Al-Kindy College Medical Journal

Background: Ambulatory peritoneal dialysis
introduced by Popvich et al (13) in 1978 , consists of a
four to five hours lavage of peritoneal cavity with 2000
ml of glucose solution .It remains a useful method for
treating patients with end stage renal failure till renal
transplantation becomes possible.
Objectives: The aim of the study is to evaluate the
value of cytological changes of mesothelial cells in
dialysate patients.
Methods: Within one year period, 32 cytological
peritoneal fluid samples were collected from patients
with end stage renal failure regardless of the underlying
causes, admitted to the dialyzing unit in Kadimya
Teaching Hospital. Smears were prepared and fixed in
95 % ethyl alcohol and then stained with H & E stain to
be interpreted by the same pathologist.
Results: Thirty two samples of peritoneal fluid were
obtained from patients in peritoneal dialysis with a
mean age of 54.8 years and male to female ratio of
about 1.9: 1.
Twenty two had short term dialysis were compared with
10 patients with long term dialysis.
Gross examination of the samples revealed clear yellow
fluid. Macroscopical examination showed no evidence
of inflammatory cells with increased exfoliation,
cellularity and three dimensional mesothelial cellular
clustering pattern with increased nuclear size. No
statistical significances were found in the changes seen
in cytological smears between both groups but
remarkable nuclear changes were shown in both of
them.
Conclusion: This study demonstrated that peritoneal
dialysis of any duration can induce significant atypical
changes in mesothelial cells. The pathologist needs to
be aware of these changes and to include peritoneal
dialysis in the list of other benign conditions that cause
reactive mesothelial atypia

Background: It is well known that mycotic antigens have an important
role in atopy and the induction of asthma. Now one of the important
subjects is the relation between respiratory bacterial and viral
infections in the inflammatory reactions accompanied with bronchial
asthma viruses Bacteria or their metabolites act as trigger for asthma
or increase it's intensity .
Objectives: To show the relation between asthma and some viral
infections serologically.
Methods: Direct ELISA test was employed to detect lgG specific for
Respiratory Syncytial virus (Rsv) parainfluenza virus type (p13) and
influenza virus in sera of (100) asthmatic patients of two age groups.
(10-17) and(18-50) years old. Serum samples from(32) intact control
individuals of the same age groups were also investigated.
Results: significant mean values of lgG specific for parainfluenza type-3
and Respiratory Syncytial viruse were found incontrast to normal
control individuals. Non significant values of lgG specific for influenza
virus were detected in asthmatics in contrast to control normal
individuals.
Conclusion: Respiratory Syncytial virus appears to be a prominent cause
of concomitant infections in asthmatic children and some adults as
well as parainfluenza virus type-3 within age group ( 10-17) years old
asthmatics so RSV and p1-3 viruses may be contributers to asthma
severity in asthmatic patients.

Background: Dyslipidemia is a major cause of
cardiovascular disease, which in turn, is the most
common cause of female morbidity and mortality.
Postmenopausal women (natural and surgical) are at
higher risk of developing cardiovascular disease,
especially coronary artery atherosclerosis.
Objective: To observe the relationship between blood
lipids: total cholesterol (TC), high density lipoproteincholesterol (HDL-C), low density lipoproteincholesterol (LDL-C), triglycerides (TGs), and very low
density lipoprotein- cholesterol (VLDL-C), LDL-C/
HDL-C ratio (atherogenic index) and menopausal
status, and to determine the co-factors that may explain
this relationship
Methods: A prospective, cross-sectional study, which
includes 279 women, age range from 35-55 years
agreed to participate in this study. They were divided
into 4 groups according to their menopausal status.
These were pre-, peri post- natural and surgical postmenopausal. Data were collected from participants in a
pre-coded questionnaire and an overnight fasting blood
sample was collected for biochemical analysis.
Results: Postmenopausal women had higher levels of
lipids than pre or peri-menopausal. TC concentration
and LDL-cholesterol levels were higher in natural and
surgical menopause than in pre and pri-menopausal
women (p<0.01 and p<0.05 respectively). While
LDL/HDL-C ratio (atherogenic index) were higher in
the surgical postmenopausal women than in premenopausal group (p<0.05). No significant inter-group
differences were found in HDL-C. Triglycerides, and
VLDL levels were higher in surgical menopause group
than in both pre- and peri-menopause groups (p<0.05).
No significant differences were demonstrated in pre-,
peri-, and natural menopausal women with regard to
triglyceride and VLDL levels and LDL/HDL-C ratio.
Conclusion : Dyslipidemia is more frequent among
women with natural and surgical menopause groups
than in the other groups. This makes those women
more susceptible to CVD. Certain co factors appear to
have direct associations with lipid levels in each group
and those were discussed.

Background: left ventricular hypertrophy is independent risk factor for cardiovascular morbidity and mortality. The presence of diabetic complications such as autonomic neuropathy and retinopathy may predict cardiac structural changes in diabetic patients. Objective: To explore the chance of occurrence of left ventricular hypertrophy in diabetic patients and whether it is related to the presence of other diabetic complications. Methods: ninty seven (97) normotensive diabetic patients (57) type II with mean duration of diabetes of (12±6 y) and forty (40) type I with mean duration of (8±6 y) were studied by echocardiography and compared with 41 patients as control. Results: The LVMI was significantly higher in type II diabetics compared to control (102±31 vs. 67±16 p< 0.001), although LVMI was higher in type I compared to controls but it was statistically non significant (76.7±18 vs. 76 ±16 P < 0.25). The increased in LVMI was correlated with long duration of diabetes > 15 years in type I but not in type II (p<0.001), retinopathy (34.5% vs. 4.8 p< 0.001), sings and symptoms of autonomic dysfunction (32.7% vs. 10.4% p=0.008) and (38.2% vs. 12.7%p=0.004) respectively. After adjustment for duration of diabetes, age, gender and the type of diabetes, the LVMI was only significantly correlated with long duration of diabetes (>10y). Conclusion: LV mass index was higher in diabetic patient mainly in type II, more prevalent with long duration of diabetes and if there are other diabetic complications

Background: Bloody diarrhea plays a major role in
morbidity and mortality especially in developing
countries, it is usually a sign of invasive enteric
infection, there is a thought that amoebic dysentery is
more common than bacillary dysentery in Iraq, and
from 1989 to 1997 amoebic dysentery increase from
20000to 550000 patients.
Objectives: This study aims to:
1. Outline the incidence of various infectious causes of
bloody diarrhea in Erbil district.
2. Assess the effect of multiple factors like age, sex,
source of water supply, etc... On the incidence of
amebic and bacillary dysentery.
3. To provide baseline data for making strategic plan to
reduce the diarrhoeal mortality and morbidity.
Methods: A prospective case- series study was
conducted on 116 infants and children aged 2 month –
12 years admitted to hospital complaining of bloody
diarrhea. Information was taken from their mothers
regarding (age, sex, geographical area, feeding pattern
and source of water supply) , their stool have been
examined for the presence of RBC, leukocyte, parasitic
cyst and trophozoit, however blood examination was
conducted for the presence of band.
Results: The results reveal 77.5% of patients were in the
younger age group (<2 year). Entamoeba histolytica was
the most common enteropathogen isolated in 60.3% of
patients, other enteropathogens identified were Shigella
3.5%, E.coli2.6%, Salmonella2.6%, mixed infection
were reported in 1.72%, 28.5%of patients have non
isolated pathogen.
On the other hand, source of water supply and type of
feeding have significant effect on incidence of
enteropathogens. The presence of fever, vomiting,
convulsion and band in peripheral blood mostly
indicates bacterial etiology.
Conclusion: Entamoeba histolytica was the commonest
enteropathogen isolated; the incidence of bloody
diarrhea was more in younger age group. There was
significant effect of source of water supply on the
incidence of bloody diarrhea with most enteropathogen
isolated from patients who have well water supply.
Breastfeeding was protective against enteropathogen
especially bacterial agents in infants under 6 month of
age. Presence of band in the peripheral blood indicates
most probably bacterial agents

Back ground: AIDS is considered a dreaded disease.
According to recent estimates, 42 million people suffer
from HIV/AIDS (90% of these being in the developing
countries), with 5 million people newly infected with HIV
and 3.1 million deaths in the year 2002 globally. At
present, there is no effective vaccine to prevent the
disease. Hence, Health education (Information, Education
and Communication) activities bringing about behavioral
changes in the community, promoting healthy sexual
behavior and preventing the risky ones is the best possible
solution to the problem of AIDS.
Objectives: To find out the knowledge, beliefs and
attitudes regarding various aspects of HIV/AIDS amongst
intermediate and secondary school teachers in Baghdad.
Methods: For this cross-sectional study, we randomly
selected 48 intermediate and secondary schools covering
the 6 educational directorates in Baghdad, and 642
teachers serving in these schools were selected to answer
the questionnaire containing different statements
concerning basic knowledge of the human
immunodeficiency virus (HIV) and Acquired
Immune Deficiency Syndrome (AIDS).
Results: Revealed an intermediate overall awareness
about HIV/AIDS.
Conclusions: Study highlights the need for teaching the
proper aspects of HIV/AIDS curriculum in Iraqi schools.

Background: Ruptured uterus is a catastrophic event to both
mother and her fetus. Apart from maternal and fetal mortality
rates, the incidence of rupture of uterus is often taken as an
index of the standard of obstetric care.
Objective: To determine the frequency, causes, management
outcome of ruptured uterus at Al Batool maternity hospital.
Method: The study was conducted in the department of
obstetrics and gynecology at Al Batool maternity hospital
Mosul-Iraq over a period of three years from October 1st 2002
to August 30th 2005. All the cases of uterine rupture presented
during the study period were recorded and managed in the
department. Data was recorded on designed forms.
Results: Thirty nine cases of ruptured uterus out of 44539
deliveries were registered, the incidence was 0.087%. Age
ranged from 15 to45 years. The majority of the patients were
grandmultipara (Para 5 and above), but 7 of the patients were
nulliparous women (17.94%). 26 ruptures (66.66%) occurred
in unscarred uterus and 13 ruptures (33.33%) occurred in
scarred uterus, cephalopelvic disproportion and obstructed
labor were the cause of rupture in 11 cases (28.2%), in
addition to the mentioned causes 11 cases of the uterine
ruptures we registered in our study (28.2%) were mishandled
by the traditional birth attendants, and in 14 cases (35.89%)
there was injudicious use of oxytocin. We had three maternal
deaths (7.69%) out of 39 patients, and only 10 fetuses out of
39(25.64%) were alive.
Conclusion: Rupture uterus is still an important cause of
maternal and perinatal mortality and morbidity in Iraq, it is
not always suspected, and hence increased vigilance is vital.
Further studies may help in the development of preventive
strategies and ensure prompt management to reduce maternal
and perinatal mortality and morbidity

Background: The liver is one of the most common organs
injured after blunt abdominal trauma. The control of severe
hemorrhage remains a problem.
Methods: One-hundred thirty-eight patients diagnosed as
liver injury between 09/2003 and 08/2006 had been evaluated
prospectively in Al- Kindy Teaching Hospital.
A distinction was made between hemodynamically stable and
unstable patients. Different modalities of surgical procedures
were done concentrating on perihepatic gauze packing.
Results: (60 out of 138) patients included in the study were
clinically evaluated as hemodynamically stable. The average
abbreviated injury severity score (ISS) was 25. Twenty
patients underwent abdominal surgery. In 12 of them
additional liver treatment was performed. The mortality was
three, all were non-liver related.
Seventy eight patients were considered to be
hemodynamically unstable, and had an average ISS of 38. All
of them needed abdominal surgery.
Gauze packing was used as initial therapy for bleeding
control from injured liver in 34 patients of both
hemodynamically stable and unstable groups with a mortality
of 11 patients (32.7%).
Conclusion: perihepatic gauze packing is considered as a life
saving and a quick method for controlling ongoing
hemorrhage in the treatment of liver injuries before
undertaking definitive repair under controlled conditions

Background: Respiratory distress is one of the
commonest disorders within the firs 48 - 72 hours of live
and any sign of postnatal respiratory distress is an
indication for roentgenogram of the chest.
Objectives: Is to show the range of chest radiographic
findings in full term newborn babies suffering from
respiratory distress, at or soon after birth.
Method: This is a prospective study that was conducted
in the special care baby units in Baghdad teaching
hospital and Children welfare teaching hospital during
2002. Anteroposterior chest radiograph in supine
position of (129) full term newborn babies, presented
with a chief complaint of respiratory distress were
examined.
Results: The commonest cause of respiratory distress
was transient tachypnea of newborn (41.8%), most of
these showed hyperinflation (77%) and prominent
pulmonary markings (68%) .Normal chest films seen in
(16%). Pulmonary infection seen in (17.8%) of cases,
with findings of bronchopneumonia (43%), and lobar
consolidation affecting mostly the right upper lobe
(34%). Other causes were respiratory distress syndrome
(13.1%), meconium aspiration (13.1%), congenital heart
disease (9.3%). Less frequent causes were
pneumothorax, congenital lobar emphysema, congenital
diaphragmatic hernia and pleural effusion.
Conclusion: Any sign of post– natal respiratory distress
is an indication for roentgenogram of the chest which
should be taken as early as possible. In addition, chest
radiograph should be read by an expert radiologist

Background: The altered status of some essential trace elements observed in diabetes could have deleterious influences on the health of the diabetics. Objectives: To estimate and study the potential role of serum Selenium in type 1, type 2 diabetics and healthy subjects; and its relation with lipid profile and glycemic index. Methods: A case control designed study was carried out at the National Diabetes Center (NDC) / Al-Mustansiria University; on a total of 94 participants formed of 32 type 1 diabetics, 32 type 2 diabetics and 30 healthy control participants. Data collected about age, sex and BMI; also, blood samples examined for FPG, HbA1C, serum total cholesterol, HDL cholesterol, non-HDL cholesterol, serum triglyceride and sera were examined for Selenium by using atomic absorption technique. Results: Type 1 and type 2 diabetic groups show respectively 75% and 65% decrement in S. Selenium, <70 µg/L. The mean of S. Selenium, age, BMI, waist/hip ratio, FPG, HbA1c, total cholesterol, triglyceride, HDL, Non-HDL and atherogenic index (total cholesterol/HDL cholesterol) for the type 1 and type 2 diabetics shows statistically significant differences from control group. Type 1 diabetics versus type 2 diabetics shows statistically insignificant differences between mean of the S.Selenium, total cholesterol, HDL cholesterol and atherogenic index (t-test, P > 0.05) while the mean of FPG, HbA1c and triglyceride show highly statistical significant differences (t-test, < 0.001).Simple linear correlation and regression analysis of FPG, HbA1c, total cholesterol, triglyceride, HDL, Non-HDL and atherogenic index of the studied groups shows weak to moderate correlation with their serum Selenium levels. Conclusions: The inverse relationship between Selenium status and glucose tolerance suggest the potential role of Selenium in diabetics. Serum Selenium levels show high statistically significant differences from healthy subjects; while the differences between type1 and type 2 diabetic groups’ shows no statistically significant differences. Inverse correlations and regression were noticed between S.Selenium levels of all studied groups with their FPG, HbA1c, total cholesterol, triglyceride, HDL, Non-HDL and atherogenic index. Low S.Selenium and HDL-cholesterol plus an increase in total cholesterol, non-HDL and atherogenic index enhance risk of cardiovascular diseases progression among the diabetics.

Background: Pleural effusion is a common clinical
problem.
Objective: The aim of the study was to evaluate the
diagnostic utility of Carcino embryonic antigen
(CEA), CA 15- 3, and alpha-feto protein ( AFP ) as
a tumor markers in serum and pleural effusion and
evaluate the value of combining them as a diagnostic
tools that are complementary to cytology in the
diagnosis of malignancies .
Methods: Forty patients (18 malignant and 22 benign
pleural effusion) were included in this study .The
serum and effusion levels of CEA, CA 15 – 3 and
AFP were measured using immunoradiometric assay
Results: from the 40 effusions studied 26 were
exudates and 14 were transudates. The level of
pleural effusions of CEA, CA 15 – 3 and AFP were
increased above the cutoffs in 72.5%, 94.4 % and 5.5
% of tested samples with malignancies respectively.
A direct strong significant correlation between serum
and pleural fluid CEA, CA 15 – 3 and AFP was
noted.
Conclusion: Pleural effusion CEA is the most
accurate marker for the diagnostic separation of
malignant and benign. The combination of both CEA,
CA 15 – 3 improves the sensitivity by up to 11 %.
AFP has no role in the process

Back ground: Visceral leishmaniasis is endemic in the
middle and south of Iraq, it involves mostly infants. The
disease is observed mainly among rural areas that are far
from equipped medical centers. Therefore, there is a need
for anon- invasive, cost- effective, reliable, easily
available and fast method of diagnosis of this dngerous
disease.
Objective: The aim was to compare the validity and
predictive values of the recombinant K39 antigen (rK39)
test with that of the indirect fluorescent antibody test
(IFAT) test (the usual laboratory method) in the detection
of visceral leishmaniasis.
Methods: A Cross-sectional study was done in ALMansour Pediatric Hospital (in AL-Rusafa), and Central
Pediatric Hospital (in AL-Karkh) in Baghdad for 6
months duration (from the 1st of December 2004 to 30th of
May 2005). Children less than five years who suspected to
be infected with visceral leishmaniasis were selected and
investigated by IFAT test and rK39 dipstick strip.
Results: The validity of rK39 test when evaluated with
the standard methods IFAT test showed a sensitivity of
90.5%, specificity of 90.7%, predictive value positive of
77.9%, predictive value negative of 96.4% and 90.7%
accuracy.
Conclusions: The rK39 antigen strip test is valid in the
diagnosis of suspected children with visceral
leishmaniasis as the test is rapid, sensitive, and specific

Background: planter fasciitis is a common condition
seen in adults and sport men, it is characterized by dull
pain in the heel, especially when getting up and
standing on the foot in the morning or after sitting for a
long time.
Recently low level laser therapy is used as a method of
treatment.
Objective: to evaluate the benefit of laser therapy in
treatment of planter fasciitis.
Methods: Out of twenty five patients with planter
fasciitis exposed to laser therapy. Laser used is (diode
type) given in two cessions per week for four weeks,
time for each cession is about (12 minutes).
Results: complete recovery seen in (32%) of patients,
moderate improvement in (16%), mild improvement in
(24%), no response in (28%), deterioration (0%).
Conclusion: laser therapy is safe for treatment of
planter fasciitis, free of side effects, very effective as
an alternative to surgery and local steroid injection,
with no deterioration in the condition during or after
laser therapy

Background: psychiatric and behavioral side effects
are common in patients with epilepsy and it may
represent an intrinsic feature of the disease itself or a
side effect of the antiepileptic use. Our aim in the
present study is to assess the psychiatric side effects of
Sodium Valproate and Carbamazipine .as these drugs
are the most commonly used antiepileptic drugs in Iraq.
Methods: 80 patients with primary generalized
epilepsy on Carbamazipine and 50 patients on Sodium
Valproate were enrolled in the present study; all the
patients were assessed for any psychological
disturbances using semi-structural interview based on
the tenth edition of the international classification of
the diseases(ICD 10) adopted by WHO.
Results: Thirty percent of patients taking Sodium
Valproate and (9%) of patients taking Carbamazipine
were found to have depression while (16%) of patients
taking Sodium Valproate and (20 %) of patients taking
Carbamazipine were found to have anxiety. There were
no reported psychosis, suicidal attempts, cognitive
deficit and mania in both groups of patients in the
present study.
Conclusion: Carbamazipine is preferred to Sodium
Valproate when the efficacy of both drugs is
comparable.

Background: Schneiderian first rank symptoms are
considered highly valuable in the diagnosis of
schneideria.
They are more evident in the acute phase of the
disorder and fading gradually with time. Many studies
have shown that the rate of these symptoms are
variable in different countries and are colored by
cultural beliefs and values.
Objectives: To find out the rate of Schneiderian first
rank symptoms among newly diagnosed schizophrenic
patients, to assess which symptom(s) might
predominate in those patients, and to find out if there
is/are any correlation(s) between the occurrence of
these symptoms and the sex of the patients.
Methods: Out of twenty-four patients with no past
psychiatric history and whom were diagnosed as
Schizophrenia for their first time depending on
Diagnostic and Statistical Manual-4th Edition-Text
Revised criteria for diagnosis were evaluated for the
presence of Schneiderian First Rank Symptoms by
using a semi-structured interview schedule.
Results: Out of twenty -three patients (54.7%) had
present with one or more Schneiderian First Rank
Symptoms.' Third person Hallucinatory Voices",
"running Commentary Hallucinatory Voices', and "
Somatic Passivity" were present more frequently than
other symptoms.
The study revealed no sex differences in regard of the
occurrences of the Schneiderian (FRS). More than 82%
of those who had the symptoms showed more than one
symptom.
Conclusions: Many factors influence the presence or
absence of Schneiderian First Rank Symptoms among
schizophrenic patients including the criteria selected
for the diagnosis of the disorder, the tools adopted for
the detection of these symptoms, the duration of the
illness, and probably patient's cultural background.
Although there are individual differences of First Rank
Symptoms among different cultures, still we expect
certain symptoms to be present more than others. The
influence of cultural factors in altering the basic
symptoms of psychiatric illnesses is of great
importance

Background:- Cholesterol is high in ascetic fluid due
to malignancy and other causes of exudates.
Objective:-To use cholesterol as a marker to
differentiate between exudative and transudative
ascetic fluid and to compare that with other routine
parameters.
Methods:-Twenty eight patients were included in this
study 17 females with mean age of 41.9 years, 11
males with mean age of 48.2 years. The patients were
divided in group I suspected transudate, and group II
suspected exudate according to history and clinical
examination.
Ascetic fluid samples were sent for total protein,
albumin, and cholesterol measurement blood samples
were sent for serum protein and albumin measurement.
Results:-In this study ascetic fluid cholesterol was fit
with history and clinical examination to differentiate
between exudative and transudative ascetic fluid.
Cholesterol was a good marker when compared with
ascetic fluid total protein and ascetic serum protein
ratio in group I, but not in the others.
Conclusion: - cholesterol can be used as a marker for
the diagnosis of a cites cases but a large number of
patients is important for accurate results

Background: Tumors of the oral cavity are under
estimated in general dental and medical practice,
some authors describe it as the forgetting disease,
others wondering if the attention paid to this disease
compared to its fatality (The 5-year survival rate is
about 50%) is enough for disease control? However;
this disease deserves a comprehensive assessment by
all dental and medical fields assumed to examine the
oral cavity regularly, especially otolaryngologist.
Objectives: To find out the sensitivity and specificity
of clinical examination in diagnosing oral tumors and
premalignant conditions by otolaryngologist.
Methods: Across sectional retrospective study was
conducted in the:
-study design: Cross sectional.
-settings: Ear Nose Throat (ENT)departments in
Al-kindy Teaching Hospital
and Al-Yarmouk Teaching Hospital.
On Patients attending ENT department with oral
presentation.
The outcome variables includes: The sensitivity,
specificity, positive predictive value (Pv+ve), negative
predictive value (PV-ve), and the accuracy of clinical
examination in diagnosing oral tumors and
premalignant conditions in ENT clinic.
Results: The results revealed a high sensitivity and
specificity for otolaryngologist in diagnosing
malignant conditions and premalignant lesions of the
oral cavity.
Conclusion: The study highlights the need for fixed
clinical criteria for early diagnosis of premalignant
conditions and oral tumors

Myoma is a common benign uterine tumor; therefore
it is common in pregnancy. One in ten women will
have complications related to myoma in pregnancy.
Few treatment options are available during pregnancy,
conservative treatment with analgesia, reassurance and
supportive therapy is almost always adequate but in
carefully selected patients, myomectomy has been
performed successfully without jeopardizing
pregnancy outcome. The usual indications for surgery
during pregnancy include torsion of pedunculated
uterine myoma and obstructed labor, surgical
intervention during pregnancy is occasionally
necessary in uncommon cases of intractable pain.
19 years old lady presented with intractable lower
abdominal pain during pregnancy. Ultrasound showed
fetus of 18 weeks gestation and ovarian cyst. The pain
did not respond to rest and sedation, so emergency
exploration laparotomy was done; incarcerated
intramural uterine myoma was the cause of the pain, it
was enucleated successfully through myomectomy
and the pregnancy progressed normally

Fibro-adenoma is the most common lesion of the breast, it occurs in25%of asymptomatic women (1,2 )
It is usually a disease of early reproductive life, the peak incidence is between the ages15 and 35 years.(3,4) It presents as firm highly mobile, non tender mass .(5)
Less than 5% of fibro-adenomas grow rapidly and display the clinical and histologic characteristics of giant fibro-adenoma which is defined as a-tumour either having a diameter greater than 5 cm. And /or amass weighing more than 500 grams, and are conventionally a benign tumor of breast.(6)
Giant fibro-adenomas appear as well-circumscribed but not encapsulated masses on mammography and solid and the texture is homogenous and hypoechoic with low level echoes on U/S. (6, 7)
It is hormone dependent that lactates during pregnancy and involutes along with the rest of the breast in perimenopause.(5)
Excessive estrogen stimulation and /or receptor sensitivity, or lack of estrogen antagonist havebeen implicated in the etiology. (2)
Giant fibro-adenoma is often confined to one breast as a solitary mass occupying part or the whole breast and in rare cases it may be multifocal and involve both breasts. (8)
Giant fibro-adenomas are benign and do not become malignant. (9)
Histological cut surfaces have a lobulated grey-white myxoid semitransparent to dens fibrous appearance, it consist of epithelial and fibrous components, the pericanalicular fibro-adenoma maintains round and oval dilated ductal spaces whereas in the intracanalicular type the ductal lumens are compressed by polypoid fibrous stroma creating slit –like irregular spaces , the ducts are lined by two layers of cells: epithelial and myoepithelial cells and under influence of hormones the ducts become hyper plastic with papillary formation and more than two layers of cells varies from myxoid and hypo cellular to fibrous and moderately cellular . (2)
Surgical treatment of giant fibroadenoma ranges from shelling the tumour out in case it occupies part of the breast, to simple mastectomy. (10)