Clinicopathological patterns and distribution of Schistosomiasis in Asir Region.

OBJECTIVE: The objective of this study is to report, for the first time, the histopathologic pattern of Schistosomiasis from the Asir Region and to compare it to patterns reported from other regions of the Kingdom of Saudi Arabia. Several studies have reported the patterns of Schistosomiasis in other regions of the Kingdom of Saudi Arabia and other countries where Schistosomiasis is endemic. Schistosomiasis is endemic in certain areas of Asir region, however no data is available concerning the clinicopathological pattern of Schistosomiasis in the Asir Region. METHODS: This is a retrospective analysis of 217 cases of Schistosomiasis from surgical and biopsy files of Asir Central Hospital during a period from January 1990 to October 1999. RESULTS: Our study revealed that Schistosomiasis was more common among the expatriate population of Asir Region than Saudi nationals residing in this area. The urinary tract was most commonly involved, and then in descending frequency came the vermiform appendix, liver and large bowel. CONCLUSION: These findings are somewhat different from those observed in the Riyadh Region where the vermiform appendix was the most commonly affected organ. Based on the histopathologic pattern, our study describes the pattern of Schistosomiasis in the Asir Region and may serve as a base-line for future research work.

Tuberculous cervical lymphadenopathy: should antituberculous therapy be preceded by histological proof?

In this retrospective study, 212 patients with cervical lymphadenopathy (CL) were studied over a 4-year period (1987-1990). Ninety-six (45.3%) were found to be tuberculous, 64 (30.2%) had reactive hyperplasia, 31 (14.6%) had a malignant lymphoma, 12 (5.7%) showed metastatic carcinoma and nine (4.2%) were due to miscellaneous causes. The original provisional diagnosis was incorrect in 20 cases who were later found to have tuberculous lymphadenopathy (TL) and in 12 patients with secondary malignancy who were originally diagnosed as tuberculous. The study shows that treatment should be preceded by histological proof to avoid delay in treatment of serious malignant disorders, to avoid unnecessary antituberculous treatment in patients with benign reactive lymphadenopathy and to prevent delay of antituberculous treatment in tuberculous patients with atypical clinical presentations.

Ultrastructural changes in animal fat associated lipoid pneumonia: report of two cases.

Traditional or cultural practices in different parts of the world where oils are used continue to produce lipoid pneumonia. We report the ultrastructural findings and observations in animal fat associated lipoid pneumonia from two children following a cultural practice of forced feeding with animal fat (ghee). Clinical findings showed an acute or chronic chest infection which failed to respond to anti-microbial therapy. X-ray and chest CT scan revealed collapse/consolidations of the right middle and left lower lobes. Histology and electron microscopy revealed thickening and destruction of the alveolar septa, filling of alveolar spaces with red blood cells and macrophage which contained both primary and secondary lysosomes. The alveolar walls contained mostly type II pneumocyte with most of them surrounded by thickened basement membranes with only a small portion of their surfaces exposed directly to the alveolar space where it showed numerous microvilli.

Idiopathic lobular granulomatous mastitis: Is it a form of terminal duct lobular unit duct ectasia?

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Intra-abdominal pulmonary sequestration: diagnostic difficulties.

This case report describes the unusual occurrence of congenital cystic adenomatoid malformation (CCAM) type 2 in an intra-abdominal pulmonary sequestration as a cause of diagnostic difficulties. The mass was discovered incidentally during a routine prenatal ultrasound in an infant with no other congenital malformation. Extralobar pulmonary sequestrations (EPS) located in the abdomen are rarely diagnosed prior to excision. The presence of CCAM type 2 in this situation might impose difficulties in histologic diagnosis of EPS, especially at the time of frozen section as happened in this case. To our knowledge this case is the sixth reported case of intra-abdominal EPS and the sixteenth case of EPS histologically displaying the feature of CCAM type 2. Pathologists should be aware that EPS in any location might display histologic features of CCAM type 2 even if the EPS is intra-abdominal.

Non-neoplastic changes in gastric antrum: are they different in distally located intestinal and diffuse-type gastric adenocarcinoma?

A total of 126 cases of primary adenocarcinoma of distal (antrum and/or adjacent body) stomach were reviewed. These cases were collected from the histopathology laboratory of Asir Central Hospital, Southwestern Saudi Arabia over an 8 year period (1987-94). Only gastrectomy specimens with non-neoplastic antral mucosa available for histological examination were included. Of 126 cases, 85 (67.5%) were of the intestinal type and 41 (32.5%) were of the diffuse type. Histological examination of the non-neoplastic antral mucosa showed: gastritis in 100% of these cases; Helicobacter pylori in 103/126 cases (81.8%); multifocal atrophic gastritis (MAG) in 53/126 cases (42.1%); intestinal metaplasia (IM) in 62/126 (49.2%); and type III intestinal metaplasia in 30/62 cases (47.7%). None of these non-neoplastic changes of antral mucosa was significantly different when the prevalence of these changes in intestinal and diffuse type gastric adenocarcinoma were compared using the chi 2 test. The prevalence of these non-neoplastic lesions were calculated in a 126 dyspeptic age- and sex-matched control patients and were as follows: H. pylori 91%; gastritis 78%; MAG 7.4%; IM 19% and type III IM 1.6%. The prevalence of H. pylori bacilli and gastritis was not significantly different between the cancer patients and the controls. The prevalence of MAG, IM and type III IM was significantly higher among cancer patients compared with the control group.

Bronchiectasis due to lipid aspiration in childhood: clinical and pathological correlates.

We report the clinical and pathological features in six Arab children with bronchiectasis caused by ghee lipid aspiration. They all had a history of ghee administration followed by a history of chronic cough dating from early childhood. Chest radiographs showed consolidation/collapse of the right middle and left lower lobes in the majority, and bronchography and chest CT scan confirmed bronchiectasis. The children were treated medically, without any improvement, and five required surgery. The histology of the lung revealed dilated bronchi filled with vacuolated granular eosinophilic material and the peripheral lung tissue was mostly atelectatic with patchy lymphocytic bronchiolitis. Frozen sections of the lung tissue showed scattered lipogranulomas with fat-laden macrophages and fat droplets within peripheral and perivascular lymphatics. In communities where the traditional practice of force-feeding infants and children with ghee exists, it may be an important predisposing cause of bronchiectasis.

Histology of gastric antrum in intestinal-type gastric adenocarcinoma from Asir Central Hospital, Saudi Arabia.

The objective of this study was to look at non-neoplastic, precancerous histologic changes in the antrum of 49 resected stomachs with intestinal-type adenocarcinoma. Chronic superficial gastritis was seen in all 49 cases. Focal atrophic gastritis was seen in 32/49 cases (65.3%). Helicobacter pylori bacilli were seen in 41/49 cases (84%) and intestinal metaplasia in 39/49 cases (79.6%). 42/49 cases (85.7%) with chronic superficial gastritis showed non-active quiescent chronic inflammation. None of the 49 cases showed early gastric cancer, i.e. adenocarcinoma restricted to the gastric mucosa. The progressive changes of longstanding chronic superficial gastritis, focal atrophic gastritis and intestinal metaplasia were seen in all cases studied (individually or in combination). Knowledge of these precancerous lesions and their prevalence is fundamental to controlling gastric cancer (early detection) and eventual prevention.

Phytobezoars: a revisit to an unusual cause of acute small bowel obstruction.

Phytobezoars or undigested food concretions in the gastrointestinal tract are mostly due to ingestion of astringent immature fruits following gastric surgery and can lead to the serious complication of acute small bowel obstruction. We are reporting a case of acute small bowel obstruction in a 40 year old Turkish male, 48 months following bilateral vagotomy and pyloroplasty. Important clinical pathological features are emphasised to increase the awareness of this rather uncommon cause of acute intestinal obstruction.

Reaction of human lungs to aspirated animal fat (ghee): a clinicopathological study.

We report the clinical findings and pathological lung changes in four children following a cultural practice of forced feeding with animal fat (ghee) during infancy. The clinical presentation was of acute or chronic chest infection which failed to respond to antimicrobial therapy. The radiographic features ranged from extensive bronchopneumonia to collapse/consolidation and bronchiectasis. The light microscopy findings included diffuse mononuclear interstitial pneumonia, intraalveolar desquamation of pneumocytes, lipid granuloma formation, lung atelectasis and bronchiectasis. In the two children with longstanding reactions, the striking feature was the minimal lipid engulfment by the macrophages, the continuation of the mononuclear interstitial pneumonia, bronchiectasis and minimal lung fibrosis. In these two older children, the lung lymphatics were probably the main channels for drainage of the aspirated ghee.

Gastric cancer in southern Saudi Arabia.

A total of 84 cases of primary gastric cancer were diagnosed in the histopathology laboratory of Asir Central Hospital over a five year period (1987 to 1991). Seventy-two patients (86%) were Saudis and 12 cases (14%) were non-Saudis. The mean age of the patients included in this study was 60 years with a range of 22 to 85 years and a male:female ratio of 4.6:1. Intestinal adenocarcinoma occurred in 63 patients (75%) followed by malignant lymphomas in 12 cases (14%) and diffuse adenocarcinoma in nine cases (11%). The gastric antrum was the most common site affected (47%), followed by gastric corpus (27%), cardia (14%), and fundus (12%). Comparisons of our findings to similar reports from other provinces of Saudi Arabia and other countries are discussed.

Pattern of malignant skin tumors in Asir region, Saudi Arabia.

The current study describes the pattrn of malignant skin tumors in 137 cases seen in Asir Central Hospital histopathology laboratory over a five year period (1987 to 1991). Ninety percent (90.5%) were Saudis and the mean age was 61.0 years with a male:female ratio of 1.6:1. Squamous cell carcinoma was the most common type of skin cancer presenting (41.6%), followed by basal cell carcinoma (36.5%), and then malignant melanoma (11.7%). Ninety-eight percent of basal cell carcinoma occurred on the head, compared to only 47.4% of squamous cell carcinoma; and 24.6% of squamous cell carcinoma cases occurred in the lower limbs. Eighty-seven percent (87.6%) of malignant melanoma cases occurred in the extremities. The distribution of the other types of malignant skin tumors are also discussed. Our findings were compared with the very few studies from the Kingdom and other parts of the world.

Helicobacter pylori associated dyspepsia in 208 patients from southern Saudi Arabia.

The frequency of Helicobacter pylori (HP) infection in 208 patients with upper gastrointestinal tract symptoms from the Southern Province of Saudi Arabia was studied prospectively. The occurrence of HP was documented histologically and using a rapid urease test in antral endoscopic biopsies. Our results showed that 82.2% of the 208 patients included were positive for HP with a male:female ratio of approximately 1:1 (88:83). The age range was 14 to 80 years and the median age was 38.2 years. The frequencies of HP infection among Saudi and non-Saudi patients were 86% and 71%, respectively. Frequencies of HP infection were 88%, 77.5%, and 93% during the second, third, and fourth decades of life. Among the 140 patients with histologically proven antral gastritis, 128 cases (91%) were positive for HP whereas 29 cases (17%) of the 171 patients positive for HP did not show histologic evidence of antral gastritis. Our data showed that HP was present in 92.5% of patients with endoscopic diagnosis of duodenal ulceration, 81% of patients with duodenitis, 80% of patients with both duodenitis and gastritis, 69% of patients with gastric antral erythema, and 81% of patients with non-ulcer dyspepsia (normal upper gastrointestinal endoscopy). Histologically proven antral gastritis was seen in 80% of patients with endoscopic diagnosis of duodenal ulceration, 76% of patients with antral erythema, 70% of patients with both duodenitis and gastritis, 33% of patients with duodenitis only, and 66% of patients with non-ulcer dyspepsia. Among the 208 patients included in the study, gastric ulcerationw as only seen in two cases, both positive for HP.

Association of Epstein-Barr virus with pediatric Hodgkin's disease.

A bimodal age incidence curve has been shown for Hodgkin's disease (HD). In developing countries, the first age incidence peak occurs in childhood; however, this peak is delayed until young adulthood in developed countries. This difference may reflect differences in the age of exposure to infectious agents involved in the development of HD or may suggest different etiological agents. Epstein-Barr virus (EBV) has been implicated in the pathogenesis of a proportion of HD cases. In this study, EBV association was investigated in a series of 55 pediatric HD cases from three geographical locations (United Kingdom, Brazil, and Saudi Arabia) and the relationship between country, age, sex, histological subtype, and EBV positivity was evaluated. EBV was detected in 38 cases using RNA in situ hybridization, Southern blot, or immunohistochemical analysis. No significant difference in EBV positivity by country, age, or sex was observed; however, children under 10 years of age were particularly likely to be EBV-associated. The difference in EBV association in the pediatric group compared with that observed previously for young adult HD was highly statistically significant (P < 0.0001). These results are consistent with the hypothesis that pediatric and young adult HD have different etiologies and suggest that EBV is likely to be involved in the pathogenesis of pediatric HD.

Bilharzial and nonbilharzial bladder cancer in Asir: A comparative clinicopathological study.

A total of 48 bladder cancer patients out of 96 consecutive genitourinary cancer cases were divided into bilharzial and nonbilharzial groups on a histological basis in order to investigate the impact of bilharziasis on tumor behavior. Despite being a bilharzial endemic area, only 10/48 (21%) of our patients had bilharzial cancer (BC) of whom 8 (80%) had squamous cell carcinoma (SCC) and 2 (20%) had adenocarcinoma. Out of 38 patients with nonbilharzial cancer (NBC), 35 (92%) had transitional cell carcinoma (TCC), and 3 (8%) had SCC. BC in males presented at a younger age than NBC (P<0.05). All ten patients with BC presented with deeply invasive (T3 and T4) tumors as compared to 22/38 (58%) with NBC (P<0.05). Comparison of clinical and laboratory features in both groups in both groups did not reveal any significant difference. We conclude that in the Asir region, TCC is the most common bladder cancer. However, with bilharziasis, bladder cancer tends to be of the squamous type and presents at an earlier age and at an advanced stage.