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BACKGROUND: Phyllodes tumor (PT) accounts for <1% of all breast tumors worldwide. Based on their microscopic features, these tumors are classified into benign, borderline, and malignant. This study aimed at evaluating the clinical experience and the clinicopathologic features of PT. METHODS: A retrospective cohort study of 46 female patients with histologically diagnosed PT. Data collection and evaluation was done on patient demographics, preoperative radiological assessment and pathology, surgical procedure, post-surgery pathological evaluation, radiation therapy (RT), and follow-up. RESULTS: The median age at diagnosis was 42 years and young premenopausal patients (median age 35 years) had malignant PT. Forty-five patients underwent core needle biopsy (CNB) with high sensitivity and the positive predictive value (82.2% and 97.4% respectively). Thirty-nine patients (86.7%) underwent conservative surgery and 6 (13.3%) had a mastectomy. Twenty-seven (58.6%) were classified as benign, 11 (23.9%) as borderline and only 8 (17.4%) as malignant PT. Malignant PT had the greatest median tumor size (13 cm). Mortality and recurrence rates were 4.3% and 2.2% respectively. RT was administered in 6 patients (13.0%), 5 having malignant and 1 borderline PT. The metastatic rate was found to be 6.5%. CONCLUSION: PT are rare breast tumors with variable biologic behavior and heterogenous clinicopathological findings. Young, premenopausal women with large tumors may have malignant PT with a risk of recurrence and metastasis. Core needle biopsy is a reliable tool for diagnosis of PT with strict follow-up recommended for large tumors diagnosed as fibroadenoma on CNB. Surgical management must ensure a tumor-free margin on excision to reduce recurrence.
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Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/patologia , Tumor Filoide/diagnóstico , Tumor Filoide/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fibroadenoma/diagnóstico , Fibroadenoma/patologia , Seguimentos , Humanos , Margens de Excisão , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Mortalidade/tendências , Metástase Neoplásica/patologia , Recidiva Local de Neoplasia/epidemiologia , Tumor Filoide/classificação , Tumor Filoide/ultraestrutura , Valor Preditivo dos Testes , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Centros de Atenção Terciária , Adulto JovemRESUMO
The College of Science and Health Professions offers a university preprofessional program. Like most medical schools in Saudi Arabia, the teaching delivery strategy in the university preprofessional program is on campus and face-to-face. During the month of March 2020, teaching activities of the spring semester were proceeding as normal; however, the sudden emergence of COVID-19 disturbed routine activities and compelled authorities to switch all teaching activities from face-to-face to online. Training sessions and workshops for all stakeholders on online delivery methods were arranged. Blackboard and other online facilities were utilized. All teaching materials, including newly made video clips for anatomy and physiology practicals, were uploaded on Blackboard and discussed online with students. Students' anxiety related to the exam was reassured by giving them the option of open book quizzes during summative continuous assessment. All scheduled teaching sessions, lectures, and practicals were conducted proficiently. Revision sessions and assessment quizzes were conducted with students' satisfaction. At the end of the semester, a final exam was conducted online as an open book exam. Students with technical issues while attempting the exam were given an opportunity to make up for it. After a successful final exam, the cumulative block grades showed students secured higher grades in the open book exam. Following that, the King Saud bin Abdulaziz University for Health Sciences has managed to conduct on-campus close book exams that abide by self-distancing and standard operating procedure policies.
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Anatomia/educação , COVID-19 , Educação a Distância/organização & administração , Fisiologia/educação , Universidades , Humanos , Arábia Saudita , Faculdades de Medicina , EnsinoRESUMO
Many medical schools offer pre-professional programs to undergraduate students. The main purpose of the university pre-professional program (UPPP) is to equip students with the necessary knowledge and skills required to successfully cope with the academic demands of further education provided by professional colleges. The aim of this commentary article is to describe the role of UPPP at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in preparing students to continue studies at the College of Medicine (COM) and other health-related colleges. The anatomy and physiology course is presented as a representative model. An outline of the UPPP in the context of the curriculum, teaching strategies, learning facilities, and assessment is presented. The pre-professional program at KSAU-HS prepares school graduates to become self-learners and enable them to learn effectively in the clinical context in a problem-based learning curriculum at COM.
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Anatomia/educação , Ocupações em Saúde/educação , Fisiologia/educação , Aprendizagem Baseada em Problemas/métodos , Estudantes de Ciências da Saúde , Universidades , Humanos , Arábia SauditaRESUMO
We report the development of a chemotherapeutic nanoformulation made of polyvinylpyrrolidone-stabilized magnetofluorescent nanoparticles (Fl-PMNPs) loaded with anticancer drugs as a promising drug carrier homing to human breast cancer cells, primary tumors, and solid tumors. First, nanoparticle uptake and cell death were evaluated in three types of human breast cells: two metastatic cancerous MCF-7 and MDA-MB-231 cells and nontumorigenic MCF-10A cells. While Fl-PMNPs were not toxic to cells even at the highest concentrations used, Dox-loaded Fl-PMNPs showed significant potency, effectively killing the different breast cancer cells, albeit at different affinities. Interestingly and superior to free Dox, Dox-loaded Fl-PMNPs were found to be more effective in killing the metastatic cells (2- to 3-fold enhanced cytotoxicities for MDA-MB-231 compared to MCF-7), compared to the normal noncancerous MCF-10A cells (up to 8-fold), suggesting huge potentials as selective anticancer agents. Electron and live confocal microscopy imaging mechanistically confirmed that the nanoparticles were successfully endocytosed and packaged into vesicles inside the cytoplasm, where Dox is released and then translocated to the nucleus exerting its cytotoxic action and causing apoptotic cell death. Furthermore, commendable and enhanced penetration in 3D multilayered primary tumor cells derived from primary lesions as well as in patient breast tumor biopsies was observed, killing the tumor cells inside. The designed nanocarriers described here can potentially open new opportunities for breast cancer patients, especially in theranostic imaging and hyperthermia. While many prior studies have focused on targeting ligands to specific receptors to improve efficacies, we discovered that even with passive-targeted tailored delivery system enhanced toxic responses can be attained.
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Neoplasias da Mama/patologia , Doxorrubicina/química , Portadores de Fármacos/química , Compostos Férricos/química , Corantes Fluorescentes/química , Espaço Intracelular/metabolismo , Nanopartículas/química , Antineoplásicos/química , Antineoplásicos/farmacologia , Transporte Biológico , Biópsia , Sobrevivência Celular/efeitos dos fármacos , Doxorrubicina/farmacologia , Portadores de Fármacos/metabolismo , Composição de Medicamentos , Humanos , Células MCF-7 , Povidona/químicaRESUMO
Introduction: Breast cancer (BC) is one of the commonest cancers among women worldwide. Differences regarding tumor biology, presentation, genetics, and molecular subtypes may contribute to the relatively poorer prognosis among younger women. Limited information exists regarding pathologic characteristics and long-term outcomes among this group. Methods: This retrospective cohort study included 695 BC patients diagnosed over a 10-year period and investigated the clinicopathological characteristics and long-term disease outcomes among patients diagnosed at age less than or equal to 40 years compared with older ones. Cox regression analysis was performed, and Kaplan-Meier curves were generated to assess overall survival (OS). Results: Compared with the younger patients (⩽40 years) estrogen receptor (ER) and progesterone receptor (PR) expression was mainly positive in older patients (>40 years) (76.2% vs 61.3% and 64.2% vs 49.6%, respectively). The most common molecular subtype in both age groups was luminal B (44.1% in older and 40.3% in younger). A clinical complete remission after neoadjuvant therapy was observed more frequently in older patients (76.7%; N = 442) in comparison with the younger patients (66.4%; N = 79) (P = .018). Recurrence and disease progression were significantly more likely to occur among younger patients accounting for 12.6% and 29.4% of the cases, compared with 6.3% and 18.2% in older patients (P = .016 and P = .006, respectively). The overall mortality was 132 (19%) of 695, with 88% cancer-related deaths. Estrogen receptor and PR expression (P ⩽ .001 and P = .003, respectively), molecular subtype (P = .002), tumor grade (P = .002), and N stage (P = .038) were the variables that were found to be significantly influenced by age. The OS was not statistically different among 2 age groups, but younger patients with luminal A molecular subtype showed significantly poor outcome (P = .019). Conclusion: Overall survival in women diagnosed with BC at age less than or equal to 40 years is not significantly worse than older patients. However, among patients with luminal A subtype, younger women had relatively poor survival. Further research is needed to understand this age-based disparity in outcomes.
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Inflammatory myofibroblastic tumors (IMTs) are soft-tissue tumors that are rarely malignant. They can occur throughout the body but are rarely seen in the female genital tract. To our knowledge, the literature reports only a few cases of uterine IMTs. This article describes a 60-year-old female with a uterine IMT presumed to be a fibroid. The correct diagnosis was made based on a combination of gross appearance, microscopic findings from multiple hematoxylin and eosin-stained tumor slides, and immunohistochemical staining. We also provide a literature review and compare our findings to other reported cases.
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Background Neoadjuvant chemotherapy (NAC) is being widely used in treating breast cancer (BC). This study aimed to analyze the correlation between clinicopathological features, immunohistochemistry (IHC)-based molecular subtypes, and the pathological response to NAC and its relationship with disease-free survival (DFS) and overall survival (OS). Materials and methods A retrospective analysis of 211 breast cancer patients who received NAC between 2008 and 2018 was performed. Tumors were classified by IHC into luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative subtypes. The chi-square test was used to assess the association between pathological response and clinicopathological parameters. Cox regression analysis was used to assess factors related to DFS and OS. Results Post NAC, 19.4% of patients achieved a pathologic complete response (pCR). Estrogen receptor (ER), progesterone receptor (PR), HER2 (p<0.001, 0.005, and 0.02), Ki67 (p=0.03), molecular subtypes (p<0.001), T stage (p=0.04), and N stage (p=0.01) were significantly associated with pathological response. The rate of pCR was highest among HER2-enriched and triple-negative tumors (45.2% and 28%, respectively) with OR=0.13 and p<0.001 for the HER2-enriched subtype. Patients with pCR were 61% less likely to develop metastasis (adjusted hazard ratio [aHR]=0.39, p=0.06, 95% CI=0.14-1.06) and were significantly associated with better OS (aHR=0.07, p=0.02, 95% CI=0.01-0.61). Patients who were ≤40 years old (aHR=2.1, p=0.01), with T4 (aHR=3.4, p=0.02), grade 3 (aHR=2.5, p=0.01), and node-positive disease (HR=2.24, p=0.02) were at an increased risk of developing metastasis. High Ki67 was found to be significantly associated with better DFS (p=0.006). Conclusion HER2-enriched and triple-negative BC were associated with a higher rate of pCR. Patients with pCR had significantly better DFS and OS. Younger age, advanced stage, higher grade, and lymph node involvement were risk factors for metastasis.
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Purpose: The College of Science and Health Professions offers the University Pre-Professional Program (UPPP) to newly enrolled students. This study aimed to evaluate the effectiveness of the program in preparing students to become self-directed learners and to seek students' perceptions about student-centered teaching. Methods: A quantitative quasi-experimental study that used a pre and post-test survey in two stages, before and after semester-4. A self-developed questionnaire was distributed online. Results: The t-test showed students (n=701) after semester-4 had a significant increase in the understanding of Problem-Based Learning (PBL) (t (699) = -8.27, p < 0.01), PBL dynamics (t (699) = -5.12, p < 0.01), learning and dynamics of Case-Based Learning (CBL) and Self-Directed Learning (SDL) (t (699) = -6.48, p < 0.01), and facilitators' role in such curriculum (t (699) = -3.41, p < 0.01). The ANOVA showed students attending various courses perceived the program variables differently (Learning in PBL p = 0.08, PBL dynamics p < 0.01, CBL and SDL dynamics p < 0.01, role of facilitator in PBL p < 0.01). Regarding the resources used by students during the basic medical sciences courses, no significant difference was observed between the study groups (p = 0.06). However, the only significant difference observed was in their satisfaction with the question related to assessment and course (p < 0.01). Conclusion: The UPPP improved students' understanding of student-centered teaching and learning approaches, especially the PBL. Thus, UPPP helps students shift their learning habits from didactic to student-centered modern learning approaches. Variation among different students' groups could be attributed to their previous academic background and change in learning medium to English. This study suggests that preparatory teaching programs like UPPP are helpful for students interested in joining the bachelor's programs in countries like Saudi Arabia where English is not a native language.
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Introduction Innovating strategies have become a compulsion in all fields associated with improved outcomes. Similarly, an innovation was introduced in the curriculum design and content to be tested for the Anatomy and Physiology course at the College of Science and Health Professions (COSHP), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), in the spring semester of 2020. Before the COVID-19 pandemic, until the spring semester of 2019, two examinations were conducted as continuous assessments (Midterm I and II), followed by a comprehensive Final examination. In the spring semester of 2020, these examinations were replaced with Block I, II, and III examinations, respectively, with modified content and weightage. The Final examination was comprehensive and included 24 Anatomy, 21 Physiology lectures, and three case-based learning (CBL) sessions, whereas Block III included only eight Anatomy, seven Physiology lectures, and 1 CBL session. Midterm I and II weighed 20% each with a comprehensive examination of 35%, while Block I, II, and III were all 25% each. This study focuses on the impact of the curriculum modifications on the results of written examinations for preprofessional students enrolled at Riyadh, Jeddah, and Al-Ahsa campuses. Methods This retrospective study included data from 2356 male and female students from Riyadh, Jeddah, and Al-Ahsa. Data included Midterm I and II grades and Final examination grades for spring semester 2019 and Block I, II, and III examination grades for spring semester 2021. The results of the spring semester 2021 examinations were compared with the spring semester 2019 examination. The spring semester of 2020 was skipped to avoid the effect of online examinations during the COVID-19 restriction period. Data were analyzed using the statistical software SPSS version 23.0 (IBM Corporation, Armonk, NY, USA). Coefficient of variation (CV) compared spring semester 2019 and spring semester 2021 examination outcomes. The findings were analyzed concerning data related to gender, student groups, and campuses. An independent t-test of proportion was used to compare the CVs for spring 2019 and 2021. Results The overall comparison showed better results in the spring semester of 2021 (p-value < 0.01). Campus-wise, the results were significantly better for Riyadh (p-value < 0.01). The gender-wise study showed better performance from male students (p-value < 0.01). Concerning campus and gender, the results of male and female students of the Riyadh campus came out to be highly significant (p-value < 0.01). Conclusions Changing from Midterms to the Block system significantly improved the Block III examination results in spring semester 2021, particularly at the Riyadh campus. Overall, the changes remained helpful to all students. Further studies are needed to investigate the long-term effect of the curriculum changes.
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Perivascular epithelioid cell tumors (PEComas) are infrequent mesenchymal neoplasms. Primary uterine PEComas are extremely uncommon. To the best of knowledge, around 110 cases of uterine PEComas have been documented in the English-language literature thus far. Herein, we present the case of primary uterine PEComa in a 56-year-old Saudi woman who presented to clinical attention with a six-month history of left-sided abdominal pain. Gynecological examination showed a 5-cm solid mass involving the left adnexa. Tumor markers were normal. Computed tomography scan demonstrated a 4.2 x 4.4 x 3.4 cm superior left fundal exophytic mass. Patient underwent total abdominal hysterectomy plus bilateral salpingo-oophorectomy. Final histopathological examination demonstrated benign/uncertain malignant potential PEComa. No further adjuvant therapy was administered. At six-month follow up, the patient was asymptomatic without recurrence. In conclusion, uterine PEComas are rare. Histopathological assessment establishes the definitive diagnosis. Surgery remains the gold standard in the treatment of uterine PEComas and adjuvant therapy should be guided based on clinical and histopathological risk factors. Keywords: Uterine perivascular epithelioid cell tumor; PEComa; Uterine sarcoma; hysterectomy.
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Neoplasias de Células Epitelioides Perivasculares , Neoplasias Uterinas , Biomarcadores Tumorais , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Neoplasias de Células Epitelioides Perivasculares/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias Uterinas/cirurgiaRESUMO
Vulvar leiomyosarcoma is a rare smooth muscle malignant neoplasm but it is the commonest type of vulvar sarcomas. It may mimic benign tumors and misdiagnosis could delay proper management. We report a case of a 38-year-old pregnant woman with leiomyosarcoma of the vulva. The patient presented to her primary general practitioner with a small vulvar mass that she had first noticed one year prior. The tumor was suspected to be benign Bartholin's cyst and treated with antibiotics. The patient declined improvement and had many consultations to different clinics where she had been diagnosed and treated the same. The tumor size started to grow rapidly after she got pregnant, and the patient was referred to our hospital where she underwent tumor resection. Histopathology revealed leiomyosarcoma. The patient had further assessment and close follow-up and has had no recurrence for 12 months. There is little literature available on vulvar leiomyosarcoma, most of which are case reports, and most gynecologic oncologists will go through their whole careers without seeing a single case.
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This work reports the fabrication of iron oxide mesoporous magnetic nanostructures (IO-MMNs) via the nano-replication method using acid-prepared mesoporous spheres (APMS) as the rigid silica host and iron (III) nitrate as the iron precursor. The obtained nanosized mesostructures were fully characterized by SEM, TEM, DLS, FTIR, XRD, VSM, and nitrogen physisorption. IO-MMNs exhibited relatively high surface areas and large pore volumes (SBET = 70-120 m2/g and Vpore = 0.25-0.45 cm3/g), small sizes (~300 nm), good crystallinity and magnetization, and excellent biocompatibility. With their intrinsic porosities, high drug loading efficiencies (up to 70%) were achieved and the drug release rates were found to be pH-dependent. Cytotoxicity, confocal microscopy, and flow cytometry experiments against different types of cancerous cells indicated that Dox-loaded IO-MMNs reduced the viability of metastatic MCF-7 and KAIMRC-1 breast as well as HT-29 colon cancer cells, with the least uptake and toxicity towards normal primary cells (up to 4-fold enhancement). These results strongly suggest the potential use of IO-MMNs as promising agents for enhanced and effective drug delivery in cancer theranostics.
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INTRODUCTION: The Oncotype DX assay plays an important role in the identification of the specific subset of hormone receptor (HR)-positive and node-negative breast cancer (BC) patients, who would benefit the most from adjuvant chemotherapy. The current study aimed at assessing the level of agreement among medical oncologists on adjuvant chemotherapy decisions before and after Oncotype DX, as well as the intra-observer agreement of each medical oncologist's decision of prescribing adjuvant chemotherapy based on clinicopathological and immunohistochemical parameters only and followed by Oncotype DX recurrence score (RS) results. METHODS: A retrospective analysis of data related to clinicopathological and immunohistochemical parameters, and Oncotype DX RS result for 145 female, estrogen receptor (ER)-positive, HER2 negative, and both node-negative and positive BC patients was performed. Initially, the data without Oncotype DX RS was sent to 16 oncologists in multiple centers in the Middle East. After one week, the same data with the shuffling of cases were sent to the oncologists with the addition of the Oncotype DX RS result for each patient. The inter and intra-observer agreement (kappa and Fleiss multi-rater kappa) among oncologists' decision of prescribing adjuvant chemotherapy pre and post-Oncotype DX RS results were assessed. Oncotype DX risk scores were used as continuous variables as well as based on old RS grouping, categorized into low (0-17), intermediate (18-30), and high risk (≥ 31) groups. A test with a p-value of < 0 .05 will be considered statistically significant. RESULTS: The mean age ± SD of the cohort was 51.9 ± 9.4 years. Sixty-nine patients (47.6%) were premenopausal whereas 76 patients (52.4%) were postmenopausal. The mean Oncotype DX RS was 17.8 ± 8.6 and 54.5% had low recurrence risk (RR), 37.9% had intermediate RR and only 7.6% had high RR. The majority of our cases were grade two (53.1%) and T stage one (49%), whereas 29.7% had positive one to three lymph nodes. The addition of Oncotype DX results improved the agreement among oncologists' decision from fair to moderate (kappa = 0.52; p <0.001). On average, an oncologist's decision of prescribing adjuvant chemotherapy pre and post-Oncotype DX had an agreement in 70.6% of the cases, with agreement observed mostly for cases where the initial decision of adjuvant chemotherapy was (no) and it was retained with post-Oncotype DX assay (46.1%), compared to 24.5% cases where the initial decision was (yes) and it was retained with post-Oncotype DX assay (kappa = 0.39; p <0.001). The addition of the Oncotype DX RS result avoided chemotherapy in 20.4% of cases and identified 9% of cases as candidates for adjuvant chemotherapy (kappa = 0.38; p <0.001). The disagreement was highest among cases with intermediate RR (33.6%) followed by high and low RR (31.3% and 21.6%) with a statistical significance of <0.001. CONCLUSION: We conclude that the Oncotype DX RS significantly influenced the decision to prescribe adjuvant chemotherapy among HR-positive, HER2 negative, and both node-negative and positive patients, as it increased the level of agreement among oncologists and led to a decrease in the use of adjuvant chemotherapy compared to the pre-Oncotype recommendations.
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The curriculum of medical schools includes courses on antibiotics. Therefore, it is worth exploring information related to the knowledge and attitudes about antibiotics. In this cross-sectional study the questionnaire was administered to the undergraduates in two phases, before and after attending the basic medical science courses. The data were collected on demographic variables, source of antibiotics, level of knowledge, and changes in attitude statements. Data analysis was implemented using SPSS. The mean age of participants was 19.87 and 20.15 in phases I and II, respectively. Most of the participants' parents had education at the university level and a monthly income above 15,000 SAR. Generally, students had good knowledge and attitude about antibiotics. A significant improvement in students' knowledge in phase-II was noticed in "level of knowledge" (p-value = 0.044), "paracetamol is considered an antibiotic" (p-value < 0.001) and "overuse of antibiotics can cause antibiotics resistance" (p-value = 0.003). The overall knowledge and attitude of pre-professional students were good in both phases, but their attitude did not improve at a significant level in phase-II. There is a need to put more focus on antimicrobial therapy in their training.
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High-grade endometrial carcinomas are a heterogeneous group of tumors and include grade 3 endometrioid (EC-3), serous (SC), and clear cell carcinomas (CCC). There are conflicting data about the prognosis of these subtypes of high-grade endometrial carcinoma; this may be a result of lack of reproducibility in classifying tumor cell type. The purpose of this study was to examine differences in immunophenotype and outcome in a series of high-grade endometrial carcinomas, focusing on the comparison of EC-3 versus SC. We selected 180 endometrial carcinomas of SC, EC, or CCC type. No mixed carcinomas were included in the study. We chose the following immunohistochemical markers, estrogen receptor (ER), insulin-like growth factor 2 mRNA-binding protein 3 (IMP3), p16, p53, progesterone receptor (PR), and phosphatase and tensin homolog (PTEN) as being significantly differentially expressed in endometrial carcinoma subtypes. The tumors were stratified into 4 groups on the basis of their cell type and grade: EC grade 1 or 2, EC-3, SC, and CCC. Univariate survival analysis revealed significant differences in outcome between the 4 groups (P<0.0001), with significantly longer disease-specific survival for grade 1 or 2 EC versus EC-3 (P=0.0001), and EC-3 versus SC (P=0.0003). p16, PTEN, and IMP3 expression was observed more frequently in SC compared with EC-3 (P<0.0001, P=0.021, and P=0.031, respectively). These 3 markers showed the highest sensitivity and specificity in distinguishing between EC-3 and SC, with receiver operating characteristics area under the curve of 0.85, 0.69, and 0.71, respectively. ER and p53 approached but did not reach significance for differential expression in EC-3 versus SC (P=0.055 and P=0.068, respectively). A combination of p16 and PTEN predicts EC-3 versus SC with a sensitivity of 90.0% and specificity of 96.8%. p16 and PTEN can aid in distinguishing between EC-3 and SC of the endometrium, and are superior to ER, PR, and p53 for this purpose. EC-3 carcinomas have a significantly better prognosis than SC carcinomas of the endometrium.
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Adenocarcinoma de Células Claras/patologia , Carcinoma Endometrioide/patologia , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/patologia , Adenocarcinoma de Células Claras/imunologia , Idoso , Carcinoma Endometrioide/imunologia , Cistadenocarcinoma Seroso/imunologia , Neoplasias do Endométrio/imunologia , Feminino , Humanos , Imuno-Histoquímica , Imunofenotipagem , Pessoa de Meia-Idade , PTEN Fosfo-Hidrolase/imunologia , Proteínas de Ligação a RNA/imunologia , Curva ROC , Receptores de Estrogênio/imunologia , Receptores de Progesterona/imunologia , Estudos Retrospectivos , Análise de Sobrevida , Proteína Supressora de Tumor p53/imunologiaRESUMO
Embryonal rhabdomyosarcoma (ERMS) is a malignant neoplasm mostly affecting the genitourinary system of children and is rarely seen in adults. ERMS in uterine cervix is rare and can be misdiagnosed in adult as adenosarcoma or carcinosarcoma. The use of immunohistochemical staining is highly recommended to make sure that the correct diagnosis is reached. To the best of our knowledge, only seven cases of cervical ERMS in women above the age of 50 have been reported in English literature. Herein, we report a rare case of cervical ERMS in a 50-year-old woman that was initially misdiagnosed as an adenosarcoma.
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Adenossarcoma/diagnóstico , Rabdomiossarcoma Embrionário/patologia , Neoplasias do Colo do Útero/patologia , Idoso , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Rabdomiossarcoma Embrionário/diagnóstico , Neoplasias do Colo do Útero/diagnósticoRESUMO
PURPOSE: Breast cancer affects a significant number of patients younger than 40 years in the Gulf and breast conservative treatment is highly preferred. Pathological complete response (pCR) following neoadjuvant chemotherapy is increasingly being observed with the new chemotherapy agents. Although MRI is more accurate in such evaluations, digital mammography and high-resolution ultrasound (US) which are less expensive may accurately predict pCR which is the focus of this study. METHODS: A 6-year retrospective study of 93 breast cancer cases who had neoadjuvant chemotherapy and had presurgical radiological localization was carried out. Forty-five had US localization while 48 underwent mammographic localization when US failed to define any residual mass. Radiologic complete response (rCR) was defined as absence of mass with only postbiopsy clip overlying normal breast parenchyma pattern in US and in mammography (clip sign). Mass or abnormal parenchymal pattern was considered as residual tumor. The pathology reports of pCR or not with background changes were recorded. RESULTS: Ultrasound localization correctly predicted 42 out of 43 pathologic masses with 98 % accuracy. Mammographic localization correctly predicted 40 out of 43 pCR with 93 % accuracy. The best responders were triple negative and HER2 positive hormone negative breast cancer. CONCLUSION: The study defines radiologic complete response (rCR) as absence of a mass with the postbiopsy tissue marker overlying a normal-looking breast parenchyma in both ultrasound and mammographic evaluation. A correlation of 93 % was found with pCR. The few false negative cases were associated with overlying dense breast and possibly post treatment reaction. Allocation of a BI-RADS category for rCR is suggested.
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Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Mamografia/métodos , Terapia Neoadjuvante/métodos , Cuidados Pré-Operatórios/métodos , Ultrassonografia Mamária/métodos , Antineoplásicos/uso terapêutico , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Feminino , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Oncotype Dx is used to predict the long-term recurrence risk in patients with estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative invasive breast cancer (BC). This study aimed at establishing a correlation between clinicopathological parameters and recurrence score (RS), subsequently improving predictability and ultimately justifying the use of the multigene assay. MATERIALS AND METHODS: A retrospective analysis of the pathology and clinical data of 114 female patients with BC who had Oncotype Dx testing between 2012 and 2019. The pathological parameters included are tumor cell type, tumor grade, pathological stage, and mitotic index (MI). The expression of ER, progesterone receptor (PR), HER2, and Ki67 was assessed by immunohistochemistry. A univariate and multivariate linear regression analysis was performed to assess the correlation between these parameters and the RS. RESULTS: In univariate analysis, age (Ë40 years), higher tumor grade, and low PR expression were significantly associated with higher RS (P = .02; Ë.001; and Ë.001, respectively). Both MI and Ki67 were also strongly correlated with an increase in the RS with a P value of .01 (Spearman correlation 0.34 and 0.33). In multivariate linear regression analysis, age, MI, and Ki67 lost their significance, but both higher grade and PR remained significantly associated with a higher RS along with the tumor stage (P Ë .001; Ë.001; and .04, respectively). CONCLUSIONS: Tumor grade and PR immunohistochemical expression are the main predictors of RS in our study population. Other clinicopathological features were not significant predictors of change in RS in multivariate analysis.
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Rhabdomyosarcoma (RMS) is a malignant neoplasm that originates from undifferentiated myogenic progenitor cells. It is predominantly a pediatric disease, and its occurrence in adults is exceedingly rare. Adult primary RMS of gynecologic origin is an uncommon phenomenon, and the cervix is the most frequently involved site. The incidence of adult primary uterine RMS is extremely scarce. Herein, we present the case of primary uterine RMS in a 54-year-old Saudi postmenopausal woman who presented to clinic attention with a six-month history of abdominal pain and vaginal bleeding.
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INTRODUCTION: The use of complementary and alternative medicine (CAM) in dermatology has been increasing in recent years. Patterns of CAM use by vitiligo patients have not previously been assessed in Saudi Arabia. Therefore, it is worth exploring the perceptions, knowledge, and attitudes of Saudi vitiligo patients toward CAM. METHODS: A cross-sectional study was conducted for 12 months among Saudi vitiligo patients at King Abdulaziz Medical City in Riyadh. A validated self-administered questionnaire, comprised of four sections, was used to collect the data. Descriptive analysis was used, and a chi-squared test was used to determine the association between dependent and independent variables. RESULTS: Two hundred patients with vitiligo were enrolled, 56% of whom were female. The average age was 31.6 ± 15.45 years. Approximately 52% of the patients were either current or previous users of CAM. Among the patients, 44.5% had been asked by their dermatologist about their CAM use, and 18.5% preferred not to disclose their CAM use. Social media was the most common source of information for CAM (28%). CONCLUSION: More than half of the vitiligo patients in our study used some form of CAM. The most popular remedies were honey (37%), Nigella sativa (29%), and olive oil (29%).