Mohamed B. Satti

Appendicular schistosomiasis: a cause of clinical acute appendicitis?

The role of schistosomes in the pathologenesis of acute appendicitis in an endemic area was investigated. Of 1600 appendicectomies received in our laboratory, 26 showed appendiceal schistosomiasis, which prompted what we believe to be the first detailed histopathological evaluation of all appendices with schistosomal infestation, without prior knowledge of the clinical and operative diagnoses. The results suggest that there are two types of schistosomal appendicitis, each with distinct clinicopathological features and different pathogenetic mechanisms. They could be called obstructive and granulomatous schistosomal acute appendicitis, respectively.

Peripheral neural involvement in cutaneous Leishmaniasis: a pathologic study of human and experimental animal lesions

ABSTRACT: Peripheral neural involvement in cutaneous leishmaniasis has recently been recognized. A man presented with several tender hyperesthetic skin nodules. Histopathologic examination confirmed the diagnosis of cutaneous leishmaniasis. Of most interest was the presence of a striking lymphohistiocytic inflammatory infiltrate around and within cutaneous nerves in addition to demonstrable leishmania organisms in the perineural space. This observation led to a detailed histopathologic evaluation of leishmanial skin lesions that developed in 13 mice after subcutaneous injection with leishmania major promastigotes. Varying degrees of neural involvement was noted in skin lesions from nine animals. In some lesions, in addition to inflammatory cells in the nerves, organisms were demonstrable within probable schwann cells. Three pathologic stages of dermal neural involvement were identified, namely, an early, intermediate, and late stage, depending on the severity of damage; however no correlation was found between the pathologic stage and the duration of the leismanial skin lesion of a specific animal.

Amyloid deposits in basal cell carcinoma of the skin

Deposits of amyloid were detected in 101 of 199 basal cell carcinomas (51%). The frequency of amyloid deposits in solid, adenoid, and cystic histologic subtypes was slightly higher than overall, whereas in partial sclerosing and morphea-like tumors the frequency was much lower. The amyloid of basal cell carcinoma showed histochemical characteristics that were different from those of locally deposited amyloid in endocrine tumors such as medullary carcinoma thyroid and from those of secondary amyloid. No major differences in the histochemical characteristics, however, were observed between amyloid associated with basal cell carcinoma and myeloma-associated or primary amyloid. Nevertheless, immunohistochemical staining with rabbit antihuman keratin antibodies by the peroxidase antiperoxidase technique demonstrated positivity only in amyloid deposits associated with basal cell carcinoma and not in those of myeloma-associated amyloid. This evidence supports the concept that amyloid of basal cell carcinoma is produced in the stroma from degenerated epithelial cells through filamentous degeneration or apoptosis.

Primary localized cutaneous amyloidosis: a clinicopathologic study from Saudi Arabia.

Background Primary localized cutaneous amyloidosis (PLCA) refers to deposition of amyloid in apparently previously normal skin with no evidence of deposits in internal organs. Certain ethnic groups are particularly predisposed. The objective of this study was to investigate the occurrence of PLCA in a hospital‐based set‐up and to review the clinicopathologic findings of histologically confirmed cases.

Non-Hodgkin's Lymphoma in Saudi Arabia: Prognostic Factors and an Analysis of the Outcome of Combination Chemotherapy Only, for Both Localized and Advanced Disease

Seventy-eight previously untreated patients with clinical stage (CS) I and II (42 patients) and CS III and IV (36 patients) and non-Hodgkins lymphoma (NHL) were treated with systemic chemotherapy only. All patients had intermediate or high grade lymphoma. Two different regimens were used: bleomycin, adriamycin, cyclophosphamide, vincristine and prednisone (BACOP); and a combination of methotrexate with folinic acid rescue, epirubicin, cyclophosphamide, vincristine, prednisone and bleomycin (MECOP-B), for 57 and 21 patients respectively. Objective clinical remission was achieved in 90% of the cases, of which 73% were complete. Complete remission (CR) was demonstrated in 90% and 53% of patients with CS I + II and III + IV respectively (P = 0.0008). Two variables, bone marrow and liver involvement, were negatively associated with CR rate in a multivariate analysis. The actuarial overall survival for the entire group was 65%. The median survival for complete responders has not been reached, but a projected 80% relapse-free survival at 3 years is estimated. The Cox proportional hazards model predicted that advanced stage (CS III and IV) and pretreatment lactic dehydrogenase serum level above 400 iu/l (N less than 200 iu/l) independently influenced survival adversely. The latter prognostic variables were used to identify several groups with different risk probabilities. Despite an apparent comparability between patients receiving the two regimens, no significant difference in response or survival rates was noted between the two protocols. We conclude that the results of systemic chemotherapy compared favorably with radiation therapy for early stage disease and is an acceptable strategy for developing countries with limited availability of radiotherapy facilities. Based on certain risk factors, therapy should be individualized so that more intense regimens, with or without radiation, should be offered only to those patients in the high risk group at highly specialized centers.

Cutaneous schistosomal granuloma

A 12-year-old Sudanese boy presented to the Dermatology Department, King Faisal University, with an itchy groin nodule of 3 months duration. The lesion had started as an erythematous papule that gradually enlarged to reach its present size. Examination revealed a 1.5 X 3.5 cm, slightly pigmented, smooth, lobulated, firm, tumor-like mass, freely mobile over the underlying tissues in the right groin. Several small satellite papules were observed around it (Fig. 1). There was no tenderness, inflammation, regional lymphadenopathy, or lymphedema. The clinical differential diagnosis included condyloma accuminatum, nevus verrucosus, and lymphangioma circumscdptum. The lesion was excised and histopathological examination showed marked acanthosis of the epidermis with pseudoepitheliomatous hyperplasia overlying dense dermal chronic inflammatory infiltrate rich in eosinophils. In various sections, numerous granulomata were seen surrounding schistosoma ova, and central eosinophilic necrosis (Figs. 2, 3). On second questioning, the patient gave a history of urinary schistosomiasis with terminal hematuria for which he had received treatment in Sudan. On abdominal examination, hepatosplenomegaly was absent. Complete

Splenic Foam Cells: A Clinico-Pathologic Analysis of 92 Splenectomized Patients

Spleens from 92 patients who underwent splenectomy for various indications were examined. These indications included hematologic disease in 38 patients and nonhematologic problems in 54. Of all the group foam cells were seen in hematoxylin and eosin (HE)-stained sections of spleens from 12 patients. This number increased to 21 (23%) when the diastase periodic acid-Schiff stain was used as a screening test. The cells in these 9 additional cases were too scanty to be observed on HE-stained sections alone. All the 21 spleens with positive foam cells were from patients with hematologic disease, specifically beta-thalassemia major, hemoglobin S/beta-thalassemia, hemoglobin AS, and idiopathic thrombocytopenic purpura. None of the spleens from the 54 nonhematologic patients showed foam cells. Factors that determine the probability of presence of foam cells were calculated. Also, certain differences in the staining reactions of foam cells were observed. The results of both, and the relation of these foam cells to the syndrome of the sea-blue histiocyte are presented and discussed.

Hepatocellular Carcinoma in Saudi Arabia: Evaluation of Prognostic Factors

ABSTRACT The medical records and pathologic materials of 41 Saudi patients (22 males and 19 females) with confirmed diagnosis of hepatocellular carcinoma were reviewed retrospectively. None of the ...

Epidermal nevus syndrome : a clinicopathologic study with six-year follow-up

A 2-month old girl had a congenital generalized cutaneous disease. She was the product of a normal delivery after an uneventful pregnancy. Both parents and three siblings were normal. Initial examination revealed an aiert, cheerful infant with smooth, elevated, yellowish plaques on the forehead and cheeks. Plaques also infiltrated the lateral part of the left lower eyelid margin, and eyelashes were absent. Lesions extended to the nuchal and occipital areas, with erythema and alopecia. Her upper back showed whorled, erythematous, hyperkeratotic streaks that extended over the right arm. The lower back and sacral area had large bluish macules simulating huge mongolian spots, with scattered pigmented nevi within. Two soft tissue hemiations were noted, one below the right costal margin and the other in the suprastemal notch. Both swellings became more apparent and tense on straining. Detailed evaluation, including ophthalmologic examination, chest and skull radiograms, and brain computerized tomography, revealed no evidence of systemic developmental anomalies except for the left madarosis and skeletal muscle weakness causing the herniations. A clinical diagnosis of epidermal nevus syndrome (ENS) was confirmed by two skin biopsies.

Lipoid proteinosis: Clinical genetic, and pathological study of a Saudi Arabian family.

We present the morphological features and clinical progression of lipoid proteinosis observed in six patients from a Saudi family. The index case presented with hoarseness and characteristic skin lesions. Some of the patients had photosentivity with milia and hypertrichosis. The diagnosis of lipoid proteinosis was confirmed by histopathology and by the findings of normal blood porphyrin levels. The condition is inherited as an autosomal recessive disorderm and consanguinity was an important factor. The rarity of this condition and the common occurrence of close-relative intermarriages in Saudi Arabia prompted this report, which we believe is the first and largest family with lipoid proteinosis possessing an established Arabian ancestry.