Disseminated peritoneal tuberculosis mimicking advanced ovarian cancer.

The objective was to evaluate the clinical and radiological features of peritoneal tuberculosis (PTB) that resembled advanced ovarian malignancy. A retrospective review of all patients diagnosed with PTB over a period of 10 years was made. The data included: age, presenting symptom(s), CA125 level, microbiological, histological and cytological studies of the surgical specimens. The radiological and operative findings were also reviewed. A total of 16 patients were identified. The median age was 29.5 years (range 13-65 years). The median CA125 level was 319 U/ml (range 45-1,072 U/ml). The most common symptoms were abdominal distention and pain in 13 patients. Imaging studies showed ascites in all patients. Six patients had laparotomy and 10 had laparoscopy procedure. All patients received anti-tuberculosis treatment and had complete cure. A high index of suspicion of PTB is important to avoid unnecessary extended surgery in relatively young patients with nonspecific clinical features.

Prevalence and distribution of high-risk human papillomavirus genotypes in cervical carcinoma, low-grade, and high-grade squamous intraepithelial lesions in Jordanian women.

PURPOSE: To assess high-risk human papillomavirus (HR-HPV) prevalence, and genotype distribution in invasive cervical cancer (CC) and its precursors in Jordanian patients. MATERIALS AND METHODS: A total of 124 different specimens of formalin-fixed, paraffin embedded samples, including 18 low-grade squamous intraepithelial lesions (LSILs), 28 high grade squamous intraepithelial lesions (HSILs), and 78 CCs were included in this study. HPV detection and typing was done using HPV High Risk Typing Real-TM Kit that enables the concomitant detection of the 12 most common HR-HPVs. RESULTS: Overall, HR-HPV prevalence was 87.2%, 78.6%, and 72.2% in CC, HSIL, and LSIL respectively. Genotype 16 was the most predominant in all cervical lesions, detected in 53.8%, 46.4%, and 38.9% of CC, HSIL, and LSIL, respectively. Among all HPV genotypes, HPV-16 and HPV-18 were found separately or together in 50% of LSILs, 60.7% of HSILs, and 76.9% of CC specimens. HPV-31 was the second most common type detected in LSILs (22.2%) and HSILs (21.4%). HPV-45 was the third most common type detected in CC (11.5%). CONCLUSION: The prevalence and genotypes distribution patterns of HR-HPV types among patients with CC and its precursors in Jordan are similar to known international patterns. The results of this study provide baseline information on the HPV type distribution, which may guide the development of CC prevention and control programs in Jordan.

Osteoid osteoma of the odontoid process of the axis associated with atlanto-axial fusion.

Osteoid osteoma is a primary benign bone tumour with characteristic imaging and pathological features. In about 10% of the cases it involves the spine, especially the posterior elements. We report a pathologically proven case of osteoid osteoma of the odontoid process of the second cervical vertebra associated with atlanto-axial fusion. The case was diagnosed pre-operatively using plain radiography, multiplanar helical CT, contrast-enhanced MRI and radioisotope bone scanning.

Transitional cell carcinoma of the urinary bladder: a clinicopathological study.

INTRODUCTION: The aim of the paper was to highlight the clinicopathological features of urinary bladder cancer in Jordan as a model for the Middle East. Only scattered reports from this region are currently available. METHODS: A total of 115 patients with bladder cancer were managed at our hospital, between the years 1994 and 2000. Transitional cell carcinoma (TCC) comprised 110 patients. The medical records of these patients were reviewed and included in the present study. RESULTS: There were 99 male and 11 female patients. The mean age of the patients was 60.6 (range 19-91) years. 66 of the cases had low-grade and 44 had high-grade tumours. Pathological staging showed that 60 (54.5 percent) of the cases were stage PTa, 19 (17.3 percent) PT1, 22 (20 percent) PT2, eight (7.3 percent) PT3 and one (0.9 percent) PT4. Transurethral resection, segmental resection, radical cystectomy, and partial cystectomy with intestinocystoplasty, was performed in 81, 12, eight, and four patients, respectively. Palliative urinary diversion and radiotherapy were done in two patients. Three patients were unsuitable for surgery. Recurrence was found in 22 patients (31.4 percent). Of the 105 patients who received definitive surgical treatment, 97 patients were followed-up for a mean period of 23.1 months. By the end of the study, five patients died from cancer. CONCLUSION: The age of presentation of TCC in Jordan is similar to that in the west, but a higher male-to-female ratio was observed. The stage at presentation is also very close to that in the west but inadequate follow-up may be the cause of a lower rate of recurrence observed in this study.

Image-based discriminating morphological features for gastric atrophy assessment: a step to go further.

The aim of this study is to establish a basis for automated assessment of gastric atrophy according to the Updated Sydney System. We sought to minimize inter- and intra-observer variations in the application of the Sydney System. A total of 160 biopsies were examined by three pathologists and graded using the visual scale of the Updated Sydney System. A consensus was reached on 135 biopsies. Digital images were captured for the studied biopsies. Image processing techniques were used to extract four morphological features that uniquely discriminate each atrophy grade. The features are related to gland density and shape. To validate the reproducibility of these features, the K-Means clustering technique was used. We were able to grade the atrophy with an overall precision of 95.6%. Furthermore, the proposed features were able to distinguish four discrete grades without any significant overlap. This has not been achieved by previous studies.

Primary gastric lymphoma in Jordan with special emphasis on descriptive epidemiology.

The aim of this study was to examine the clinicopathological features and epidemiology of primary gastric lymphoma in Jordan as a model for Middle East countries where such data is scarce. From 1991--2002, 219 patients with primary gastric malignancy were managed at our hospitals. Among these there were 19 patients with primary gastric lymphoma. Pertinent data for these patients were analyzed. Primary gastric lymphoma constituted 65.5% of all gastrointestinal lymphoma and 8.7% of all gastric malignancies. Male-to-female ratio was 2.8:1. The mean age was 56 years (range 39--82). The incidence was 0.6/100,000. The proximal third was the most common localisation. Abdominal pain was the commonest presentation. Low-grade MALT lymphomas, high-grade MALT lymphomas, diffuse large cell B lymphomas and T cell lymphoma were found in 21.1, 26.3, 47.4 and 5.3%, respectively. Nine patients had gastrectomy followed by chemotherapy, 6 patients had palliative resection, 3 patients had chemotherapy only and the remaining patient was treated with Helicobacter pylori eradication. The mean follow-up for all patients was 42.2 months. The 5-year survival rates for stages IE (n=5), IIE (n=4), IIIE (n=6) and IVE (n=4) were 100, 67, 27 and 0%, respectively (p=0.0003). The overall 5 years survival was 48.2%. Primary gastric lymphoma in Jordan shares some epidemiological features with western disease. Jordanian patients are detected and treated after a relatively long delay. Advanced stage at diagnosis correlated with poor outcome. There is a need of an earlier diagnosis and subsequent better care.

Tuberculous mastitis: a disease not to be forgotten.

OBJECTIVE: To present our experience with tuberculous mastitis to increase the awareness of surgeons, pathologists and radiologists about this rare disease. PATIENTS AND METHODS: Records of nine patients with tuberculous mastitis were retrospectively reviewed. RESULTS: Tuberculous mastitis was seen in 0.6% of our patients with surgically treated mammary disease. There were eight females (mean age 32.9 years) and one male. All female patients were parous, two were lactating and one was pregnant. A unilateral breast mass mimicking breast cancer and breast abscess were the presenting feature in seven and two patients, respectively. Two patients had previous pulmonary tuberculosis. Radiological findings were not specific. Fine needle aspiration was performed for seven patients, and excisional biopsy for all patients. The final diagnosis was based on demonstration of acid-fast bacilli in biopsy specimens in two patients, and histopathology aided by polymerase chain reaction in the remaining seven patients. Mastectomy was performed for one patient due to severe breast destruction. All patients had satisfactory results on antituberculosis treatment. CONCLUSION: Tuberculous mastitis is a rare entity in patients with mammary disease. A high index of suspicion is the cornerstone for diagnosis. Conservative surgery and anti-tuberculosis drugs seem to be adequate treatment.

Tumour T-lymphocyte subset infiltration and tumour recurrence following curative resection for colorectal cancer.

AIM: The relationship of tumour T-lymphocytic subset infiltration and recurrence in patients undergoing potentially curative resection for colorectal cancer has not been clearly defined. METHODS: Tumour sections from patients who had undergone potentially curative resection for colorectal cancer were stained and counted for CD4+ and CD8+ T-lymphocytes. RESULTS: Twenty-three patients developed recurrence during the follow-up period. Patients were grouped according to whether or not they developed recurrence. The groups were similar in age, sex, site of tumour, Dukes stage and the numbers of patients receiving adjuvant therapy. The total percentage volume of labelled CD4+ T-lymphocytes in the tumour was significantly lower in the patients who recurred (p<0.05). CONCLUSIONS: The results of the present pilot study suggest that a reduction in tumour T-lymphocyte infiltration, in particular CD4+ T-lymphocyte infiltration, is associated with recurrence in patients following potentially curative resection for colorectal cancer.