Shaesta Naseem Zaidi

Mucinous tubular and spindle cell carcinoma of the kidney with sarcomatoid transformation.

Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney is a recently described entity in the World Health Organization (WHO) 2004 classification and has a relatively indolent behavior. Sarcomatoid differentiation has been well documented in most histologic variants of renal cell carcinoma and its presence is known to have a worse prognosis. Its occurrence in an otherwise benign MTSCC is extremely rare. Here, we report a unique case of MTSCC in a 64-year-old patient with multiple areas of high-grade spindle cells and large areas of necrosis in it. The patient had a rapidly fatal clinical outcome.

Malignant Gastric Glomus Tumor: A Case Report and Literature Review of a Rare Entity.

A glomus tumor is a mesenchymal neoplasm that usually develops in the peripheral soft tissue, especially in the distal part of the extremities. The subungual zones of the fingers and toes are the most frequent sites of observation. The majority of glomus tumors are entirely benign, and the malignant counterparts are very rare, especially those arising in the visceral organs. We report a case of an extremely rare malignant glomus tumor arising in the stomach of a 53-year-old female admitted to the King Khalid University Hospital, Saudi Arabia. The patient reported a four-month history of pain and fullness in the left hypochondrium. She underwent laparotomy and resection of the gastric mass. The mass was analysed by histopathology. Based on the pathological findings of large tumor size, nuclear atypia, increased mitotic rate, atypical mitosis, the presence of necrosis, and characteristic immunohistochemistry the diagnosis of malignant glomus tumor was rendered. Ultrastructural study confirmed the diagnosis. The patient is well and continues regular follow-up.

The Histological Spectrum of Early Mycosis Fungoides: A Study of 58 Saudi Arab patients.

OBJECTIVES The histopathological diagnosis of Mycosis Fungoides (MF) is challenging in its early stages and can easily be confused with inflammatory dermatoses. This study aims to; (i) assess the frequency and significance of different histopathological parameters in early MF, seen in Saudi patients, and (ii) to study the utility of these parameters in differentiating between early MF and inflammatory dermatoses. METHODS This is a five years study of 66 skin biopsies generated from 58 patients with clinically suspicious MF lesions or early patch stage MF. These cases were retrieved from the archives of the Department of Pathology, King Khalid University Hospital, Riyadh from the year 2002 to 2006. Histological criteria were assessed and graded semi-quantitatively on a four-point scale by a dermatopathologist and two pathologists independently. RESULTS The histological parameters suggesting the diagnosis in early stages MF include epidermotropism, dermal fibrosis, Pautriers micro abscesses, Basal alignment of neoplastic lymphocytes, hyperconvoluted dermal and epidermal lymphocytes and grandiosity sign (size of lymphocytes becoming larger as they migrate towards granular layer of epidermis). These parameters on univariate analysis achieved statistical significance (p<0.05) in differentiating MF from non-MF cases. In addition, hyperconvoluted dermal and epidermal lymphocytes proved to be highly reliable with high specificity and sensitivity. CONCLUSION The histopathological diagnosis of early MF lesions and their discrimination from inflammatory simulators can be achieved by carefully observing the hyperconvoluted dermal and epidermal lymphocytes along with the constellation of the other parameters.

Utility of endobronchial ultrasound-guided-fine-needle aspiration and additional value of cell block in the diagnosis of mediastinal granulomatous lymphadenopathy

Background: Endobronchial ultrasound-guided transbronchial fine-needle aspiration is a minimally invasive technique for diagnosis of mediastinal lesions. Although most studies have reported the utility of EBUS-FNA in malignancy, its use has been extended to the benign conditions as well. Objective: To evaluate the diagnostic yield and cytologic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-FNA) in cases of clinically and radiologically suspected granulomatous diseases. Patients and Method: From May 2010 to April 2015, 43 of 115 patients who underwent EBUS-FNA at one center for radiologically and clinically suspicious granulomatous lesions, and with no definite histological diagnosis, were included in this retrospective study. Results: When the histological diagnosis was taken as the gold standard, the sensitivity of EBUS-FNA was 85% and specificity was 100% with the positive predictive value of 100. The combined diagnostic sensitivity of EBUS-FNA and transbronchial lung biopsy was 100%. In 4 cases, cell block provided an exclusive morphological diagnosis of sarcoidosis which was noncontributory by EBUS-FNA. Conclusion: Our study supports the use of EBUS-FNA, by virtue of being a safe, minimally invasive, and an outpatient procedure, in the diagnosis of granulomatous mediastinal lymphadenopathy, thereby obviating more invasive testing in a significant number of patients. Also, cell block provides additional data in the diagnosis in these benign mediastinal diseases.

A case of yolk sac tumor of the vagina in an infant

We report a case of a vaginal yolk sac tumor in a 5-month-old female infant who presented with short history of bleeding per vagina. Magnetic resonance imaging showed a mass occupying most of the vagina that had lobulated outlines and heterogeneous echo texture. The serum alpha-fetoprotein was elevated, and a biopsy revealed a vaginal yolk sac tumor. The patient was given six cycles of chemotherapy and continues to be disease-free on follow up. To preserve sexual and reproductive function, we encourage consideration of chemotherapy as a sole modality to treat this rare tumor.

HER2/neu Immunostaining in Invasive Breast Cancer: Analysis of False Positive Factors.

OBJECTIVES HER2/neu gene amplification by Fluorescent in situ hybridization and protein expression by immunohistochemistry have been used for prognosis and guidance for the treatment of invasive ductal carcinoma of the breast with Trastuzumab. False positive results are a significant problem where immunohistochemistry is exclusively used to test HER2/neu protein over expression. A minority of cases of breast cancer scoring HER2 (3+) by immunohistochemistry using Hercep test may not be associated with amplification of the HER2/neu gene by FISH, a test which is a more specific and sensitive than immunohistochemistry. This study aims to examine the factors contributing to false positive results by immunohistochemistry and subsequently not showing HER2/neu gene amplification by FISH analysis. METHODS A retrospective analysis of 18 cases (3+) by immunohistochemistry in the pathology laboratory not associated with HER2/neu gene amplification was performed. The histological review of these cases was done, the technical error (i.e staining of blood vessels or benign ducts) and the interpretation errors were evaluated. RESULTS Polysomy 17 was absent in all the cases studied by FISH analysis. By immunohistochemistry, five of the 18 cases were purely interpretation errors and the remaining were a combination of technical and interpretational errors. CONCLUSION False positive results related to technical and interpretational errors can be prevented by properly educating the technologist and pathologist to perform high quality immunostains and to render an accurate diagnosis respectively. This issue is of utmost importance as it may have deleterious effects on the selection of therapeutic arsenal in invasive ductal carcinoma of the breast.

Testicular capillary hemangioma - A case report of a rare tumor

Testicular hemangioma is a very rare benign vascular neoplasm, mostly occurring in children and young adults. We present a case of capillary hemangioma of the testis in a twenty three years old male who presented with painless mass in the right scrotum of 2 months duration. He was diagnosed with a right testicular tumor based on the physical examination, ultrasonography and magnetic resonance imaging studies. Serum tumor markers were normal. Right radical orchiectomy was performed. On histology, the tumor was diagnosed as capillary hemangioma of the testis. Immunohistochemical staining for CD31 and factor VIII confirmed the vascular nature of the tumor. To our knowledge, there are only twenty two cases of testicular hemangiomas reported in the literature. Although it is a rare tumor, surgeons and pathologists should be aware of it especially with the negative tumor marker findings. Intra-operative frozen section examination may be requested as tumor enucleation with testicular sparing surgery is considered adequate.

Utility and diagnostic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration cytology of mediastinal lesions: Saudi Arabian experience

Objective: The objective of this study is to evaluate the cytological accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) of the mediastinal mass/nodular lesions. Study Design: Over 3½ years from inception at King Khalid University Hospital, a retrospective analysis of the cytological diagnoses of all the EBUS-TFNA procedures performed in 80 patients who had mediastinal mass/nodular enlargement. Cytology results were reviewed and correlated with the histologic follow-up. Results: Of the 80 patients who underwent EBUS-TFNA, 15 cases (18.75%) were positive for malignancy, 48 cases (60%) negative for malignancy and 17 cases (21.25%) unsatisfactory. Of the 48 cases, which were negative for malignancy, 24 (50%) cases were of granulomatous inflammation. The overall diagnostic yield of our EBUS-TFNA specimen was 78.75%. Forty-seven cases (58.75%) of 80 cases had histological follow-up biopsies. Among them, 32 cases (68%) had the same cytological and histological diagnosis and 15 cases (31.09%) had discordance between the cytology and the follow-up histological diagnosis. The sensitivity, specificity, and positive and negative predictive values for diagnosing granulomas by EBUS-TFNA are 77%, 82%, 83%, and 75% and for diagnosing malignancy are 71%, 100%, 100%, and 82%, respectively. Conclusion: Preliminary results show that cytological samples obtained through EBUS-TFNA are accurate and specific in making a diagnosis of the mediastinal mass/nodular lesions. Its optimum use depends on the effective collaboration between the cytotechnologist, pathologist, and the bronchoscopist.

Utility of endoscopic ultrasound-guided transbronchial fine-needle cytology in the diagnosis of sarcoidosis: A Saudi experience

Background: Endoscopic ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) is a minimally invasive technique for diagnosis of mediastinal masses/lesions. Although most studies have reported the utility of EBUS-TFNA in malignancy, its use has been extended to the benign conditions as well. Objective: The present study focused on utility of EBUS in contributing to reach the final diagnosis of sarcoidosis. Design: From May 2010 to December 2013, 19 of 80 patients who underwent EBUS-TFNA at one center for radiologically suspicious lesions for sarcoidosis, and with no definite histological diagnosis, were included in this retrospective study. Results: When the histological diagnosis was taken as the gold standard, the sensitivity of EBUS-TFNA was 84.2% and specificity 100% with the positive predictive value of 100. The combined diagnostic sensitivity of EBUS-TFNA and transbronchial lung biopsy was 100%. Conclusion: EBUS is a valuable, minimally invasive diagnostic modality to support the diagnosis of sarcoidosis in appropriate clinical setting, after conventional work-up – particularly if patients have suspicious radiological findings. This minimally invasive procedure helps in providing a final diagnosis without exposing the patient to the risk of complications from more invasive procedures.

Clinical-pathological Study of Rosacea in a Small Cohort of Saudi Arabia@@@دراسة الروابط السريرية النسيجية لمرضى الوردية في مجموعة صغيرة من المملكة العربية السعودية

Although rosacea is a common disease, it is rarely biopsied. There are few reports on the histopathological changes in rosacea in literature, but no attempt has been made in Saudi Arabia, to correlate such changes with clinical findings. In the present study, our aim was to analyze the clinical diversity and histological alteration of rosacea in a small cohort. The study included eight patients with a diagnosis of rosacea. A skin biopsy with 4mm punch was performed in each case from the clinically involved area. The patients had broad clinical spectrum of lesions ranging from erythematous telangiectatic plaque to rhinophyma. No histological pattern was found to be unique for rosacea. Demodex mite infestation, which is considered to be significant in literature, was found not to be a contributing factor. Rosacea demonstrates a wide range of clinical presentation. Elastoid degeneration was an outstanding feature due to the ultraviolet sensitivity of the disease and the fact that our sunrays are potentially damaging all year round.