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Choueiry R, Faddoul J, Najjar J, Ghorra C, Mansour J, Safi N, Amara J. An unusual presentation of Whipple’s disease: adenopathies, polyarthralgia and dermatomyositis-like symptoms. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Whipple’s disease (WD) is a rare systemic disease caused by gram-positive bacillus bacteria that invades multiple organs mainly the intestinal epithelium. Its manifestation is not only limited to the gastrointestinal tract but it also affects the joints, muscle and skin. This is a case of a 54-year-old male patient with a medical history of chronic arthritis presenting with bilateral progressive calves pain, anterior tibial hyperpigmentation, joints pain, anemia and weight loss. He was misdiagnosed as rheumatoid arthritis, for which he was treated by immunosuppressors for several years with no amelioration. After advanced investigations, he was found to have multiple retroperitoneal and mesenteric adenopathies, with an incidental finding of a mesojejunal mass during laparoscopy, from which the biopsies revealed the presence of histiocytosis and numerous intra-cytoplasmic particles with positive periodic acid–Schiff (PAS) suggesting the diagnosis of WD. Endoscopy was done and intestinal histology with polymerase chain reaction (PCR) test confirmed the diagnosis of WD. The patient was then treated with antibiotics (ceftriaxone and trimethoprim-sulfamethoxazole) with a remarkable clinical amelioration. To be aware of WD as a potential etiology behind malabsorption, musculoskeletal and skin abnormalities, is the first step in order to establish the diagnosis and provide adequate treatment, thus, improving the patient’s quality of life. WD is a rare, without antibiotic treatment deadly systemic infectious disease caused by the ubiquitary Gram-positive bacterium Tropheryma whipplei. This article aims to report a case marked with dermatomyositis like presentation that had a missed and delayed diagnosis.
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Affiliation(s)
- Randa Choueiry
- Internal Medicine and Clinical Immunology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon; Internal Medicine and Clinical Immunology Department, Lebanese Hospital Geitaoui, Beirut, Lebanon
| | - Joelle Faddoul
- Internal Medicine and Clinical Immunology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon; Internal Medicine and Clinical Immunology Department, Lebanese Hospital Geitaoui, Beirut, Lebanon
| | - Jacqueline Najjar
- Internal Medicine and Clinical Immunology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Claude Ghorra
- Anatomo Pathology Department, Lebanese Hospital Geitaoui, Beirut, Lebanon; Anatomo Pathology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Josiane Mansour
- Anatomo Pathology Department, Lebanese Hospital Geitaoui, Beirut, Lebanon; Anatomo Pathology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Neemtallah Safi
- Gastroenterology Department, Lebanese Hospital Geitaoui, Beirut, Lebanon
| | - Joseph Amara
- Gastroenterology Department, Lebanese Hospital Geitaoui, Beirut, Lebanon
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Choueiri R, Faddoul J, Ghorra C, Al Najjar J, Akiki BB, Boustany S, Nseir V. A case report: 19-year-old male diagnosed with C1q nephropathy requiring renal replacement therapy. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
C1q nephropathy is a rare glomerular disease. Clinical presentation is diverse and ranges from asymptomatic hematuria or proteinuria to symptoms and signs of nephrotic/nephritic syndrome. On light microscopy, it can be classified into two subtypes: minimal change disease (MCD)/focal segmental glomerulosclerosis (FSGS) group and immune complex mediated proliferative glomerulonephritis group. A case of a 19-year-old male patient presenting nausea and decreased appetite will be reported. The labs showed severe nephrotic syndrome and a progressive kidney injury over a few months that were never diagnosed. The immune workup came back negative. The patient mentioned that he was taking protein shakes a few months earlier for bettering his physical fitness. A renal biopsy was done and showed a major reduction in renal mass and C1q nephropathy. He received steroids without any improvement. He was started on hemodialysis afterward then got transplanted 8 months later. In front of this rapid deterioration, FSGS might be the underlying etiology rather than MCD. Further studies are warranted to establish a connection between protein supplements, and progression of kidney disease.
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Affiliation(s)
- Randa Choueiri
- Department of Internal Medicine, Lebanese University, Beirut 0000, Lebanon; Department of Internal Medicine, Lebanese Hospital Geitaoui, Beirut 0001, Lebanon
| | - Joelle Faddoul
- Department of Internal Medicine, Lebanese University, Beirut 0000, Lebanon; Department of Internal Medicine, Lebanese Hospital Geitaoui, Beirut 0001, Lebanon
| | - Claude Ghorra
- Department of Pathology, Lebanese University, Beirut 0000, Lebanon; Department of Pathology, Lebanese Hospital Geitaoui, Beirut 0001, Lebanon
| | - Jaqueline Al Najjar
- Department of Internal Medicine, Lebanese University, Beirut 0000, Lebanon; Department of Internal Medicine, Lebanese Hospital Geitaoui, Beirut 0001, Lebanon
| | - Beatrice-Blondine Akiki
- Department of Pathology, Lebanese University, Beirut 0000, Lebanon; Department of Pathology, Lebanese Hospital Geitaoui, Beirut 0001, Lebanon
| | - Sora Boustany
- Department of Nephrology, Lebanese University, Beirut 0000, Lebanon
| | - Vanessa Nseir
- Department of Nephrology, Lebanese Hospital Geitaoui, Beirut 0001, Lebanon
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Kansoun A, Chamma L, Sadek M, Maerevoet M, Ghorra C, Abboud AA, Alam H. Intestinal presentation of non-Hodgkin lymphoma: Case report. Int J Surg Case Rep 2021; 86:106346. [PMID: 34454215 PMCID: PMC8405975 DOI: 10.1016/j.ijscr.2021.106346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background MEITL (monomorphic epitheliotropic intestinal T-cell lymphoma) is a rare primary intestinal T-cell lymphoma associated with high mortality rate. Being intestinal this implies difficult diagnostic workup and management. Case We present a case of 59-year-old male presented with abdominal pain and found to have 15 × 11 cm mass in the right iliac fossa. Decision for surgical excision was retained and the Pathological examination determined monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) with CD30 positive immune-histochemical profile. Conclusion MEITL is a rare entity which retains challenging diagnosis and management as well as variable immune-histochemical profile. In the absence of clear guidelines for the management of intestinal manifestation of lymphoma, surgical approach may have its indications. Intestinal manifestation of lymphoma is a rare entity. This report highlights the surgical indication in establishing the diagnosis and the management. MEITL may present with variable immune-histochemical profile being CD30 positive.
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Affiliation(s)
- Alaa Kansoun
- Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Beirut, Lebanon.
| | - Linda Chamma
- Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Beirut, Lebanon
| | - Maroun Sadek
- Lebanese University, Faculty of Medical Sciences, Department of Hematology and Oncology, Beirut, Lebanon
| | - Marie Maerevoet
- Department of Hematology, Institute of Bordet, Universite Libre de Bruxelles, Bruxelles, Belgium.
| | - Claude Ghorra
- Lebanese University, Faculty of Medical Sciences, Department of Pathology, Beirut, Lebanon
| | - Antoine Abi Abboud
- Lebanese University, Faculty of Medical Sciences, Department of Gastro-enterology, Beirut, Lebanon
| | - Houssam Alam
- Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Beirut, Lebanon
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Manhal W, Yared G, Tahtouh R, Hilal G, Ghorra C, Lutomski D, Changotade S, Senni K, Younes R. Poor Biointegration of Porcine Acellular Dermal Matrix Associated with Unfavorable Gingival Healing: A Report of Three Cases. J Contemp Dent Pract 2021; 22:951-958. [PMID: 34753851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM The aim of the present work was to explain the poor biointegration of acellular dermal xenogeneic matrix, leading to an unfavorable gingival healing following a grafting procedure for the treatment of soft tissue deficiencies. BACKGROUND Numerous works have demonstrated the successful use of acellular dermal matrix (ADM) in soft tissue augmentation procedures. However, spare human investigations reported adverse healing outcomes at microscopic level. CASE DESCRIPTION Three patients showing various soft tissue deficiencies (recession, gingival thickening) requiring a gingival augmentation were grafted using an ADM porcine acellular dermal matrices (pADM) as a soft tissue substitute. For this purpose, appropriate soft tissue augmentation surgeries were performed and the grafted pADM was left for proper healing. Biopsies were harvested from two out of the three patients, respectively, at 11 and 27 weeks in order to conduct a histological evaluation of the pADM's doubtful biointegration. Moreover, the ultrastructural analysis of pADM was performed using scanning electron microscopy, and additional histological procedures were used to assess its ability to support human gingival fibroblast cultures. Signs of gingival inflammation persisted several months postoperatively. Histologically, numerous inflammatory cells characterized the grafted site. Indeed, the high number of foreign body giant cell granulomas and the very densified newly formed collagen fibers highlighted a fibrotic process within gingival connective tissue. The ultrastructural and histological analysis showed that pADM was characterized by very thick and dense collagen bundles demonstrating a nonphysiological collagen network organization. Cell culture experiments showed fibroblasts proliferating on the matrix surface, sparing its deeper part, even though the collagen matrix degradation seemed to occur following a gradient from the pADM surface inward. CONCLUSION The unfavorable clinical results may be caused by the poor colonization of matrix cells and poor angiogenesis leading to the inadequate biointegration of pADM. Hence, the pADM structure in terms of porosity and degradability should be further investigated. CLINICAL SIGNIFICANCE The present cases highlighted a poor integration of pADM following soft tissue grafting procedures, which was caused by the inadequate ultrastructure of the used pADM. Therefore, despite the utility of such tissue substitutes, their manufacturing improvement could be required to obtain a better biointegration.
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Affiliation(s)
- Wassim Manhal
- Faculty of Dental Medicine, Division of Oral Biology, Craniofacial Research Laboratory, Saint Joseph University of Beirut, Beirut, Lebanon, e-mail:
| | - Ghassan Yared
- Faculty of Dental Medicine, Division of Oral Biology, Craniofacial Research Laboratory, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Roula Tahtouh
- Faculty of Medicine, Cancer and Metabolism Laboratory, Saint Joseph University, Beirut, Lebanon
| | - George Hilal
- Faculty of Medicine, Cancer and Metabolism Laboratory, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Pathology Department, Geitawi Hospital, Beirut, Lebanon
| | - Didier Lutomski
- Unité de Recherche Biomatériaux Innovants et Interfaces, Université Sorbonne Paris Nord, Bobigny, Paris, France; Université de Paris, Montrouge, Paris, France
| | - Sylvie Changotade
- Unité de Recherche Biomatériaux Innovants et Interfaces, Université Sorbonne Paris Nord, Bobigny, Paris, France; Université de Paris, Montrouge, Paris, France
| | - Karim Senni
- Ecole de Biologie Industrielle, Laboratoire EBInnov, Cergy, Paris, France
| | - Ronald Younes
- Faculty of Dental Medicine, Craniofacial Research Laboratory, Saint Joseph University of Beirut, Beirut, Lebanon
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Siblani D, Kanj M, Ghorra C, Haddad Y, Jomaa M, Mansour Z. A liposarcoma arising in a pulmonary hamartoma, coexisting with benign metastasizing leiomyoma. Ann Thorac Surg 2021; 113:e203-e205. [PMID: 34081980 DOI: 10.1016/j.athoracsur.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
Pulmonary hamartoma is a common benign tumor that rarely degenerates into malignancy. We document a unique case of pulmonary hamartoma with malignant transformation into well differentiated liposarcoma, coexisting in proximity to pulmonary nodules representing benign metastasizing leiomyoma in a sixty-year-old lady.
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Affiliation(s)
- Dima Siblani
- Department of Pulmonary medicine, Lebanese Geitaoui University Medical Centre, Beirut, Lebanon
| | - Mouhammad Kanj
- Department of Cardiothoracic Surgery, Lebanese Geitaoui University Medical Centre, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Lebanese Geitaoui University Medical Centre, Beirut, Lebanon
| | - Youssef Haddad
- Department of Pulmonary medicine, Lebanese Geitaoui University Medical Centre, Beirut, Lebanon
| | - Mohammad Jomaa
- Department of Cardiothoracic Surgery, Lebanese Geitaoui University Medical Centre, Beirut, Lebanon
| | - Ziad Mansour
- Department of Cardiothoracic Surgery, Lebanese Geitaoui University Medical Centre, Beirut, Lebanon.
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Eid R, Hage S, Antonios I, Moussa R, Khoury M, Haddad FG, Kourie HR, Kesrouani C, Ghorra C, Abadjian G, Kattan J. Epidemiologic and histologic characteristics of CNS lesions: a 20-year experience of a tertiary center in Lebanon. CNS Oncol 2020; 9:CNS55. [PMID: 32603607 PMCID: PMC7341156 DOI: 10.2217/cns-2020-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: Report the epidemiologic and histologic characteristics of CNS lesions in the Lebanese population. Methods: We conducted a retrospective study evaluating 2025 CNS lesions diagnosed between 1998 and 2017 in the pathology laboratory of a Lebanese tertiary center. Results: 52.2% of patients were men with a median age of 50 years. The most frequent symptoms were epilepsy (22.5%), headache (20.6%) and motor impairment (19.9%). 90.7% of tumors were primary. Lung (35.6%) and breast (16.5%) were the most frequent primaries of metastases. 46.2% of primary CNS tumors were glial, predominantly astrocytic (56.4%), and (42.5%) were nonglial, predominantly meningeal tumors (58%). Conclusion: Compared with Western literature, the Lebanese population is characterized by a younger age of onset of brain tumors, a lower rate of meningiomas and a higher rate of gliomas.
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Affiliation(s)
- Roland Eid
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Stephanie Hage
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ingrid Antonios
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rita Moussa
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Makram Khoury
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fady Ghassan Haddad
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Carole Kesrouani
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gerard Abadjian
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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7
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El Naderi S, Abou-Jaoude R, Rassy M, Nasreddine H, Rassy E, Ghorra C. ALK gene rearrangement status in non-squamous non-small cell lung carcinoma in the Middle Eastern population. Gulf J Oncolog 2020; 1:38-44. [PMID: 32342917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Worldwide, the frequency of ALK rearrangement ranges between 3-6%, however its prevalence in the Middle Eastern population has not been reported. The aim of this study is to determine the frequency of the ALK rearrangement, as well as the clinico-pathologic characteristics of Lebanese patients with ALK-rearranged lung adenocarcinoma. METHODS 152 patients diagnosed with non-squamous non-small cell lung carcinomas (NSCLC), at Hôtel-Dieu de France University Hospital between February 2014 and July 2016, were included in the study. ALK gene rearrangement expression was screened by immunohistochemistry (IHC) (D5F3 Clone). Positive cases were then sent for confirmation with Fluorescence in situ hybridization (FISH) technique. RESULTS On immunohistochemistry, patients were distributed as following: score 0: n=108, score 1+: n=26, score 2+: n= 9, score 3+: n= 9. ALK gene rearrangement was detected in 6 out of 18 (2+ and 3+ score) tested patients by FISH technique. The presence of ALK rearrangement was significantly associated with the female gender (n=6, p=0.003) and with non-smoking status (n=4, p=0.0.18). CONCLUSION This study confirms that the prevalence of the ALK gene rearrangement in the Middle Eastern region is within the worldwide ranges and is almost exclusive to patients with adenocarcinoma subtype and tends to occur more frequently in women and non-smokers.
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Affiliation(s)
- Samah El Naderi
- Department of Pathology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rosy Abou-Jaoude
- Department of Pathology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marc Rassy
- Department of Pathology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hussein Nasreddine
- Department of Pathology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elie Rassy
- Department of Hematology and Oncology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Eid R, Hage S, Antonios I, Moussa R, Khoury M, Haddad F, Kourie HR, Kesrouani C, Ghorra C, Abadjian G, Kattan JG. Epidemiologic and histologic characteristics of central nervous system lesions: A 20-year experience of a single institution in Lebanon. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13544 Background: Lesions of the central nervous system (CNS) are a heterogeneous group of tumoral and non-tumoral lesions, benign or malignant, primary or metastatic. The overall incidence rate of all brain tumors is estimated to be 10.82 per 100 000 person-years. There is no data in Lebanon characterizing the CNS lesions. The aim of our study is to report the epidemiologic and histologic characteristics of these lesions in a Lebanese tertiary center. Methods: This is a retrospective study evaluating the characteristics of the CNS lesions diagnosed in 20 years (from January 1998 to June 2017) in the pathology laboratory of Hôtel Dieu de France, Saint Joseph University hospital of Beirut, Lebanon. The data were extracted from the computerized records of the laboratory. Different variables were evaluated, from the samples types and epidemiologic characteristics, to the revealing symptoms and the histologic subtypes. Statistical analysis was performed using SPSS 24.0. Results: 2025 tumoral lesions over 20 years were interpreted. 25.4% of the samples were obtained by biopsy, 65% by surgical resection, 3.7% were cerebral spinal fluid and 5.9% were undetermined. 52.2% of the patients were men and 47.8% were women with a median age of 50 years, from 0 to 89 years. The most frequent revealing symptoms were epilepsy (22.5%), headache (20.6%) and motor impairment (19.9%). 90.7% of the CNS tumors were primary and 9.3% were metastatic. Lung (35.6%) and breast (16.5 %) were the two most frequent primaries of the metastatic lesions. 46.2% of primary CNS tumors were glial, 42.5% non-glial, 3.5% mixed neuroglial and 6.4% mesenchymal. The two most frequent glial tumors were astrocytic (56.4%) and oligodendroglial (17.9%) tumors, while the most frequent non-glial tumors were meningeal tumors (58%) and cranial nerve and paraspinal tumors (16.3%). Conclusions: The histological and epidemiological characteristics of brain tumors in Lebanon are consistent in many features with what is known in the literature, but the Lebanese population differs by a younger age of onset, a lower rate of meningiomas, and a higher rate of gliomas.
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Affiliation(s)
- Roland Eid
- Saint Joseph University, Beirut, Lebanon
| | | | | | - Rita Moussa
- Universite Saint-Joseph de Beyrouth, Beirut, Lebanon
| | - Makram Khoury
- Universite Saint-Joseph de Beyrouth, Beirut, Lebanon
| | - Fady Haddad
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | | | | | - Claude Ghorra
- Universite Saint-Joseph de Beyrouth, Beirut, Lebanon
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9
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Richa T, Ghorra C, Melkane AE. Unusual Presentation of Merkel Cell Carcinoma. Ear Nose Throat J 2019; 99:200-202. [PMID: 30974990 DOI: 10.1177/0145561319838884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tony Richa
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Antoine E Melkane
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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10
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Slim R, Assaf A, Ghorra C, Yaghi C, Sayegh R, Honein K, Noun R. Esophageal Abrikossoff tumor. Indian J Gastroenterol 2018; 37:569-570. [PMID: 30617470 DOI: 10.1007/s12664-018-0924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/03/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Rita Slim
- Gastroenterology Department, Hotel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon.
| | - Antoine Assaf
- Gastroenterology Department, Hotel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Claude Ghorra
- Pathology Department, Hotel-Dieu de France Hospital, Saint Joseph University ofBeirut, Beirut, Lebanon
| | - Cesar Yaghi
- Gastroenterology Department, Hotel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Raymond Sayegh
- Gastroenterology Department, Hotel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Khalil Honein
- Gastroenterology Department, Hotel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Roger Noun
- Surgery Department, Hotel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
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11
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Nehmeh WA, Rassy M, Ghorra C, Abdayem P, Tohmé C. Sporadic colon cancer in Lebanon: A clinicopathological study. Gulf J Oncolog 2018; 1:60-63. [PMID: 30145553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 06/08/2023]
Abstract
Colon cancer is a heavy public health burden. No data has been previously published on colon cancer epidemiology in Lebanon. The objective of this study was to report the clinical and pathological features of surgically operated colon cancer. From July 2005 to July 2012, 187 sporadic colonic tumors were operated in Hotel-Dieu de France Hospital (Beirut, Lebanon). Demographic, clinical, pathological and staging data was collected. The male: female sex ratio was 1.3 and the mean age at diagnosis was 66.0 years. Most tumors occurred at the right colon (54.0%). Histologically, conventional adenocarcinoma had the biggest proportion (88.2%), followed by mucinous adenocarcinoma (9.1%). Most cases operated belonged to stages II, III or IV, leaving only 8.0% of the cases in stage I. Some characteristics were similar to western countries like the predominance of right tumors while others were similar to developing countries like the sex ratio and the high proportion of stage IV tumors at diagnosis. This study reports for the first time in the middle-eastern populations a clinico-pathological analysis of surgically operated colon cancer.
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Affiliation(s)
- William A Nehmeh
- General Surgery Department, Hotel Dieu de France University Hospital, Beirut, Lebanon
- Saint Joseph University Faculty of Medicine, Beirut, Lebanon
| | - Marc Rassy
- Pathology Department, Hotel Dieu de France University Hospital, Beirut, Lebanon
- Saint Joseph University Faculty of Medicine, Beirut, Lebanon
| | - Claude Ghorra
- Pathology Department, Hotel Dieu de France University Hospital, Beirut, Lebanon
- Saint Joseph University Faculty of Medicine, Beirut, Lebanon
| | - Pamel Abdayem
- Oncology Department, Hotel Dieu de France University Hospital, Beirut, Lebanon
- Saint Joseph University Faculty of Medicine, Beirut, Lebanon
| | - Cyril Tohmé
- General Surgery Department, 2Pathology Department, 3Oncology Department, Hotel Dieu de France
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12
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Rassy M, Kesrouani C, Kourie H, Kattan J, Ghorra C. Impact of the new World Health Organization classification concept of neuroendocrine tumors. MINERVA CHIR 2017; 73:116-118. [PMID: 29154515 DOI: 10.23736/s0026-4733.17.07473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marc Rassy
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon -
| | - Carole Kesrouani
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Kourie
- Department of Hematology and Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Hematology and Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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13
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Khoueir N, Mhawej R, Ghorra C, Haddad A. Giant cell granuloma: Report of a rare location in the hard palate and review of the literature. Acta Oto-Laryngologica Case Reports 2017. [DOI: 10.1080/23772484.2017.1303331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Nadim Khoueir
- Department of Otolaryngology – Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Rachad Mhawej
- Department of Otolaryngology – Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Amine Haddad
- Department of Otolaryngology – Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Kourie HR, Rassy M, Ghorra C, Naderi S, Kattan J. Histologic Distribution of Pulmonary Tumors in Lebanon: A 5-Year Single Institution Experience. Asian Pac J Cancer Prev 2016; 16:5899-902. [PMID: 26320469 DOI: 10.7314/apjcp.2015.16.14.5899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the current histologic distribution of lung cancer in Lebanon to the worldwide trends, according to the 2004 WHO Classification. MATERIALS AND METHODS 1,760 patients with a pulmonary pathology examination at Hotel-Dieu de France University Hospital between July 2009 and July 2014 were included. RESULTS Some 676 out of the total investigated patients (38.4%) had a lung tumor. In 665 (98.4%) the tumors were malignant, with a mean age at diagnosis of 63.8 years and a male/female (M/F) sex ratio of 1.7:1. Among the malignant tumors, 86.2% were epithelial tumors with a mean age at diagnosis of 64.8 years and an M/F sex ratio of 1.9. Other malignant tumors consisted of metastatic tumors (10.2%), lymphoproliferative tumors (2.1%) and mesenchymal tumors (1.5%). Most common carcinoma subtypes were adenocarcinoma (48.0%), squamous cell carcinoma (23.0%) and small cell carcinoma (13.3%). Carcinoid tumors were the only carcinoma subtype with an M/F sex ratio below 1 (0.7). Salivary gland tumors were the carcinoma with lowest mean age at diagnosis (45.5 years). CONCLUSIONS The histologic distribution of lung tumors in Lebanon is similar to that in developed countries. We believe this resemblance is due to common smoking habits, known to be responsible for the increase of lung adenocarcinoma at the expense of other subtypes.
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Affiliation(s)
- Hampig Raphael Kourie
- Hematology-Oncology Department, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon E-mail :
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Farah C, Ghorra C, Nassif C, Tabchy B, Haddad A. PAROTID TUMORS: IS SURGERY ALWAYS THE ONLY WAY? ACTA ACUST UNITED AC 2016; 63:179-84. [PMID: 26821399 DOI: 10.12816/0017964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM OF THE STUDY To analyze the characteristics and management of parotid tumors in a tertiary care center. STUDY DESIGN Retrospective cohort study. METHODS All cases of parotid tumors (or masses) in our department between Jan 1, 1999 and December 31st, 2012 were studied. Demographic data, clinical characteristics, histopathology and management were analyzed. We also evaluated the diagnostic value of fine needle aspiration cytology (FNAC) in our center. RESULTS Of the 216 parotid tumors, 164 underwent parotidectomy and 52 were not managed surgically; 73.1% had a benign tumor (36.6% had Warthin's tumor) and 16.7% had a malignant one. In our center, FNAC was found to have a sensitivity for reporting malignancy of 71.4% and a specificity to rule in malignancy of 100%. CONCLUSION In our series, Warthin's tumor was the most frequent mass probably related to the high tobacco use. The prevalence of malignant tumors was relatively high in our series. Primary malignant tumors and pleomorphic adenomas should always be treated surgically, however, lymphomas, metastatic and benign inflammatory masses and cases of Warthin's tumors could be managed nonsurgically.
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Kourie HR, Ghorra C, Rassy M, Kesserouani C, Kattan J. Digestive Neuroendocrine Tumor Distribution and Characteristics According to the 2010 WHO Classification: a Single Institution Experience in Lebanon. Asian Pac J Cancer Prev 2016; 17:2679-2681. [PMID: 27268650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NEN) are relatively rare tumors, not equally distributed in the gastrointestinal system. In 2010, a revised version of the WHO classification of GEP-NENs was published. This study reports for the first time the distribution and characteristics of GEP-NENs in a Lebanese population. MATERIALS AND METHODS This descriptive retrospective study concerns all the digestive neuroendocrine tumors with their characteristics diagnosed in Hotel Dieu de France in Beirut, Lebanon from 2001 to 2012, all the pathology reports being reanalyzed according to the latest WHO 2010 classification. The characteristics and features of GEP-NEN analyzed in this study were age, gender, grade and site. RESULTS A total of 89 GEP-NENs were diagnosed, representing 28.2% of all neuroendocrine tumors. The mean age of GEP-NEN patients was 58.7 years and the M/F sex ratio was 1.2. The primary localization was as follows: 21.3%(19) pancreatic, 18% (16) gastric, 15.7% (14) duodenal, 11.2% (10) appendix, 10.1% (9) intestinal, 10.1% (9) colorectal (7.9% colonic and 2.2% rectal), 5.6% (4) hepatic, 2.2% (2) ampulla, 1.1% (1) esophageal and 7.9%(5) NOS digestive (metastatic with unknown primary). Of the 89 patients with GEP-NEN, 56.2% (50) were diagnosed as grade I, 11.2% (10) as grade II, 20.2% (18) as grade III and 12.4% (11) were considered as mixed adeno-neuroendocrine carcinomas (MANEC). CONCLUSIONS This study, one of the rare examples based on the 2010 WHO classification of neuroendocrine tumors in the literature, indicates that in the Lebanese population, all duodenal and appendicular tumors are G1 and the majority of MANEC tumors are gastric and pancreatic tumors. Moreover, more duodenal tumors and fewer rectal tumors were encountered in our study compared to European reports.
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Affiliation(s)
- Hampig Raphael Kourie
- Hematology-Oncology Department, Faculty of medicine, Saint Joseph University, Beirut, Lebanon E-mail :
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Kattan J, Eid R, Kourie HR, Farhat F, Ghosn M, Ghorra C, Tomb R. Mesotheliomas in Lebanon: Witnessing a Change in Epidemiology. Asian Pac J Cancer Prev 2016; 17:4169-4173. [PMID: 27644679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Mesotheliomas are relatively rare tumors in Lebanon. The only previous study goes back to 14 years ago, when we published epidemiological characteristics of mesotheliomas in Lebanon, showing that the pleural location accounted for the vast majority of cases, with clear evidence of asbestos exposure from the Eternit factory of Chekka region. The objective of this current study was to estimate the incidence of mesothelioma in the past decade and to identify its epidemiological, clinical and therapeutic characteristics, making comparisons with our first study published in 2001. MATERIALS AND METHODS Between 2002 and 2014, patients diagnosed with malignant mesothelioma at Hotel-Dieu de France University Hospital were investigated. Epidemiological data focusing on asbestos exposure history were collected from medical records and interviews with the families. RESULTS A total of 26 patients were diagnosed with mesothelioma, 21 of which were successfully investigated. The mean age of these 21 patients is 62.5 (19-82). Only 3 (14.29%) are women. 18 (85.71%) were smokers. Among the 21 available mesotheliomas, 15 (71.4%) are pleural, while 5 (23.8%) are peritoneal and 1 (4.8%) pericardial. Only 60% of patients with pleural mesothelioma and 50% of those with an obvious exposure to asbestos lived and/or worked in Chekka region. The mean time of asbestos exposure in patients with mesothelioma is 24.5 (1-50) years and the mean latency is 37.4 (4-61) years. Of the 21 patients, 10 (47.6%) underwent surgery during their treatment, 16 (76.2%) received chemotherapy and 3 (14.3%) received best supportive care. CONCLUSIONS Compared to the previous study (1991-2000), substantial changes in the epidemiology of mesothelioma in Lebanon were observed, such as an increase in peritoneal localizations and a lower correlation with Chekka region asbestos contamination.
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Affiliation(s)
- Joseph Kattan
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon E-mail :
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Kesrouani C, Ghorra C, Rassy M, Kourie HR, Kattan J. Distribution and Characteristics of Pulmonary Neuroendocrine Tumors: Single Institution Experience in Lebanon. Asian Pac J Cancer Prev 2016; 17:2579-2581. [PMID: 27268633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Neuroendocrine tumors represent 20% of primary lung neoplasms in some registries. According to the WHO classification of 2004, reconsidered for 2015, these lung tumors are divided into 4 groups: typical and atypical carcinoid, small cell and large cell neuroendocrine carcinomas. We report in this paper, for the first time in Lebanon, the distribution and the population characteristics of these tumors. MATERIALS AND METHODS This descriptive retrospective study concerned all the pulmonary neuroendocrine tumors (NET) with their characteristics diagnosed in Hotel Dieu de France in Beirut, Lebanon from 2001 to 2012, with attention to features like age, gender and subgroup. RESULTS Of 194 patients with pulmonary NET, 12.4% were typical carcinoid tumors, 3.6% atypical carcinoid, 66.5% small cell lung cancer, 7.7% combined small cell carcinomas and 9.8% large cell neuroendocrine tumors. The mean ages of patients were respectively 51.2 years in typical carcinoid, 64 years in atypical carcinoid, 64.2 years in small cell lung cancers, 67.2 in combined small cell lung cancer and 66.9 in large cells neuroendocrine tumors. The M/F sex ratios were respectively 0.3, 1.3, 1.4, 2.7 and 2.2. CONCLUSIONS The characteristics of lung neuroendocrine tumors in our Lebanese institution are comparable to those reported in the literature.
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Affiliation(s)
- Carole Kesrouani
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon E-mail :
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Abstract
An 82-year-old man, with known chronic renal failure and a creatinine clearance (CrCl) of 18 mL/min, was diagnosed with low-grade marginal zone non-Hodgkinlymphoma (NHL) of his right orbit. He received rituximab as single treatment (375 mg/m 2 every 3 weeks). After eight cycles, almost complete response was obtained, rituximab was extremely well-tolerated, and his creatinine levels remained stable throughout the whole treatment.
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Affiliation(s)
| | | | - Joseph Kattan
- Department of Hematology - Oncology, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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Naderi S, Ghorra C, Haddad F, Kourie HR, Rassy M, El Karak F, Ghosn M, Abadjian G, Kattan J. EGFR mutation status in Middle Eastern patients with non-squamous non-small cell lung carcinoma: A single institution experience. Cancer Epidemiol 2015; 39:1099-102. [PMID: 26362141 DOI: 10.1016/j.canep.2015.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/01/2015] [Accepted: 08/27/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) represents an important molecular target in the treatment of lung adenocarcinomas; many anti-EGFR therapies are approved as first line and second-line treatment in patients having metastatic lung adenocarcinomas. The occurrence of this mutation varies in terms of race; it is around 10% in Caucasians and can reach 30% in Asians. Its prevalence in our Middle Eastern region is not well known. METHODS Patients diagnosed with non-squamous non-small cell lung carcinomas between March 2013 and March 2015 were included. This study was conducted at Hôtel-Dieu de France University Hospital, a tertiary medical center in Lebanon. EFGR mutations were analyzed using real time PCR technique on the Rotor-Gene Q using Scorpions and ARMS technologies. The following data was collected: the patients' characteristics (age, gender, smoking status, stage), the samples' characteristics (histology subtype, TTF-1 and Napsin A immunostainings, the site and the adequacy and the type of the sample), and the mutational EGFR status (presence and type of mutation). These variables were analyzed using SPSS 20. RESULTS 201 patients were included. The mean age was 65.2 years [31-87]; 40.2% were females. 78.1% of the included patients were smokers or ex-smokers. 12.9% of patients had a localized disease, 17.4% a locally advanced disease and 69.7% a metastatic disease. Adenocarcinoma was the main histologic subtype found in 90.5% of patients, followed by large cell carcinoma (3.5%), adenosquamous carcinoma (3.0%) and non-small cell carcinoma not otherwise specified (3.0%). 11.9% of patients had an EGFR mutation: 48% of them presented a deletion on exon 19, 40.0% a L858R mutation on exon 21, 4.0% a G719X mutation in exon 18, 4.0% an insertion in exon 20, and 4% a T790M mutation in exon 20. The presence of an EGFR mutation was significantly associated with the female gender (two-third) (p<0.05) and the non-smoking status (two-third) (p<0.05). CONCLUSIONS The prevalence of EGFR mutation (11.9%) detected in our Lebanese population is similar to that observed in the Caucasian population. This mutation is also significantly more frequent in females and non-smokers.
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Affiliation(s)
- Samah Naderi
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fady Haddad
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marc Rassy
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Fadi El Karak
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marwan Ghosn
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gérard Abadjian
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Daher P, Riachy E, Khoury A, Raffoul L, Ghorra C, Rehayem C. Growing teratoma syndrome: first case report in a 4-year-old girl. J Pediatr Adolesc Gynecol 2015; 28:e5-e7. [PMID: 25256881 DOI: 10.1016/j.jpag.2014.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/14/2014] [Accepted: 03/18/2014] [Indexed: 12/31/2022]
Abstract
Growing teratoma syndrome (GTS) consists of germ cell tumors that grow following chemotherapy despite complete eradication of the malignant cells. They can metastasize to any site, particularly the retroperitoneum, mediastinum and cervical region. It typically affects young adults and adolescents. Here we describe the youngest case reported in a 4-year-old girl with an ovarian mixed germ cell tumor who underwent an oophorectomy. Her tumor markers normalized by the end of her chemotherapeutic treatment; however, she developed a retroperitoneal mass that was subsequently resected. Histopathology revealed a mature teratoma, consisting of a GTS. We stress the need for early recognition and treatment of GTS to avoid the subsequent morbidity and mortality associated with it. Although GTS has an excellent prognosis when completely resected, it is essential that the patient be regularly followed-up with serum tumor markers and imaging.
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Affiliation(s)
- Paul Daher
- Department of Pediatric Surgery, Hotel-Dieu de France University Hospital, Beirut, Lebanon
| | - Edward Riachy
- Department of Pediatric Surgery, Hotel-Dieu de France University Hospital, Beirut, Lebanon.
| | - Antoine Khoury
- Department of Pediatric Surgery, Hotel-Dieu de France University Hospital, Beirut, Lebanon
| | - Lara Raffoul
- Department of Pediatric Surgery, Hotel-Dieu de France University Hospital, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Hotel-Dieu de France University Hospital, Beirut, Lebanon
| | - Caline Rehayem
- Department of Pathology, Hotel-Dieu de France University Hospital, Beirut, Lebanon
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22
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Younes J, Ghorra C, Abadjian G, Sidaoui J, Abboud B. Differentiated thyroid carcinoma in early adulthood patients. Acta Chir Belg 2014; 114:388-392. [PMID: 26021683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND This paper reviews the clinico-pathologic features and outcomes of differentiated thyroid -carcinoma in early adulthood patients. STUDY DESIGN Retrospective study. MATERIAL From january 2000 to december 2012, 71 patients aged between 20 and 44 years who underwent thyroidectomy for differentiated thyroid carcinoma were included. The following parameters were recorded : age, gender, pre-operative symptoms and diagnosis, thyroid hormonal status, substernal extension, operative details, preoperative and postoperative calcium and phosphorous values, perioperative complications, length of hospital stay, final histology, survival and disease progression. RESULTS There were 59 females (83%) and 12 males with a median age of 29 years (20-44 years). None had a previous neck irradiation. Total thyroidectomy was performed on 65 patients (92%). There were 66 papillary (93%) and 5 follicular carcinomas. Extrathyroidal invasion and lymph node involvement were present in 44% and 37% of cases respectively. Transient hypocalcemia and dysphonia occurred in 15% and 4 % of cases respectively. Permanent hypocalcemia and vocal cord paralysis occurred in 1% and 0% of cases respectively. Adjuvant radioactive I(131) therapy was given to 50 patients. There were 7 cases (10%) of lymph node recurrences but no disease-related deaths. The only statistical differences between this group and all ages group were the extracapsular invasion (44% vs 20% p = 0,0014) and lymph node metastasis (37% vs 18% p = 0,0091). CONCLUSIONS Differentiated thyroid carcinoma has a good prognosis in early adulthood patients. Although death from this condition is rare, recurrence is frequent and long term follow up is mandatory.
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Affiliation(s)
- J Younes
- Department of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Otrock ZK, Saab J, Aftimos G, Nasr F, Farhat FS, Khairallah S, Abadjian G, Ghosn M, Sidani H, Ibrahim A, Tawil A, Ghorra C, Meguerian Z, Mokaddem W, Dayeh W, Salem Z, Chahine G, Bitar N, Mugharbel A, Makdessi J, Khater C, El Hajj M, Abi Gerges D, Sfeir C, Kattan J, Ibrahim K, Saade M, Sadek H, Mahfouz RA, Kharfan-Dabaja MA, Zaatari G, Bazarbachi A. A collaborative nationwide lymphoma study in Lebanon: incidence of various subtypes and analysis of associations with viruses. Pathol Oncol Res 2013; 19:715-22. [PMID: 23653112 DOI: 10.1007/s12253-013-9634-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/02/2013] [Indexed: 12/29/2022]
Abstract
Incidence of various Hodgkin (HL) and non-Hodgkin lymphoma (NHL) subtypes and association with viruses in Lebanon are not known. We undertook a nationwide study of 272 patients diagnosed with lymphoma in 2007. HL comprised 32.7 % (n = 89) of cases while NHL represented 67.3 % (n = 183). Consistent with the literature, nodular sclerosis was the most predominant HL subtype (n = 57/89). Among NHL, B-cell NHL represented 88 % (n = 161/183), T-cell NHL 9 % (n = 17/183), whereas in 2.7 % it was not classifiable. The B-cell NHL comprised predominantly diffuse large B-cell lymphoma (46 %) and follicular lymphoma (23 %). 81 cases were reviewed by a panel of pathologists with 87.6 % concordance rate. Serology was negative for hepatitis C in 122 tested cases. HIV was positive in 2 cases. Two adult T-cell leukemia/lymphoma were HTLV-I positive. EBV IgG were positive in 88.5 % of cases. 38 EBV seropositive cases [27 NHL (24 B-cell, 3 T-cell) and 11 HL] were studied for EBV genome expression using EBV-encoded RNA (EBER)-in situ hybridization. EBER expression was positive in 8 (21 %) cases (6 HL, 2 T-cell NHL). The distribution of lymphoma subtypes in Lebanon appears similar to that of Western countries. The high rate of EBV positivity in HL and T-cell lymphoma by EBER deserves further investigation.
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Affiliation(s)
- Zaher K Otrock
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
BACKGROUND Many studies have reported that drainage after thyroidectomy does not decrease the rate of local postoperative complications. We sought to review the safety of thyroidectomy combined with cervical neck dissection (CND) without drainage. METHODS The medical records of consecutive patients who underwent thyroidectomy without drainage were retrospectively reviewed. Two groups were defined depending on whether CND was or was not performed. The main outcome was identification of patients with cervical bleeding, hematoma or seroma. RESULTS We included 1127 patients (139 who had CND and 988 who did not). Of these, 207 patients (18%) had transient postoperative hypocalcemia, 9 (0.8%) had permanent postoperative hypoparathyroidism, 56 (5%) had transient postoperative hoarseness and 7 (0.6%) had permanent vocal cord paralysis. A total of 44 patients (4%) experienced postoperative hematoma and/or seroma: 8 patients (6%) who had CND and 36 (4%) who did not. There was no major bleeding in the 2 groups; all patients had minor bleeding or seroma not requiring surgical intervention. The postoperative stay in hospital for both groups was 1 day in 92% of patients. Wound infection occurred in 0.8% of all patients: 1 (0.7%) who had CND and 8 (0.8%) who did not. There was no significant difference between the groups in overall perioperative complications or in time of hospital discharge. CONCLUSION Thyroidectomy without drains is safe and effective, even in combination with CND.
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Affiliation(s)
- Bassam Abboud
- Department of General Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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25
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Abstract
This study aims to review the safety of thyroidectomy combined with cervical neck dissection without drainage in well-differentiated thyroid carcinoma (WDTC). The medical records of consecutive patients who underwent thyroidectomy without drainage for WDTC were retrospectively reviewed. Group 1 included 123 patients who underwent thyroidectomy with central neck dissection and Group 2 included 46 patients who underwent thyroidectomy with central and lateral neck dissection. One hundred twenty-seven patients underwent thyroidectomy without neck dissection and were included in Group 3. Overall, 16 patients (5%) developed postoperative hematoma and/or seroma, seven patients (6%) in the Group 1, three patients (7%) in the Group 2, and six patients (5%) in Group 3. All patients had minor bleeding or seroma not requiring surgical intervention. Overall, 68 patients (23%) had transient postoperative hypocalcaemia, and four patients(l%) had permanent hypoparathyroidism. Seventeen patients (6%) had transient postoperative hoarseness and three had permanent vocal cord paralysis (0.6%). The postoperative stay for all groups was 1 day in 91 per cent of the cases. Patients from Groups 1 and 2 had no increased perioperative local complications or length of stay as compared with Group 3. Cervical neck dissection and thyroidectomy without drains is safe and effective in the treatment of WDTC.
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Affiliation(s)
- Bassam Abboud
- Departments of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Departments of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Jenny Tannoury
- Departments of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ronald Daher
- Departments of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Gerard Abadjian
- Departments of Pathology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Departments of Pathology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Abboud B, Sleilaty G, Tannoury J, Daher R, Abadjian G, Ghorra C. Cervical neck dissection without drains in well-differentiated thyroid carcinoma. Am Surg 2011; 77:1624-1628. [PMID: 22273220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study aims to review the safety of thyroidectomy combined with cervical neck dissection without drainage in well-differentiated thyroid carcinoma (WDTC). The medical records of consecutive patients who underwent thyroidectomy without drainage for WDTC were retrospectively reviewed. Group 1 included 123 patients who underwent thyroidectomy with central neck dissection and Group 2 included 46 patients who underwent thyroidectomy with central and lateral neck dissection. One hundred twenty-seven patients underwent thyroidectomy without neck dissection and were included in Group 3. Overall, 16 patients (5%) developed postoperative hematoma and/or seroma, seven patients (6%) in the Group 1, three patients (7%) in the Group 2, and six patients (5%) in Group 3. All patients had minor bleeding or seroma not requiring surgical intervention. Overall, 68 patients (23%) had transient postoperative hypocalcaemia, and four patients(1%) had permanent hypoparathyroidism. Seventeen patients (6%) had transient postoperative hoarseness and three had permanent vocal cord paralysis (0.6%). The postoperative stay for all groups was 1 day in 91 per cent of the cases. Patients from Groups 1 and 2 had no increased perioperative local complications or length of stay as compared with Group 3. Cervical neck dissection and thyroidectomy without drains is safe and effective in the treatment of WDTC.
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Affiliation(s)
- Bassam Abboud
- Department of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
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Affiliation(s)
- Bassam Abboud
- Hotel-Dieu de France Hospital Saint Joseph University Beirut, Lebanon
| | - Thierry Yazbeck
- Hotel-Dieu de France Hospital Saint Joseph University Beirut, Lebanon
| | - Ronald Daher
- Hotel-Dieu de France Hospital Saint Joseph University Beirut, Lebanon
| | - Georges Chahine
- Hotel-Dieu de France Hospital Saint Joseph University Beirut, Lebanon
| | - Claude Ghorra
- Hotel-Dieu de France Hospital Saint Joseph University Beirut, Lebanon
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Abboud B, Yazbeck T, Daher R, Chahine G, Ghorra C. Papillary thyroid carcinoma after chemotherapy for Hodgkin's disease. Am Surg 2010; 76:1316-1317. [PMID: 21140714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Haddad F, Jammal M, Azar H, Mallat S, Nasr F, Dabar G, Ghorra C. Amylose systémique découverte par une atteinte trachéobronchique. Rev Med Interne 2010; 31:e4-6. [DOI: 10.1016/j.revmed.2009.03.353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 03/08/2009] [Accepted: 03/18/2009] [Indexed: 10/19/2022]
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Abstract
Therapeutic attitudes for papillary thyroid microcarcinoma (PTMC) range from observation alone to aggressive management. Clinicopathologic features, therapeutic options, and follow-up results are described in a series of PTMC revealed by cervical adenopathies. Twelve patients were enrolled in this retrospective study. They were all treated by total/near-total thyroidectomy with dissection of suspect cervical lymph nodes followed by radioactive iodine (RAI) and suppressive L-thyroxine therapies. Mean age at diagnosis was 32 years with a mean elapsed time to diagnosis of 45.3 months. Fine needle aspiration cytology and excisional biopsy of the lymph node led to a diagnosis in all cases. Cervical mass was ipsilateral to primary tumor in six patients (50%). Multifocality, bilaterality, and capsular invasion were encountered in 66.7, 66.7, and 41.7 per cent of patients, respectively. Lymph node involvement was bilateral in seven patients (58.3%) of whom thyroid foci were unilateral in two. No complications of thyroidectomy were encountered. At 60-month-follow up, no recurrence or metastasis was noted. PTMC revealed by cervical lymph node metastasis shows aggressive clinicopathologic features. They must be considered as papillary thyroid cancers and managed by total/near-total thyroidectomy with bilateral lymph node exploration followed by RAI therapy and suppressive L-thyroxine doses.
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Affiliation(s)
- Bassam Abboud
- Departments of General Surgery and Saint-Joseph University, Beirut, Lebanon
| | - Ronald Daher
- Departments of General Surgery and Saint-Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Departments of General Surgery and Saint-Joseph University, Beirut, Lebanon
| | - Gerard Abadjian
- Departments of Pathology, Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Departments of Pathology, Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Abboud B, Daher R, Sleilaty G, Abadjian G, Ghorra C. Are papillary microcarcinomas of the thyroid gland revealed by cervical adenopathy more aggressive? Am Surg 2010; 76:306-311. [PMID: 20349662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Therapeutic attitudes for papillary thyroid microcarcinoma (PTMC) range from observation alone to aggressive management. Clinicopathologic features, therapeutic options, and follow-up results are described in a series of PTMC revealed by cervical adenopathies. Twelve patients were enrolled in this retrospective study. They were all treated by total/near-total thyroidectomy with dissection of suspect cervical lymph nodes followed by radioactive iodine (RAI) and suppressive L-thyroxine therapies. Mean age at diagnosis was 32 years with a mean elapsed time to diagnosis of 45.3 months. Fine needle aspiration cytology and excisional biopsy of the lymph node led to a diagnosis in all cases. Cervical mass was ipsilateral to primary tumor in six patients (50%). Multifocality, bilaterality, and capsular invasion were encountered in 66.7, 66.7, and 41.7 per cent of patients, respectively. Lymph node involvement was bilateral in seven patients (58.3%) of whom thyroid foci were unilateral in two. No complications of thyroidectomy were encountered. At 60-month-follow up, no recurrence or metastasis was noted. PTMC revealed by cervical lymph node metastasis shows aggressive clinicopathologic features. They must be considered as papillary thyroid cancers and managed by total/near-total thyroidectomy with bilateral lymph node exploration followed by RAI therapy and suppressive L-thyroxine doses.
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Affiliation(s)
- Bassam Abboud
- Department of General Surgery, Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
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Azoury F, Nasr E, Nehme Nasr D, Tabchy B, Ghorra C, Fares G, Haddad A. Radiothérapie des T1 glottiques : résultats fonctionnels et satisfaction des patients. Cancer Radiother 2009. [DOI: 10.1016/j.canrad.2009.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Younes R, Ghorra C, Khalife S, Igondjo-Tchen-Changotade S, Yousfi M, Willig C, Senni K, Godeau G, Naaman N. Pertinent cell population to characterize periodontal disease. Tissue Cell 2009; 41:141-50. [DOI: 10.1016/j.tice.2008.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 09/26/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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Younes R, Yousfi M, Ghorra C, Khalife S, Igondjo-Tchen-Changotade S, Willig C, Senni K, Charpiot P, Naaman N, Godeau G. The defensive role of lysozyme in human gingiva in inflammatory periodontal disease. J Periodontal Res 2008; 44:578-87. [PMID: 18752566 DOI: 10.1111/j.1600-0765.2008.01148.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The presence of lysozyme in human gingiva has not previously been demonstrated. In this study, we looked for evidence for the potential role of lysozyme as a protector of gingival elastic fibres. The objective of this study was also to determine the ex vivo susceptibility to hydrolysis of gingival elastic fibres from patients with or without periodontal disease by human leukocyte elastase and by human cathepsin G. MATERIALS AND METHODS Using gingival tissue sections from eight control, 10 gingivitis and 10 periodontitis patients, we evaluated the area fraction occupied by gingival elastic fibres (after selective staining) by the use of automated image analysis. In the ex vivo experiments, serial tissue sections from four control, four gingivitis, four young periodontitis and four aged periodontitis patients were submitted to the action of human leukocyte elastase and cathepsin G, after which enzymatic activities were determined by image analysis. Indirect immunodetection of lysozyme was also done on tissue sections for all patients included in this study. RESULTS Large variations of the area fraction occupied by elastic fibres were observed in human gingiva from young and aged patients with and without periodontal disease. In control and gingivitis patients, leukocyte elastase and cathepsin G had high comparable elastin solubilizing activities. With young and aged periodontitis patients, the two serine proteinases had weak elastin solubilizing activities. Lysozyme appeared to be present at the periphery of gingival elastic fibres in periodontitis patients. CONCLUSION Lysozyme can be considered an important natural protector of elastic fibres in pathological gingiva.
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Affiliation(s)
- R Younes
- Faculty of Dental Medicine, St Joseph University, Beirut, Lebanon.
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Noun R, Riachy E, Ghorra C, Yazbeck T, Tohme C, Abboud B, Naderi S, Chalhoub V, Ayoub E, Yazbeck P. The impact of obesity on surgical outcome after pancreaticoduodenectomy. JOP 2008; 9:468-476. [PMID: 18648138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CONTEXT The effect of obesity on surgical outcome is becoming an increasingly relevant issue given the growing rate of obesity worldwide. OBJECTIVE To investigate the specific impact of obesity on pancreaticoduodenectomy. DESIGN A retrospective comparative study of a prospectively maintained database was carried out to investigate the specific impact of obesity on the technical aspects and postoperative outcome of pancreaticoduodenectomy. PATIENTS Between 1999 and 2006, 92 consecutive patients underwent pancreaticoduodenectomy using a standardized technique. The study population was subdivided according to the presence or absence of obesity. RESULTS Nineteen (20.7%) patients were obese and 73 (79.3%) patients were non-obese. The two groups were comparable in terms of demographics, American Society of Anesthesiology (ASA) score as well as nature and type of pancreatico-digestive anastomosis. The rate of clinically relevant pancreatic fistula (36.8% vs. 15.1%; P=0.050) and hospital stay (23.1+/-13.9 vs. 17.0+/-8.0 days; P=0.015) were significantly increased in obese vs. non-obese patients, respectively. Pancreatic fistula was responsible for one-half of the deaths (2/4) and two ruptured pseudoaneurysms. The incidence of the other procedure-related and general postoperative complications were not significantly different between the two groups. Intrapancreatic fat was increased in 10 obese patients (52.6%) and correlated positively both with BMI (P=0.001) and with the occurrence of pancreatic fistula (P=0.003). CONCLUSION Obese patients are at increased risk for developing pancreatic fistula after pancreaticoduodenectomy. Special surgical caution as well as vigilant postoperative monitoring are therefore recommended in obese patients.
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Affiliation(s)
- Roger Noun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon.
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Tohmé C, Ata T, Ghorra C, Noun R, Abboud B, Sarkis R. [Retroperitoneal cystic lymphangiomas in adults: four case reports and review of the literature]. J Med Liban 2008; 56:42-45. [PMID: 19534090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Retroperitoneal location of cystic lymphangiomas in adult patients is rare. Their clinical presentation is not specific. Magnetic resonance imaging is the best radiological exam for the diagnosis. These tumors must be distinguished from mesenteric cysts which are more frequent and can degenerate. The authors report four cases of retroperitoneal cystic lymphangioma with a literature review.
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Affiliation(s)
- Cyril Tohmé
- Service de Chirurgie générale, CHU Hôtel-Dieu de France, Université Saint-Joseph, Beyrouth, Liban.
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Abboud B, Sleilaty G, Braidy C, Ghorra C, Abadjian G, Tohme C, Noun R, Sarkis R. Enlarged parathyroid glands discovered in normocalcemic patients during thyroid surgery. Am J Surg 2008; 195:30-3. [DOI: 10.1016/j.amjsurg.2007.01.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Revised: 07/15/2007] [Accepted: 01/31/2007] [Indexed: 10/22/2022]
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Abboud B, Aouad R, Jaoude JB, Ghorra C. [A rare cause of acute abdomen: jejunal diverticulitis]. Presse Med 2007; 37:416-9. [PMID: 18031981 DOI: 10.1016/j.lpm.2007.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 04/17/2007] [Accepted: 05/06/2007] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Jejunal diverticulitis is a rare cause of acute abdomen and is diagnosed preoperatively only infrequently. CASE A 34-year-old man presented with a history of increasing nonradiating epigastric and left upper abdominal pain and with fever, constipation, nausea and vomiting. His white blood cell count was 18,300/mm(3). Liver function tests and pancreatic enzymes were in the normal range. An abdominal CT scan showed jejunal diverticulitis and bubble gases in the extraluminal space. Perineal irritation led to an emergency midline laparotomy, which discovered diverticulitis of the jejunum at 50 cm from the Treitz ligament, resected the jejunum and performed end-to-end anastomosis. The pathology examination confirmed the diagnosis. DISCUSSION Because the clinical presentation of complicated jejunal diverticulitis is generally nonspecific, diagnosis is very difficult. CT scan is a reliable diagnostic tool. Surgery, including resection of the diseased bowel portion with direct anastomosis, is the treatment generally reported for small intestinal diverticulitis complicated by hemorrhage, obstruction, or perforation. Some authors report using medical treatment only for diverticulitis.
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Affiliation(s)
- Bassam Abboud
- Département de chirurgie générale, Hôpital Hôtel-Dieu de France, Faculté de médecine, Université Saint-Joseph, LB-16-6830 Beyrouth, Liban.
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Boujaoude J, Samaha E, Honein K, Noun R, Abboud B, Ghorra C, Sayegh R. A benign cause of obstructive jaundice with von Hippel-Lindau disease. A case report and review of the literature. JOP 2007; 8:790-794. [PMID: 17993732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
CONTEXT Von Hippel-Lindau disease is a genetic disorder characterized by neoplasms with multiple organ involvement, the pancreas being involved in about half of the cases. Conservative treatment is indicated because the disease is usually asymptomatic with long-term follow-up. CASE REPORT We herein present the case of a 64-year-old man with von Hippel-Lindau disease who presented with obstructive jaundice which resulted as being caused by a fibro-cystic pancreatic nodule. In addition, we reviewed the literature concerning pancreatic involvement in von Hippel-Lindau disease with emphasis on their presentation, type of lesions and appropriate management, especially in cases with obstructive jaundice. CONCLUSION Conservative management is advocated in the majority of VHL disease patients with pancreatic involvement, but surgery is sometimes required, especially when patients are symptomatic (obstructive jaundice, upper gastrointestinal bleed).
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Affiliation(s)
- Joseph Boujaoude
- Department of Gastroenterology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
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Abboud B, Sleilaty G, Braidy C, Zeineddine S, Ghorra C, Abadjian G, Tabchy B. Careful Examination of Thyroid Specimen Intraoperatively to Reduce Incidence of Inadvertent Parathyroidectomy During Thyroid Surgery. ACTA ACUST UNITED AC 2007; 133:1105-10. [DOI: 10.1001/archotol.133.11.1105] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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41
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Noun R, Zeidan S, Ghorra C, Slaba S, Menassa-Moussa L, Sayegh R. Jaundice in a chronic hepatitis B carrier. Gut 2007; 56:1409, 1425. [PMID: 17872570 PMCID: PMC2000233 DOI: 10.1136/gut.2006.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- R Noun
- Saint Joseph University of Beirut, Department of Digestive Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
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Abboud B, Sleilaty G, Ayoub S, Hachem K, Smayra T, Ghorra C, Abadjian G. Intrathyroid Parathyroid Adenoma in Primary Hyperparathyroidism: Can It Be Predicted Preoperatively? World J Surg 2007; 31:817-23. [PMID: 17354026 DOI: 10.1007/s00268-006-0767-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The role of cervical ultrasonography (US)-guided surgery for intrathyroid parathyroid adenoma in primary hyperparathyroidism is rarely reported. The aim of this study was to elucidate the role of cervical US in identifying this entity. METHODS From 1996 to 2003, cervical explorations were performed in 178 patients (mean age 57 years) with primary hyperparathyroidism. High-resolution cervical US was performed in all of the patients. Patients' characteristics were reviewed to identify predictive factors for intrathyroid adenoma. RESULTS Cervical US identified abnormal parathyroid glands in 163 of 178 patients, with a positive predictive value (PPV) of 100%. Six patients (3.4%) were found to have intrathyroid parathyroid adenomas (two in the superior parathyroid and four in the inferior parathyroid). Cervical US predicted this anomaly in four of six patients (67%) in whom the thyroid gland was not nodular and allowed total enucleation of the adenoma to be performed in three and subtotal thyroid loboisthmectomy in three; these operations were performed uneventfully and rapidly. The PPV in this anomaly was 80%. Thirteen patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at the time of the last clinic visit, with follow-up varying from 12 to 96 months. On multivariable analysis, no factor predicted intrathyroid localization of parathyroid adenoma. CONCLUSIONS The PPV of high-resolution cervical US for identifying an abnormal parathyroid gland was 100% in this series. It was 80% for predicting intrathyroid localization of the adenoma. This method allows us to shorten the operating time by guiding the exploration immediately toward the thyroid gland.
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Affiliation(s)
- Bassam Abboud
- Department of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Alfred Naccache Street, Beirut, Lebanon.
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Noun R, Zeidan S, Ghorra C, Tohme-Noun C. Malignant masquerade of the biliary confluence. Gut 2007; 56:379. [PMID: 17339247 PMCID: PMC1856810 DOI: 10.1136/gut.2006.095398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- R Noun
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Achrafieh, Beirut, Lebanon
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Boujaoude J, Honein K, Hobeika E, Ghorra C, Ghorra P, Hobeika E. When does severe diarrhoea disclose a hereditary disease? Gut 2007; 56:342. [PMID: 17339243 PMCID: PMC1856794 DOI: 10.1136/gut.2006.093468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- J Boujaoude
- Department of Gastroenterology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
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Affiliation(s)
- Bassam Abboud
- Department of General Surgery, Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Alfred Naccache Street, 16-6830 Beirut, Lebanon.
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Badoual C, Maruani A, Ghorra C, Lebas P, Avigdor S, Michenet P. Pathological prognostic factors of invasive breast carcinoma in ultrasound-guided large core biopsies—correlation with subsequent surgical excisions. Breast 2005; 14:22-7. [PMID: 15695077 DOI: 10.1016/j.breast.2004.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Revised: 07/06/2004] [Accepted: 07/28/2004] [Indexed: 11/15/2022] Open
Abstract
Core biopsy is currently used as the initial diagnostic procedure in breast cancer. Prognostic information is required before decisions on subsequent therapy are possible. The aim of this study was to compare prognostic data observed in ultrasound-guided core biopsies and in surgical specimens. We conducted a retrospective study of a mean of 1.2 biopsies from a total of 110 consecutive malignant breast masses. Histological tumour type and grade, presence of a ductal carcinoma in situ (DCIS) component and hormonal status were evaluated. Our results showed excellent sensitivity (100%) of core biopsy for the diagnosis of breast cancer and for the assessment of tumour type (concordance of 73.6%). We also reached a reasonable level of agreement between core biopsy and surgical excision specimens for histological grading (73.1%). Underestimation of grading on core biopsy was due predominantly to underscoring of mitotic counts (32.3%). The presence of DCIS associated with infiltrative carcinomas was widely underestimated in biopsy specimens. There were good levels of agreement for oestrogen receptors and for progesterone receptors: 90.3% and 89.3%, respectively. Diagnoses were made on the basis of a small number of ultrasound-guided core biopsy specimens taken from breast masses. Grade and hormonal status were reliably evaluated.
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Affiliation(s)
- C Badoual
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital de La Source, CHR d'Orléans, BP 6709, 45067 Orléans Cedex 2, France.
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47
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Ghorra C, Nemr E, Vieillefond A. [Difficulties of the new classification system for bladder cancer]. J Med Liban 2002; 50:180-3. [PMID: 15298479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Bladder cancer is a public health problem because of its increasing incidence. The histological grade being an important prognostic parameter in evaluating mainly superficial, non-infiltrative, urothelial tumors, it is of great interest to define a reproducible classification that can be made available to oncologists, urologists and family doctors as well. New classifications have been recently proposed. They will be discussed here. It will be argued that the current classification is still valid and should be maintained.
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Affiliation(s)
- Claude Ghorra
- Laboratoire d'anatomie et cytologie pathologique, Hôpital Saint-Joseph, Dora, Beyrouth, Liban.
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48
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Caulet S, Capron F, Ghorra C, Brechot JM, Lebeau B, Diebold J. Flow cytometric DNA analysis of 20 bronchopulmonary neuroendocrine tumours. Eur Respir J 1993. [DOI: 10.1183/09031936.93.06010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deoxyribonucleic acid (DNA) content of bronchopulmonary neuroendocrine tumours was measured by flow cytometry in order to investigate correlations between ploidy, S-phase fraction (SPF) and two histological classifications (World Health Organization (WHO), Warren and Gould), and clinical staging. A paraffin-embedded technique was used on 20 surgical specimens. Cases comprised (according to the classification of Warren and Gould) 7 carcinoids, 3 well-differentiated neuroendocrine carcinomas (WDNC), 6 intermediate neuroendocrine carcinomas (INC), and 4 small cell neuroendocrine carcinomas (SCNC). DNA aneuploidy was demonstrated in 3 out of 7 of the carcinoids, 3 out of 9 of the WDNCs and INCs, and 2 out of 4 of the SCNCs. A variable SPF was found in each group, except for the SCNCs which showed a constantly high SPF. In our small series, no correlation was noted between high SPF or aneuploidy and metastases. In conclusion, we observed no diagnostic value of malignancy for DNA aneuploidy. The SCNC group appeared to be an homogeneous group according to the SPF compared to the small cell carcinoma (SCC) group of the WHO classification. This and the prognostic incidence of high SPF need to be further studied.
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Caulet S, Capron F, Ghorra C, Brechot JM, Lebeau B, Diebold J. Flow cytometric DNA analysis of 20 bronchopulmonary neuroendocrine tumours. Eur Respir J 1993; 6:83-9. [PMID: 8425599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Deoxyribonucleic acid (DNA) content of bronchopulmonary neuroendocrine tumours was measured by flow cytometry in order to investigate correlations between ploidy, S-phase fraction (SPF) and two histological classifications (World Health Organization (WHO), Warren and Gould), and clinical staging. A paraffin-embedded technique was used on 20 surgical specimens. Cases comprised (according to the classification of Warren and Gould) 7 carcinoids, 3 well-differentiated neuroendocrine carcinomas (WDNC), 6 intermediate neuroendocrine carcinomas (INC), and 4 small cell neuroendocrine carcinomas (SCNC). DNA aneuploidy was demonstrated in 3 out of 7 of the carcinoids, 3 out of 9 of the WDNCs and INCs, and 2 out of 4 of the SCNCs. A variable SPF was found in each group, except for the SCNCs which showed a constantly high SPF. In our small series, no correlation was noted between high SPF or aneuploidy and metastases. In conclusion, we observed no diagnostic value of malignancy for DNA aneuploidy. The SCNC group appeared to be an homogeneous group according to the SPF compared to the small cell carcinoma (SCC) group of the WHO classification. This and the prognostic incidence of high SPF need to be further studied.
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Affiliation(s)
- S Caulet
- Dept of Pathology Jacques Delarue, Hotel-Dieu, Paris, France
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