Two Different Meningioma Variants in the Same Tumor: A Rare Histopathological Finding

We report a case of meningioma with both secretory and lipomatous features in an advanced middle aged female patient with a 3-month history of headaches and convulsions. Radiological findings are revised and compared to other reported cases in the literature

Respiratory Epithelial Orbital Cyst: A Case Report and Literature Review

A 44-year-old male with schizophrenia presented with progressive right proptosis for one year and conjunctivitis for two months. An orbital cyst was seen in the superotemporal region on computerized tomography and was surgically removed. There was no history or radiological signs of paranasal sinus disease or previous trauma. Histopathologic evaluation revealed a cyst lined with respiratory epithelium. Respiratory choristomatous cysts of the orbit are considered rare in both pediatric and adult patients. We review the literature of respiratory orbital cysts and conclude that they tend to present in adults and should be considered in the differential diagnoses of orbital cysts

Supraclavicular Lymphadenopathy: Initial Manifestation of Metastasis in Carcinoma of Cervix

Introduction. Carcinoma of cervix rarely metastasizes to cervical lymph nodes and is associated with poor prognosis. To date, only few case reports have been reported in the medical literature. Here, we report a case of this unusual manifestation of carcinoma of cervix. Case Presentation. A 39-year-old Saudi woman who was treated three years ago for bulky IB stage carcinoma of cervix with total abdominal hysterectomy and bilateral salpingo-oophorectomy and adjuvant chemoradiation presented to us during her routine follow-up visit with left supraclavicular lymphadenopathy. Staging workup revealed additional para-aortic nodal and osseous metastases. The biopsy of left supraclavicular mass confirmed the diagnosis of carcinoma of the cervix. Patient was started on chemotherapy and bisphosphonates. Conclusion. Supraclavicular lymph nodes are a rare site of metastasis in carcinoma of cervix, and this can be explained by outlining the drainage of the lymphatic system from the cervix. Supraclavicular lymphadenopathy is associated with variable prognosis

The Epidemiology of Primary Central Nervous System Tumors at the National Neurologic Institute in Saudi Arabia: A Ten-Year Single-Institution Study

Objectives. This study is aimed at describing the epidemiological trends of primary CNS tumors in children and adults at the National Neurologic Institute in Saudi Arabia. Methods. A retrospective epidemiological approach was used where data was obtained from the department of pathology registry files and pathology reports. The records of all patients registered from January 2005 to December 2014 with a diagnosis of primary CNS tumor (brain and spinal cord) were selected. Data about sex, age, tumor location, and histologic type were collected. The classification was based on the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3). Results. Nine hundred and ninety-two (992) cases of primary CNS tumors throughout the ten years (2005 to 2014) were reviewed. There were 714 (71.97%) adults and 278 (28.02%) in the pediatric age group. Nonmalignant tumors dominated the adult population (60.08%) while malignant tumors were more frequent in the pediatric population. Gliomas constituted the most common neoplastic category in children and adults. The most common single tumor entity was meningioma (26.99%, ICD-O-3 histology codes 9530/0, 9539/1, and 9530/3). Medulloblastomas (ICD-O-3 histology codes 9470, 9471, and 9474) were the most common single tumor entity in the pediatric age group (26.62%). Conclusions. This is an institution-based, detailed, and descriptive epidemiological study of patients with primary CNS tumors in Saudi Arabia. In contrast to other regional and international studies, the medulloblastomas in our institution are more frequent than pilocytic astrocytomas. Limitations to our study included the referral bias and histology-based methodology

Large cell/anaplastic medulloblastoma with myogenic, melanotic and neuronal differentiation: A case report of a rare tumor

Medulloblastoma is an embryonal neuroepithelial tumor of the cerebellum and is the most common malignant central nervous system tumor in children. Different histological variants and patterns have been described. The classic variant represents the majority of cases. This report describes a rare case of large cell/anaplastic medulloblastoma with myogenic, melanotic and neuronal differentiation arising in the cerebellum of a 3-year-old boy who presented with headache and vomiting. Magnetic resonance imaging demonstrated a heterogeneously enhanced lesion in the fourth ventricle. Surgical resection of the tumor was accomplished, but a residual tumor was left behind because of the involvement of the brainstem. Postoperatively, the patient received chemotherapy and radiotherapy. Currently, 20 months after treatment, the patient has survived without further progression. Pathological examination revealed a high grade primitive neuronal tumor with foci of myogenic features, melanin containing epithelial elements and ganglion-like cells, which were confirmed by immunohistochemistry

Programmed death‐ligand 1 expression in Epstein‐Barr virus positive nasopharyngeal cancer

Abstract Nasopharyngeal cancer (NPC) is common in Saudi Arabia; Most cases are related to the Epstein‐Barr virus (EBV), which is associated with treatment failure and a high recurrence rate. Programmed cell death protein 1 (PD‐1) and Programmed death‐ligand 1 (PD‐L1) inhibitors emerged as breakthroughs in cancer treatment, including head and neck cancers. The benefit of these therapies was seen in patients with high expression of PD‐L1, which is unknown in our population.  We aim to assess PD‐L1 expression in EBV‐related NPC patients presented to King Fahd Medical City (KFMC). We identified 41 cases of EBV‐related NPC diagnosed between 2016 and 2019. PD‐L1 expression was assessed using the Tumor Proportion Score (TPS) and Combined Positive Scores (CPS). Results showed that PD‐L1 expression was negative in 51% and 29% using TPS and CPS scores, respectively. High expression of PD‐L1, more than 50%, was seen in 17% using TPS and 22% using CPS. There was no statistically significant correlation between the degree of PD‐L1 expression by TPS or CPS and many variables, including gender, comorbidities, BMI, TNM staging, and smoking status. Over a median follow‐up of 29.7 months, Kaplan‐Meier survival curves did not show a statistically significant difference between all groups of PD‐L1 expression for O.S. or PFS; However, there were shorter O.S noted with CPS 1%–9%, log‐rank p‐value = 0.031. These findings support investigating the role of Immunotherapy, especially in the high expression subgroup. Data for these patients' outcomes and further studies to explore the role of PD‐L1 in NPC are needed

Papillary Squamotransitional Cell Carcinoma of the Uterine Cervix: A Case Report and Review of the Literature

Introduction. Papillary squamotransitional cell carcinoma (PSTCC) is an uncommon histopathological variant of squamous cell carcinoma (SCC) of the uterine cervix, which occurs in postmenopausal women. Presentation of Case. Herein, we describe a case of a 63-year-old woman who presented with 4-month history of postmenopausal vaginal bleeding. Vaginal examination revealed a fragile lesion of size 1×1 cm invading left posterior vaginal fornice and parametrium. Biopsy showed the presence of papillae containing fibrovascular cores lined by multilayered atypical epithelial cells resembling squamous and transitional cell epithelium, confirming the diagnosis of PSTCC of the uterine cervix. After staging work-up she was staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging system 2009 as FIGO IIB, and she was started on extended field concurrent chemoradiation. Discussion. PSTCC of the uterine cervix is an extremely rare and aggressive entity. PSTCC is often characterized by the presence of papillary structures with prominent fibrovascular cores. PSTCC of the uterine cervix should be differentiated from transitional cell carcinoma, squamous papilloma, papillary adenocarcinoma, and cervical intraepithelial neoplasia with papillary features. Conclusion. PSTCC of the uterine cervix is a diagnostic challenge; further studies regarding the mechanism underlying the development of PSCC are warranted