Concurrence of Adenomyoepithelioma of the Breast and Gastrointestinal Stromal Tumor of the Stomach: A Case Report and Review of the Literature.

Adenomyoepithelioma (AME) of the breast and gastrointestinal stromal tumors (GISTs) are rare benign (primarily) tumors observed in the breast and gastrointestinal tract, respectively. The coexistence of both of these rare tumors is extremely rare; therefore, the author describes the clinical presentation and pathophysiological findings of such a unique case in this study. A 56-year-old female patient with no medical history presented with a substantial right breast lump, severe nausea, and vomiting, and suffered from iron deficiency anemia. Radiological observation and a right breast excisional biopsy diagnosed the patient with AME associated with ductal carcinoma in situ (DCIS). Endoscopy and a CT scan of the stomach revealed the existence of GIST. This is the first reported case of concurrence of a huge mass of AME and GIST in a patient. Histological and immunohistochemistry tests using p63, SMA, calponin, and Ki67 markers for the breast tumor and DOG-1, CD34, and CD117 markers for the gastric tumor revealed the non-invasive benign state. The patient had a right breast mastectomy with a negative resection margin. AME of the breast and GIST pose diagnostic challenges due to their erratic morphological characteristics and can cause misinterpretation drawn solely from radiological tests. Effective and accurate diagnostics require assessing the histological and immunohistochemistry findings of the tumor to identify the invasiveness of the neoplasm and the associated risk levels. This report, thus, creates awareness among clinicians and pathologists for the consideration of such possibilities and, therefore, conducts the necessary diagnostics and prophylactic treatments.

Assessing incidence and risk factors of laparoscopic cholecystectomy complications in Jeddah: a retrospective study.

Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. However, it is associated with several complications. No previous studies have investigated LC complications and their associated risk factors in the western region of Saudi Arabia. Aims: We aimed to identify the risk factors for postoperative complications (POCs) of LC at a tertiary institute in Jeddah, Western Saudi Arabia. Settings and design: This retrospective study was conducted between June 2021 and August 2021 among patients who underwent LC at a tertiary centre in Jeddah, Saudi Arabia. Materials and methods: Records of 596 patients were reviewed, and 510 patients were included in the final analysis after applying the exclusion criteria. Data were collected from hospital medical records. χ 2 tests and independent t tests were used to analyse categorical and continuous variables, respectively. The Mann-Whitney U test was used for nonparametric data. Multivariate regression analysis was used to adjust the P values to determine the most strongly and independently associated risk factors. Results: Our data showed that the overall incidence of intraoperative complications (IOCs) was 10.8%. The most common complications were gallbladder perforation (n=28, 5.5%), bile leakage (n=25, 4.9%), and bleeding (n=15, 2.9%). POCs occurred in 11% of the patients; the majority complained of abdominal pain (n=36, 6.9%), had elevated liver function tests (n=14, 2.7%), and retained stones (n=11, 2.2%). Acute cholecystitis, overweight, diabetes, and male sex were significant predictors of IOC, POC, and conversion to open cholecystectomy (P<0.05). Conclusions: LC complications have a multifactorial aetiology. Patient awareness of all possible IOCs is fundamental. The improved skill and experience of the surgical team can mitigate serious complications.

The prevalence of hypocalcemia following total thyroidectomy. A retrospective study based at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

OBJECTIVES:  To estimate the prevalence of hypocalcemia following total thyroidectomy (TT) at a tertiary center. METHODS: This retrospective study was conducted between 2014 and 2019 at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The study was based at the Department of General Surgery and was approved by the Research Ethics Committee of KAUH. Medical records of 154 patients who had undergone TT were reviewed. Data such as age, gender, level of postoperative calcium at 24 and 48 hours after surgery, parathyroid hormone (PTH) levels, central neck dissection (CCND), histological diagnosis were entered into Microsoft Excel sheets. RESULTS:  Hypocalcemia occurred more on the second day after surgery in 67.4% of patients. Among them, 83.9% were female and 16.1% were male. The majority of patients were asymptomatic and benign thyroid disease was the most common. There was a significant association between hypocalcemia and the PTH level (p less than 0.001). CONCLUSION:  There was a high prevalence of hypocalcemia on the second day after surgery. Presence of hypocalcemia association with the PTH level. Meticulous surgical technique and preservation of parathyroid vascularity are important in preventing postoperative hypocalcemia.

Clinicopathological Features and Metastatic Pattern of Triple-positive Breast Cancer Among Female Patients at a Tertiary Care Hospital.

Objectives The heterogenicity of breast cancer (BC) is determined by the status of human epidermal growth factor receptor 2 (HER2/neu), estrogen receptor (ER), and progesterone receptor (PR). Triple-positive BC (TPBC) expresses the amplification/overexpression of the HER2 pathway and is positive for ER and PR. This subtype has a distinct clinical behavior. However, very few studies are focused on TPBC. This study investigated the clinicopathological features and metastatic pattern of TPBC. Methods A seven-year retrospective study was conducted at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. All females with TPBC diagnosed between January 1, 2010, and June 30, 2017, were enrolled. Mean and standard deviation were calculated. Results From 1205 BC patients, the TPBC incidence was 10% (n = 124). The mean age at diagnosis was 51 years. On physical examination, a high tendency to show pathological skin changes was observed. Invasive ductal carcinoma was the most common histological type, presenting with a poorly differentiated histological grade (grade 3). Over a median two-year follow-up, the incidence of metastasis was 27.4% (n = 34). Bone was the most common site. The incidence of locoregional recurrence was 9.7%. Overall survival was 89.5%. Conclusion TPBC has an early tendency for metastasis and commonly affects the breast skin. BC should be approached based on the immunohistochemical diagnosis. We encourage more comprehensive studies to target TPBC for more insights into the heterogeneity of BC.

Suspected acute appendicitis in female patients. Trends in diagnosis in emergency department in a University Hospital in Western region of Saudi Arabia.

OBJECTIVE: To determine the negative appendectomy rate; utilization, accuracy of Alvarado scale, ultrasound (US), computed tomography (CT) in diagnosis of acute appendicitis. METHODS: Hospital records of 124 female patients admitted for suspicious of acute appendicitis from January 2003-January 2004 to the Emergency Department (ED) at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia were reviewed retrospectively. We reviewed the age of patients, clinical presentation, Alvarado scale, US, CT, histopathological diagnosis of appendicular specimen. RESULTS: A total of 124 female patients aged 6-64 years were presented to ED with right iliac fossa pain. Of the total, 103 patients have appendectomies (83.1%), 21 (16.9%) patients underwent conservative treatment. Prevalence of advanced appendicitis was 13.7% and negative appendectomy rate was 27.2%. Accuracy rate of appendicitis with Alvarado scale was 67.7%, US was 57.9%, CT was 66.7%. Postoperative complications were found in 2.4%. Positive correlation was found between advanced cases and Alvarado scale (r=0.338), and hospital stay duration (r=0.250, p<0.01). CONCLUSION: Clinical findings and experience remain of major importance in appendicitis-diagnosis. When appendicitis appears with atypical presentations, it remains a clinical challenge. In such cases, laboratory and imaging investigation may be useful in establishing a correct diagnosis. Alvarado scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis especially for junior surgeons.