometry for lineage subtyping. This is a retrospective review of acute leukemia cases conducted at department of Hematopathology at King Hussein Medical Center between January 2011 to December 2013. A total of 340 acute leukemia cases were analyzed using flow cytometry method. The diagnosis was based on morphological assessment of peripheral blood and bone marrow aspirate smears and immunophenotyping by flow cytometry. A total of 340 cases of acute leukemia were studied. 164 cases [48.2%] were acute lymphoblastic leukemia, 176 [51.8%] were acute myeloid leukemia. Acute leukemia was diagnosed among adults in 51.8% whereas 48.2% were children. Of the acute lymphoblastic leukemia cases, 130 cases [79.3%] were B-cell type and 34 cases [20.7%] were T-cell type. All cases of B-acute lymphoblastic leukemia showed expression of pan B-cell markers [CD19, CD22 and cytoplasmic CD79a] and 117 [90%] of cases expressed CD10. Cytoplasmic CD3 and CD5 were the most sensitive markers for diagnosis of T-acute lymphoblastic leukemia. Of the 176 cases of acute myeloid leukemia, 16 cases [9%] were identified as acute promyelocytic leukemia, while the rest 160 cases showed expression of CD34 and HLA-DR in 41.4% and 68.7% retrospectively. None of the cases of acute promyelocytic leukemia were positive for both CD34 and HLA-DR. CD13 and CD33 were expressed in all cases of acute myeloid leukemia studied. Flow cytometric immunophenotyping is a powerful method for accurate diagnosis, identification and subtyping of acute leukemia. Furthermore, it has a great therapeutic and prognostic implications on such cases with unique usefulness in differentiation between acute lymphoblastic leukemia and acute myeloid leukemia-M0. Immunophenotyping results of acute leukemia in this group of Jordanian patients were comparable to the international data. By combining morphology and immunophenotyping, we were able to diagnose and classify cases of acute leukemia at our center where peripheral blood and adequate bone marrow aspirates are available

Cutaneous malignant melanoma: a clinicopathological study of 24 cases

To evaluate our experience in primary cutaneous malignant melanoma at King Hussein Medical Center which is a main tertiary care teaching hospital in Jordan, in order to determine the early recognition and diagnosis to give a better chance for treatment and a better prognosis and survival rate. Twenty four cases of primary cutaneous malignant melanoma, 14 males and 10 females, have been diagnosed at King Hussein Medical Center during the period January 2001 - May 2005 were included in this study. The histopathology records of these cases were reviewed and analyzed in accordance to their clinical data. Out of the 24 cases of cutaneous malignant melanoma, 14 males and 10 females with age range 15 years to 85 years old, and the mean age of [49] years for females, and [57] years for males with skin type [II-IV]. There were only four cases that have been diagnosed at early stage with Clark level I, and II, and III. The rest of 20 cases were Clark level IV and V. There were nine cases out of the 20 who had metastases at the time of diagnosis. In this study, we noticed that most of malignant melanoma cases were not diagnosed at their early treatable and curable stage. So we need to improve public and physician awareness of this highly malignant yet visible tumor and also advise people for self skin examination to detect any pigmented lesions that look unusual. Skin biopsy is essential for the diagnosis of melanoma for any suspicious skin lesions

Thyroid tubeculosis: a case report

Thyroid tuberculosis is a rare disease, although there is an increase incidence of extra pulmonary forms of tuberculosis. We report a case of thyroid tuberculosis associated with mediastinal and pulmonary tuberculosis, which was confirmed by open biopsy and treated successfully by anti tuberculous medications for six-months. Tuberculous thyroiditis must be differentiated from thyroid cancer and other causes of granulomatous thyroiditis