Outline of breast diseases in Qatif central hospital

Breast diseases are common health problems especially among women. Data on the prevalence of various breast diseases in the Kingdom of Saudi Arabia is deficient since most of previously reported literature was focused on breast cancer. Although this study is hospital based, it can still shed some light on the distribution of breast diseases in the region. To review the pattern of breast diseases as seen in Qatif Central Hospital. Qatif Central Hospital, Eastern Province, Kingdom of Saudi Arabia. Aretrospective analysis of all breast specimens received in the histopathology laboratory over a 14 year period [1988-2001]. Eight hundred breast specimens from 753 patients [669 female and 84 male] were processed, re p resenting 2.4% of all samples received in the laboratory during the same period. Out of 669 female patients, 17% were diagnosed as inflammatory process, 56.2% as benign proliferative lesions, 11.2% as benign lesions of skin and soft tissues, accessory breast, fibrosis, breast hypertrophy or normal and 15.5% as malignant neoplasm. Most of the breast lesions occurred at a young age. 87% of patients were <45 years of age, and although breast cancer is common [15.5%] with an average age of 45 years, fibroadenoma is the single most common breast lesion representing 37.8% of all females with a mean age of 23 years. Fibrocystic disease ranked third accounting for 12.3% with a mean age of 34 years. 30% of breast cancer occurred in women <35 years of age. The majority of male breast lesions were gynecomastia [81%], 3.6% were inflammatory and 2.4% were neoplastic. Conclusions: Breast diseases are variable and affect a wide age range in both men and women. The findings in this study can help launch future breast screening and was reness programs, which should cover younger females as compared to the practice in other countries

Idiopathic granulomatus lobular mastitis. A forgotten clinical diagnosis

To review clinicopathological features of all cases diagnosed as idiopathic granulomatous lobular mastitis [IGLM] in our hospital and compare them with other data from the Kingdom of Saudi Arabia. Reports of all breast specimens received in histopathology laboratory in Qatif Central Hospital, Kingdom of Saudi Arabia over a 14 year period [1988 through to 2002] were collected and those diagnosed as IGLM were selected for analysis of both pathological material and clinical data. Eleven patients representing 1.6% of all breast specimens were diagnosed as IGLM. The mean age was 35 years [range 25-50]. Both breasts were equally affected. The most frequent presenting symptom was a breast mass of 2-22 weeks duration. The most common clinical diagnosis was chronic abscess [5 patients]. Relation to pregnancy, lactation or oral contraceptives pills was elicited in 4 patients. Recurrence at different time intervals occurred in 3 patients. Microscopically there was an evident granulomatous inflammation mostly in lobular distribution. Ductal inflammation with epithelial changes was noted in most cases. Staining and cultures were negative for both mycobacterium and fungal organisms. Granulomatous mastitis is not unheard of and clinicians should keep it in their list of differential diagnosis of breast lumps so appropriate handling of breast specimens including microbiological studies can be pursued. Utility of fine needle aspiration biopsy as a diagnostic tool is to be considered

Acute appendicitis in patients with sickle cell disease

Patients with sickle cell disease [SCD] often present with abdominal pain, usually attributed to vaso-occlusive crisis, but not rarely, it may be caused by other surgical conditions. Acute appendicitis although common in patients with SCD, it is rare and has a rapid course with a high incidence of perforation. Over a period of 7 years from 1995 to 2001, only 8 patients with SCD out of 1563 [0.5%] patients with acute appendicitis underwent operation at Qatif Central Hospital, Qatif, Kingdom of Saudi Arabia. Their histological slides were reviewed and the findings were compared to those with sickle cell trait [9 patients] and control group [28 patients]. All patients with SCD and in spite of a short duration of symptoms had a moderate to severe inflammation and the vessels were packed with sickle red blood cells [RBCs] except one who had an intact mucosa, extensive transmural hemorrhage and congested blood vessels with sickled RBCs without inflammatory cell infiltrate. The mucosa was intact in only one patient with SCD when compared to 5 [55.6%] in those with sickle cell trait and 6 [21.4%] in the control group and in the majority [87.5%] of those with SCD there were moderate to severe mucosal ulcerations when compared to those with sickle cell trait [44.4%] or controls [64.3%]. In patients with SCD, acute appendicitis is rare, and these appendicular changes were a sequelae of blockage of appendiceal vessels by sickled RBCs leading to congestion, edema, and ischemia with subsequent mucosal ulceration and marked inflammatory cell infiltrate