Lipomatous (Fat-Forming) Solitary Fibrous Tumor of the Breast: A Case Report of an Uncommon Variant of a Rare Clinical Entity.

Solitary fibrous tumor (SFT) is an uncommon tumor of mesenchymal origin, which can arise at any anatomic location and can exhibit versatile histological features and a clinical course ranging from benign to frankly malignant. Lipomatous (fat-forming) SFT is a morphological variant of SFT characterized by an adipose tissue component. Breast SFT is an extremely rare clinical entity, and the literature review yielded only 28 previously reported cases. However, lipomatous (fat-forming) SFT is much less common than conventional tumors and, to our knowledge, it has never been reported in the breast. We describe a case of a 54-year-old postmenopausal woman who presented with a palpable mass on her right breast. No other associated features such as nipple discharge, skin changes, or axillary lymphadenopathy were present. The clinical differential diagnosis included fibroadenoma, phyllodes tumor, and mammary hamartoma. A ultrasound scan examination demonstrated a large, oval, well-circumscribed lesion with indeterminate features, but suspicious of malignancy. However, a needle core biopsy was performed and histological examination with ancillary immunohistochemical staining confirmed the diagnosis of SFT, a lipomatous variant. The lesion was excised with clear margins and histological examination confirmed SFT with low-risk features and follow-up was planned. Careful histological evaluation with diffuse and strong nuclear expression of STAT6 helped to distinguish lipomatous SFTs from other mimics. Here, we describe the first case of a lipomatous variant of a SFT involving the breast.

Aneurysmal bone cyst on top of fibro-osseous lesion of the ethmoid sinus with orbital and intracranial extension in a child.

Objective: Aneurysmal bone cysts (ABCs) rarely involve the cranium. We report a case arising in the ethmoid sinus with orbital and intracranial invasion. Imaging suggested an associated fibro-osseous lesion. The lesion was completely resected. Histology confirmed the imaging diagnosis of ABC on top of an ossifying fibroma. A multidisciplinary approach is essential for optimal surgical outcomes. Methods: We report a case of an 8-year-old boy with a 5 week history of painless, increasing prominence of the left eye. Clinical examination revealed non-pulsatile left proptosis. Visual acuity and ocular movements were normal. CT and MRI scans of the maxillofacial regions showed a large space-occupying lesion involving the left ethmoid air cells with left orbital and left inferior frontal intracranial extension. Multiple fluid levels with blood products were seen. Areas of the bony component of the lesion showed ground-glass density on CT. Imaging was consistent with an ABC with an underlying fibro-osseous lesion; probably fibrous dysplasia which was confirmed after surgical removal of the lesion. A multidisciplinary team of maxillofacial, neurosusugery and ENT surgeons performed the surgery. Results: ABC arising from an osseous fibroma of the skull is rare. Total resection can be achieved with a multidisciplinary surgical approach. Post-operative histology confirmed by the imaging findings.

Thyroid malignancy among patients with thyroid nodules in the United Arab Emirates: a five-year retrospective tertiary Centre analysis.

OBJECTIVES: Thyroid malignancy constitutes the sixth common cancer type in the United Arab Emirates (UAE). There are no epidemiological data outlining the prevalence of cancer in thyroid nodules, nor previous analysis of ultra-sonographic features correlating with thyroid malignancy in the UAE. This study aimed to estimate the prevalence of thyroid malignancy in patients with thyroid nodules and to describe the ultra-sonographic characteristics of thyroid nodules harbouring malignancy. METHODS: A retrospective electronic medical records review of all thyroid nodules in patients (aged 18 to 80 years) with normal thyroid-stimulating hormone (TSH) levels, who underwent ultrasound guided fine needle aspiration cytology (UG-FNA) at Sheikh Khalifa Medical City (SKMC) during 2011-2015. RESULTS: 436 patients with normal TSH underwent UG-FNA cytological examination of thyroid nodules (n = 555 nodules). The overall crude prevalence of thyroid cancer among patients was 10.1% (95% CI 7.5-13.3). The age-adjusted prevalence of thyroid cancer among UAE nationals, Arabs, Far East Asians, and Caucasians were 9.6% (3.6-15.6), 10.0% (6.2-13.8), 16.8% (4.5-29.0) and 16.3% (1.7-30.9), respectively. The crude prevalence was 14.5%(95% CI 6.2-22.8) in men, and 9.3%(95% CI 6.3-12.2) in women. The echogenicity features were significantly different between the cancerous and noncancerous nodules (p = 0.025). Cancerous nodules were relatively more hyper- and hypo-echoic, while noncancerous nodules were mostly complex. CONCLUSION: We report a higher prevalence of thyroid malignancy among patients with thyroid nodules relative to that reported in other parts of the world. The rate of thyroid malignancy was higher in patients of Far-East Asian and Caucasian ethnic background.

Spectrum of lymphoma in Bahrain. A retrospective analysis according to the World Health Organization classification.

OBJECTIVES: To determine the spectrum of various types of lymphoma in Bahrain according to the latest World Health Organization classification criteria.  Methods: A retrospective review was conducted for all new lymphoma cases diagnosed at Salmaniya Medical Complex, Manama, Bahrain during the period from January 2010 to December 2015.  Results: Two hundred and twenty-one new cases of lymphoma in Bahraini patients were diagnosed in the study period. Eighty patients had Hodgkin lymphoma, 140 had non-Hodgkin lymphoma, and one patient had composite lymphoma. In the Hodgkin lymphoma group, nodular sclerosis type was the most frequent type (48.75%), followed by mixed-cellularity type (27.5%), and nodular-lymphocyte predominant type (16.25%). In the non-Hodgkin lymphoma group, 124 (88.6%) cases were B-cell lymphomas, while the remaining were T-cell lymphomas. Diffuse large B-cell lymphoma was the most frequent type of non-Hodgkin B-cell type lymphoma (55.7%), followed by follicular lymphoma (10%).  Conclusion: The distribution of lymphoma in Bahrain is similar to neighboring Middle East countries with a predominance of Hodgkin lymphoma and diffuse large B-cell lymphoma.

Gastric Strongyloidiasis: Report of 2 Cases and Brief Review of the Literature.

Strongyloides stercoralis is an intestinal nematode with a complicated lifecycle and auto-infection. In healthy individuals, this parasite usually does not cause any symptoms. But in immunocompromised patients, the symptoms vary from abdominal pain and discomfort to sepsis and death.Gastric infection and involvement by this nematode are rare and uncommon. Here we report 2 cases of Strongyloides stercoralis hyperinfection that were discovered in gastric biopsies in 2 immunocompromised patients. A gastric biopsy was taken for each patient and both showed cross sections of adult worms, eggs, and rhabditiform larvae of S. stercoralis embedded within gastric crypts. This short report describes these 2 immunocompromised patients with disseminated infection by S. strecoralis with gastric involvement with emphasis on recognition of the histological findings in gastric biopsies.

Concomitant orbital aspergillosis and mucormycosis in a 17 months old immunocompetent child.

Isolated multiple orbital fungal infection (aspergillosis & mucormycosis) is extremely rare disease in immunocompetent individuals and especially in children. Placement of prosthetic device during the surgery could be one of the risk factors. The presentation is usually masquerading other entities which make early diagnosis a challengeable. This case presenting a 17 months old immunocompetent child who is diagnosed with isolated multiple orbital fungal infection: aspergillosis & mucormycosis. The presentation was mimicking orbital cellulitis and chronic dacryocystitis. The definitive diagnosis was made by tissue biopsy. The child was managed by surgical debridement and IV amphotericin B liposomal. High index of suspicion to fungal infection should be considered after surgical intervention with insertion prosthetic materials. To the best of our knowledge, orbital aspergillosis in immunocompetent young children is exceptionally rare.

Granulomatous hypophysitis: rare disease with challenging diagnosis.

Granulomatous hypophysitis is rare pathology that mimics pituitary adenoma. Diagnosis is only confirmed by histopathology examination. Trans-sphenoidal surgery is considered diagnostic when descent tissue specimen is obtained and therapeutic by decompressing optic pathway and the sella. Pathological findings always reveal granulomatous areas, multinucleated giant cells, plasma cells, and lymphocytes.

Childhood Autoimmune Hepatitis in Bahrain: a Tertiary Center Experience.

BACKGROUND: Autoimmune hepatitis (AIH) in childhood has variable modes of presentation, and the disease should be suspected and excluded in all children presenting with symptoms and signs of prolonged or severe acute liver disease. In AIH, the liver biopsy histopathology shows inflammation in addition to presence of serum autoimmune antibodies and increased levels of immunoglobulin G (IgG). OBJECTIVES: To investigate the situation of childhood autoimmune hepatitis in Bahrain and to compare it with other studies worldwide. METHODS: A retrospective study describing the AIH pediatric cases diagnosed during the period of Jan 2005 to Dec 2009. We report the clinical, biochemical, histopathological, and immunological findings, mainly autoimmune profile, in addition to response to treatment, of Bahraini children with autoimmune hepatitis. RESULTS: Five Bahraini children, three females and two males were diagnosed as autoimmune hepatitis during the study period. Their ages at presentation ranged from 9 to 15 (median 10.6) years. One of our patients had a fulminating type. Two had other autoimmune related conditions, namely autoimmune sclerosing cholangitis and ulcerative colitis. All were AIH type 1. Variable response to conventional immunosuppressive therapy was found, from an excellent response with good prognosis, to cirrhosis, hepatic failure and liver transplantation. CONCLUSION: Childhood AIH is a rare medical problem in Bahrain, with both sexes affected and a variable response to immunosuppressive therapy.