value of urine cytology in the diagnosis of bladder cancer Cytopathological correlation

To identify the value of urine cytology in the diagnosis of bladder cancer by comparing cytologic and histologic findings. This study was conducted from January to December 2012 at the Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. The laboratory database was retrospectively reviewed for all patients with a histopathological diagnosis of urothelial carcinoma [UC] between January 2007 and December 2011. Histopathological diagnosis was considered the gold standard, and urine cytology findings were correlated with the results of bladder biopsy. Biopsies with low- and high-grade lesions were considered positive. All data were analyzed using the Statistical Package for Social Sciences. We reviewed the results of 191 patients. Urine cytology results were positive for malignancy in 70 cases [36.6%] and negative in 19 [9.9%]. One hundred and two cases [53.4%] were considered suspicious for malignancy. Histopathological examination revealed that there were 82 cases [42.9%] of low-grade UC, and 64 cases [33.5%] of high-grade UC. Seven cases [3.7%] were positive for malignancies other than UC. For urine cytology, the overall sensitivity was 94.1%, and 26.3% specificity. The sensitivity of urine cytology for low-grade was 18.3%, and 51.3% for high-grade UC. The specificity for both grades was 26.3%. This study shows that sensitivity of urine cytology is higher in high-grade UC than in low-grade UC. The high sensitivity of urine cytology confirms that it is still a valuable tool in bladder cancer diagnosis

Histopathological pattern of ovarian neoplasms and their age distribution in the western region of Saudi Arabia

To identify the different histopathological types of ovarian neoplasms and their age distribution. This is a retrospective study were ovarian neoplasms received by the Pathology Department of King Abdulaziz University, Jeddah, Saudi Arabia between January 1995 and December 2010 were reviewed and their frequencies in different age groups were calculated. Out of 618 ovarian specimens studied, 382 [61.8%] were ovarian neoplasms while 38.2% were non-neoplastic functional cysts. Benign neoplasms [n=278; 72.8%] were more common than borderline [n=20; 5.2%] and malignant ones [n=84; 22%] in all age groups. Surface epithelial neoplasms were the most common [61%] followed by germ cell [28%], gender cord stromal [7.6%] and metastatic tumors [3.4%]. The most common benign neoplasm was serous cystadenoma [44.6%] and the most common malignant was serous cystadenocarcinoma [33.3%]. The most common ovarian neoplasm below the age of 20 years was surface epithelial tumors [n=24] followed by germ cell tumor [16 cases]. Benign neoplasms [n=213] were more common than malignant ones [n=42] in the age group from 20-51 years. Malignant ovarian neoplasms [35 out of the 71] were more common than benign [34 cases] in the age above 52. Benign ovarian neoplasms are more common than malignant ones. The most common benign ovarian neoplasm is serous cystadenoma and the commonest malignant neoplasm is serous cystadenocarcinoma. The prevalence of malignant ovarian neoplasms increases with increasing age

Histopathological pattern of endometrial sampling performed for abnormal uterine bleeding

Abnormal uterine bleeding is a challenging gynecological problem caused by various endometrial pathologies. The present study aims to identify the pattern of histopathological diagnoses encountered in women of various age groups presenting with abnormal uterine bleeding. A retrospective age specific comparative analysis. Department of Pathology. Two thousand two hundred ninety-five endometrial samples from women presenting with abnormal uterine bleeding from January 1995 to June 2008 were retrieved and analyzed. The commonest histopathological diagnosis was secretory endometrium 571 [24.9%], followed by proliferative endometrium 498 [21.7%], endometrial polyp 227 [9.9%], disordered proliferative endometrium 200 [8.7%], simple cystic hyperplasia 160 [7%], chronic endometritis 134 [5.8%], inactive endometrium 126 [5.5%], atrophic endometrium 70 [3.1%], uterine malignancies 41 [1.8%], complex hyperplasia without atypia 33 [1.4%] and finally complex hyperplasia with atypia 15 [0.7%]. Two hundred twenty [9.6%] revealed no endometrial tissue and were considered insufficient for diagnosis. Uterine malignancies and complex hyperplasia with atypia were more common in the age group of 52 years and older, 3.3% and 1.2% respectively. The present study revealed that secretory and proliferative endometrium are the most common endometrial histopathological patterns identified in endometrial samples obtained for abnormal uterine bleeding in our region

Histopathological pattern of thyroid lesions in western region of Saudi Arabia

Partial or complete thyroidectomies are frequently encountered by the practicing pathologist and the possibility of neoplastic disease is of major concern in patients with thyroid nodules. Pathological evaluation of those specimens ranged from non-neoplasticlesion to highly aggressive malignancy. This study aimed to document the frequency of different patterns of thyroid diseases as presented to pathology departments at King Abdul-Aziz University Hospital [KAUH] and King Faisal Specialty Hospital and Research centre [KFSHRC] within the last twelve years. All specimens presented to pathology departments at KAUH [1997-2008] and KFSHRC [2000-2008] as thyroidectomies [partial or complete] were retrospectively reviewed and categorized according to their histological appearance. The total number of the studied cases was 845 cases. The age of the patients ranged between 9 and 93 years. One hundred seventy eight were males and 667 were female [male to female ratio; 1:3.7]. The reviewed cases were classically categorized into two main groups; Non-neoplastic [494; 58.5%] and Neoplastic [351; 41.5%]. The non-neoplastic group includes: Multinodular Goiter [311 cases; 36.8%], hashimoto/chronic lymphocytic thyroiditis [64 cases; 7.6%], single hyperplastic nodule [51 cases; 6%], Grave's disease [8 cases; 0.9%], miscellaneous [58 cases; 6.9%]. The neoplastic group includes benign category represented by "Adenomas" and includes 94 cases [11% of all cases, and 26.8% of neoplastic cases] and the malignant category includes 256 cases, representing 30.3% of all studied cases and 73% of the neoplastic category. Two hundred and nine cases [81.6% of malignant] were papillary carcinoma. Thyroid lesions are more common in Saudi female. The majority of the thyroid nodules in Saudi are non-neoplastic. Papillary carcinoma is the commonest type of thyroid cancer in Saudi society. Thyroid neoplasm is rare in Saudi children

Massive ascites as the primary clinical presentation in a postmenopausal woman with malignant ovarian steroid cell tumor, NOS [18 month follow up]

Steroid cell tumors, not otherwise specified [NOS] are rare, usually benign, ovarian sex Cord stromal tumors of the ovary presenting with virulization in middle age women [Average age: 43]. Rarely, these tumors occur in postmenopausal women and, even More rarely, show a malignant clinical behavior. Although excess androgen secretion with Virulization is usually the primary presenting symptoms, rarely patients with this tumour may Present primarily with ascites. A case of a 65-year-old woman with malignant steroid cell Tumor who primarily presented with [sudden onset of] massive ascites is reported. Aspects of presentation, pathologic findings and management are presented

Non insulinoma pancreatogenous hypoglycemia syndrome in a Saudi male

Nesidioblastosis is focal or diffuse islet hyperplasia leading to hyperinsulinism with subsequent hypoglycemia in the absence of insulinoma, usually described in neonates and infancy. We described the first adult case of nesidioblastosis in Saudi Arabia and the Gulf region. The diagnosis and treatment of the condition can be very difficult and challenging. Despite the fact that our patient responded initially to surgical treatment, his hypoglycemic symptoms occasionally recurred and needed adjunctive medical treatment. Although initially thought to affect only infants and children, cases of nesidioblastosis can affect adults and pose a diagnostic and therapeutic challenge to the clinicians

Pattern of abnormal Pap smears in developing countries: a report from a large referral hospital in Saudi Arabia using the revised 2001 Bethesda system

Reports describing the frequency and pattern of abnormal Pap smears in developing countries using the revised Bethesda system for Pap smear are few. We studied the pattern of cervical intraepithelial le- sions and carcinoma detected in Pap smears of Saudi females in the western region of Saudi Arabia using the revised system. All cervical Pap smears reported in the Department of Pathology of King Abdulaziz Medical City, Jeddah, from 1 January 1998 to 31 August 2005 were reclassified according to the revised system with age ranges identified. Of 5590 sufficient smears, 261 [5%] were identified as abnormal and were further classified as atypical squamous cells of undetermined significance [ASC-US] [103 cases, 40%], atypical squamous cells of high grade [6 cases, 2%], low-grade squamous intraepithelial lesions [LSIL] [56 cases, 22%], high-grade squamous intraepithelial lesions [HSIL] [31 cases, 12%], glandular cell abnormalities [30 cases, 11%] and invasive squa-mous cell carcinoma [21 cases, 9%]. The ASC-US/SIL ratio was 1.9%. Invasive adenocarcinoma accounted for 14 cases [4%] with a similar age range as invasive squamous cell carcinoma. Although this study showed a lower incidence and a wider age range of cervical epithelial cell abnormalities than others published internationally, the results emphasize the need for a well-organized cervical screening program supplemented by larger national studies on the pattern of cervical abnormalities in this country. The information provided in this study will encourage use of the Pap smear as a screening method for cervical cancer in developing countries

Hysterectomy: a clinicopathologic correlation

To study the most common pathologies identified in hysterectomy specimens and to correlate the findings with the clinical indications. Department of Pathology, King A. Aziz Medical City, Jeddah. All hysterectomy specimens in the period between January 2000 and December 2003 were retrieved and studied for the following variables: the primary clinical indication, the pathological diagnosis, the mode of surgery [abdominal versus vaginal] and the patient age. The total number of hysterectomy specimens received was 179. The patient's age ranged between 23-90 years with an average age of 49 years old. The most common clinical indication for hysterectomy was present and previous malignancies 50 [27.9%] including cases of therapeutic and follow up hysterectomies for gynecologic malignancies followed by uterine leiomyoma 44 [24.5%]. Other clinical indications included dysfunctional uterine bleeding 29 [16.2%], uterine prolapse 15 [8.3%], endometrial polyps 10 [5.5%], adenomyosis 5 [2.7%] and endometrial hyperplasia 6 [3.3%]. Emergency hysterectomy for post partum hemorrhage and placenta accreta 15 [8.3%]. Abdominal hysterectomy was the preferred approach [85.4%] for cases other than uterovaginal prolapse. The vaginal route was used in 13.4% of cases and two cases underwent laparoscopic hysterectomy. The most common pathology identified was leiomyoma 62 [34%], followed by adenomyosis in 33 [18.4%] and endometrial polyp in 24 [13.4%]. Changes consistent with uterovaginal prolapse accounted for 15 [8.3%]. Other less frequent pathologies identified included disordered proliferative endometrium, endometritis and simple hyperplasia, which was present in 12 [6.75]. The pathologic examination confirmed the clinical diagnosis in all cases of leiomyomas, adenomyosis and endometrial polyps. This study confirms previous international published data that benign pathologies are more common in hysterectomy specimens than their malignant counterparts and that the most common pathology identified in hysterectomy specimens is leiomyoma. The clinical and pathological correlation is 100% in cases of leiomyoma, adenomyosis and endometrial polyps

Osteomalacic Myopathy due to celiac disease

Celiac disease is a gluten-sensitive enteropathy characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine. It is well known to be associated with a variety of neurological disorders including epilepsy, myopathy, neuropathy and ataxia. The nature of this association is unclear. Although osteomalacia secondary to vitamin D deficiency is a recognized complication of celiac disease, however, severe osteomalacic myopathy as the only presentation of celiac disease is extremely rare. We present 2 interesting cases of osteomalacic myopathy secondary to celiac disease, which were treated successfully with full recovery. An important and unique observation was the brisk reflexes noticed in both patients. The mechanism behind this phenomenon is not well understood. Work-up for celiac disease is warranted in any young patient that presents with myopathy