Clinicopathological profile of gastric cancers in Al-Madinah, Saudi Arabia.

OBJECTIVE: To characterise the clinicopathological features of gastric cancer. METHODS: This retrospective study was conducted at the histopathology laboratory of King Fahad Hospital, Madinah, Saudi Arabia, and comprised record of gastric cancer patients from January 2006 to September 2015. Data of all patients who had undergone gastrectomy was included. SPSS 19 was used for data analysis. RESULTS: Of the 63 patients, 42(66.7%) were males while 21(33.3%) were females. The overall mean age was 58.5±14.6years (range: 23-95 years). The mean age of males at diagnosis was greater than the mean ages of females (60.4 ± 15.1vs. 54.5 ± 13.6 years). Adenocarcinoma was the most common histologic type, occurring in 49(77.8%) patients. There were 30(47.6%) cases of intestinal subtype and 19(30.2%) cases of diffuse subtypes of adenocarcinoma. The mean age of patients with intestinal subtype was greater than those with diffuse type (60.2 ± 14.9 vs. 56.8±14.2 years). Younger patients mainly presented with poorly differentiated tumours as compared to elder patients. The most common site of gastric cancer was body 28(44.5%), followed by antrum 12(30.1%). . CONCLUSIONS: Gastric cancer was diagnosed in advanced stages and in young females. Younger patients were more frequently affected by poorly differentiated and diffuse adenocarcinoma.

Histopathological pattern of benign endoscopic gastric biopsies in Western Saudi Arabia: A review of 1236 cases.

OBJECTIVE: To determine the histopathological pattern of gastritis and benign gastric diseases in western Saudi Arabia. METHODS: TThis retrospective histopathology-based study was conducted in a tertiary care hospital in Madinah, Saudi Arabia, and comprised medical records of all patients who were diagnosed to have benign gastric diseases from January 2006 to December 2015.SPSS 19 was used for data analysis. RESULTS: Of the 1,236 patients, 669(54.1%) were males and 567(45.9%)were females. The overall mean age was 43±10.75 years (range: 10-100 years). Besides, 755(61.1%) patients were in the age group of 20-49 years. Gastritis was diagnosed in 1,105(89.4%) cases, 1,091(88.3%) of which were chronic. Benign polypi was found in 34(2.75%) cases and normal biopsies in 97(7.85%) cases. Helicobacter pylori organisms were detected in 402(32.5%) cases. Helicobacter pylori gastritis was active in 331(82.5%) cases, atrophic in 4(0.9%) and metaplastic in 11(2.7%) cases. The mean age of gastric polypi patients was 50.1±12.52 years (range: 16-90 years). Hyperplastic polypi was seen in 30(88.2%) cases. Fundic gland polypi were found in 4(11.8%) cases. CONCLUSIONS: Benign gastric diseases appeared to affect the younger individuals. Gastritis was more prevalent and benign polypi was less so.

Urinary bladder cancer in adults: a histopathological experience from Madinah, Saudi Arabia.

OBJECTIVE: To delineate the frequency and clinicopathological features of urinary bladder cancer. METHODS: This retrospective study was conducted at the King Fahd Hospital, Madinah, Saudi Arabia, and comprised medical records related to bladder tumours, from January 2006 to October 2015. Data was obtained from histopathologic reports and evaluated for age, gender, cystoscopic findings and histopathological characteristics at the time of presentation. RESULTS: Of the 116 cases, 96(82.7%) were of men while 20(17.3%) were of women. The mean age was 62.4±15.62 years (range: 20-115 years). Transitional cell carcinoma was the most common histological type, seen in 111(95.7%) cases, followed by adenocarcinoma 3(2.6%) and squamous cell carcinoma 2(1.7%). Of the transitional cell carcinoma cases, 78(70.5%) were superficial, while 33(29.5%) were muscle invasive. Most of the transitional cell carcinoma cases 72(65%) were of lower grade (grade I and II), while 39(35%) were of grade III. CONCLUSIONS: Our hospital-based pathology experience of urinary bladder cancer was comparable with earlier studies.

Metaplastic squamous cell carcinoma of breast. A pathology case report with review of literature.

Metaplastic Breast Carcinoma (MBC) is a group of rare breast cancers; squamous cell carcinoma (SCC) is its most common member. Due to rarity of the condition, frequent case reports have been published of late. In the last one year alone, there were about a dozen such reports. Here we report a case of primary squamous cell carcinomain a 62-year-old female, with a 3.5cm mass in the left breast. Biopsy and mastectomy reports confirmed Metaplastic carcinoma, with 21 benign lymph nodes.. The tumour was triple negative and cytokeratin 5/6 positive. We are reporting the first case of squamous cell carcinoma of breast from our region, and we recommended large multi centre studies.

Histopathological patterns of thyroid disease in Al-Madinah region of Saudi Arabia.

OBJECTIVES: This study aimed to characterize the histopathological pattern of thyroid lesions among Saudi patients and to highlight the age and gender variations of these lesions as base line data. MATERIALS AND METHODS: We retrospectively analyzed the data from thyroid specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. RESULTS: The 292 thyroidectomy specimens received during the study period came from 230 (78.8%) females and 62 (21.2%) males giving a female: male ratio of 3.7:1. Age of the patients ranged from 14 to 95 years with a mean age 39.7 years. Two hundred and eleven (72.3%) cases were found to be non-neoplastic and 81 (27.7%) cases were neoplastic. The non-neoplastic group included: colloid goiter, including both diffuse and nodular goiter (170 cases; 58.2%), nodular hyperplasia (28 cases; 9.6%), Hashimoto/chronic lymphocytic thyroiditis (12 cases; 4.1%), and Grave's disease (1 case; 0.3%). In neoplastic lesions, there were 7 benign tumors and 74 malignant tumors. Among the benign tumors, 5 were follicular adenomas and 2 were Hurthle cell adenomas. Papillary carcinoma was the commonest malignant tumor accounting for 87.8% of all thyroid malignancies, followed by lymphoma, follicular carcinoma and medullary carcinoma. The size of papillary carcinoma was more than 2 cm in 40 cases (76.9%). CONCLUSIONS: Non-neoplastic thyroid lesions were more common than neoplastic ones. Colloid goiter was the most common lesion. Follicular adenoma was the commonest benign tumor and papillary carcinoma was the commonest malignant lesion. There appears to be a slightly increased trend of papillary carcinoma diagnosis, most being diagnosed at an advanced stage.

Pattern of lymph node pathology in western Saudi Arabia.

BACKGROUND: This study aimed to characterize the histopathological pattern of lymph node pathology among Saudi patients and to highlight the age and gender variations of these lesions as base line data. MATERIALS AND METHODS: We retrospectively analyzed the data from lymph node biopsy specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. RESULTS: Of the 289 lymph node biopsy specimens received, 154 (53.3%) were from males and 135 (46.7%) from females giving a male: female ratio of 1.14:1. Age of the patients ranged from 2.5 to 96 years with a mean age 33.9 years. The commonest lymph node group affected was the cervical (30.4%) followed by axillary (9.7%) and inguinal (8.7%). Malignant lymphoma [71 Hodgkin's disease (HD), 57 non Hodgkin's lymphoma (NHL)] 128 (44.3%), reactive hyperplasia 68 (23.5%), and tuberculosis 41 (14.2%) were the common causes of lymph node enlargement. While HD, reactive hyperplasia and tuberculosis were commonest in young adult patients (10-29 years old) and rare above the age of 50 years; NHL was the predominant cause of lymph node enlargement above 50 years. CONCLUSIONS: Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Among the biopsied nodes, lymphomas were the most common (44.3%) followed by non-specific reactive hyperplasia (23.5%) and tuberculous lymphadenitis (14.2%).

Histopathological features of colorectal cancer in Al-Madinah region of Saudi Arabia: 8 years experience.

BACKGROUND: To determine the histopathological pattern of colorectal cancer (CRC) among Saudi patients with a view to determine various epidemiological and histopathological features of the disease. MATERIALS AND METHODS: We retrospectively collected and analyzed the demographic and histopathological data of all the patients with CRC diagnosed at King Fahad Hospital, Madinah, Saudi Arabia over a period of 8 years from January 2006 to December 2013. RESULTS: Of 324 cases of CRC reviewed, 200 cases (61.7%) were males while 124 cases (38.3%) were females giving a male to female ratio of 1.6: 1. Age of the patients ranged from 20 to 100 years with a mean age 57.9 years. The rectosigmoid region was the most frequent anatomical site (13.6%) involved and adenocarcinoma (88.6%) was the most common histopathological type. The majority of adenocarcinomas (87.3%) were moderately differentiated. A total of 47.8% of patients were in stage B and 43.5% of patients were in stage C of the Aster-Coller classification. Most patients (75.7%) presented with large size tumors. Lymphovascular invasion and lymph node metastasis were recorded in 67.9% and 43.6% of cases, respectively. CONCLUSIONS: Colorectal cancer is common in our environment and the majority of patients present late with an advanced stage. Screening programs regarding CRC should be enhanced to improve the outcome of the patients.

Chronic gastritis and Helicobacter pylori: a histopathological study of gastric mucosal biopsies.

The aim of this study was to observe the histological features of chronic gastritis and associated effects due to Helicobacter pylori infection in 176 randomly selected antral biopsy specimens of chronic gastritis cases. The specimens were reviewed for the presence or absence of H.pylori. The activity (neutrophilic infiltration) of gastritis and the presence or absence of mucosa-associated lymphoid tissue (MALT) were also noted. Chi-square test (Pearson value) was used to analyze categorical variables. H.pylori was detected in 110 (62.5%) cases of chronic gastritis. There was a significant association between H.pylori infection and activity of chronic gastritis (p=0.002). Lymphoid aggregates were significantly more frequently noted in H.pylori-positive patients (68.2%) vs. H.pylori negative group (47%), (p=0.005). It is concluded that H.pylori is significantly associated with active chronic gastritis and with formation of mucosa-associated lymphoid tissue (MALT), which may develop into gastric lymphoma (MALT type).

Incidence of cancer esophagus in Quetta and Karachi, Pakistan.

OBJECTIVE: To study the differences in the incidence of cancer esophagus in Karachi and Quetta, Pakistan. METHODS: Incident cases of cancer esophagus registered from January 1, 1995 to December 31, 2000 were included for Karachi South, and those registered from January 1, 1998 to December 31, 2000 were included for Karachi Division and Quetta. RESULTS: In Quetta, cancer esophagus had age-standardized incidence rate (ASIR) of 25.5/100,000 population in males and 23.4/100,000 population in females, and it was the commonest malignancy in both genders. In comparison, in Karachi South and Karachi Division, cancer esophagus ranked 7th among cancers in males (ASIR 6.2/100,000 and 5.0/100,000 population, respectively) and 5th in females (7.0/100,000 and 4.9/100,000 population, respectively). The ASIR was similar among males and females in all data sets. CONCLUSION: The incidence of cancer esophagus in Quetta is comparable to that in high-incidence regions, whereas the incidence in Karachi is similar to that in moderate-incidence zones. In contrast to other world regions, cancer esophagus was equally common in males and females in Pakistan. The high risk in Quetta warrants investigation for risk factors and a targeted cancer control program.

Cancer of the oral cavity and pharynx in Karachi--identification of potential risk factors.

The objective of the study was to provide an overview of the demographics of cancer of the oral cavity and pharynx in Karachi South (1995-2001), and identify potential risk factors. Cases recorded for Karachi South, at Karachi Cancer Registry during 1(st) January 1995 to 31(st) December 2002 were analysed. For maximum completion of data cancer cases, recorded from 1(st) January 1995 to 31(st) December 2001 were included for final analysis. The age standardized incidence rates per 100000 population (ASIRs) for cancer of the oral cavity (excluding salivary gland) in Karachi South were 17.1 and 16.5 in males and females whereas the ASIRs for cancer of the pharynx (excluding nasopharynx) were 7.1 and 2.4 in males and females, respectively. The oral pharyngeal ratios were 2.4 and 6.9 for males and females and gender ratios (M F) were 1.04 for the oral cavity and 3.0 for the pharynx. The mean ages were 51 years (95% CI 49.6; 52.2) and 56.1 years (95% CI 54.4; 57.8) respectively. Cancer of the oral cavity ranked 2(nd) in Karachi in both genders. Cancer of the pharynx ranked 7(th) in males and 14(th) in females. Approximately 97% of the oral cavity and pharyngeal cancers were histologically confirmed. The majority of the oral (47.1%) and pharyngeal (51.9%) cancer cases presented as grade II lesions, and were discovered at advanced stages. Of the cancers reported during 1995-2001, 60.4% of the oral and 78.1% of the pharyngeal lesions had spread to a distant site at the time of diagnosis. Squamous cell carcinoma comprised 96.5% and 91.8% of the totals. The incidences of these cancers are comparable to the highest risk regions of the world. As distinct from other geographical areas oral cancer is as common in females as in males, which may reflect the pattern of exposure to known risk factors such as betal quid, arecanut and tobacco and the absence of alcohol as a risk factor in both genders. Apergillus contamination of arecanut could also be a risk factor but no confirmation studies or quantification is available. Despite the common risk factors, incidence of pharyngeal cancer is three times higher in men as compared with women. The keys to reducing the incidence and mortality due to oral and pharyngeal cancers are prevention and control, emphasizing cessation of tobacco use and cancer screening. However a targeted cancer and tobacco control program does not presently exist in Pakistan.

Large-scale pathology-based cancer data--a reflection of population-based cancer data.

Pathology-based cancer data is a high quality reflection of the patterns of cancer in the population it represents, provided the demographic details of the patients are carefully recorded. Relative frequency data is neither a replacement for population-based data nor a suggested alternative; it simply enhances the quality of population data and in very large data sets reflects the cancer patterns observed in the representative populations. Aware of the standard shortfalls of pathology-based data, the department of pathology, The Aga Khan University Hospital (AKUH) standardized its data, representing 53.4% of the cancer data of Karachi Division (Pakistan) and also reflecting the cancer pattern of other provinces of Pakistan. This data was compared with 4 different population and institutional-based data sets. The findings substantiate the observation that despite the problems of interpretation of data from pathology laboratories, they are an invaluable source of information on cancer patterns in much of the world where incidence data are unavailable . If developing countries, unable to organize National Population- Based Registry should as an alternate develop National Pathology-based Registers a well targeted and monitored, a Cancer Control Program would be possible. A good quality, large-scale pathology data with demographic details of the patient recorded can also be extended to give coverage to the population.

Comparative analysis of viral titers and histologic features of Pakistani patients infected with hepatitis C virus type 3.

BACKGROUND: Serum hepatitis C virus (HCV) RNA levels and genotypes are considered to be important determinants of the response to interferon treatment. Generally, patterns of viral loads have been reported for HCV type 1 infections and categorized as low- or high-level viremia. We studied the distribution of HCV RNA levels in patients predominantly infected with HCV type 3 and correlated it with hepatic damage. METHODS: Serum HCV RNA levels and HCV serotypes were determined in 245 anti-HCV-positive patients representing all the major ethnic groups of Pakistan. Patients were grouped according to their HCV RNA levels as: level I (up to 50th percentile); level II (50th to 75th percentile); and level III (>75th percentile). RESULTS: Sixty-one patients (25%) had high-level viremia (level III) of 13.9 mega equivalent per milliliter (MEq/mL) or greater. These were more likely to be males (48 versus 13, P<0.05). A higher viral load correlated with advanced levels of fatty changes in liver. HCV type 3 was found in 68% of the samples, and type 1 in 14%; the rest were undefined. Mean HCV RNA levels were lower in patients infected with HCV type 3 than in patients infected with HCV type 1 (8.63 MEq/mL versus 37 MEq/mL; P<0.001). CONCLUSIONS: Most patients with HCV type 3 infection had viremia that was significantly lower than that in HCV type 1-infected patients. This may be the reason for the better response to treatment usually seen in such cases. The severity of histologic changes was not associated with HCV type 3 viremia levels.