Eosinophilic esophagitis in Saudi children: symptoms, histology and endoscopy results

Eosinophilic esophagitis [EE] is a clinicopathologic entity characterized by esophageal symptoms in association with a dense eosinophilic infiltrate currently defined as >15 eosinophils per high power field in the appropriate clinical context. This is the first pediatric study in Saudi Arabia to give the experience with EE and examine its symptom, histology and endoscopy results. Retrospective chart review of all patients diagnosed with EE at National Guard Hospital, Jeddah Between 2007 and 2009. The authors identified EE on histologic criteria [>15 eosinophils per high-power field] together with their clinical context. The authors reviewed medical records for details of clinical presentation, laboratory data, radiologic, endoscopic, and histologic findings, and the results of treatment. We identified 15 patients in our database in the last three years. 100% of the patients were males. The median age at presentation was 10 years [range, 3-17 years]. The commonly reported symptoms were failure to thrive [86%], epigastric abdominal pain [53%], poor eating [40%], dysphagia with solid food [26%], food impaction [13%], and vomiting [20%]. Asthma was reported in 46% and allergic rhinitis in 40%. Peripheral eosinophilia [>0.7 x 10/1] was found in 66%. High serum IgE Level [>60 lU/ml] was found in 60%. Upper endoscopic analysis revealed esophageal trachealization in 46%, esophageal erythema in 46%, white specks on the esophageal mucosa in 33%, esophageal narrowing in 13%, and normal endoscopy in 13%. The mean eosinophils per high-power field was 30.4 [range, 20-71]. Histologic characteristics included degranulated eosinophils [86%], basal cell hyperplasia [93%] and eosinophils clusters [micro-abscess] in 73%. The treatment of EE revealed that they used swallowed corticosteroid in 50%, proton pump inhibitors in 66%, elemental diet/ food elimination in 13% and systemic corticosteroid in 13%. Failure to thrive and abdominal pain in a male, atopic school-aged child was the most common feature of EE. Peripheral eosinophilia, high serum IgE and endoscopic esophageal erythema and trachealization should significantly raise the clinical index of suspicion for the diagnosis of EE

Pulmonary hyalinizing granuloma. Bilateral pulmonary nodules associated with chronic idiopathic thrombocytopenic purpura

We report a case of a 30-year-old female who had been treated periodically with steroids for idiopathic thrombocytopenic purpura ITP over the last 10 years. Recently, during the course of investigation, she was found to have incidental asymptomatic multiple pulmonary nodules on chest CT. Following a needle biopsy to exclude malignancy, 2 nodules were excised and were histologically confirmed as pulmonary hyalinizing granuloma PHG. The remaining 2 nodules regressed on increasing her dose of steroids. The case is discussed with emphasis on the histological and radiological differential diagnosis, in addition to including ITP among the spectrum of immunologic conditions associated with PHG

Chronic hepatitis- an update on terminology

This is a review on the updated terminology of chronic hepatitis, a topic that has gained much popularity in the current literature of gastroenterology. The aim of this review is to familiarize readers with its use and to discourage the old terminology. The new terminology of chronic hepatitis takes into consideration etiology, severity [grade] and degree of chronicity measured by fibrosis [stage]. The use of the new terminology would standardize our diagnosis with the aim of standardizing therapeutic modalities for the purpose of reproducibility of results

morphological spectrum of tumors of adipose tissue: a pathological analysis of 685 tumors

Over a seven-year period, 1093 cases of tumors of soft-tissue origin were recorded by the Pathology Department of King Fahd Hospital of the University, Al-Khobar. Of these, detailed histopathological analysis was performed on 685 tumors of adipose-tissue origin removed from 640 patients. Of the 45 multiple tumors, 31 were angiolipomas and 14 were lipomas. Of the total tumors there were 579 lipomas removed from 565 patients, 89 angiolipomas removed from 58 patients, three spindle-cell lipomas, four pleomorphic lipomas, two myelolipomas, two angiomyolipomas, and six liposarcomas. The majority of adipose-tissue tumors occurred in males, for a ratio of 3:1 and dominantly affected patients in the age range 16 to 60 years [overall mean age, 37 years]. The most common site affected was the trunk. The histological subtypes as correlated to their clinical parameters are presented and discussed

Lipoid proteinosis: clinical, genetic, and pathological study of a Saudi Arabian family

We present the morphological features and clinical progression of lipoid proteinosis observed in six patients from a Saudi family. The index case presented with hoarseness and characteristic skin lesions. Some of the patients had photosensitivity with milia and hypertrichosis. The diagnosis of lipoid proteinosis was confirmed by histopathology and by the finding of normal blood porphyrin levels. The condition is inherited as an autosomal recessive disorder, and consanguinity was an important factor. The rarity of this condition and the common occurrence of close-relative intermarriages in Saudi Arabia prompted this report, which we believe is the first and largest family with lipoid proteinosis possessing an established Arabian ancestry

Cecal diverticulitis: a report of three cases

Three patients, all over 30 years old, had acute isolated cecal diverticulitis. The preoperative diagnosis was acute appendicitis in all cases. The intraoperative diagnosis was cecal diverticulitis in one case and carcinoma in the other two. All three patients had right hemicolectomy. The pathological diagnosis in all three cases was isolated cecal diverticulitis. The purpose of this presentation is to focus on the clinical and operative findings in this condition which closely mimics acute appendicitis clinically and cecal carcinoma at operation. The relative rarity of the condition prompts cases to be reported for further characterization so as to avoid an unnecessary hemicolectomy

Fibromatosis: an interesting Clinicopathological entity; report of two cases

Two patients with adult type desmoid fibromatosis are reported. One patient had a tumour in the abdominal wall, diagnosed as lipoma. The other patient had intra-abdominal tumours which were regarded as malignant, probably lymphoma. The pathological findings are presented. This interesting clinicopathological entity seems not to be well recognized; no report of it has been found in the Saudi literatur