Prevalence and correlation of human papilloma virus and its types with prognostic markers in patients with invasive ductal carcinoma of the breast in Kuwait

This study aimed to document the association of human papilloma virus [HPV] and its types in breast carcinoma tissues in Kuwaiti women, and correlate this with known prognostic markers. The clinicopathological data of archived tissue from 144 cases of invasive ductal breast carcinoma were studied [age, histological grade, size of tumour, lymph node metastases, oestrogen/progesterone receptors and human epidermal growth factor receptor 2 status]. HPV frequency was documented using immunohistochemistry [IHC] and chromogenic in-situ hybridisation [CISH]. HPV types were documented by CISH using HPV probes. CISH and IHC techniques were compared and HPV correlated with prognostic parameters. The HPV prevalence as determined by CISH and IHC was 51 [35.4%] and 24 [16.7%] cases, respectively. The sensitivity of HPV by IHC was 37.3% and specificity was 94.6%. The sensitivity and specificity of HPV-CISH compared to HPVIHC was statistically significant [P <0.001]. HPV-CISH was seen in 51 cases. A combination of HPV 6 and 11, and 16 and 18 was seen in 2 [3.9%] cases, and a combination of HPV 6, 11, 31 and 33 was seen in 7 [13.7%] cases. All three HPV probes: 6 and 11, 16 and 18, as well as 31 and 33 were present in 2 [3.9%] cases. The prevalence of HPVCISH in the Kuwaiti and non-Kuwaiti populations was 27 [52.9%] and 19 [37.2%], respectively. No correlation was observed with the prognostic parameters. The frequency of HPV in breast carcinoma cases in Kuwait was 35.4% [CISH]. Of those, 52.9% were Kuwaitis in whom both low- and high-risk HPV types were detected

Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-year period

The aim of this study was to determine the incidence of squamous cell abnormalities in cervical cytology in Mubarak Al-Kabeer Hospital, Kuwait, and to document any change in the pattern of these lesions. Over a 13-year period [1992-2004], 86,434 cervical smears were studied in Mubarak Al-Kabeer Hospital, Kuwait. Conventional Pap smears were first examined by cytotechnicians and finally reported by cytopathologists. The smears were classified according to the modified Bethesda system. The age of presentation of squamous cell abnormalities in Kuwaiti women was analyzed. Smears from 83,052 [96.09%] patients were found satisfactory for reporting while the remaining 3.9% was unsatisfactory. Atypical squamous cells of undetermined significance [ASCUS] were seen in 1,790 [2.2%] cases, atypical glandular cells of undetermined significance [AGUS] in 630 [0.8%] cases, low grade squamous intraepithelial lesion including human papillomavirus changes [LSIL] in 824 [1.0%] cases, high grade squamous intraepithelial lesion [HSIL] in 189 [0.2%] cases, and carcinoma in 79 [0.1%] cases of which 44 [0.05%] were squamous cell carcinoma. A comparison of average cases/annum during the study period revealed a significant increase in ASCUS from 1.13 to 2.83% [p < 0.001] and AGUS from 0.33 to 1.08% [p < 0.001]. However, the percentage of LSIL, HSIL and carcinoma detected in Pap smears remained the same. A significant linear trend [p < 0.001] was observed in satisfactory smears, ASCUS and AGUS over the years. However, no significant change was found in the detection of LSIL, HSIL and carcinoma. A reduction in the age of LSIL/HSIL and an increasing trend in the number of Kuwaiti women over the years was also observed which makes screening of young women essential in Kuwait

Role of fine needle aspiration, intraoperative imprint cytology and frozen section the diagnosis of breast lumps and thyroid lesions

Background and Lesions of the thyroid and breast represent the two commonest sources of frozen section in Kuwait. This study investigates the value of intraoperative cytology [IC], preoperative fine needle aspiration cytology [FNAC] and intraoperative frozen section [FS], in improving the diagnostic accuracy of such lesions. Material: Thirty-one breast masses and 45 thyroid lesions were included. In each case, diagnosis was established by [1] preoperative FNAC, [2] intraoperative IC and [3] FS. Their accuracy was compared to paraffin section diagnosis. Sensitivity of FNAC, IC and FS for breast malignancy was 82.6, 95.8 and 91.7%, respectively, while for thyroid malignancy sensitivity was 68.4, 85.0 and 65%, respectively. All three had 100% specificity and 0% false-positive rates. A 100% diagnostic accuracy was achieved by combined FNAC and IC in breast, and 93.3% with combined IC and FS in thyroid lesions. Intraoperative IC improves the diagnostic accuracy of FNAC and FS in breast and thyroid lesions

Parasite infestation of the vermiform appendix: the experience in Kuwait

A histology-based retrospective study was carried out in Kuwait to determine the frequency and type of helminthic infestation of the appendix in this predominantly desert environment. In 1,674 consecutive appendectomies, 109 parasites [5.6%] of five species were detected: Schistosoma sp. 70 [4.1%], Enterobius vermicularis 36 [2.1%], and a single case each of Ascaris lumbricoides, Taenia sp. and Trichuris trichiura. Schistosomiasis was seen exclusively in immigrants of whom 12 had evidence of coexistent extra-appendiceal infestation of the urinary system. Suppuration in this group was common [79%] in addition to fibrosis [74%] and granulomata [43%]. Enterobiasis seen in both natives and immigrants predominantly affected children. Suppuration in this group was uncommon [22%] but a fecalith or thick lumen contents containing the parasites were frequently seen [72%]. It was concluded that parasite infestation of the appendix is important to report even in countries such as Kuwait which is nonendemic for many intestinal parasites. Such data contribute to further understanding of epidemiology, enable the diagnosis of easily treatable disease such as enterobiasis, or provokes a search for more significant extra-appendiceal infection as in schistosomiasis. Enterobiasis should be suspected in children and young adults with normal histology of the appendix. Examination of the lumen contents may improve the chances of detecting intraluminal parasites

Bone formation in abdominal surgical scars

Four cases of heterotopic bone formation in abdominal scars are presented and possible causative factors discussed with reference to the literature. The awareness of the condition will prevent unnecessary investigations and anxiety. Excision of the bony mass is indicated only when symptomatic, without the need for local irradiation