Clinical and pathological patterns of non-epithelial malignant ovarian tumours in Western Saudi Arabia.

Objective: To report a single-center experience in non-epithelial malignant ovarian tumours (NEMOT), by presenting different clinical and pathological characteristics, management and outcomes. Methods: We retrospectively reviewed electronic files of all female patients who underwent surgery for NEMOT at the Gynecology Department of King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from July 2003 to July 2019. We collected baseline demographic, anthropomorphic and clinical data; pathological characteristics; management and follow-up data; and outcomes including residual disease, recurrence and last follow-up status (deceased or alive). Results: Thirty-three women were included; mean (standard deviation) age = 33.24 (17.72) years, range = 4, 86 years. Granulosa cell tumor was the most frequent subtype diagnosed in 17 (51.5%) patients, followed by germ cell tumours 13 (39.4%). The majority of patients were diagnosed at FIGO Stage I (22, 66.7%) and with tumor Grade 1 (23, 69.7%), while 8 (24.2%) were diagnosed with Grade 3 tumors. Granulosa cell and Sertoli-Leydig cell tumours were diagnosed at an older age (mean age = 39.30 vs. 23.92 years) compared to germ cell tumours, respectively (P = 0.012). Two-third of the patients benefited from conservative surgery including oophorectomy + staging, and 16 (48.5%) benefited from chemotherapy with bleomycin, etoposide and platinum being the most common protocol (13, 39.4%) for germ cell tumours. Postoperatively, only 2 (6.1%) patients had residual disease. Recurrence and mortality were reported in one and four patients, respectively, resulting in recurrence rate = 3.0% (95% confidence interval [CI] = 0.01%, 15.8%) and mortality rate = 12.1% (95% CI = 3.4%, 28.2%). Conclusions: The present series of NEMOT was predominated by sex cord-stromal cell tumors, which were diagnosed in patients with older age, while germ cell tumours were underrepresented. Although survival rates were comparable to those reported internationally, more consideration should be given to following up patients regarding fertility outcomes to provide a more comprehensive evaluation of treatment success and quality of care.

Overall and progression-free survival in endometrial carcinoma: A single-center retrospective study of patients treated between 2000-2018.

BACKGROUND: Investigating survival in endometrial cancer (EC) is crucial to determine the effectiveness of overall management as it will reflect on the level of care provided among this population. OBJECTIVE: The study was conducted to analyze the overall survival (OS) and progression-free survival (PFS) in treated endometrial carcinoma and to determine the associated predictors. DESIGN: Retrospective SETTING: Department of obstetrics and gynecology in university tertiary hospital PATIENTS AND METHODS: Baseline demographic and clinical data, tumor characteristics and perioperative and outcome data were collected from consecutive patients treated for EC between 2000 and 2018. Kaplan-Meier method and multivariate Cox regression were used to analyze factors and predictors of OS and PFS. MAIN OUTCOME MEASURES: OS, PFS and prognostic factors SAMPLE SIZE: 200 RESULT: Endometrioid type was the most common type accounting for 78.5% of the cases, followed by papillary serous carcinoma (18.5%). At diagnosis, 21.5% were stage III, and 12.0% were stage IV. Invasiveness features showed involvement of the myometrium (96.5%), lymph vessels (36.5%), cervix stroma (18.5%), lower segment (22.0%), and parametrium (7.0%). The majority of patients had open surgery (80.0%), while 11.5% and 7.0% had laparoscopy and robotic surgery, respectively. Staging and debulking were performed in 89.0% of patients, and 12.5% of patients had residual disease of more than 2 cm. The mean OS and PFS were 104.4 (95% CI=91.8-117.0) months and 96.8 (95% CI=83.9-109.7) months, respectively. The 5-year OS and PFS were 62.5% and 46.9%, respectively. The majority of the factors we assessed were significantly associated with OS or PFS. However, reduced OS was independently associated age ≥60 years (hazard ratio [HR]=1.99, P=.010), papillary serous carcinoma (HR=2.35, P=.021), and residual disease (HR=3.84, P=.007); whereas PFS was predicted by age ≥60 years (HR=1.87, P=.014) and residual disease (HR=3.22, P=.040). CONCLUSION: There is a need for a national strategy to tackle the growing burden of EC, by identifying the locally-specific incidence, delayed diagnosis and survival outcome. LIMITATIONS: This was a single-center study conducted at a tertiary center, which may question the generalizability of the findings, as the sample may be biased by overrepresentation with patients who were diagnosed at an advanced stage.

The Diagnosis of Cervical Dysplasia in a University Hospital Using Pap Smear and Colposcopy in the Western Region of Saudi Arabia: A Correlational Study.

Objectives To assess the diagnostic performance of Pap smear screening with or without human papillomavirus (HPV) testing and colposcopy in detecting preinvasive lesions of the cervix among women with reference to histopathological findings. Materials and methods We performed a retrospective study in a tertiary care center of the clinical and pathological records of women with evocative symptomatology. The diagnostic performance of Pap smear screening and colposcopy was analyzed. The sensitivity and specificity of Pap smear screening and colposcopy in detecting preinvasive lesions of the cervix were calculated in 388 patients. Results The mean age was 45.12 years, and the most frequent gynecological symptoms included abnormal bleeding (17.2%) and postcoital bleeding (10.9%). Histopathology showed abnormal results in 26.5% of the 388 patients, including cervical intraepithelial neoplasia 1 (CIN 1; 20.4%), CIN 2 (2.8%), CIN 3 (1.3%), and SCC (1.3%). Both Pap smear screening and colposcopy were highly sensitive in detecting CIN 1+ (94.2%vs.93.2%, respectively) and CIN 2+ (100.0% vs.95.8%, respectively) intraepithelial lesions; however, Pap smears had very low specificity in detecting both CIN 1+ (8.1% vs.73.7%, respectively) and CIN 2+ (8.0% vs. 59.3%, respectively) compared with colposcopy. When combined with HPV status, the specificity of Pap smear increased considerably. Conclusion It has become a high priority to improve the efficiency of cervical cancer (CC) screening programs by optimizing the practice of Pap smear screening, increasing the test specificity, and implementing systematic cytology-HPV co-testing.

Survival and prognostic factors in women treated for epithelial ovarian cancer in western region of Saudi Arabia.

OBJECTIVES: To assess survival and prognostic factors among women with epithelial ovarian cancer in Western Saudi Arabia. METHODS: A retrospective cohort study was carried out between October 2000 and May 2018, reviewing clinical and pathology data of all women who underwent staging or debulking surgery for epithelial ovarian cancer. Analysis of disease-free survival (DFS), overall survivals (OS) and the associated factors used Kaplan-Meier method in addition to cox multivariate regression. RESULTS: A total of 144 patients were included (median age=49.5 years), with a median follow-up time was 3.4 years. Majority (59.7%) of the patients were diagnosed at an advanced stage (III or IV). The mean (95% CI) DFS was 82.3 (67.8-96.8) months, OS was 96.2 (81.3-111.2) months, and the 5-year survival rate was estimated as 38.9%. Univariate analysis showed that older age, clear cell or papillary carcinoma subtypes, serous type, advanced International Federation of Gynecology and Obstetrics (FIGO) stage and the presence of residual disease were associated with poorer DFS and OS (log rank <0.05). Cox regression showed FIGO stage and residual disease >1cm as the strongest prognostic factors independently associated with DFS and OS. CONCLUSION: Improving early diagnosis and achieving optimal cytoreduction are the most critical challenges to achieve significant positive impact on survival of women with epithelial ovarian cancer.

Prevalence of Diabetes and Hypertension Among King Abdulaziz University Employees: Data From First Aid and Cardiopulmonary Resuscitation Training Program.

Objectives Saudi Arabia has a very high rate of chronic illnesses, especially hypertension (HTN) and diabetes. This study aimed to investigate the prevalence and control of diabetes and hypertension among employees at a university in Saudi Arabia, including the associated risk factors, and to evaluate the need for early screening among these individuals. Methods This retrospective study used data from the first aid training program. In total, there were 3964 employees who completed the program, and only 1000 employees were enrolled. The program was conducted at King Abdulaziz University (KAU), Jeddah, Saudi Arabia. Blood pressure (BP), random blood sugar, and body mass index (BMI) were measured in all employees. Descriptive data, including mean, standard deviation (SD), crosstab, chi-square, and linear regression, were analyzed. Categorical variables were described using frequencies and percentages. Results The prevalence of hypertension and diabetes was 31% and 5%. There were 365 males and 635 females. Employees with risk factors such as gender, age, and body mass index had significant effects on having high blood pressure and random blood glucose measurements. Of the employees who reported being free from chronic diseases, 2.9% had abnormal random blood glucose readings (prediabetic and diabetic ranges), while 37.4% had abnormal blood pressure readings (prehypertensive and hypertensive ranges). Conclusion The high prevalence of hypertension and diabetes reflects the crucial role of early screening in diabetes and hypertension protocols and raising awareness regarding protocol implementation in Saudi Arabia to improve quality of life (QoL) at the individual and community levels.

Prognostic value of E-Cadherin and its tumor suppressor role in Saudi women with advanced epithelial ovarian cancer.

The extracellular matrix (ECM) disruption and cytoskeleton reorganization are crucial events in tumor proliferation and invasion. E-Cadherin (E-CAD) is a member of cell adhesion molecules involved in cell-cell junctions and ECM stability. The loss of E-CAD expression is associated with cancer progression and metastasis. This retrospective study aimed to assess E-CAD protein expression in ovarian cancer (OC) tissues and to evaluate its prognostic value. PATIENTS AND METHODS: 143 formalin-fixed and paraffin-embedded (FFPE) blocks of primary advanced stages OC were retrieved and used to construct Tissue microarrays. Automated immunohistochemistry technique was performed to evaluate E-CAD protein expression patterns in OC. RESULTS: E-CAD protein expression was significantly correlated with OC histological subtype (p < 0.0001), while borderline significant correlations were observed with both tumor grade (p = 0.06) and stage (p = 0.07). Interestingly, Kaplan-Meier survival analysis showed that OC patients with membranous E-CAD expression survived longer than those with no E-CAD expression mainly those at advanced stages (p < 0.009). Further in silico analysis confirms the key roles of E-CAD in OC molecular functions. CONCLUSION: we reported a prognosis value of membranous E-CAD in advanced stage OC patients. Further validation using larger cohorts is recommended to extract clinically relevant outcomes towards better OC management and individualized oncology.

Growing teratoma syndrome with porta hepatis involvement - a case report.

Growing teratoma syndrome is a rare entity of tumors, it arises seldomly from ovarian and testicular carcinoma. It presents with disseminating masses of mature teratoma during or following chemotherapy of malignant germ cell tumors. We are reporting a 19-year old presented with recurrent left ovarian mass and supra renal large mass close to the porta hepatis was seen on magnetic resonance imaging. This patient was treated 3 years ago for stage I immature teratoma with left ovarian cystectomy and chemotherapy. Surgical excision of the left ovary and the abdominal mass required meticulous dissection, and the mass was shaved off the porta hepatis with no intraoperative or postoperative complications. Pathology showed mature teratoma. She has no recurrent 5 years after treatment. To the best of our knowledge, this is the first case report describing close relation of growing teratoma syndrome to the porta hepatis, no such case report like this has been reported in our region.