Characteristics of Ovarian Tumors in Lebanon 19 years of experience in a Tertiary Center

Background: Ovarian cancer is the 8th most common cancer among women in Lebanon. Despite new advances in the treatment of these tumors, their prognosis remains very poor. The histology of ovarian tumors and their stage at the time of diagnosis are the two most relevant prognostic factors. Epithelial tumors, including serous, mucinous, endometrioid, clear-cell, Brenner and seromucinous tumors, account for the vast majority of ovarian tumors. Germ cell tumors and tumors of the sexual cord are respectively the second and third subgroups of ovarian tumors. In Lebanon, there are no data concerning borderline and malignant ovarian tumors

Aim: We report the epidemiological and histological characteristics of borderline and malignant ovarian tumors in a Lebanese tertiary hospital

Material and Methods: This is a retrospective study evaluating the characteristics of borderline and malignant ovarian tumors diagnosed in 19 years [from 1999 to 2017] at the pathology laboratory of Hotel-Dieu de France, Saint Joseph University Hospital in Beirut, Lebanon. The data were extracted from the computerized registers of the laboratory. Statistical analysis was performed using SPSS 24.0

Results: Atotal of 996 ovarian lesions were found. Of these, 529 [53.1percent] were epithelial [342 [64.7percent] serous, 107 [20.2percent] mucinous, 23 [4.3percent] endometrioid, 18 [3.4percent] undifferentiated carcinoma, 15 [2.8percent] seromucinous, 12 [2.3percent] clear cell and 12 [2.5percent] Brenner]; 285 [28.6percent] were germinal [including 245 [86.0percent] mature teratomas, 12 [4.9percent] dysgerminomas and 7 [2.5percent] immature teratomas]; 83 [8.3percent] were stromal tumors of the sexual cord. Of the 529 epithelial tumors, 261 [49.3percent] were benign [60percent were serous cystadenomas], 46 [8.7percent] were borderline [26 serous, 18 mucinous and 2 serous] and 222 [42.0percent] were malignant [of which 139 [62.6percent] were high grade serous carcinomas, 19 [8.6percent] endometrioid, 18 undifferentiated, 12 low-grade serous and 12 clear cell]. Mean age for malignant epithelial tumors and borderline epithelial tumors were 54.3 years and 39.7 years respectively

Conclusion: Our data are compatible with those published in Western countries. Many studies will be launched on the basis of this database, including the evaluation of somatic and germinal ovarian panel mutations in high-grade ovarian serous carcinoma and in those with borderline tumor sequencing

Growth hormone deficiency short stature in a third world adult endocrine clinic: Usefulness of clonidine test in its diagnosis.

Background: Short stature (SS) can be treatable; yet the diagnostic value of a simple test in correctly identifying the two common etiologies in developing countries, viz., growth hormone deficiency (GHD) and normal variant short stature (NVSS), has not been reported in a typical third world population. Objectives: The aim of the study was to evaluate the reliability of clonidine test in differentiating short stature caused by GHD from NVSS. Settings and Design: Data of subjects evaluated for growth hormone deficiency SS at a Saudi Arabian university hospital were retrospectively reviewed. Materials and Methods: Clonidine and insulin tolerance tests (ITT) were conducted on 60 subjects aged 12 years and above with SS, while peak stimulated growth hormone cut off value of < 10 microg/l was used to diagnose GHD. Statistical Analysis: Sensitivity and specificity for clonidine test and ITT were computed, while receiver operator characteristic (ROC) curves were constructed from the results in order to assess the diagnostic usefulness of the two tests. Mann-Whitney test was used to determine level of significance. RESULTS: Clonidine test showed superior sensitivity and specificity, viz., 81% and 82%, as against 65% and 59% for ITT respectively. Overall, the efficiency of clonidine test in correctly differentiating short stature caused by GHD from NVSS was higher, viz., 90%, compared to ITT's 77%. Conclusions: Clonidine test proved to be an excellent test for initial assessment of GHD and may be used as a screening test for short stature in third world countries.

Hirsutism in Saudi females of reproductive age: a hospital-based study

Hirsutism among women of fertile age is commonly seen in clinical practice, but the pattern of the disease in Saudi Arabs has not been studied. The aim of the study was to determine the clinical, biochemical and etiologic features of hirsutism in Saudi females. 101 Saudi Arab women presenting with hirsutism at King Khalid University Hospital, Riyadh, Saudi Arabia, from 1 January 2000 to 31 December 2005 were prospectively assessed using the recently approved diagnostic guidelines for hyperandrogenic women with hirsutism. Polycystic ovary syndrome [PCOS] was the cause of hirsutism in 83 patients [82%] followed by idiopathic hirsutism [IH] in 11 patients [11%]. Others causes of hirsutism included late onset congenital adrenal hyperplasia in 4 patients [4%], microprolactinoma in 2 [2%] and Cushing's syndrome in 1 [1%] patient. Age at presentation of PCOS was 24.5_6.6 years [mean +/- SD] and 51% of the subjects were obese. Furthermore, 74 [89%] of patients with PCOS had an oligo/anovulatory cycle while the remaining 9 patients [11%] maintained normal regular menstrual cycle. Luteinizing hormone and total testosterone were significantly higher in patients with PCOS than in those with IH [P<.05]. The present data show PCOS to be the commonest cause of hirsutism in our clinical practice and PCOS is prominent amongst young obese females. However, further studies on a larger scale are needed to verify our findings

Treatment of Graves' hyperthyroidism - prognostic factors for outcome

To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves' disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi [481-555 MBq]] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine [odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01]. Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation [p=0.003]. In patients with Graves' hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi [481-555 MBq] seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients