Breast hamartomas: a hidden diagnosis

Breast hamartomas are rare and poorly defined tumors made of glandular, adipose and fibrous tissue. We present two cases of breast hamartomas diagnosed within one year. Mammograms performed for both patients were not suggestive of a breast hamartoma and a prospective diagnosis could only be obtained through MRI in one patient. Both diagnoses were confirmed by histopathology. Despite the increasing incidence of breast hamartomas as a result of increased screening, the diagnosis of breast hamartoma may be missed due to the variability in its mammographic and histopathological findings

accuracy of PET-CT scan in detecting axillary lymph node metastasis in breast cancer

Objective: To evaluate the accuracy of positron emission tomography CT scan in detecting axillary lymph node metastases compared to the pathology results in patients with primary breast cancer

Setting: Breast Surgery Unit, King Hamad University Hospital, Bahrain

Design: A Retrospective Comparative Study

Method: Twenty-one newly diagnosed females with invasive breast cancer and staged using FDGPET-CT scan. Images were evaluated by two experienced radiologists for any abnormal increase in axillary FDG uptake. Imaging results were compared to axillary lymph node pathology, such as sentinel lymph node biopsy, FNA cytology from axilla or axillary clearance

Result: All patients had histopathology results that matched the PET-CT finding except 2 [10%] patients who matched the CT scan alone but not the PET scan. The sensitivity of the PET-CT for detection of axillary lymph node metastasis in this series was 80% and the specificity was 100%. Both sensitivity and specificity were noted to be high compared to other published data

Conclusion: PET-CT scan is highly sensitive and specific in detecting axillary lymph nodes metastases in breast cancer. The sensitivity reached 80% and the specificity was 100% in our study; this could be attributed to the small number of patients and the improvement in the new generation of the PET-CT scanners with high resolution, which led to further increase in the diagnostic value. Therefore, recent evidence does not support the use of PET-CT scan to replace clinically negative axillary lymph nodes as initial assessment

Pilomatrixoma

Pilomatrixoma is a benign skin tumor that arises from the hair cell matrix. It is a rare tumor that commonly presents in certain locations of the body. We present a seventeen-year-old female with pilomatrixoma located in the lateral aspect of the right thigh. The tumor is rare and presented in a rare location

clinicopathological study of emergency appendectomy

Background: Acute appendicitis is one of the most frequent reasons for admission to the surgical unit and appendectomy is the most common emergency procedure performed worldwide. The accuracy of diagnosis is not straightforward at all times. A lower negative appendectomy rate [NAR] is regarded internationally as a quality indicator of the treating center

Objective: To determine the diagnostic accuracy of appendicitis by clinical, radiological and histopathological findings. Design: A Retrospective Review. Setting: King Hamad University Hospital, Bahrain

Method: Patients who had appendectomy were included in the study. Data were documented between January 2013 and December 2014. All patients above 14 years of age were included. Incidental appendectomy and appendicitis during pregnancy were excluded from the study

Result: The medical records of 286 patients who underwent appendectomy were reviewed; 187 [65.4%] were males. The mean age was 29.3 years. The negative appendectomy rate [appendix is normal on histopathology] was 29 [10.1 %] while another pathology other than appendicitis was found in one [0.349%]. Twenty-nine patients had a normal appendix, 20 were females. The total perforation rate was 28 [10%]. Complications were encountered in 2 [0.69%] patients. Ultrasound was used in 86 [30.1%] patients and conventional tomography used in 67 [23.43%] cases. The overall accuracy of both clinical and radiological diagnosis was 89.16%. The mean age was 29.3 years

Conclusion: The diagnostic accuracy, in our study, was 89.16%. Clinical diagnosis and radiological imaging, especially in females, could decrease the NAR to an acceptable rate

Ileocaecal schistosomiasis - a case report from King Hamad University Hospital Bahrain

Bilharziasis [schistosomiasis] is a chronic parasitic infection caused by the nematode family called Schistosoma species which include; S. mansoni which is common in southern and sub-Saharan Africa, South America and Caribbean and transmitted through contaminated fresh water. S. haematobium is distributed throughout Africa and is transmitted through contaminated water. S. japonicum, found in Southeast Asia. S. mekongi found in Cambodia and Laos. S. intercalatum, found in parts of Central and West Africa. A case of Schistosomiasis was reported of the ileo-cecal area and discuss the clinical and pathological features, and review the relevant literature

Retroperitoneal schwannoma, incidental detection - case report King Hamad University Hospital Bahrain

Shwannomas are benign nerve sheath tumors that mostly occur in the head and neck, extremities, and mediastinum. These rarely present as retroperitoneal masses. A case was reported of an incidentally detected retroperitoneal shwannoma in a 32-year-old female. Schwannomas, the benign nerve sheath tumors, grow slowly but they may cause pain, weakness, numbness, or stay asymptomatic. Symptoms depend on the location and size of the tumor. Sometimes the patients, who present to the Accidents and Emergency with vague abdominal pain. Imaging incidentally may detect a pelvic lesion that is always diagnosed on histopathology after complete resection

Smooth muscle proliferation in fibroadenoma

A twenty-nine-year-old Bahraini female presented with painless right breast lump of thirteen years duration. The lump was 7.5 cm, well-defined, mobile and located in the lower inner quadrant of the right breast with no palpable axillary lymph nodes. Breast ultrasound findings revealed right breast hypoechoic mass slightly irregular and lobulated with minimal cystic changes, vascularity and faint focal calcification. Fineneedle aspiration cytology was C2 [benign]. The lump was surgically removed. The lump measured 55x55x32 mm, lobulated, firm and tan colored tissue. Histopathology revealed benign tumor formed of mixed epithelial and stromal components. Immunohistochemically, the stromal spindle cells were strongly positive for smooth muscle myosin. Microscopic and immunohistochemical findings proved that the abundant stromal elements were smooth muscle cells

Is it time for a virtual autopsy service in Bahrain?

Post-mortem examination, or autopsy, is known to have been first performed by the ancient Egyptians to prepare the deceased by embalming and other means for their journey into the after-life. In the second century AD, Galen established the concept of autopsy in Rome, albeit mainly in monkeys; this was the first attempt to correlate the physical findings on post-mortem with the symptoms and signs experienced by the patient before death. Autopsy appears to have then become unfashionable or undesirable until the time of the Renaissance and afterwards. In the mid-sixteenth century, Vesalius practiced autopsy and taught it to his students. In about 1543 or 1544, he published De humani corporis fabrica on the composition of the human body based on his post-mortem studies, which is probably the most important anatomy textbook ever published1. Of interest to intensivists, he was the first to describe artificial ventilation by attaching a pair of bellows to a post-mortem trachea-lung preparation. In the nineteenth century, the study of the body post-mortem became more widespread. Doctors such as Rudolph Virchow [Virchow's node] in Germany described an organized technique of carrying out a post-mortem; and much of the progress in western medicine during that time can be attributed to the postmortem study of Virchow and others. The practice of teaching anatomy using cadavers also became widespread during the nineteenth century. Since then, post-mortem science has progressed greatly. It is now possible to extract a healthy infant from the womb of a pregnant woman immediately after death, and it is even possible to harvest the spermatozoa of a dead man, either by the transrectal electro-ejaculation method or by collecting the contents of the epididymis immediately post-mortem. It is important to remember that the harvesting of entire organs for use in transplantation takes place during post-mortem dissection, either with or without a beating heart. The benefits of performing a post-mortem today include: 1. Discovery of the cause of death when the cause is unexplained. 2. As a quality marker, to assess whether the diagnosis and treatment were correct. 3. To assess the effect of treatment given. 4. To look for genetic conditions and give genetic counselling as a result. 5. Teaching medical students and trainee doctors. 6. Forensic purposes. There are particular areas in a hospital where the availability of a post-mortem service is important. Clearly, a patient dying of multiple long-standing illnesses in a hospital medical ward would not usually merit a post-mortem, but a patient dying of a sudden unexplained illness in an emergency department or an adult Intensive Care Unit would need post-mortem investigation to determine the cause of death and to rule out foul play. In addition, neonates and older children dying of unexplained conditions need to have their cause of death investigated to satisfy the parents' unanswered questions and to establish the presence or otherwise an inherited cause of death. It has been a source of considerable frustration to the first author that no post-mortem study has been possible in patients where the cause of death has not been fully explained. Different religions have different views on post-mortem study. No religion encourages it. Christianity tolerates it as a necessary aspect of science. However, Muslims, Hindus and Jews have similar views; all three religions object to post-mortem dissection on three grounds: first, the body should be moved as little as possible, second, the integrity of the body as a whole must not be compromised, and third, post-mortem delays burial [or cremation in the case of Hindus] as burial should take place quickly, preferably on the same day. It is probably reasonable to assume that all religions in olden times viewed corpses as a potent source of infection, and were anxious for burial or cremation to take place as soon as possible after death