Primary pancreatic lymphoma: Histopathological pattern of 8 cases.

OBJECTIVES: To report the histopathological pattern of primary pancreatic lymphoma (PPL) in 2 tertiary hospitals. METHODS: The pathology slides and reports of all the cases diagnosed in pathology departments in 2 referral hospitals were reviewed. An additional immunohistochemistry study was done to reclassify lymphomas according to the current system. RESULTS: Eight patients with PPL have been identified. The ages ranged from 36 to 71 years. Clinical presentation includes abdominal pain, weight loss, jaundice, abdominal mass, nausea, and vomiting. Pathological evaluation revealed 5 diffuse large B-cell lymphomas, one high-grade B-cell lymphoma, one MALT lymphoma, and one follicular lymphoma. CONCLUSION: Primary pancreatic lymphoma is a very rare tumor without specific clinical, laboratory tests, or radiological findings. Abdominal pain is the most common clinical presentation. Diffuse large b-cell lymphoma is the most common pathological subtype. Primary pancreatic lymphoma should be taken into consideration when evaluating pancreatic mass to avoid unnecessary surgical resection.

Primary lymphoma of the kidney: Pathology experience from 2 tertiary hospitals in Western Saudi Arabia.

OBJECTIVES: To document the clinicopathological features of primary renal lymphoma (PRL) at 2 tertiary hospitals in the western region of the Kingdom of Saudi Arabia. METHODS: Data were retrieved from all PRLs that were diagnosed at King Abdulaziz University Hospital and King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia, between January 2002 and April 2022. Histopathological and immunohistochemical slides were reviewed, and additional immunohistochemistry stains were carried out in selected cases. Follow-up data were also collected. RESULTS: There were 17 identified cases of PRL. The age of the patients ranged from 4-76 years (median: 50.5 years and mean: 46.8 years), 11 (64.7%) were males, and 6 (35.3%) were females. There were 12 cases of diffuse large B-cell lymphoma, 3 cases of Burkitt's lymphoma, and 2 cases of post-transplant lymphoproliferative disorder. The median follow-up duration was 22 months. The one-year overall survival rate was 71% and the 2-year overall survival rate was 43% during follow-up. CONCLUSION: Primary renal lymphomas in Saudi patients are more common in males and seen in a relatively younger age group compared to the available worldwide data. The diagnosis of PRL is important to avoid tumor dissemination and unnecessary nephrectomy. Diffuse large B-cell lymphoma is the most common pathological type and non-germinal center B-cell is the most common subtype.

Genotype-Phenotype Correlation of a Rare Transthyretin Variant Causing Amyloidosis.

Left ventricular hypertrophy is a common entity with a broad differential diagnosis. We present a case of a middle-aged woman with left ventricular hypertrophy and neuropathy caused by a rare transthyretin variant in the absence of a family history or regional reports of hereditary transthyretin amyloidosis. This report outlines the diagnosis and management of patients with a mixed phenotype of hereditary transthyretin amyloidosis and enriches clinical data supporting the pathogenicity of a rare variant of transthyretin.

L'hypertrophie ventriculaire gauche est une entité clinique fréquente pour laquelle le diagnostic différentiel est vaste. Nous décrivons le cas d'une femme d'âge moyen présentant une hypertrophie ventriculaire gauche et une neuropathie, causées par un variant rare de la transthyrétine en l'absence d'antécédents familiaux ou de cas régionaux déclarés d'amylose héréditaire à transthyrétine. Le présent article décrit le diagnostic et la prise en charge des patients qui présentent un phénotype mixte d'amylose héréditaire à transthyrétine, et il alimente le bassin de données cliniques sur la pathogénicité d'un variant rare de la transthyrétine.

Rosai-Dorfman disease: A pathological experience from 2 tertiary care hospitals in Western Saudi Arabia.

OBJECTIVES: To document the clinicopathological features of Rosai-Dorfman disease (RDD) at 2 tertiary hospitals in the western region of Saudi Arabia. METHODS: We retrieved all cases diagnosed as RDD at King Abdulaziz University Hospital and King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, diagnosed between January 2001 until June 2021. RESULTS: A total of 13 new RDD cases were reported, including 7 nodal and 6 extranodal type. The extranodal sites included larynx, optic chiasm, dura and brain, lumbar vertebrae, and left arm soft tissue.There were 6 males and 7 females. Ages averaged 34 years and ranged from 4-56 years. A total of 2 cases were associated with Hodgkin's lymphoma, and 2 cases have been initially misdiagnosed as other entities. All patients were treated with surgical excision, and steroid was added in 3 cases. Over 2-60 months of follow-up, recurrence occurred in 2 cases. CONCLUSION: Awareness of this entity is important for pathologists to avoid misdiagnosis. While the optimal treatment remains controversial, surgical resection is generally curative. The prognosis is good with rare recurrence. Multicenteer prospective studies are probably the best to evaluate treatment options and improve outcomes.

Overexpression of SIRT1 in urothelial carcinoma of the urinary bladder is associated with local recurrence and poor survival.

OBJECTIVES: To investigate the relationship of Silent mating type information regulation 2 homolog-1 (SIRT1) immunostaining to urothelial carcinoma of the urinary bladder (UCB) clinicopathological parameters. METHODS: The study includes a total of 147 specimens composed of 122 urothelial carcinoma and 25 of non-neoplastic normal mucosae. The clinical information and the corresponding paraffin blocks of the cases were collected from the Pathology Department at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. Tissue microarrays were prepared and unstained slides were cut from the recipient blocks. Immunohistochemistry study was performed using anti-human SIRT1 antibody. The study was conducted from July 2016 until May 2018. RESULTS: In UCB, high SIRT1 immunostaining (59.8%) was greater than low SIRT1 immunostaining (40.2%). High SIRT1 immunostaining was associated with local disease recurrence (p=0.017). However, there was no relation with other clinicopathological parameters. Regression analysis demonstrated that SIRT1 overexpression is an independent predictor of local disease recurrence (p=0.002). High SIRT1 immunostaining was associated with lower overall survival (log rank [Mantel-Cox]=6.478, and p=0.011) and disease-free survival (log rank [Mantel-Cox])=4.281, and p=0.039). CONCLUSION: The results revealed that SIRT1 is an important prognostic factor for UBC patients and is a potential target for therapeutic intervention. Further immunohistochemical and molecular evaluations are required to explore the mechanism of action of SIRT1 and to investigate molecular downstream of this potential biomarker in UCB.

Invasive aspergillus sinusitis with orbitocranial extension.

CONTEXT: Invasive sinonasal aspergillosis is a silently progressive disease that, left untreated, may invade the adjacent intracranial and intra-orbital compartments incurring serious morbidity. AIM: To evaluate our results of a collaborative surgical management plans for patients with invasive sinonasal aspergillosis with orbitocranial extension. SETTING AND DESIGN: Retrospective study. MATERIALS AND METHODS: Between the years 2000 and 2012, 12 patients with Aspergillus sinusitis with orbitocranial extension were treated at our institution. Preoperative CT and MRI scans were done in all cases and cerebral angiography in two patients with subarachnoid hemorrhage (SAH). Surgical combined transcranial and endonasal approaches to the skull base were considered in all patients. Adjuvant antifungals were administered postoperatively with regular clinical and radiologic follow up. RESULTS: All cases had a long history of headache and nasal obstruction (n = 12). Five presented with unilateral proptosis, one with meningitis, one with epilepsy, two with SAH, and one patient presented with trigeminal neuralgia. Craniotomy alone was chosen for the patients with isolated sphenoiditis (n = 2) while a combined cranial and endonasal approach was elected for the other patients (n = 10). Adjuvant antifungal therapy was used for 3-12 months. Patients were followed up clinically and radiologically for an average 36-month period (range = 12-50 months) with disease eradication achieved in eight patients (67%). Two died as consequence to SAH. Follow up also showed that three patients (25%) had sinunasal recurrence requiring evacuation through an endonasal approach. CONCLUSIONS: Surgical intervention, with adjuvant antifungal therapy, aiming for safe total removal of the fungal burden, whenever feasible, has a major role in the management of invasive sinonasal aspergillosis with orbitocranial extension with minimal morbidity and good outcomes.

Infrequent Immunohistochemical Expression of Napsin A in Endometrial Carcinomas.

INTRODUCTION: Many studies described napsin A as a specific diagnostic marker that aids in differentiating lung adenocarcinomas from other respiratory tumors. This study describes the expression phenotype of napsin A in endometrial neoplasms, it investigates the relationship between this expression profile and the clinicopathologic parameters, and assess its utilization as an independent predictive marker. METHODS: A total of 76 cases of previously diagnosed endometrial carcinoma (including 53 endometrioid adenocarcinomas, 6 endometrioid adenocarcinomas with squamous differentiation, 9 serous adenocarcinomas, 6 clear cell adenocarcinomas, and 2 malignant mixed mullerian tumors) and 30 tissue samples of noncancerous endometrium (including 16 proliferative endometriums, 10 secretory endometriums and 4 endometrial polyps) were retrieved from the archives of Pathology Department at King Abdulaziz University, Jeddah, Saudi Arabia. For napsin A detection, tissue microarrays and immunostaining were used. RESULTS: A total number of 12 (15.78%) cases were positive for napsin A immunostaining. Brown granular cytoplasmic expression of napsin A was detected in 9.4% of endometrioid adenocarcinomas, 16.7% of endometrioid adenocarcinomas with squamous differentiation, 22.2% of papillary serous endometrial carcinomas, and 66.7% of clear cell carcinomas. Three (10%) control cases showed similar granular cytoplasmic expression. Positive napsin A immunostaining was more frequent in clear cell carcinoma, and there is a significant association between positive napsin A immunostaining and clear cell carcinoma (P-value=0.007). Significant associations have been found also between napsin A expression and older ages (above 60 y) and higher stage (IVB), the P-values of which were 0.035 and 0.043, respectively, but not with the tumor recurrence or survival rate. CONCLUSIONS: Although napsin A is infrequently expressed in endometrial carcinomas, positive results of napsin A immunostaining in endometrial neoplasms might support the diagnosis of clear cell carcinoma when the pathologic differential diagnosis includes other histologic subtypes.

Cyclin D1 as a therapeutic target of renal cell carcinoma- a combined transcriptomics, tissue microarray and molecular docking study from the Kingdom of Saudi Arabia.

BACKGROUND: Renal cell carcinoma (RCC) is a seventh ranked malignancy with poor prognosis. RCC is lethal at metastatic stage as it does not respond to conventional systemic treatments, and there is an urgent need to find out promising novel biomarkers for effective treatment. The goal of this study was to evaluate the biomarkers that can be potential therapeutic target and predict effective inhibitors to treat the metastatic stage of RCC. METHODS: We conducted transcriptomic profiling to identify differentially expressed genes associated with RCC. Molecular pathway analysis was done to identify the canonical pathways and their role in RCC. Tissue microarrays (TMA) based immunohistochemical stains were used to validate the protein expression of cyclinD1 (CCND1) and were scored semi-quantitatively from 0 to 3+ on the basis of absence or presence of staining intensity in the tumor cell. Statistical analysis determined the association of CCND1 expression with RCC. Molecular docking analyses were performed to check the potential of two natural inhibitors, rutin and curcumin to bind CCND1. RESULTS: We detected 1490 significantly expressed genes (1034, upregulated and 456, downregulated) in RCC using cutoff fold change 2 and p value < 0.05. Hes-related family bHLH transcription factor with YRPW motif 1 (HEY1), neuropilin 2 (NRP2), lymphoid enhancer-binding factor 1 (LEF1), and histone cluster 1 H3h (HIST1H3H) were most upregulated while aldolase B, fructose-bisphosphate (ALDOB), solute carrier family 12 (SLC12A1), calbindin 1 (CALB1) were the most down regulated genes in our dataset. Functional analysis revealed Wnt/ß-catenin signaling as the significantly activated canonical pathway (z score = 2.53) involving cyclin D1 (CCND1). CCND1 was overexpressed in transcriptomic studies (FC = 2.26, p value = 0.0047) and TMA results also showed the positive expression of CCND1 in 53 % (73/139) of RCC cases. The ligands - rutin and curcumin bounded with CCND1 with good affinity. CONCLUSION: CCND1 was one of the important upregulated gene identified in microarray and validated by TMA. Docking study showed that CCND1 may act as a potential therapeutic target and its inhibition could focus on the migratory, invasive, and metastatic potential of RCC. Further in vivo and in vitro molecular studies are needed to investigate the therapeutic target potential of CCND1 for RCC treatment.

Primary intracranial lymphomas.

BACKGROUND: Primary CNS lymphoma (PCNSL), a rare form of aggressive extranodal non-Hodgkin's lymphoma (NHL), has increased in incidence during the last three decades and occurs in both immune compromised and immune competent hosts. It has an overall poor prognosis. OBJECTIVE: This study attempts to further delineate the clinico-pathological, immunohistochemical and radiological profile of PCNSL at Jeddah to King Faisal Hospital and Research Center. METHODS: Computerized search through the archives of King Faisal Hospital and Research Centre between July 2000- December 2012 identified 15 patients with pathologically confirmed PCNSL. These were analyzed retrospectively. Their clinico-pathological, immunohistochemical and radiological data were analyzed. RESULTS: Of the 15 PCNSL patients, 8 (53.3%) were females and 7 (46.6%) were males. There was female predilection especially in the age group of 40-59 years. Mean age at diagnosis for all patients was 50.4 years. There was no patient in the pediatric age group. The most common location in the brain was the frontal region in 7 patients (46.6%), 7 (46.6%) had multiple intracranial masses; all 15 (100%) were Non Hodgkin B-cell lymphomas, among which 13 (86.6%) were diffuse large B-cell lymphomas. All 15 (100%) cases showed diffuse and strong positivity for CD 45, and CD 20. Fourteen patients were immune competent while one was immune compromised. CONCLUSIONS: PCNSL often occurs in middle-aged and aged patients. There is female predilection especially in the middle age. Frontal region is the most common location with diffuse large B-cell lymphoma being the predominant subtype.

Molecular interaction of a kinase inhibitor midostaurin with anticancer drug targets, S100A8 and EGFR: transcriptional profiling and molecular docking study for kidney cancer therapeutics.

The S100A8 and epidermal growth factor receptor (EGFR) proteins are proto-oncogenes that are strongly expressed in a number of cancer types. EGFR promotes cellular proliferation, differentiation, migration and survival by activating molecular pathways. Involvement of proinflammatory S100A8 in tumor cell differentiation and progression is largely unclear and not studied in kidney cancer (KC). S100A8 and EGFR are potential therapeutic biomarkers and anticancer drug targets for KC. In this study, we explored molecular mechanisms of interaction profiles of both molecules with potential anticancer drugs. We undertook transcriptional profiling in Saudi KCs using Affymetrix HuGene 1.0 ST arrays. We identified 1478 significantly expressed genes, including S100A8 and EGFR overexpression, using cut-off p value <0.05 and fold change ≥2. Additionally, we compared and confirmed our findings with expression data available at NCBI's GEO database. A significant number of genes associated with cancer showed involvement in cell cycle progression, DNA repair, tumor morphology, tissue development, and cell survival. Atherosclerosis signaling, leukocyte extravasation signaling, notch signaling, and IL-12 signaling were the most significantly disrupted signaling pathways. The present study provides an initial transcriptional profiling of Saudi KC patients. Our analysis suggests distinct transcriptomic signatures and pathways underlying molecular mechanisms of KC progression. Molecular docking analysis revealed that the kinase inhibitor "midostaurin" has amongst the selected drug targets, the best ligand properties to S100A8 and EGFR, with the implication that its binding inhibits downstream signaling in KC. This is the first structure-based docking study for the selected protein targets and anticancer drug, and the results indicate S100A8 and EGFR as attractive anticancer targets and midostaurin with effective drug properties for therapeutic intervention in KC.

Impact of S100A8 expression on kidney cancer progression and molecular docking studies for kidney cancer therapeutics.

BACKGROUND/AIM: The proinflammatory protein S100A8, which is expressed in myeloid cells under physiological conditions, is strongly expressed in human cancer tissues. Its role in tumor cell differentiation and tumor progression is largely unclear and virtually unstudied in kidney cancer. In the present study, we investigated whether S100A8 could be a potential anticancer drug target and therapeutic biomarker for kidney cancer, and the underlying molecular mechanisms by exploiting its interaction profile with drugs. MATERIALS AND METHODS: Microarray-based transcriptomics experiments using Affymetrix HuGene 1.0 ST arrays were applied to renal cell carcinoma specimens from Saudi patients for identification of significant genes associated with kidney cancer. In addition, we retrieved selected expression data from the National Center for Biotechnology Information Gene Expression Omnibus database for comparative analysis and confirmation of S100A8 expression. Ingenuity Pathway Analysis (IPA) was used to elucidate significant molecular networks and pathways associated with kidney cancer. The probable polar and non-polar interactions of possible S100A8 inhibitors (aspirin, celecoxib, dexamethasone and diclofenac) were examined by performing molecular docking and binding free energy calculations. Detailed analysis of bound structures and their binding free energies was carried out for S100A8, its known partner (S100A9), and S100A8-S100A9 complex (calprotectin). RESULTS: In our microarray experiments, we identified 1,335 significantly differentially expressed genes, including S100A8, in kidney cancer using a cut-off of p<0.05 and fold-change of 2. Functional analysis of kidney cancer-associated genes showed overexpression of genes involved in cell-cycle progression, DNA repair, cell death, tumor morphology and tissue development. Pathway analysis showed significant disruption of pathways of atherosclerosis signaling, liver X receptor/retinoid X receptor (LXR/RXR) activation, notch signaling, and interleukin-12 (IL-12) signaling. We identified S100A8 as a prospective biomarker for kidney cancer and in silico analysis showed that aspirin, celecoxib, dexamethasone and diclofenac binds to S100A8 and may inhibit downstream signaling in kidney cancer. CONCLUSION: The present study provides an initial overview of differentially expressed genes in kidney cancer of Saudi Arabian patients using whole-transcript, high-density expression arrays. Our analysis suggests distinct transcriptomic signatures, with significantly high levels of S100A8, and underlying molecular mechanisms contributing to kidney cancer progression. Our docking-based findings shed insight into S100A8 protein as an attractive anticancer target for therapeutic intervention in kidney cancer. To our knowledge, this is the first structure-based docking study for the selected protein targets using the chosen ligands.

Metastatic breast neuroendocrine tumor from the rectum.

Metastatic breast neuroendocrine tumor is an exceedingly rare entity. They are commonly initially misdiagnosed as primary breast carcinoma. Correct diagnosis of this tumor is crucial owing to the different clinical management from primary breast tumor. We report an additional case of metastatic breast neuroendocrine tumor from the rectum that behaved in an aggressive fashion and failed to respond to chemotherapy treatment.

The importance of second opinion in surgical pathology referral material of lymphoma.

OBJECTIVE: To evaluate the importance of inter-institutional second opinion surgical pathology review of lymphoma, and identify the lymphoma pathologic mimics. METHODS: The surgical pathology material of patients referred to 2 tertiary care hospitals in the western region of Saudi Arabia (King Faisal Specialist Hospital and Research Centre and King Abdulaziz University Hospital, Jeddah, Saudi Arabia), for evaluation or therapy for lymphoma over a 10-year period (August 2001 to August 2011), were reviewed. This study included only cases in which the patient referred with a diagnosis previously made at the primary institution. RESULTS: Of 560 cases, the second opinion diagnosis differed significantly from the initial diagnosis in 39 cases (7%). These include changing the diagnoses from lymphoma to non-lymphoma lesions, change the type of lymphoma with major clinical impact, and change from reactive/non-diagnostic to lymphoma. CONCLUSION: Second opinion surgical pathology for lymphomas can result in major therapeutic and prognostic modifications. Thus, review of the original histologic material is recommended prior to a major therapeutic decision, and to maximize the discovery of clinically relevant major disagreements. Stringent adherence to institution's second opinion policy is an important quality assurance measure in surgical pathology.

Ewing`s sarcoma family tumors in the western region of Saudi Arabia. A pathological experience from 2 tertiary medical centers.

OBJECTIVE: To review the pattern of Ewing`s sarcoma/primitive neuroectodermal tumor (ES/PNET) in 2 medical centers in the western region of Saudi Arabia. METHODS: We retrospectively analyzed the pathological data of patients diagnosed with ES/PNET in 2 tertiary medical centers in the western region of Saudi Arabia (King Abdulaziz University Hospital, [March 1995 to November 2011], and King Faisal Specialized Hospital [April 2003 to 12 December 2010]). Age, gender, and site of tumors were analyzed. RESULTS: Sixty-nine cases were diagnosed as ES/PNET. The age range was 3-62 years (mean 22 years). Male cases were more than the female. Approximately 28.9% of cases presented within the skeleton, and 71.1% cases were presented as a soft tissue disease. Bone affection was higher in the iliac bone. Long bones were affected at a lower frequency. Soft tissue affection showed a higher incidence in the head and neck region followed by the lower limb. CONCLUSION: The current study represents a review of a large number of Ewing`s sarcoma family of tumors in western Saudi Arabia. Cases showed clinicopathological features comparable to those reported from other locations worldwide apart from relatively higher soft tissue affection than skeletal affection and a higher incidence of head and neck involvement by soft tissue ES/PNET. Further, multicenter studies (epidemiological and genetic) are recommended to obtain profiling of the disease and effect on outcome and therapy.

Anti-inflammatory and antiproliferative activities of date palm pollen (Phoenix dactylifera) on experimentally-induced atypical prostatic hyperplasia in rats.

BACKGROUND: Atypical prostatic hyperplasia (APH) is a pseudoneoplastic lesion that can mimic prostate adenocarcinoma because of its cytologic and architectural features. Suspension of date palm pollen (DPP) is an herbal mixture that is widely used in folk medicine for male infertility. The aim of the present study was to evaluate the effect of DPP suspension and extract on APH-induced rats. METHODS: APH was induced in adult castrated Wistar rats by both s.c. injection of testosterone (0.5 mg/rat/day) and smearing citral on shaved skin once every 3 days for 30 days. Saw palmetto (100mg/kg), DPP suspension (250, 500 and 1000 mg/kg), and lyophilized DPP extract (150,300 and 600 mg/kg) were given orally daily for 30 days. All medications were started 7 days after castration and along with testosterone and citral. RESULTS: The histopathological feature in APH-induced prostate rats showed evidence of hyperplasia and inflammation. Immunohistochemical examination revealed that the expressions of IL-6, IL-8, TNF-α, IGF-1 and clusterin were increased, while the expression of TGF-ß1 was decreased that correlates with presence of inflammation. Moreover, histopathological examination revealed increased cellular proliferation and reduced apoptosis in ventral prostate. Both saw palmetto and DPP treatment has ameliorated these histopathological and immunohistochemical changes in APH-induced rats. These improvements were not associated with reduction in the prostatic weight that may be attributed to the persistence of edema. CONCLUSION: DPP may have a potential protective effect in APH-induced Wistar rats through modulation of cytokine expression and/or upregulation of their autocrine/paracrine receptors.

Kikuchi-Fujimoto disease. Histiocytic necrotizing lymphadenitis.

Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a self-limited disease of complex and unclear etiology. Clinically and microscopically, it may mimic malignant lymphoma and other non-malignant diseases. Recognition of this entity is crucial, as mistaking this disease as lymphoma has major clinical consequences. Although KFD is a well-recognized entity in the literature, many clinicians and pathologists are still unaware of its existence. In this article, a review of KFD is provided with special emphasis on the pathogenesis and pathological differential diagnosis of this disease.

Castleman's disease. Update on pathogenesis.

Castleman's disease (CD) is an unusual lymphoproliferative disorder that may mimic lymphoma clinically and pathologically. It is classified clinically as localized and multicentric types, and pathologically as hyaline vascular and plasma cell types. It is associated with increased risk of lymphoma and follicular dendritic cell tumors. The pathogenesis of CD is still controversial and complex. Active research is ongoing to highlight more on the etiopathogenesis of this entity. The aim of this article is to review the literature on pathogenesis of CD and to focus on the possible role of viruses in the development of this disease.

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.

Prostate inflammation. Association with benign prostatic hyperplasia and prostate cancer.

OBJECTIVE: To study the association and possible relationship of prostate inflammation with benign prostatic hyperplasia (BPH), and prostate cancer. METHODS: The medical records and pathological findings of all Saudi patients who underwent transrectal ultrasound guided prostatic needle biopsies in King Abdulaziz University Medical City, Jeddah,Kingdom of Saudi Arabia from June 2003 to June 2008 were reviewed retrospectively. The indications for biopsy were elevated levels of serum prostate specific antigen, abnormal findings on digital rectal examination, or both. The specimens harboring inflammation, adenocarcinoma, BPH, or their combinations, were selected and included in the study. RESULTS: A total of 214 patients were selected with an age ranging from 37-100 years (median=68). Inflammation was histologically evident in 88 patients. Of them, only one demonstrated acute inflammation, while 87/88 demonstrated chronic inflammation with, or without acute inflammation. Histopathologic features were categorized into 3 main categories: inflammation alone (12/214, 5.6%), BPH category (126/214, 58.9%), and cancer category (76/214, 35.5%) patients. The last 2 categories also included cases associated with inflammation. In the overall analysis of 214 specimens, BPH with inflammation was more prevalent than cancer with inflammation (43/214 [20.1%] versus 33/214 [15.4%]). In a subgroup analysis within each category, inflammation was less prevalent in the BPH category compared to the cancer category (43/126 [34.1%] versus 33/76 [43.4%]). CONCLUSION: The association between chronic inflammation and both BPH and cancer is obvious in our study. Further studies are needed to substantiate this observation, and to clarify the magnitude of association of inflammation with BPH compared to cancer.

The clinicopathologic patterns of prostatic diseases and prostate cancer in Saudi patients.

OBJECTIVE: To determine the clinicopathologic patterns of prostatic diseases in Saudi patients, with special emphasis on prostate cancer (PCa). METHODS: The records of patients who underwent histopathological examinations of their prostatic specimens in King Abdulaziz University Medical City and King Faisal Specialist Hospital, Jeddah, Kingdom of Saudi Arabia, between June 2003 and June 2008 were reviewed retrospectively. The age, indications for biopsy, histological diagnosis, and Gleason grading of cancer patients, were studied. RESULTS: The study included 330 patients aged 37-100 years (median=68). Specimens included 233 transrectal ultrasound (TRUS) biopsies, 85 transurethral resection of the prostate (TURP), 8 simple prostatectomies, 3 radical prostatectomies, and one radical cystoprostatectomy. Indications for TRUS guided biopsy in PCa patients were elevated prostate specific antigen (PSA) (85.2%), abnormal digital rectal examination (5.5%) or both (9.3%). Prostate specific antigen values <4 ng/ml were found in 13.6% of PCa patients. Among others, adenocarcinoma was found in 28.5%, benign prostatic hyperplasia (BPH) alone in 43.3%, BPH with inflammation in 20.3% and inflammation alone in 4.2%. In specimens of TURP or simple prostatectomy for apparently benign disease, incidental PCa was detected in 14/93 (15%). The Gleason sum of > or = 6 was found in 92.8% of patients. CONCLUSION: The incidence of prostate cancer in Saudi Arabia is low compared to the western countries. However, incidental PCa detected in presumed benign disease appears to be rising. Further future studies addressing this issue are needed to confirm the potential rising trend, and its possible etiology. Our findings support the recommendations to lower the PSA cutoff value for prostatic biopsy to 2.5 rather than 4 ng/ml.