Series Of Egyptian Patients Research Articles

Possible Role of PTEN Expression in Discriminating Benign Endometrial Hyperplasia from Atypical Hyperplasia/Endometrial Intraepithelial Neoplasia in a Series of Egyptian Patients

Background: Endometrial hyperplasia represents a heterogeneous group of lesions in response to the unopposed growth-promoting action of estrogen. WHO classified endometrial hyperplastic lesions into Benign Hyperplasia (BH) and atypical hyperplasia/ endometrial intraepithelial neoplasia AH/EIN. Phosphatase and tensin homolog (PTEN) is one of the earliest and most common genetic abnormalities detected in endometrioid adenocarcinoma (type I) and even in its precursors. This study aimed at histological evaluation of hyperplastic endometrial lesions according to WHO 2014 and investigating the role of PTEN expression in highlighting the precancerous group (AH/EIN). Patient and Method: This study included a series of 70 Egyptian patients suffered from hyperplastic endometrial lesions. They were previously diagnosed according to WHO1994 schema simple endometrial hyperplasia without atypia (n=18), simple endometrial hyperplasia with atypia (n=2), complex hyperplasia without atypia (n=25), complex hyperplasia with atypia (n=5) and hyperplastic endometrial polyps (n=20). Results: Cases were histologically re-evaluated according to WHO 2014 classification; BH (62 cases) and eight cases of AH/EIN. A significant difference in PTEN expression (regarding percentage and intensity of staining) in relation to histopathological diagnosis was detected (P-value 0.02 and <0.05, respectively). The sensitivity and specificity of the absence of diffuse PTEN protein expression (>50%) to detect AH/EIN were 100% and 77.4%, respectively. Conclusion: Diffuse, dim or loss of immunohistochemical expression of PTEN protein is significantly correlated with the new WHO classification segregation of AH/EIN as precancerous lesions. However, further studies are recommended to confirm this association.

Prolonged Fever and Lymphadenopathy in a Series of Egyptian Patients: The Etiology Based on Histopathological Examination

Introduction and study aim: prolonged fever and lymphadenopathy (LAP) are two interrelating features that constitute a diagnostic challenge in medical practice. With the great variety in differential diagnoses, a wise clinical impression is needed to reach a provisional diagnosis. This is achieved through knowledge and awareness of the prevalent etiologies among our population. Patients and methods: We included 269 patients with prolonged fever and lymphadenopathy to have an excisional biopsy to reach a definitive diagnosis via histopathological examination. In addition, laboratory tests were performed to assess the role of serology to predict probable diagnoses. Results: Three main etiologies of prolonged fever and lymphadenopathy were detected; malignancy (41.7%), followed by non-specific changes (reactive hyperplasia) (30.5%), then infections (27.8%). The most commonly involved lymph nodes were cervical and axillary, then inguinal. More than half of the patients had only fever and lymphadenopathy, while cachexia and anorexia were the most common associated presentations among others. Most of the patients had high ESR level, whereas high LDH and CRP levels presented in nearly 34% and 22% of them respectively. High CRP, eosinophilia and elevated LDH, characterized malignancy whilst infection was commonly associated with lymphocytosis, monocytosis and high ESR. Old age and high ESR were significant independent predictors of malignancy, and lymphocytosis was a significant predictor of infection. Conclusion: In our region, malignancy is the commonest etiology for fever and lymphadenopathy, in addition to reactive hyperplasia and infections, respectively.

Neuropathic pain in Egyptian patients with primary knee osteoarthritis: Relationship with functional status and radiological severity

Aim of the workThe present study was conducted to identify the frequency of neuropathic pain (NP) and its relationship with functional status and radiological severity in a series of Egyptian patients with primary knee osteoarthritis (OA). Patients and methodsThe study included 165 patients with primary KOA. Visual analogue scale (VAS)-pain was estimated and the Western Ontario and McMaster (WOMAC) Universities osteoarthritis index was used for assessment of pain, stiffness and physical function, Douleur Neuropathique in 4 questions (DN4) questionnaire was used to assess NP and Kellgren-Lawrence (KL) radiological grading was used to assess OA severity. ResultsThe mean age of the patients was 53.08 ± 6.95 years, were 144 females and 21 males, 23 were employed, body mass index was 24.87 ± 1.91 and total WOMAC was 44.24 ± 16.52. The mean DN4 score was 2.81 ± 1.27. 29 (17.6%) patients had NP. The mean symptom duration was significantly longer in patients with NP (50.9 ± 14.58 months) compared to those without (36.53 ± 25.25 months) (p = 0.008). The VAS-pain and WOMAC score were significantly increased in patients with NP compared to those without (p < 0.001) while the KL was comparable. The DN4 questionnaire significantly correlated with VAS-pain at rest (r = 0.56, p = 0.002); and with WOMAC pain subscale (r = 0.38, p = 0.043). ConclusionA relevant proportion of KOA patients have NP and is remarkably related to the disease duration. Functional capacity is adversely affected in these patients. However, no relation was found between DN4 questionnaire and the radiological severity. Once detected, suitable treatment options for NP should be included in the management of primary KOA.

MYC in addition to BCL2 or BCL6 protein coexpression ‘double-expressor’ contributes to the inferior overall survival in a series of Egyptian patients with diffuse large B-cell lymphoma

Background and aimNon-Hodgkin diffuse large B-cell lymphoma having MYC in addition to BCL2 and/or BCL6 rearrangements was recently defined as double/triple-hit lymphoma. Diagnosis by fluorescence in-situ hybridization is sensitive and specific but is time consuming and expensive. We aimed in this st

Clinical significance of Matrilin-3 gene polymorphism in Egyptian patients with primary knee osteoarthritis.

Osteoarthritis (OA) is a multifactorial, degenerative, and inflammatory disorder of joints causing damage of the articular cartilage, formation of osteophytes, and eburination of the subchondral bone. Matrilin-3 (MATN-3) is a non-collagenous oligomeric extracellular matrix protein (ECM), which is the smallest member of the matrilin family. This study was conducted to identify the potential association and clinical significance of MATN-3 rs8176070 (SNP6) polymorphism in a series of Egyptian patients with primary knee OA. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine genotypes of MATN-3 SNP6 for 50 primary knee OA patients in addition to 50 healthy subjects of the same sex and age range. Full history was obtained from OA patients, followed by clinical examination, together with clinical assessment of the severity of knee OA using Lequesne Algofunctional Index score and radiological grading using the Kellgren-Lawrence grade scale (KL). With regard to genotypes of MATN-3 gene SNP6 (rs8176070), a statistically significant difference between OA patients and healthy control subjects was found for the B\b genotype and b allele (p=0.046 and 0.042 respectively), with the prevalence being higher in OA patients with a high risk to develop OA (Odds Ratio [OR]=2.250, 95% CI=1.011-5.008). Patients with the B\b genotype had worse clinical and radiological findings than those with B\B and b\b genotypes. The investigated polymorphism in the MATN-3 gene may reflect the risk and severity of knee OA in Egyptian patients, particularly with the B\b genotype.

Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population.

Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI) in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6%) and 32 females (44.4)] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3%) cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%), septic arthritis in 10 (13.9%), tuberculous arthritis in 4 (5.6%), sickle-cell disease in 7 (9.7%), complicated with septic arthritis in 3 (4.2%), transient bone marrow edema (BME) in 3 (4.2%), osteomyelitis in 2 (2.8%), osteosarcoma in 2 (2.8%), sciatic nerve injury in 1 (1.4%), leukemia with BME in 1 (1.4%), coxa vara of both hips and L5/S1 facet joint ankylosis in 1 (1.4%), and a benign bone cyst in 1 (1.4%). MRI studies showed hip effusion in a total of 51 patients (70.8%), joint space narrowing in 9 (12.5%), and BME in 15(20.8%). MRI is a sensitive tool for assessing hip disorders in a pediatric population and can play an important role in both diagnosis and management of different hip disorders, irrespective of the underlying pathology.

HER-2/Neu Status in Gastric Carcinomas in a Series of Egyptian Patients and Its Relation to Ki-67 Expression

Objective: HER-2/neu status in gastric carcinomas (GCs) has not been studied before in the Egyptian population. Materials and Methods: Seventy-three GCs were evaluated for the expression of HER-2/neu and Ki-67 using immunohistochemistry (IHC). Fluorescence in situ Hybridization (FISH) was done for HER2/neu IHC score 2+ cases. Results: Out of the 73 gastric carcinomas, 23 (31.5%) were score 0, 17 (23.3%) were score 1+, 23 (31.5%) were score 2+, and 10 (13.7%) were score 3+. FISH analysis revealed that the HER-2/neu gene was amplified in 11 out of the 23 cases (47.8%) scored 2+ by IHC. Therefore, the overall HER-2/neu positivity rate was 28.8% and it was significantly associated with higher T-stage and lymphovascular invasion (LVI). The Ki-67 expression rate ranged between 10% and 100%, with 84.9% of the cases (n = 62) featuring high Ki-67 scores. High Ki-67 score was significantly associated with male sex, tumor grade, and number of positive nodes. HER-2/neu protein expression correlated significantly with Ki-67 score. Twenty tumors showed combined HER-2/neu positivity and high Ki-67 score and were significantly associated with higher T-stage and occurrence of LVI, implying a more aggressive behavior. Conclusions: The rate of HER-2/neu positive GCs in our series simulates universal rates, thereby mandating routine evaluation of HER-2/neu status in all GCs submitted to our laboratory to benefit from trastuzumab therapy. Further studies on a larger number of GCs are required to prove that the concurrent HER-2/neu positivity and high Ki-67 score are markers of worse prognosis.

Molecular pattern of breast cancer among a series of Egyptian patients.

e11614 Background: Triple negative (TN) breast cancer has a bad prognosis. It is associated with a poor progression-free and overall survivals. Accordingly, we explored the outcome of different molecular subtypes among a series of Egyptian breast cancer patients. Methods: A total of 661 non-metastatic breast cancer patients' files with were reviewed from Kasr Al-Aini Center of Clinical Oncology and Nuclear Medicine of Cairo University between January 2005 and December 2010. Data were analyzed for age; menopausal status, tumour size, nodal status, pathological type, grade; estrogen status, progesterone status, and human epidermal growth factor receptor 2 (HER2) status. Disease free survival (DFS) was the primary end point. Results: The median age was 50 years. 50.4% of patients were premenopausal, 93.1% had invasive duct carcinoma, 93.3% had grade II tumours, 79.4% had early tumours (T1&amp;T2), 70.4% had positive lymph nodes, 51.7% had luminal A subtype, 21.3% had luminal B, 10.2% had HER2-enriched and 16.6% had TN. Disease free survival after 3 years for each subtype was 87.8% for luminal A, 86% for luminal B, 69% for TN and 66% for HER2 (p= .008). The 3-year disease-free survival was significantly better for postmenopausal patients 92.1% as compared with premenopausal patients 80.1% (P= &lt;0.001), with early tumours (T1&amp;T2) 92.1% &amp; 87.3% respectively as compared with advanced tumours (T3+T4) 80.1% (p= &lt;0.001), LN negative (N0) 98.1% as compared with LN positive (N1+N2) 85.2% and (N3) 68% (p= &lt;0.001), (ER) positive 90.2% as compared with (ER) negative 78.2% (p= &lt;0.001), (PR) positive 90% as compared with (PR) negative 80.2% (p= 0.003), non TNBC 89.8% as compared with TN 72.1% (p= 0.012). The 3-year disease-free survival for TN patients who received adjuvant platinum-based chemotherapy was 46% and for those who received adjuvant non-platinum chemotherapy was 78% (p= 0.135). Conclusions: In our series of Egyptian patients luminal breast cancer subtypes (A and B) had the highest 3-year disease-free survival followed by TN then HER2-enriched type. Adjuvant platinum based chemotherapy had no impact on the 3-year disease-free survival when compared with non-platinum chemotherapy in TN patients.

Molecular Pattern of Breast Cancer Among A Series of Egyptian Patients

Molecular Pattern of Breast Cancer Among A Series of Egyptian Patients