Nader A. Morad

Actinomycosis of the vallecula: report of a case and review of the literature.

A rare case of actinomycosis presenting primarily as a mass in the vallecula is described. The patient was a healthy, 65-year-old Saudi, lady who was not immunocompromised and had no other primary pathology in the oral cavity. The clinical presentation and management of the case are discussed and the relevant literature reviewed.

Enterobius vermicularis (pin worm) causing symptoms of appendicitis

Continued from p 177 Malaria Retinal findingspredictiveof outcome in cerebral malaria Research in Malawi concentrated on the direct and indirect ophthalmoscope examinations of 141 Malawian children with strictly defined cerebral malaria. Two distinct and prognostically significant findings were identified, papilloedema and extramacular retinal oedema. The relative risk of death in patients with papilloedema was nearly seven times greater than those without papilloedema and extramacular retinal oedema was associated with a nearly threefold increase in the relative risk of dying. The mortality rate in patients with none of these signs was only 1.3% compared to an overall mortality rate of 9.2%. Extramacular retinal oedema was identified by finding discrete areas of intra-retinal opacification sometimes occurring within the macular area or outside it. Whilst this generally occurred in discrete spots they sometimes coalesced to give large areas of retinal whitening deep to the retinal vessels. The authors believe that this sign is unique to cerebral malaria, not having observed it over a period of 4 years examining Malawian children with other conditions. Based on these findings the authors suggest that two pathways to poor outcome may exist in children, one with increased intracranial pressure manifesting as papilloedema and the other 183 symptoms of appendicitis making even the most experienced surgeon operate in such cases. These clinical features are independent of any histopathological changes of the wall of the appendix, but are dependent on the presence of a foreign body in the lumen of the appendix. In this case the most significant findings histopathologically were the presence of the worm, and haemorrhage within the lumen of the appendix. Surgical intervention was necessary to make the diagnosis.

Intra-abdominal pulmonary sequestration: diagnostic difficulties

Summary This case report describes the unusual occurrence of congenital cystic adenomatoid malformation (CCAM) type 2 in an intra‐abdominal pulmonary sequestration as a cause of diagnostic difficulties. The mass was discovered incidentally during a routine prenatal ultrasound in an infant with no other congenital malformation. Extralobar pulmonary sequestrations (EPS) located in the abdomen are rarely diagnosed prior to excision. The presence of CCAM type 2 in this situation might impose difficulties in histologic diagnosis of EPS, especially at the time of frozen section as happened in this case. To our knowledge this case is the sixth reported case of intra‐abdominal EPS and the sixteenth case of EPS histologically displaying the feature of CCAM type 2. Pathologists should be aware that EPS in any location might display histologic features of CCAM type 2 even if the EPS is intra‐abdominal.Abbreviations: CCAM, congenital cystic adenomatoid malformation; EPS, Extralobar pulmonary sequestrations; MRI, magnetic resonance imaging.

Pattern of malignant skin tumors in Asir region, Saudi Arabia.

The current study describes the pattrn of malignant skin tumors in 137 cases seen in Asir Central Hospital histopathology laboratory over a five year period (1987 to 1991). Ninety percent (90.5%) were Saudis and the mean age was 61.0 years with a male:female ratio of 1.6:1. Squamous cell carcinoma was the most common type of skin cancer presenting (41.6%), followed by basal cell carcinoma (36.5%), and then malignant melanoma (11.7%). Ninety-eight percent of basal cell carcinoma occurred on the head, compared to only 47.4% of squamous cell carcinoma; and 24.6% of squamous cell carcinoma cases occurred in the lower limbs. Eighty-seven percent (87.6%) of malignant melanoma cases occurred in the extremities. The distribution of the other types of malignant skin tumors are also discussed. Our findings were compared with the very few studies from the Kingdom and other parts of the world.

Scrotal appendicitis mimicking acute testicular torsion in a neonate.

According to Hemalatha and Spitz Diess described the first case of neonatal appendicitis in 1908 while the first neonatal case to survive surgery was reported in 1952 by Meigher and Lucas. Alvear and Rayfield found one case of scrotal appendicitis in a six-week-old infant in the literature before 1976 and also reported his own case in a five-year-old child. The prognosis in scrotal appendicitis in neonates is better than that of intra-abdominal appendicitis. This is due to early presentation diagnosis and localization of inflammation. In intra-abdominal appendicitis in infants and neonates there is a higher incidence of perforation and failure of localization and thus a high incidence of mortality. In our case the baby presented with acute painful scrotal swelling mimicking acute testicular torsion. A right inguinal hernia was not suspected preoperatively and appendectomy was performed through scrotal incision. (excerpt)

Cellular Uterine Myoma Causing Vaginal Bleeding in a 15‐year‐old Girl

Summary: This report describes only the third case of vaginal bleeding due to uterine myoma in a patient younger than 16 years of age with unusual histological features mimicking endolymphatic stromal myosis.

Helicobacter pylori associated dyspepsia in 208 patients from southern Saudi Arabia.

The frequency of Helicobacter pylori (HP) infection in 208 patients with upper gastrointestinal tract symptoms from the Southern Province of Saudi Arabia was studied prospectively. The occurrence of HP was documented histologically and using a rapid urease test in antral endoscopic biopsies. Our results showed that 82.2% of the 208 patients included were positive for HP with a male:female ratio of approximately 1:1 (88:83). The age range was 14 to 80 years and the median age was 38.2 years. The frequencies of HP infection among Saudi and non-Saudi patients were 86% and 71%, respectively. Frequencies of HP infection were 88%, 77.5%, and 93% during the second, third, and fourth decades of life. Among the 140 patients with histologically proven antral gastritis, 128 cases (91%) were positive for HP whereas 29 cases (17%) of the 171 patients positive for HP did not show histologic evidence of antral gastritis. Our data showed that HP was present in 92.5% of patients with endoscopic diagnosis of duodenal ulceration, 81% of patients with duodenitis, 80% of patients with both duodenitis and gastritis, 69% of patients with gastric antral erythema, and 81% of patients with non-ulcer dyspepsia (normal upper gastrointestinal endoscopy). Histologically proven antral gastritis was seen in 80% of patients with endoscopic diagnosis of duodenal ulceration, 76% of patients with antral erythema, 70% of patients with both duodenitis and gastritis, 33% of patients with duodenitis only, and 66% of patients with non-ulcer dyspepsia. Among the 208 patients included in the study, gastric ulcerationw as only seen in two cases, both positive for HP.

Peripheral lymphadenopathy as a primary presenting sign: A study of 324 cases from Asir region.

Superficial lymph node biopsies received over a four year-period, 1987 to 1990, at the histopathology laboratory of Asir Central Hospital wre reviewed. Total number of patients was 324, all presented with peripheral lymphadenopathy as the primary sign. Two hundred sixty-six patients (82%) were Saudi nationals and 58 patients (18%) were non-Saudi nationals living in Asir region. Granulomatous lymphadenitis was the most common pattern (43%) followed by: nonspecific lymphoid hyperplasia (33%), malignant lymphoma (13%), metastatic nonlymphoid malignant neoplasm (6.6%), and miscellaneous specific lymphadenopathies (4.4%). The distribution patterns of various histopathologic findings according to age, sex, nationality and lymph node location are included.

Reaction of human lungs to aspirated animal fat (ghee): a clinicopathological study

We report the clinical findings and pathological lung changes in four children following a cultural practice of forced feeding with animal fat (ghee) during infancy. The clinical presentation was of acute or chronic chest infection which failed to respond to antimicrobial therapy. The radiographic features ranged from extensive bronchopneumonia to collapse/consolidation and bronchiectasis. The light microscopy findings included diffuse mononuclear interstitial pneumonia, intraalveolar desquamation of pneumocytes, lipid granuloma formation, lung atelectasis and bronchiectasis. In the two children with longstanding reactions, the striking feature was the minimal lipid engulfment by the macrophages, the continuation of the mononuclear interstitial pneumonia, bronchiectasis and minimal lung fibrosis. In these two older children, the lung lymphatics were probably the main channels for drainage of the aspirated ghee.

Gastric cancer in southern Saudi Arabia.

A total of 84 cases of primary gastric cancer were diagnosed in the histopathology laboratory of Asir Central Hospital over a five year period (1987 to 1991). Seventy-two patients (86%) were Saudis and 12 cases (14%) were non-Saudis. The mean age of the patients included in this study was 60 years with a range of 22 to 85 years and a male:female ratio of 4.6:1. Intestinal adenocarcinoma occurred in 63 patients (75%) followed by malignant lymphomas in 12 cases (14%) and diffuse adenocarcinoma in nine cases (11%). The gastric antrum was the most common site affected (47%), followed by gastric corpus (27%), cardia (14%), and fundus (12%). Comparisons of our findings to similar reports from other provinces of Saudi Arabia and other countries are discussed.