solitary fibrous tumor of the upper limb

Solitary fibrous tumors [SFT] of the upper limb are extremely rare, and we report this tumor in the arm of a 30-year-old male. He is presented with a 22 cm painless mass. Complete surgical excision was performed. The histological diagnosis of SFT was based on the presence of ectatic blood vessels and positive staining for CD34 and vimentin. He remains disease-free at the 3-year follow-up interval. The report aims to increase the awareness of the criteria for the histological diagnosis of SFT, as well as the principles of their surgical excision and follow-up

Profile of mycosis fungoides in 43 Saudi patients

Mycosis fungoides [MF] is a rare disease; and to our knowledge, there are no reports on its profile in Arabs. The objective of this study was to preliminarily analyze the clinical characteristics of MF patients seen in our institution. Retrospective review of 140 patients with pathologic or clinical diagnosis or differential diagnosis of MF for the period 2000-2006. Pathology reports with diagnosis or differential diagnosis of MF were retrieved and suspected cases were identified and reviewed. For pathologically confirmed cases, sociodemographic, clinical, laboratory, and radiological details were collected. Details of staging, treatment modalities, and disease status at the last follow-up were retrieved. A total of 43 pathologically confirmed MF patients [skin phototypes IV and V] with a mean age at diagnosis of 33.5 years were reviewed. This comprised 29 males [M:F ratio, 2:1], and the majority [86%] of patients had early-stage [I and II] MF. Twenty-one [48.8%] patients had classic MF; 18 [41.8%], hypopigmented MF; and 4 [9.3%], other variants. The male-to-female ratio was higher in the hypopigmented [3.5:1] than in the classic variant [1.6:1]. The mean age at diagnosis was lower in the hypopigmented compared to the classic variant [25 versus 38.8 years, P=.019]. The mean duration of follow-up was 27.6 months [range, 1-98 months]. At the final assessment, 4 [9.5%] patients recovered; whereas 35 [83.3%] had MF skin disease; 1 had [2.4%] extracutaneous disease; and 2 [4.8%] died of MF. MF tends to affect younger Saudi patients. The hypopigmented variant constitutes a significant proportion of MF cases, especially in younger patients

Efficacy and safety of oral mega pulse methylprednisolone for severe therapy resistant Alopecia areata

To use intensive regimen of pulse steroid in the severe forms of Alopecia areata. This prospective randomized study was conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 2003 to 2009. Patients with Alopecia universalis, Alopecia totalis, or Alopecia ophiasis were assigned to one of the 3 treatment groups: Group A received oral mega pulse methylprednisolone [MP] for 3 consecutive days once every 2 weeks for 24 weeks; Group B received 2 consecutive daily pulses every 3 weeks; and Group C received 3 consecutive daily pulses every 3 weeks. Patients who showed regrowth of 75% or more at 24 or 36 weeks continued their treatment, while intervals were increased gradually. Forty-two patients were included in this study, and 52.4% of them had atopic diathesis, while 35.7% had autoimmune thyroiditis. At 36 weeks, 12 [28.6%] patients had adequate response, 9 [21.4%] had inadequate response, and 21 [50%] patients had poor response. The response rate shows no statistically significant difference between treatment groups. There were statistically significant differences in age of onset, duration of the disease, and presence of subclinical hypothyroidism between different response groups. At follow-up: 13 [38.2%] patients relapsed; 5 [14.7%] patients developed moderate hair fall; 3 [8.8%] patients developed mild hair fall; 7 [20.1%] patients maintained their hair regrowth; and 6 [17.6%] patients were lost follow up. It was relatively well-tolerated among groups B and C. Oral mega pulse MP use in severe forms of Alopecia areata has relative efficacy and tolerance but with high relapse rate

Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature

Minute pulmonary meningothelial-like nodules (MPMNs) are incidentally found lesions in lung resection specimens and autopsies. MPMNs have been associated with neoplastic and non-neoplastic pulmonary conditions and occasionally with extrapulmonary diseases. We report a case of a female patient presenting with invasive lobular carcinoma of the breast and MPMNs, masquerading as metastatic deposits. We describe the morphological, immunohistochemical and ultrastructural features of MPMNs and emphasize the importance of their recognition for proper staging and treatment of patients. To our knowledge, this is the first case in the English literature describing this coexistence.

Clinicopathological pattern of malignant parotid gland tumors in Saudi Arabia

To report our experience of varied presentations and diverse histopathological spectrum of parotid gland malignancies. This retrospective analysis incorporated patients with histological evidence of malignant parotid tumors at King Khalid University Hospital, Riyadh, Saudi Arabia over a 20-year period from 1984 through 2004. The medical records of these patients were analyzed for their demographic characteristics, clinical features, operations performed, and pathological diversity. Thirty-two patients comprised this study group. There is a male preponderance over females with a ratio of 2.2:1 22 men and 10 women and mean age of 51.8 range 28-81 years. A painless lump was the most frequent clinical manifestation observed in 23 71.8% patients followed by facial nerve dysfunction in 14 43.7% patients. Parotidectomy was performed in 22 68.7% patients: 16 superficial and 6 total. A partial facial nerve sacrifice was undertaken in 14 43.7%, and total nerve sacrifice in 9 28.1% patients. Four 12.5% patients presented with cervical lymph node metastases necessitating radical neck dissection. Nine 28.1% patients had mucoepidermoid carcinoma, 8 25% adenoid cystic carcinoma, 6 18.7% adenocarcinoma, not otherwise specified, and 2 6.2% were reported to have carcinoma in pleomorphic adenoma. Twenty 62.5% specimens revealed high-grade aggressive lesions, and out of these, 19 59.3% patients presented with stage III/IV disease. Malignant parotid tumors are exceedingly rare, occurring at a relatively earlier age group with male preponderance, and invariably declare at a late clinical stage in our community. Histopathological features hallmark a locally advanced disease with an aggressive behavior

potential anti-inflammatory effect of tetrahydrobiopetrin administration in renal mass reduction -induced chronic renal failure

Elevated C-reactive protein [CRP], as a marker of persistent inflammation, predicts cardiovascular and over all mortality in chronic kidney disease patients. The present study aimed to investigate the impact of tetrahydrobiopetrin [BH4] supplementation on the markers of inflammation and on the histological picture of the kidney in chronic renal failure [CRF] induced in rats by subtotal nephrectomy [SNx]. This study was performed at the Faculty of Medicine, King Saud University. CRF was induced by 5/6 subtotal nephrectomy [SNx] in 20 male Wister rats and other 10 rats were sham operated by flank incision and served as controls. Ten SNx rats received l0mg/kg BH4 i.p daily for 4 weeks. Plasma CRP, IL-6, malondialdehyde [MDA], and kidney functions were measured in all rats. Histopathological examination of the kidney tissues was also performed. Untreated CRF rats showed significant elevation of plasma CRP, IL-6 and MAD levels and significant decrease in plasma albumin and total protein levels, tubuloglomerularfibrosis and, interstitial tubular infiltration with inflammatory cells in comparison to the sham operated rats. BH4 treatment significantly decreased CRP, IL-6 and MAD levels and also decreased the tubuloglomerular fibrosis and interstitial inflammation in treated CRF rats. Supplementation with exogenous BH4 decreases markers of inflammation and protects the kidney against post- renal mass reduction histologic damage. Restoration of intracellular BH4 balance could normalize NO production. Therefore, BH4 might be a promising strategy in attenuating inflammation in CRF. This may decrease endothelial dysfunction and limit the associated cardiovascular morbidity and mortality in this disease