Cancer in Lebanon: analysis of 10,220 cases from the American University of Beirut Medical Center.

Cancers seen and recorded between 1983 and 1995 in the Hospital Tumor Registry at the American University of Beirut Medical Center (AUBMC), one of the largest primary and tertiary care hospitals in Lebanon, were retrospectively reviewed and analyzed. There was a total of 10,220 cases, excluding 916 skin cancers other than skin melanoma, averaging 786 cases per year. There were 5086 cancer cases in males with the five most common cancers being: lung cancer (915 cases: 17.9%) followed by bladder cancer (503 cases: 9.8%), larynx (438 cases: 8.6%), lymphoma (393 cases: 7.7%) and leukemia (336 cases: 6.6%). As for female cancer cases, a total of 5134 cases were observed with the five most common cancers being: breast cancer (1821 cases), followed by cervical cancer (535 cases), colo-rectal cancer (256 cases: 4.9%), lymphoma (232 cases: 4.5%), and brain cancer (213 cases: 4.1%). The average age for all cancer cases was 50.5 years with a standard deviation (SD) of 18.8 years. The average age of females (48.8 yrs; SD 17.4) was relatively lower than that of males (52.2 yrs; SD 19.9) and the difference was statistically significant. 40.6% of the patients were under the age of 50 years. 49% of breast cancer patients were below 50 years of age. In children less than 15 years of age, there were 555 cases, with leukemia being the commonest (185 cases: 33.3% of childhood cases) followed by brain cancer (112 cases: 20.1%), lymphoma (63 cases: 11.3%), bone cancer (41 cases: 7.3%), soft tissue sarcoma (35 cases: 6.3%) and kidney cancer (28 cases: 5.0%). Lung cancer in males and breast cancer in females are the most common cancers in Lebanon. These cancers are amenable to prevention (cigarette cessation and anti-smoking campaigns for lung cancer) and early detection (screening, regular breast examination and mammography for breast cancer). Our paper emphasizes the importance of addressing those and other issues including bladder cancer and age at diagnosis of breast cancer. It also presents important epidemiological and historical reference data on cancer in Lebanon during the civil war and immediately after it.

Concomitant fibrous dysplasia and aneurysmal bone cyst of the skull base. Case report and review of the literature.

The combination of fibrous dysplasia and aneurysmal bone cyst of the skull base is extremely rare yet it should be recognized, lest the rapid growth of the lesion and the radiological picture lead to the wrong diagnosis of a malignant process. We report on a 6(1/2)-year-old patient who suffered from concomitant fibrous dysplasia and aneurysmal bone cyst of the skull base. He is still disease-free 4 years postoperatively. The treatment of choice remains early surgical removal of the maximal amount of involved bone that can safely be achieved. There is no role for radiotherapy in the treatment of these lesions. A review of the literature is included.

Cancer in Lebanon: an epidemiological review of the American University of Beirut Medical Center Tumor Registry (1983-1994).

PURPOSE: Cancers recorded in the Tumor Registry at the American University of Beirut Medical Center (AUBMC), the largest tertiary care center, in Lebanon were reviewed. METHODS: Results were compared with those from the same center 30 years ago and current data from western Asia. RESULTS: Between 1983 and 1994, 9364 cases were recorded, averaging 780 cases per year, representing more than one-third of the national case-load. Cases were almost equally distributed between males and females. Average age of females was significantly younger (48.7 years) than that of males (52.2 years). Among males, the five most frequently reported cancers were of the lung, bladder, larynx, lymphoma, and leukemia. Among females, the four most frequently reported cancers were of the breast, cervix uteri, lymphoma, and brain, with leukemia and corpus uteri ranking equally as fifth. Over the past 30 years, the frequency of colorectal cancer decreased and that of lung cancer increased in both sexes. Oral cancer decreased dramatically among males. Digestive system cancers in this series were less frequent than in cumulative data from western Asia area. CONCLUSIONS: Cancer dynamics changed little since the 1950s, except regard to cancers related to smoking and diet. Diet differences may explain the lower frequencies of digestive cancers in Lebanon as compared with elsewhere in western Asia. The potential impact of cancer prevention and early detection on highly prevalent cancer types such as lung, larynx, breast, and cervix was highlighted.

Mammary carcinoma with osteoclastlike giant cells cytologically mimicking benign breast disease. A case report.

BACKGROUND: Mammary carcinoma with osteoclastlike giant cells (OCLGCs) is a rare tumor. Few reports on the fine needle aspiration (FNA) findings are available. This case had cytologic findings overlapping with benign breast disease. CASE: A 50-year-old woman presented with multiple masses in her right breast and a 2-cm right axillary lymph node. Cytologic scrapings and FNA of the same breast mass showed large cohesive, two-dimensional epithelial cells with a uniform distribution of small, bland nuclei. Discohesion, single cells with features of malignancy, cytologic atypia and mitosis were lacking. Many OCLGCs were present. CONCLUSION: The cytologic features of this rare type of breast carcinoma need to become familiar to pathologists to avoid a false negative diagnosis.

Mondor's disease. A forgotten cause of anterior chest pain.

A 50-year-old woman sought a rheumatological consultation for anterior chest pain of three weeks duration. The diagnosis of superficial phlebitis of the anterior chest wall (Mondor's disease) was made. This was confirmed thereafter by the pathological report. She was treated with a non-steroidal anti-inflammatory drug Oxyphenylbutazone (Tanderil) and made a prompt recovery.

Latent Epstein-Barr virus infection is an unlikely event in the pathogenesis of immunoproliferative small intestinal disease.

BACKGROUND: The observed seasonal and geographic variations in the incidence of immunoproliferative small intestinal disease (IPSID) suggest that environmental factors contribute to its pathogenesis. One such environmental factor, the Epstein-Barr virus (EBV), has been associated with other B-cell lymphoproliferative disorders. METHODS: IPSID tissues obtained at the time of initial diagnosis were retrieved from the American University of Beirut pathology archives (1972-1983) and examined for EBV genetic information by colorimetric in situ hybridization (ISH) and polymerase chain reaction (PCR). Eight patients were identified, four of whom also had serologic and immunohistochemical evidence of alpha-heavy chain disease. Thirteen tissue samples from these eight patients were available for study: eight were intestinal and five were nodal. Non-Hodgkin's B-cell lymphoma cases (nine) were randomly selected from the same archive to serve as a control for EBV in that geographic location. The ISH method used a probe to the "W" repetitive region of EBV, with the human placental DNA probe as a control for sample preparation. The PCR method amplified a 110 base pair region in the long internal direct repeat with amplification of beta-actin as control for DNA preservation. Both assays used formalin fixed paraffin embedded Raji cells as a positive control. RESULTS: Neither ISH nor PCR demonstrated EBV in any of the eight patients with IPSID: The results for one of seven control blocks with adequate DNA preservation were positive when PCR was used but were negative when ISH was used. CONCLUSIONS: These findings do not support a role for EBV in the induction of B-cell proliferation in IPSID:

Primary malignant lymphoma of the uterine cervix: is radiotherapy the best therapeutic choice for stage IE?

The present report describes a 27-year-old woman diagnosed with Ann Arbor stage IE primary malignant lymphoma of the cervix. Radiation therapy was instituted as conventionally advocated at this early stage of the disease. Despite adequate local tumor response, central nervous system metastasis occurred a few months later. She succumbed to her condition 7 months after initial diagnosis. As occult distant foci may not be amenable to detection by available imaging techniques at the time of initial work-up, combination chemotherapy alone or in conjunction with radiation therapy may be the most appropriate first line of therapy in patients with stage IE primary malignant lymphoma of the cervix.

Squamous cell carcinoma of the cervix implanting in the episiotomy site.

The implantation of cervical cancer in an episiotomy scar is very rare. We present such a case in a patient with stage IIIB squamous cell carcinoma of the cervix. The tumor implantation responded only partially to chemotherapy and radiotherapy. Review of the literature revealed six cases of cervical cancer implanting in the episiotomy site. All followed a normal vaginal delivery. Early initial stage, small-size implantation lesion, and early surgical intervention seemed to be good prognostic factors.

33-year follow-up after simple excision of a giant renal oncocytoma with calcifications: case report and review of the literature.

Renal oncocytoma can present with calcification seen on the plain roentgenogram. From a review of the literature (both before and after 1976, when the concept of oncocytoma was popularized in the English literature), 10 cases of calcification in association with renal oncocytoma were found. In three of these 10 cases, the calcifications could be grossly demonstrated on the plain roentgenogram; in the other seven cases, the calcifications were microscopic in nature. The presence of calcification in a renal tumor does not rule out the diagnosis of oncocytoma. Grossly, a renal oncocytoma has a brownish mahogany color. A case is presented in which simple excision of an oncocytoma resulted in a 33-year survival. In the future, excision instead of nephrectomy could become the standard treatment for these tumors.

Hemangioma of the nasal septum: A clinicopathological profile.

Septal hemangioma is a rare cause of epistaxis and nasal obstruction. Ten cases were seen in our center over 25 years and constitute 31% of all cases of nasal hemangioma. The male to female ration was 2.4:1; patient age ranged between 14 and 63 years (average, 39 years). The main presenting symptom was epistaxis with progressive nasal obstruction. There was a positive history of trauma in 7 cases. Symptoms varied between 1.5 months to 4 years (average, 13 months). All tumors but one were located anteriorly in the septum and measured between 0.5 and 2 cm in diameter. Histologically they were well-defined benign neoplasms covered with stratified squamous epithelium and showed varying degrees of ulceration. In eight cases the core was composed of proliferating capillary-type vessels, and two were cavernous. Operative intervention is the treatment of choice, with recurrences likely in the event of incomplete excision (two of the ten cases recurred).

Primary localized amyloidosis of the nose and paranasal sinuses. A case report with immunohistochemical observations and a review of the literature.

Primary localized amyloidosis of the nose and nasopharynx is a rare disease. We present a case and review seven additional cases from the English literature. The ages of the patients ranged from 8 to 86 years; there was no sex predominance. Symptoms were nasal obstruction, epistaxis, and impaired hearing. Physical examination revealed a nasal mass or glue ears. The lesions were composed of amyloid and chronic inflammatory cells, mainly plasma cells. Ours is the first case of nasal amyloidosis in which the type of amyloid was determined immunohistochemically to be amyloid light chain (AL) lambda. The main treatment was surgical. Recurrences developed. Determination of the biochemical nature of this amyloid clarified its pathogenesis and may influence treatment. Amyloidosis should be considered in the differential diagnosis of nasal obstruction, epistaxis, and glue ears, even in the pediatric age group.

Mycobacterial cervical lymphadenitis.

Mycobacterial cervical lymphadenitis remains a diagnostic challenge for many clinicians despite current advances in diagnostic laboratory techniques. Although much has been done to prevent tuberculosis, cases of mycobacterial disease in endemic form still occur. Six hundred and forty-five patients with tuberculosis were diagnosed and treated at the American University of Beirut Medical Center during the period from 1970 to 1985. Twenty-nine (4.5%) of these patients had proven mycobacterial cervical lymphadenitis. We stress histopathologic examination as the single most important means for diagnosing mycobacterial cervical lymphadenitis. Operation in combination with antituberculous chemotherapy remain the treatments of choice.

Cardiac fibroma with tumor involvement of the mitral valve: diagnosis by cross-sectional echocardiography.

The clinical, cross-sectional echocardiographic, haemodynamic, and angiographic features of a case of cardiac fibroma in a newborn with unexplained pulmonary hypertension, and direct tumor involvement of the posterior leaflet of the mitral valve, are presented. The role of echocardiography in the pre-operative evaluation of cardiac tumors is discussed.

Breast sarcoma with giant cells and osteoid. A case report and review of the literature.

Breast sarcomas with giant cells and osteoid are rare and usually fatal. They should be distinguished from carcinomas with sarcomatous metaplasia. Our case is presented together with eight similar ones reported in the English literature. Their clinical, radiologic, gross, and histologic characteristics are analyzed. Most patients died within 1 1/2 years of diagnosis, survival apparently being related to the size of the tumor. Diagnosis is delayed because the tumor can be confused clinically and radiologically with a large fibroadenoma. Awareness of this problem, fine-needle aspiration, and computerized tomography may lead to earlier diagnosis and, consequently, improved survival. In our case, immunohistochemical studies supported the notion that the lesion was a primary sarcoma, rather than a carcinoma with sarcomatous metaplasia.

Gastric leiomyosarcoma: a clinicopathologic study.

Seven patients with gastric leiomyosarcoma (LMS) and leiomyoblastoma (LMB) were seen at the American University of Beirut Medical Center in the period 1970-1983. The natural history, clinical presentation, radiologic findings, histopathologic features and treatment modalities of these patients are discussed. The anatomic location of the tumor had no relation to the occurrence and number of mucosal ulcers. Ulcerations were more frequent with endogastric than exogastric tumors. Histologic pattern, cell shape and number of mitotic figures were the basic morphological criteria for differentiating between LMS and LMB. Maintenance of a reasonable gastric reservoir and avoidance of total or near total gastrectomy are important factors affecting long term morbidity following surgical resection.

Hypokalemic alkalosis, hyperreninemia, aldosteronism, normal blood pressure and normal juxtaglomerular apparatus--a new syndrome of renal alkalosis.

An infant with hypokalemic alkalosis, hyperreninemia, aldosteronism, normal blood pressure and normal juxtaglomerular apparatus (JGA) is described. This infant, along with other similar patients reported in the literature, represents a new syndrome of renal alkalosis, clinically and chemically similar to Bartter's syndrome, but without hyperplasia of the JGA.

Hemorrhagic cystitis and sicca syndrome secondary to amyloidosis in rheumatoid arthritis.

Vesical bleeding and sicca complex proved to be due to unrecognized amyloidosis in a patient with chronic rheumatoid arthritis. The features of amyloidosis of the lower genitourinary tract are outlined.

Hypergonadotropic hypogonadism with congestive cardiomyopathy: an autosomal-recessive disorder?

We report on two sisters with ovarian dysgenesis and secondary hypergonadotropic hypogonadism and congestive cardiomyopathy. Their parents are first cousins. It is suggested that these are the main manifestations of a previously unreported autosomal-recessive syndrome.