Eleven-year review of data on Pap smears in Saudi Arabia: We need more focus on glandular abnormalities!

BACKGROUND: We reviewed data from Saudi Arabia on epithelial cell abnormalities (ECA) detected by Pap smear after noticing a slight increase in the incidence of cervical glandular abnormalities in our regional laboratory in recent years. OBJECTIVE: Clarify data on adenocarcinoma (ADCA) on Pap smears in Saudi Arabia. DESIGN: Descriptive, retrospective study. SETTINGS: Regional laboratory, Riyadh. PATIENTS AND METHODS: We reviewed all Pap smears of adult females between 2006 and 2016 and compared our data with previously published results from Saudi Arabia. MAIN OUTCOME MEASURE(S): Descriptive data on ECAs. RESULTS: Among 19759 cases, atypical squamous cell of undetermined significance (ASC-US) was the most prevalent ECA (1.16%). ADCA occurred more than squamous cell carcinoma (SCC). In a comparison of published data before 2014 and after 2014 (including ours), there was a significant rise in ADCA (28 vs 48 cases; P=.004) with a significant drop in SCC, high-grade squamous intraepithelial lesions (HSIL) and low-grade squamous intraepithelial lesions (LSIL) (P < .0001, .004, and < .0001, respectively). CONCLUSION: We recommend that pathologists and cytotechnologists be vigilant in screening Pap smears in our population, particularly for glandular abnormalities. We also recommend use of Pap smears in the initial workup of women with suspected gynecological abnormalities, regardless of evolutions in HPV testing. LIMITATIONS: The pooling of data instead of analyzing by study year.

Nevoid melanoma: A study of 43 cases with emphasis on growth pattern.

BACKGROUND: Nevoid melanoma may be confused both clinically and histologically with benign nevi. OBJECTIVE: The aim of this study was to characterize the histologic features of nevoid melanoma. METHODS: Forty-three cases of nevoid melanoma from our laboratory were evaluated. RESULTS: Our study cases included 33 men and 10 women with mean age of 62 years. The back was the most common site followed by the arm. A clinical diagnosis other than melanoma was made in about 40% of the cases. Two architectural patterns were identified: Plaque and polypoid. Sheetlike confluence of melanocytes expanding the papillary dermis was seen in 60% of the cases. Nests disposed in parallel arrays at the base of the tumor (parallel theque pattern) were present in roughly 81% of our series. Mitoses were evident in one-third of cases ranging from less than 1 to 4 per square millimeter. Genomic abnormalities characteristic of melanoma were detected in 7 of 8 tested cases. LIMITATION: This is a descriptive study. No follow-up information was available for 32 of the 43 patients. In the other 11, follow-up was limited to the re-excision specimens. CONCLUSION: Characteristic growth patterns including confluence of dermal melanocytes with no intervening connective tissue and the parallel theque pattern can be helpful in suggesting a diagnosis of nevoid melanoma at scanning magnification.

Medallion-like dermal dendrocytoma.

Medallion-like dermal dendrocytoma is a benign cutaneous neoplasm that mimics dermatofibrosarcoma protuberans histologically. The distinction between these two entities is critical to prevent unnecessary wide excisions. Herein we describe an acquired MLDD in a 55-year-old female.

Carnitine deficiency aggravates cyclophosphamide-induced cardiotoxicity in rats.

BACKGROUND: This study examined, for the first time, the involvement of carnitine deficiency in cardiotoxicity, particularly cyclophosphamide (CP)-induced cardiomyopathy, as well as effects of carnitine supplementation with propionyl-L-carnitine (PLC) on cardiotoxicity. METHODS: An animal model of carnitine deficiency was developed in rats treated with D-carnitine (DC)-mildronate (MD). Adult male Wistar albino rats were assigned to one of six treatment groups: the first three groups were injected intraperitoneally with normal saline, PLC (250 mg/kg/day), and DC (250 mg/kg/day) combined with MD (200 mg/kg/day), respectively, for 10 successive days. In groups 4-6, the same doses of normal saline, PLC and DC-MD were injected, respectively, during the 5 successive days before and after a single dose of CP (200 mg/kg). On day 6 after CP treatment, 24-hour urine was collected, then animals were sacrificed, and serum as well as hearts were isolated. RESULTS: CP caused a significant increase in serum creatine phosphokinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), urinary carnitine excretion and clearance and intramitochondrial acetyl-CoA/CoA-SH, and a significant decrease in serum free carnitine, total carnitine and adenosine triphosphate (ATP) contents in cardiac tissue. In the carnitine-depleted rats, CP induced dramatic increases in CK-MB and LDH levels, carnitine clearance and intramitochondrial acetyl-CoA/CoA-SH, as well as progressive reduction in total carnitine and ATP in cardiac tissues. Interestingly, PLC supplementation completely reversed the biochemical and histopathological changes induced by CP to the control values. CONCLUSION: (1) Carnitine deficiency is a risk factor which is involved in CP-related cardiomyopathy; (2) serum and urinary carnitine levels should be monitored and viewed as indices of CP-induced multiple organ toxicity, and (3) carnitine supplementation, using PLC, prevents the development of CP-induced cardiotoxicity.