Haemangiopericytoma presenting as acute subdural haematoma.

Haemangiopericytomas are vascular neoplasms that arise from capillary pericytes. They rarely present with haemorrhage. We report a patient whose meningeal tumour was revealed by acute subdural and intratumoural haemorrhage.

Abdominal tuberculosis in Qatar: a clinico-radiological study.

SETTING: Hamad General Hospital, the tertiary health centre for Doha, Qatar. OBJECTIVE: The purpose of the study was to define and correlate the role of radiology with clinical and pathological findings in abdominal tuberculosis. MATERIAL AND METHODS: A total of 59 patients (47 males and 12 females) diagnosed bacteriologically and/ or histologically for abdominal tuberculosis were radiologically assessed. Evaluation was based on the analysis of plain abdominal radiographs, gastro-intestinal contrast studies (barium meal follow through and barium enema), ultrasonography and computed tomography. RESULTS: Plain abdominal radiographs performed in 38 patients were positive in 19 cases (50%). Gastrointestinal contrast examinations were positive in 27 out of 34 cases (80%). Ultrasound examinations were abnormal in 25 out of 31 cases (81%), while computed tomography, performed in 24 patients, revealed abnormal findings in 19 cases (80%). Combined radiographic and imaging procedures revealed peritoneal involvement (ascites) in 16 patients (27%), bowel involvement in 36 (61%), mass lesion in 11 (19%), lymphadenopathy in 13 (22%) and organ involvement in 13 (22%). CONCLUSION: There was no single radiological method that provided all necessary information suggestive of abdominal tuberculosis. Although unequivocal diagnosis of abdominal tuberculosis can only be made by culture and histological findings, combined computed tomography and ultrasound findings were the most important imaging tools in the diagnostic process for abdominal tuberculosis, while contrast studies helped to assess the extent of bowel disease, hence influencing decisions concerning surgery.

Primary cervical choriocarcinoma.

A case of primary cervical choriocarcinoma in a 40-year-old Indian woman is reported. Though malignant transformation of a cervical pregnancy is a possibility, we believe that a D & C performed three years ago could also be the source of trophoblasts implantation in the cervix followed by subsequent malignant transformation. Primary cervical choriocarcinoma should be considered a differential diagnosis in a woman of child-bearing age presenting with postcoital bleeding and having a negative cervical cytology. A timely beta hCG assay may confirm the diagnosis and prompt early treatment.

Gynaecological malignancies in Qatar.

Gynaecological malignancies constitute 6.88% (144 of 2092) of all malignant lesions in Qatar over a 15 year period (1979-1993). Cancer of the cervix was the most common with 54.86% followed by ovarian cancer 22.91%, endometrium 15.97%, vulva and vagina 2.75% and 2.08% respectively. Malignancies of the corpus uteri were rare. No tumours of the Fallopian tubes were registered during the study period. Early marriage, frequent coitus started early in life and increasing number of pregnancies were predisposing factors for the genesis of cancer of the cervix. As in some other developing countries, cervical and ovarian neoplasms tend to occur in the younger age group. Germ cell and gonadal stromal tumours were rare in Qatar and this may suggest rarity of these tumours in women of Arab and Indian subcontinent descent. Increasing number of pregnancies seems to protect against ovarian cancer. Abortions and age at menarche do not influence the incidence of gynaecological malignancies. Our findings provide an adequate data base for planning of gynaecological cancer education, screening programmes and resource allocation in Qatar.

Idiopathic pulmonary calcinosis: a variant of alveolar microlithiasis.

Diffuse pulmonary calcinosis has been observed in hyperparathyroidism, chronic renal disease, vitamin D intoxication, but has never been reported in the absence of any underlying disease. We report the case of a young man in whom diffuse pulmonary calcifications was found without any underlying disease and whose clinical and histological features suggest a variant or an incomplete form ('forme fruste') of alveolar microlithiasis.

Localized Leishmania lymphadenitis. Immunohistochemical studies.

Tissues from 10 patients with localized leishmania lymphadenitis were stained by immunoperoxidase technique for leishmanian antigens, immunoglobulins (Ig), complement, components, alpha 1-antitrypsin, and fibrin and by routine and chloroacetate esterase techniques. Lymph nodes with leishmania lymphadenitis showed a granulomatous process with a varying degree of necrosis, leishmanian amastigotes, abundant plasma cells, and focal fibrosis. Leishmanian antigens stained by rabbit anti-Leishmania tropica antiserum was detected in lymph nodes with granulomatous lymphadenitis (eight cases examined) and in a skin lesion but not in a lymph node showing only nonspecific hyperplasia. Positive antigen staining was seen in leishmanian amastigotes, granulomata, and (in three cases) vascular smooth muscles. Dominant plasma cell classes were IgG and IgE. Macrophages and granulomata stained positively for IgG and IgE (but not for IgM or IgA), faintly for C3, and strongly for alpha 1-antitrypsin. Mast cells were few. IgG and IgE may be involved in a specific way in this condition; formation of immune complexes with leishmanian antigens leads to immunologically mediated lysis of the host macrophages. This finding is important for the understanding of the pathogenesis of leishmania lymphadenitis and for effective elimination of the parasites.

Spindle cell hemangioendothelioma in association with epithelioid hemangioendothelioma.

A forty-two-year-old man presented with a twelve-year history of a multilobular, firm, but nonulcerated tumor (6 by 4.5 cm) of the dorsum of the right foot. He had capillary telangiectasia of both ankles but no lymphedema. Results of tests for human immunodeficiency viruses I and II were nonreactive. The tumor showed a complex combination of features of spindle cell hemangioendothelioma, epithelioid hemangioendothelioma, and areas suggestive of a possible well-differentiated (lymph) angiosarcoma. The tumor was completely excised with minimal healthy margin. There was no evidence of local or distant lesion at one-year follow-up examination.

Kikuchi's lymphadenitis in Qatar.

The clinicopathologic features of five cases of Kikuchi's lymphadenitis (histiocytic necrotizing lymphadenitis without granulocytic infiltration) occurring in Qatar are presented. There were three females and two males aged from 18 to 36 years with a mean of 29 years. Three were Indians and two were Qataris. Cervical lymph nodes were affected in all cases while one patient also had inguinal and femoral lymph node enlargement. Three patients achieved complete remission within three months. The differential diagnosis both clinically and histologically, included malignant lymphoma, toxoplasmosis, tuberculosis, leprosy, Yersinia and viral infections. To avoid errors in diagnosis, especially that of malignant lymphoma, attention must be paid to the location of the lesion, composition of the cellular infiltrate and the typical fibrinoid type of necrosis in the background.

Esophageal cancer in Qatar.

There were 41 cases of esophageal cancer over a 7 years period in the State of Qatar. Qataris accounted for 30 (73.17%) of these cases while representing about 38% of the entire population. Also there is a slight preponderance of female cases especially among Qataris. Nutritional factors, dietary preferences, environmental factors, social status and habits as well as genetic factors may constitute important etiologic factors in the genesis of esophageal cancer in Qatar.

Endometrial ossification.

A case of endometrial ossification in a 22-year-old woman is reported. Chronic endometritis following post-abortion evacuation was considered the basis for the osseous metaplasia in her endometrium. Besides being a reversible cause of infertility, endometrial ossification needs to be differentiated from mixed mesodermal tumours of the endometrium.

Solitary bronchial papilloma presenting with recurrent dyspnea attacks: case report with computed tomography findings.

A case of solitary bronchial papilloma is reported which, because of its unusual location near the carina and marked mobility, presented with attacks of dyspnea that were misdiagnosed as asthma for many years. It caused no abnormality on a plain chest X-ray, but could be visualized on linear and computed tomograms. The computed tomograms further demonstrated the absence of extraluminal extension of the tumor or mediastinal lymphadenopathy which could not be excluded by linear tomography or bronchoscopy. Transbronchial resection resulted in complete relief of symptoms.

Cyst of seminal vesicle associated with ipsilateral renal agenesis.

A case of cyst of seminal vesicle associated with ipsilateral renal agenesis in a twenty-three-year-old man presenting primarily with rectal symptoms is reported. The usual symptoms had been urinary bladder irritation and pain on ejaculation. The embryologic development of this rare entity is discussed.

Malignant transformation in an anal condyloma acuminatum.

A 61-year-old man had malignant transformation of an anal condyloma acuminatum, demonstrated by light and electron microscopic studies. Intranuclear virus-like particles were seen in the benign condylomatous koilocytotic cells but these were absent in the malignant cells. Multinucleation, syncytial giant cells and nuclear atypia in a condyloma acuminatum are considered features of in-situ carcinomatous change. Anal condyloma acuminatum requires wide excision and thorough examination of anorectal canal in order to exclude hidden disease, which will predispose to recurrence. Homosexuality is considered a predisposing factor. The authors stress the importance of histopathologic examination of all anorectal warts to exclude malignant change.