Prevalence of Esophageal Eosinophilia, Eosinophilic Esophagitis, and Lymphocytic Gastritis in Children with Celiac Disease: A Saudi Tertiary Center Experience.

Background: Celiac disease (CD) is an immune-mediated enteropathy that has been associated with other immune-related gastrointestinal disorders, such as eosinophilic esophagitis (EoE) and lymphocytic gastritis (LG). To our knowledge, this is the first study in Saudi Arabia that has described such an association. Aim: To evaluate the prevalence of EoE and LG in children and adolescents with CD. Methods: This was a retrospective cross-sectional study of all pediatric patients (aged 0-18 years) with CD following up at King Abdulaziz University Hospital, between January, 2014, and December, 2021. The study examined clinical, demographic, endoscopic, and histopathological data. Results: Seventy-five patients with CD were included in the analysis. The median age was 12 years (range, 2-18 years). Male constituted 54.7% of the overall cohort (n = 41). The most common clinical symptoms were short stature (54.7%), weight loss (34.7%), abdominal pain (33.3%), abdominal distension (29.3%), anorexia (29.3%), diarrhea (24%), and vomiting (21.3%). The esophageal biopsy results reported were basal cell hyperplasia in 24 patients (32.9%), esophageal eosinophilia in 23 patients (31.5%), and EoE in 3 patients (4.1%). The gastric biopsy results were normal in 40 patients (53.3%). The most common abnormality was chronic inactive gastritis with no Helicobacter pylori (HP) infection (16%). LG was found in 3 patients (4%). Conclusions: The prevalence of EoE in this cohort of patients with CD was lower than the prevalence recorded in a number of other studies. Further studies are needed to determine the effects of a gluten-free diet (GFD) on EOE and LG.

Comparison of flexible endoscopy and magnetic resonance imaging in determining the tumor height in rectal cancer.

BACKGROUND: Several modalities are available for the diagnosis of rectal cancer, including conventional gold standard rigid endoscopy and recent flexible endoscopy and magnetic resonance imaging (MRI). Each modality affects the management of these patients. AIM: To compare the accuracy of flexible endoscopy and MRI in the measurement of tumor height in patients with rectal cancer. METHODS AND RESULTS: This study included 174 patients with rectal cancer who underwent flexible endoscopy and MRI for the measurement of tumor height. Data on patient demographics, comorbidities, treatment, and histopathology were identified and collected. We evaluate intraclass correlation coefficient (ICC) and Bland-Altman plot to test the agreement between the measurements. ICC were excellent with an ICC of 89% (95%CI 48%-99%). The mean ± standard deviation of the distance from the anal verge to the distal part of the tumor was 7.73 ± .47 for flexible endoscopy and 6.21 ± 0.39 for MRI, with mean difference of 1.52 (p Ë‚ .001). The accordance between the two modalities was not affected by sex, age, body mass index, histopathology, or metastasis. CONCLUSION: Excellent agreement between flexible endoscopy and MRI was noted, and no factor was found to affect such concordance.

Solitary rectal ulcer syndrome in children and adolescents: a descriptive clinicopathologic study.

Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of the rectum. While benign, it can cause concern for patients and affect quality of life. Reported studies on SRUS worldwide are scarce. The aim of this study is to describe the clinicopathologic characteristics of SRUS in a cohort of children based in Saudi Arabia. In this study, children with a confirmed diagnosis of SRUS at King Abdulaziz University Hospital (KAUH) were included, during the period November 2003 to November 2017. Data were collected from hospital medical records. The study comprised twenty-one patients: 17 males (81%) and 4 females (19%); the median age was 11.4 years (range, 5.43-17.9 years). The most common presenting symptoms were rectal bleeding in 21 patients (100%), passage of mucus in 16 (76.1%), abdominal pain in 14 (66.6%), constipation in 13 (61.9%), straining in 9 (42.9%), and rectal prolapse in 5 (23.8%). The most common finding at initial colonoscopy was a single ulcer in 7 patients (33.3%), multiple ulcers in 6 (28.5%), polypoid lesions in 5 (23.8%), and hyperemic mucosa in 3 (14.2%). All patients received medical treatment and 14 (81%) continued to manifest one or more of the symptoms following treatment, which required subsequent modification of the treatment course. None of the patients required surgery. In conclusion, the study found rectal bleeding to be the most common presentation, with a single ulcer being the most prevalent lesion in endoscopy. Treatment response was variable, but almost half of patients reported relief of symptoms following treatment.

Extragastrointestinal stromal tumor of prostate.

Gastrointestinal stromal tumors (GISTs) that originate outside the GI tract are extremely uncommon. In this case report, we describe a GIST of primary origin in the prostate gland of an 84-year-old male who presented with severe urinary retention at King Abdulaziz University Hospital in Saudi Arabia. Diagnosis was based on patient history, radiological studies, pathologic findings, and immunohistochemical data. Digital rectal examination revealed a hugely enlarged prostate encroaching upon the rectal lumen with a smooth and firm surface. Transrectal ultrasound showed a markedly enlarged prostate with an estimated volume of 360 ml; prostate-specific antigen was 5.4 ng/ml. Immediate preoperative cystoscopy demonstrated only a moderate enlargement of the prostate, which was disproportionate to its actual size. Postoperative abdominal computed tomography showed residual prostatic tissue with an estimated weight of 78 g, multiple diffuse colonic diverticulosis, and scattered subcentimeter mesenteric lymph nodes. Histopathological examination of the prostatic tissue showed cellular spindle cell neoplastic proliferation which was diffusely positive for CD117 (c-kit), DOG1, and CD34. GISTs must be considered in the differential diagnosis of spindle cell tumors detected in the prostate.

Management of postoperative gastrointestinal leakage with autologous stromal vascular fraction.

To assess the efficacy of using autologous stromal vascular fraction (SVF) to promote healing of controlled fistula tracts in the management of postoperative upper gastrointestinal leakage. This is an experimental study conducted on 10 experimental rabbits. Animal models were divided into the SVF group which received an autologous SVF and the control group which did not receive the implantation. Surgery was performed on both groups to induce a gastric leak and create a controlled fistula tract between the leakage site in the stomach and the skin. After 2 weeks, surgery was performed on the SVF group to harvest, process and then implant the autologous SVF in the fistula tract. Animal models were followed up and their fistula tracts were evaluated for healing by gross and microscopic examination of the fistula tracts before the SVF implantation and at 24 hours, 1 week, 2 weeks and 3 weeks after implantation. The control group revealed no closure of fistula tracts by the 3(rd) week after implantation and there were no signs of inflammation or drainage. On the other hand, the SVF group showed signs of healing process with progressive closure of the fistula tract to about 95% by the 3(rd) week after implantation. The use of autologous SVF implantation to promote the healing of controlled fistula tracts seems to be a novel, safe and effective method in the management of postoperative upper gastrointestinal leakage. It could prevent reoperation and reduce hospital stay, morbidity and mortality. These results are promising and provide support for further clinical studies.

Metaplastic carcinoma of the breast: an immunohistochemical study.

BACKGROUND: Metaplastic breast carcinoma is a rare entity of breast cancer expressing epithelial and/or mesenchymal tissue within the same tumor. The aim of this study is to evaluate the clinicopathological features of metaplastic breast carcinoma and to confirm the triple negative, basal-like and/or luminal phenotype of this type of tumor by using immunohistochemical staining. METHODS: Seven cases of MBC were evaluated for clinico-pathological features including follow up data. Cases were studied immunohistochemically by CK-Pan, Vimentin, ER, PR, HER2, basal markers (CK5/6, p63, EGFR, SMA and S-100), luminal cytokeratins (CK8, CK18 and CK19), markers for syncytial cells (ß-HCG and PLAP), as well as prognostic markers (p53, ki-67 and calretinin). RESULTS: The mean age of the patients was 36 years. Three cases showed choriocarcinomatous features. All of our cases were negative for ER, PR and HER2. Six out of the 7 cases showed basal-like differentiation by demonstrating positivity with at least one of the basal/myoepithelial markers. Also 6 out of the 7 cases expressed luminal type cytokeratins (CK8, CK18 and/or CK19). P53 was positive in 3 cases, ki-67 was strongly expressed in only one case, while calretinin was expressed in 6 cases. CONCLUSION: Metaplastic breast carcinoma presents in our population at a younger age group than other international studies. All cases are categorized immunohistochemically under the triple negative group of breast cancer and 86% of them exhibited basal-like and luminal phenotype. Majority of cases developed local recurrence and distant metastasis in a relatively short period of time. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1101289295115804.

Propagation and titration of Alkhumra hemorrhagic fever virus in the brains of newborn Wistar rats.

Alkhumra hemorrhagic fever virus (AHFV) is a novel flavivirus identified first in Saudi Arabia. In this study, successful propagation of AHFV in the brains of newborn Wistar rats is described and the median rat lethal dose (RLD50) is determined. AHFV-RNA-positive human sera diluted 1:10 were injected intracerebrally into 16, ≤24h old rats. Post-inoculation, the rats were observed daily for 30 days. Brains of moribund rats were tested for AHFV-RNA using RT-PCR and cultured in LLC-MK2 cells. The titer of the isolated virus was determined and expressed in median tissue culture infectious dose (TCID50). To determine the RLD50, AHFV brain suspension was 10-fold diluted serially and each dilution was inoculated in the cerebral hemispheres of 10 rats for a total of 90 rats. Three days post-inoculation, the rats developed tremor, irritability, convulsion, opisthotonus, and spastic paresis starting in the hind limbs and ascending to involve the whole body. All infected rats died within 3-7 days with histopathologically confirmed meningoencephalitis. AHFV-RNA was detected in the brains of all infected rats and the virus titer was 10(9.4) RLD50/ml. The virus titer in LLC-MK2 was 10(8.2) TCID50/ml. In conclusion, AHFV was propagated successfully to high titers in the brains of newborn Wistar rats.

Anti-mitochondrial antibody positive autoimmune hepatitis triggered by EBV infection in a young girl.

Autoimmune hepatitis (AIH) is rare in children. Two types of childhood autoimmune hepatitis are recognized: AIH type 1 which is characterized by the presence of smooth muscle (SMA) and/or antinuclear (ANA) antibodies; and AIH type 2 which is positive for anti-liver kidney microsomal type 1 (anti-LKM-1) antibody. Anti-mitochondrial antibody (AMA) is considered the hallmark for primary biliary cirrhosis (PBC) that occurs primarily in adult women and is characterized by destruction of the intralobular bile ducts and progression to cirrhosis and liver failure. Antimitochondrial-antibody-positive AIH is extremely rare in children. We report a 13year old Saudi girl with type-1 AIH who had a strongly positive anti-mitochondrial antibody and no evidence of small bile duct disease in the liver biopsy.

Prevalence of celiac disease in children with type 1 diabetes mellitus screened by anti-tissue transglutaminase antibody from Western Saudi Arabia.

OBJECTIVE: To determine the prevalence of celiac disease (CD) in children and adolescents with type 1 diabetes mellitus (T1DM) using anti-tissue transglutaminase (anti-tTG) antibodies. METHODS: A retrospective hospital record-based study of all children and adolescents with T1DM who were screened for CD was conducted at the Pediatric Diabetes Clinic of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia (KSA) between October 2002 and June 2011. RESULTS: A total of 430 children with T1DM were screened by anti-tTG antibody. The median age at screening was 10.7 years (range; 1.1-18). The study cohort included 232 (54%) Saudi patients, and females constituted 58.8% of the total number. Anti-tTG antibody screening was positive in 91 (21.2%) patients. Forty-eight (11.2%) out of 430 children screened had biopsy-proven CD. Forty-two patients with CD (87.5%) were asymptomatic. Patients with CD had less weight for age (p=0.007), and height for age (p=0.03) z-scores than non-CD patients. They showed more association with anemia (p<0.001), low albumin level (p<0.001), and autoimmune thyroid disease (p=0.002). There was no difference in the mean glycosylated hemoglobin level (p=0.38), or insulin requirements (p=0.74) between the 2 groups. CONCLUSION: The prevalence of CD in patients with T1DM from the Western region of KSA is considered among the highest reported. Therefore, routine screening through proper serological testing is recommended.

Gastrointestinal stromal tumors in western Saudi Arabia.

OBJECTIVE: To determine the pattern of gastrointestinal stromal tumors (GIST) in the population of 2 large tertiary centers in the western province of the Kingdom of Saudi Arabia (KSA). METHODS: This retrospective study used cases diagnosed as GIST at the histopathology laboratories of King Abdul-Aziz University Hospital between January 2000 and October 2009, and King Faisal Specialist Hospital and Research Center, Jeddah, KSA, between January 2002 and December 2008. Additionally, cases diagnosed as gastrointestinal spindle cell tumors, sarcomas, schwannomas, leiomyomas, and leiomyosarcomas at King Abdul-Aziz University Hospital between January 1995 and December 1999 prior to the introduction of CD117 immunostain testing in the lab were tested for it. Positive cases were included in the study. Age and gender of the patients, as well as tumor location, maximum diameter, and mitotic count were analyzed. RESULTS: Thirty-seven cases were found in which the mean age was 55.6 years. Nineteen tumors were located in the stomach (51.4%), 7 in the small bowel (18.9%), 2 in the colorectum (5.4%), 4 in the mesentery (10.8%), and 5 in the abdomen (13.5%). Fifteen cases (40.5%) were high risk, 13 (35.2%) were intermediate risk, 3 (8.1%) were low risk, and one case (2.7%) was very low risk for aggressive behavior. CONCLUSION: The GISTs are more prevalent in Saudi Arabia than is generally thought. Most cases occurred in male adults over 40 years of age. The stomach is the most frequent location of occurrence. Most tumors are of the high-risk group.