Pathogenesis of balls in mature ovarian cystic teratoma. Report of 3 cases and review of literature.

Ovarian cystic teratomas with intracystic balls are rare, and only 11 cases have been reported since 1946. We present 2 new cases and review the literature for the clinical presentation and morphological appearances of the cysts and balls. We also present our histology findings on a third case reported in the international literature. The pathogenesis of balls formation is unknown. We put forward a hypothesis based on the forces which control the production and absorption of the intracystic contents and also recommendations for investigators who may encounter this lesion. We believe that predominance of large secretory and absorptive rather than exfoliative surfaces lining the cysts would favor the absorption of most of the contents into the general circulation, leaving the remaining material to solidify and mould into balls. Still, however, there are many unanswered questions.

Spectrum of malignant lymphomas in Bahrain. Leitmotif of a regional pattern.

OBJECTIVE: To determine the clinicopathologic features of malignant lymphomas in Bahraini patients. METHODS: A retrospective hospital-based study was conducted. All new cases of malignant lymphoma diagnosed during the period January 1996 to December 2001 at the Salmaniya Medical Complex in Bahrain were included in the study. RESULTS: Seventy-two cases met the inclusion criteria. This included 24 (33.3%) cases of Hodgkin's disease (HD) and 48 (66.7%) cases of Non-Hodgkin lymphomas (NHL). A young age at presentation (median 20 years) mixed cellularity histology, lack of extra nodal involvement and rare marrow involvement characterized HD. The majority of NHL showed diffuse high or intermediate grade lesions. A high number of primary extra nodal neoplasms (41.7% of NHL) and frequent involvement of the gastrointestinal tract with Helicobacter pylori-associated gastric lymphomas were notable features among NHL cases. Immunohistochemical staining in 30 cases showed 26 cases (86.7%) of B cell and 4 cases of T cell origin. CONCLUSION: The study highlights common features that distinguish malignant lymphoma reported from countries of the Arabian Gulf region. This pattern distinguishes them from the disease encountered in the Western world.

The pathological expressions of Brunners gland hyperplasia into adenoma and hamartoma.

The terms Brunners gland adenoma and hamartoma are 2 pathological expressions of hyperplasia of these glands. We report 3 patients and review the recent literature to support our hypothesis of common pathology. Awareness of the existence and character of Brunners gland lesions will increase the possibility of their accurate diagnosis.

Role of sequential biopsy study in the evaluation of renal transplant.

Renal biopsy is indicated in all cases of renal transplants showing renal dysfunction. This not only helps in the diagnosis but also in the institution of proper management. Study of sequential biopsies is essential for establishing the cause of renal dysfunction, evaluation of the effect of treatment and the progress of the disease. This report is based on the study of 14 samples (including three nephrectomy specimens) belonging to six patients who underwent two or more sequential renal transplant biopsies at the Salmaniya Medical Centre, Bahrain, between 1995-2000 because of deteriorating renal functions. Based on the sequential biopsies, the graft dysfunction was attributed to rejection in four cases and recurrence of primary glomerular disease in two. An important finding in this series is one case of type I membranoproliferative glomerulonephritis due to hepatitis C noticed five years after transplant and two cases of acute vascular rejection superimposed upon chronic rejection.