Gynecological cancer researches 1436 h – 2015g

2
Scientific Chair of Prof. Abdullah Hussain Basalamah
for Gynecological Cancer and Gynecology Oncology Unit
MEMBER OF
Prof. Khalid Hussain Sait
Professor and Consultant Gynecology Oncology.
King Abdulaziz University Hospital, Jeddah KSA.
Dr. Nisreen Mohammed Omer Anfinan
Assistant Professor and Consultant Gynecology Oncology.
Prof. Abdullah Hussain Basalamah
First Dean of Faculty of Medicine, King Abdulaziz University
Professor and sponsor of Scientific Chair of
Prof. Abdullah Hussain Basalamah for Gynecological Cancer.
Prof. James Bentley
Professor and Consultant Gynecology Oncology
Dalhousie University, Halifax, Canada

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Scientific Chair of Prof. Abdullah Hussain Basalamah
for Gynecological Cancer and Gynecology Oncology Unit
MEMBER OF
Dr. Hussain Abdullah Basalamah
Resident of Obstetrics and Gynecology
Hesham Khalid Sait
Medical Student
Faculty of Medicine, King Abdulaziz University, Jeddah KSA.
Dr. Bassem Salama El-Deek
Associate Professor Community Medicine,
Joint master of health profession education (JMHPE) Maastricht
KAU FOM, Medical education department.
Dr. Jawaher Ahmad Al Ahmadi
Family and Community Medicine
Dr. Faten SALAH Gazaz
Consultant in Medical Virology - Director of Virology Laboratory

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Treatment of cancer become one of the
fundamental pillars of the strategical plan in the
health sector in Saudi Arabia, represented by the
Ministry
of Health and other health sectors under the care of our government of
Saudi Arabia and the leadership of his Majesty King Salman bin
Abdulaziz Al Saud.
According to the latest statistics of Saudi Cancer registry, the number
of cancer cases has been increased over the last few years, It reached
more than 12,000 cases in 2007 in Comparison to 7,000 cases in 2005.
The female patients represent 51% of those cases.
The global development in the world over the last 10 years in the field
of gynecological cancer in addition to gestational trophoblastic
neoplasia showed imprecise development, implication of cancer and how
to contain it.
This Journal is one step further to promote awareness and education
among physicians, nurses and health care providers in Saudi Arabia and
hence more researches in the failed of gynecological Cancer.
I would like to thanks professor Abdullah Hussain Basalama for his
support in establishing this Scientific Chair of Gynecological Cancer and
many thanks for all members of the Chair for the great effort in
achieving the goals.
Prof. khalid Sait
Director of Scientific Chair of Prof. Abdullah Hussein Basalamah For
Gynecological Cancer
EDITORIAL

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In Gynecological Cancer
in Saudi Arabia 1989 – 2012
PREVIOUSLY
PUBLISHED ARTICLE

6
PREVIOUSLY PUBLISHED ARTICLE
In Gynecological Cancer in Saudi Arabia 1989-2012
Cancer. 1989 Dec 1;64(11):2309-12.
Dysgerminoma of the ovary with rhabdomyosarcoma. Report of a case.
Akhtar M
1
, Bakri Y, Rank F.
Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital, Riyadh, Saudi
Arabia.
1
Acta Obstet Gynecol Scand. 1990;69(7-8):657-8.
Carcinoma of the cervix in a pregnant woman with negative Pap smears and
colposcopic examination.
Bakri YN
1
, Akhtar M, al-Amri A.
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre,
Riyadh, Saudi Arabia.
2
3
Aust N Z J Obstet Gynaecol. 1991 Nov;31(4):327-30.
Ovarian tumours in pregnancy.
el-Yahia AR
1
, Rahman J, Rahman MS, al-Suleiman SA.
Department of Obstetrics and Gynaecology, College of Medicine and Medical Sciences, King Faisal
University, Dammam, Saudi Arabia.
Int Orthop. 1991;15(4):393-5.
Ollier's disease with secondary chondrosarcoma associated
with ovarian tumour. A case report.
Asirvatham R
1
, Rooney RJ, Watts HG.
Department of Orthopaedic Surgery, King Faisal Specialist Hospital and Research Centre,
4

7
Int J Gynaecol Obstet. 1992 Apr;37(4):289-91.
Bilateral and synchronous cervical carcinoma in situ in a didelphic
uterus.
Bakri Y
1
, Salem H, Sadi AR, Mansour M.
Department of Obstetrics and Gynaecology, King Faisal Specialist Hospital and Research Centre,
5
J Egypt Public Health Assoc. 1992;67(3-4):465-77.
An epidemiologic study of ovarian cancer. Part 1:
Reproductive and social factors.
Badawy YA
1
, Bayoumi DM.
Department of Community Medicine, Faculty of Medicine, University of Alexandria, Egypt.
6
7
Gynecol Oncol. 1992 Sep;46(3):384-90.
Vulvar sarcoma: a report of four cases.
Bakri YN
1
, Akhtar M, el-Senoussi M, Wierzbicki R.
1
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital
and Research Centre, Riyadh, Saudi Arabia.
Acta Obstet Gynecol Scand. 1992 Jan;71(1):67-8.
Gestational choriocarcinoma in a tubal ectopic pregnancy.
Bakri YN
1
, Amri A, Mulla J.
1
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and
Research Centre, Riyadh, Saudi Arabia.
8

8
Eur J Obstet Gynecol Reprod Biol. 1994 Jun 30;55(3):205-8.
Struma ovarii with pseudo-Meigs' syndrome: report of a case and
review of the literature.
Amr SS
1
, Hassan AA.
1
Dhahran Health Center, Saudi Aramco, Saudi Arabia.
9
J Reprod Med. 1994 Mar;39(3):175-8.
Pulmonary metastases of gestational trophoblastic tumor. Risk
factors for early respiratory failure.
Bakri YN
1
, Berkowitz RS, Khan J, Goldstein DP, von Sinner W, Jabbar FA.
1
King Faisal Gestational Trophoblastic
Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
10
11
J Clin Pharmacol. 1995 Oct;35(10):1003-7.
Pharmacokinetics of carboplatin in a patient with cervical cancer with ureteric
obstruction before, during, and after hemodialysis.
el-Yazigi A
1
, Alfurayh O, Amer M.
1
Department of Biological and Medical Research, King Faisal Specialist Hospital and Research Centre, Riyadh,
Saudi Arabia.
Gynecol Oncol. 1996 Jun;61(3):451-3.
Pericardial metastasis in carcinoma of the uterine cervix.
Jamshed A
1
, Khafaga Y, El-Husseiny G, Gray AJ, Manji M.
1
Oncology Department,King Faisal Specialist Hospital and Research Centre, Riyadh,
Saudi Arabia.
12

9
J Reprod Med. 1998 Jan;43(1):11-3.
Complete molar pregnancy. Clinical trends at King Fahad
Hospital, Riyadh, Kingdom of Saudi Arabia.
Felemban AA
1
, Bakri YN, Alkharif HA, Altuwaijri SM, Shalhoub J, Berkowitz RS.
1
Department of Obstetrics and Gynaecology, King Fahad Hospital, Riyadh, Kingdom of Saudi Arabia.
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Int J Radiat Oncol Biol Phys. 1998 Aug 1;42(1):91-100.
Carcinoma of the uterine cervix in Saudi Arabia: experience in the
management of 164 patients with stage-I & -II disease.
El-Senoussi M
1
, Bakri Y, Amer MH, DeVol EB.
1
Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom
of Saudi Arabia.
14
15
Pediatr Surg Int. 1998 Nov;14(1-2):62-5.
Laparoscopy for ovarian pathology in infancy and childhood.
Jawad AJ
1
, Al-Meshari A.
1
Division of Paediatric Surgery, Department of Surgery, King Khalid University Hospital,
P.O. Box 7805, Riyadh 11472, Saudi Arabia.
Scand J Urol Nephrol. 1998 Feb;32(1):73-6.
Metastatic transitional cell carcinoma of the ovary from superficial
bladder tumour.
Kardar AH
1
, Lindstedt EM, Tulbah AM, Bazarbashi SN, al Suhaibani HS.
1
Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
16

10
Ann Saudi Med. 1999 Sep-Oct;19(5):438-9.
Ovarian cancer recurrence at the laparoscopic port for cholecystectomy.
Al-Sobhi S
1
, Shirah HA, Subhi J, Amin T, Martan A, Al Deery M.
1
Departments of Surgery and Obstetrics and Gynecology, King Faisal Specialist Hospital and Research
Centre, Riyadh, Saudi Arabia.
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Acta Oncol. 1999;38(4):455-60.
Malignant ovarian germ cell tumours -- a survival and
prognostic analysis.
Ezzat A
1
, Raja M, Bakri Y, Subhi J, Memon M, Schwartz P, Stuart R.
1
Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
18
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Eur J Gynaecol Oncol. 1999;20(5-6):412-5.
Carcinoma of cervix, the King Faisal Specialist Hospital & Research Center
experience--the need for screening forcervical cancer in developing countries.
Manji MF
1
, Pradhan D, El-Senoussi M, Bakri Y, Subhi J, Ezzat A, Zwan F, Ramirez C.
1
Department of Oncology, King Faisal Specialist Hospital & Research Center, Riyadh,
Kingdom of Saudi Arabia.
Eur J Pediatr Surg. 2000 Aug;10(4):252-7.
Congenital cervical teratoma in neonates. Case report and review.
Elmasalme F
1
, Giacomantonio M, Clarke KD, Othman E, Matbouli S.
1
Department of Pediatric Surgery, Maternity and Children's Hospital, Jeddah, Saudi Arabia.
20

11
Eur J Obstet Gynecol Reprod Biol. 2000 Jan;88(1):103-6.
Polypoid endocervical stromal sarcoma with heterologous elements. Report of a case with
Amr SS
1
, Sheikh SM.
1
Pathology Services Division, Saudi Aramco-Dhahran Health Center, Saudi Aramco Medical Services
Organization, Dhahran, Kingdom of Saudi Arabia. amrss@aramco.com.sa
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APMIS. 2000 Nov;108(11):756-60.
p53 and Bcl-2 oncoprotein expression in placentas with hydropic
changes and partial and complete moles.
Al-Bozom IA
1
.
1
Department of Pathology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
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J Reprod Med. 2000 Feb;45(2):94-6.
CSF/serum beta-hCG ratio in patients with brain metastases of gestational
trophoblastic tumor.
Bakri Y
1
, al-Hawashim N, Berkowitz R.
1
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center,
Eur J Obstet Gynecol Reprod Biol. 2000 May;90(1):87-91.
Malignant germ cell tumors of the ovary. Pregnancy considerations.
Bakri YN
1
, Ezzat A, Akhtar, Dohami, Zahrani.
1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, King Fahad
National Guard Hospital, Riyadh, Saudi Arabia
24

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Eur J Obstet Gynecol Reprod Biol. 2001 Aug;97(2):245-8.
Uterine artery aneurysm mimicking pelvic sarcoma. A case report and review of literature.
raslanwf@aramco.com.sa.
Raslan WF
1
, Marier RR.
1
Pathology Services Division, Saudi Aramco, Dhahran Health Center, Room D-205-2, Box 76, Saudi Aramco
Medical Services Organization, 31311, Dhahran, Saudi Arabia
25
Saudi Med J. 2001 Oct;22(10):914-6.
Synchronous endometrioid carcinoma of
the ovary and endometrium associated with ovulation induction.
Ghourab S
1
.
1
Department of Obstetrics and Gynecology, King Khalid University Hospital, King Saud University, PO Box 2925,
Riyadh 11461, Kingdom of Saudi Arabia. sghourab@ksu.edu.sa
26
27
Gynecol Oncol. 2001 Jun;81(3):477-80.
Positron emission tomography for the evaluation of metastases in patients
with carcinoma of the cervix: a retrospective review.
Kerr IG
1
, Manji MF, Powe J, Bakheet S, Al Suhaibani H, Subhi J.
1
Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia.
Gynecol Oncol. 2001 Apr;81(1):105-9.
Scalp and cranial bone metastasis of endometrial carcinoma: a case
report and literature review.
Mustafa MS
1
, Al-Nuaim L, Inayat-Ur-Rahman N.
1
Department of Obstetrics and Gynaecology, King Khalid University Hospital, Riyadh 11472, Saudi Arabia.
28

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Histopathology. 2002 Nov;41(5):446-9.
Extrauterine placental site trophoblastic tumour in association with a
lithopedion.
El Hag IA
1
, Ramesh K, Kollur SM, Salem M.
1
Department of Pathology, PARAS Central Hospital, Sakaka, Al Jouf, Kingdom of Saudi Arabia.
29
Am J Clin Oncol. 2002 Jun;25(3):256-60.
Prognostic factors and treatment modalities in uterine sarcoma.
El Husseiny G
1
, Al Bareedy N, Mourad WA, Mohamed G, Shoukri M, Subhi J, Ezzat A.
1
Department of Radiation Oncology, King Faisal Specialist Hospital and Research
30
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J Ayub Med Coll Abbottabad. 2003 Apr-Jun;15(2):65-8.
Cancer ovary, present and future of management.
Parvez T
1
.
1
King Fahad Hospital, Al Madma Al Munawra, Kingdom of Saudi Arabia.
Saudi Med J. 2003 Dec;24(12):1329-33.
Prevalence of gestational trophoblastic disease. A single institution
experience.
Khashoggi TY
1
.
1
Department of Obstetrics and Gynecology, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi
Arabia.
32

14
Saudi Med J. 2004 Oct;25(10):1492-4.
Uterine lipoma.
Al-Maghrabi JA
1
, Sait KH, Lingawi SS.
1
Department of Pathology, King Faisal Specialist Hospital and Research Centre,
Jeddah, Kingdom of Saudi Arabia.
33
Saudi Med J. 2004 Jul;25(7):857-61.
Assessment of risk factors of uterine cancer in Saudi patients
With postmenopausal bleeding.
Al-Kadri HM
1
, Al-Awami SH, Madkhali AM.
1
Department of Obstetrics and Gynecology, King Fahad National Guard Hospital, PO Box 57374, Riyadh
11574, Kingdom of Saudi Arabia. kadrih@ngha.med.sa
34
35
Appl Immunohistochem Mol Morphol. 2004 Mar;12(1):79-82.
Common blue nevus of the uterine cervix: case report and review.
Zevallos-Giampietri EA
1
, Barrionuevo C.
1
Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital &
Research Center at Jeddah, Jeddah, Saudi Arabia.
Saudi Med J. 2004 Sep;25(9):1270-3.
Ovarian mucinous cystadenoma in a female with Turner syndrome.
Sait KH
1
, Alkhattabi MA, Alkushi AO, Alqahtani MH.
1
Department of Obstetrics and Gynecology, King Abdul-Aziz University Hospital, PO Box
80215, Jeddah 21589, Kingdom of Saudi Arabia.
36

15
J Obstet Gynaecol Can. 2004 Feb;26(2):137-42.
Ovarian teratoma diagnosis and management: case presentations.
Sait K
1
, Simpson C.
1
Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi
Arabia.
37
Saudi Med J. 2004 May;25(5):615-20.
Potential regulation of PTH/PTHrP receptor expression in
choriocarcinoma cells.
Alokail MS
1
.
1
Department of Biochemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
38
39
Saudi Med J. 2004 May;25(5):552-6.
Genito-urinary cancer in Saudi Arabia.
Abomelha MS
1
.
1
Department of Urology, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia.
Arch Gynecol Obstet. 2005 Apr;271(4):346-9. Epub 2004 Jun 2.
Pregnancy outcome in non-gynecologic cancer.
Sait KH
1
, Ashour A, Rajabi M.
1
Departments of Obstetrics and Gynecology, King Abdulaziz University Hospital, P.O. Box
80215, 21589 Jeddah, Saudi Arabia. khalidsait@yahoo.com
40

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Saudi Med J. 2005 Apr;26(4):588-92.
Cytopathological pattern of cervical Pap smear according to the
Bethesda system in Southwestern Saudi Arabia.
Elhakeem HA
1
, Al-Ghamdi AS, Al-Maghrabi JA.
1
Department of Pathology, King Fahad Hospital, Al-Baha, Kingdom of Saudi Arabia.
41
West Afr J Med. 2005 Jan-Mar;24(1):31-5.
Elective hysterectomy: a clinicopathological review from Abha catchment
area of Saudi Arabia.
Sobande AA
1
, Eskandar M, Archibong EI, Damole IO.
1
Department of Obstetrics & Gynaecology, College of Medicine, King Khalid University, Abha, Saudi Arabia.
42
43
Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):257-66.
Minimizing urinary bladder radiation dose during brachytherapy
for carcinoma of the cervix using balloon inflation technique.
Malaker K
1
, Shukla V, D'Souza H, Weatherburn H.
1
Radiation Oncology Section, Princess Norah Oncology Centre, Jeddah, Saudi Arabia.
Saudi Med J. 2006 Sep;27(9):1412-4.
Ovarian mucinous cystadenocarcinoma of low malignant potential associated with a
mature cystic teratoma.
Al-Ghamdi FA
1
, Al-Khattabi MA.
1
Department of Pathology, King Abdul-Aziz University Hospital, PO Box 21342, Jeddah 124743, Kingdom of
Saudi Arabia.
44

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Saudi Med J. 2006 Oct;27(10):1498-502.
Cervical cancer screening with pattern of pap smear. Review of multicenter
studies.
Altaf FJ
1
.
1
Department of Pathology, Faculty of Medicine, King Abdul-Aziz University Hospital, PO Box
51241, Jeddah 21543, Kingdom of Saudi Arabia.
45
Int J Gynecol Pathol. 2006 Jul;25(3):262-7.
Cotyledonoid dissecting leiomyoma of the uterus: a case report of a benign
uterine tumor with sarcomalike gross appearance and review of literature.
Saeed AS
1
, Hanaa B, Faisal AS, Najla AM.
1
Department of Pathology and Laboratory Medicine, King Fahad National Guard Hospital, King Abdulaziz
Medical City, Riyadh, Saudi Arabia.
46
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Int J Gynecol Cancer. 2006 Mar-Apr;16(2):675-80.
Female circumcision (female genital mutilation): a problem for
brachytherapy in cervical cancer.
Manji MF
1
, Al Badawi I, El Enbaby A, Al Bareedy N.
Departments of Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
Ann Saudi Med. 2007 Jul-Aug;27(4):268-72.
Pattern of abnormal Pap smears in developing countries: a report from a
large referral hospital in Saudi Arabiausing the revised 2001 Bethesda
System.
Abdullah LS
1
.
1
Department of Pathology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
48

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Saudi Med J. 2007 Dec;28(12):1810-8.
Molecular testing of human papillomavirus in cervical
specimens.
Gazzaz FB
1
.
1
Virology Laboratory, Faculty of Medicine, King Abdul-Aziz University Hospital,
PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia.
49
nt J Gynaecol Obstet. 2007 Dec;99(3):201-5. Epub 2007 Apr 24.
Three-dimensional ultrasound and three-dimensional power
Doppler in the assessment of ovarian tumors.
Laban M
1
, Metawee H, Elyan A, Kamal M, Kamel M, Mansour G.
1
Department of Gynecology and Obstetrics, Taibah University, Saudi Arabia.
laban63@yahoo.com
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Ann Saudi Med. 2007 Jan-Feb;27(1):1-5.
Human papilloma virus-16/18 cervical infection among women attending a
family medical clinic in Riyadh.
Al-Muammar T
1
, Al-Ahdal MN, Hassan A, Kessie G, Dela Cruz DM, Mohamed GE.
1
Department of Family Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi
Arabia.
Ann Saudi Med. 2008 Jul-Aug;28(4):282-6.
Hysterectomy for benign conditions in a university hospital in Saudi
Arabia.
Sait K
1
, Alkhattabi M, Boker A, Alhashemi J.
1
Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.
52

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J Egypt Natl Canc Inst. 2008 Mar;20(1):1-9.
Using the computed tomography in comparison to the orthogonal radiography based
treatment planning in high dose rate (HDR) brachytherapy in cervical uteri cancer patients;
a single institution feasibility study.
Bahadur YA
1
, El-Sayed ME, El-Taher ZH, Zaza KO, Moftah BA, Hassouna AH, Ghassal NM.
1
The Department of Radiation Oncology, King Abdul- Aziz University Hospital, Kingdom of Saudi
Arabia. yasirbahadur@hotmail.com
53
Saudi Med J. 2008 Jan;29(1):126-8.
Mucinous cystadenoma of the ovary in a 12-year-old girl.
Alobaid AS
1
.
1
Department of Obstetrics and Gynecology, College of Medicine, King Saud University,
PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia.
54
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J Obstet Gynaecol Res. 2008 Aug;34(4):538-42. doi: 10.1111/j.1447-0756.2008.00735.x.
Gynecological cancer incidence in a hospital population in Saudi
Arabia: the effect of foreign immigration over two decades.
Makoha FW
1
, Raheem MA.
1
Maternity and Children's Hospital, Jeddah, Saudi Arabia.
Fertil Steril. 2008 Nov;90(5):2015.e17-9. doi: 10.1016/j.fertnstert.2008.07.021. Epub 2008 Sep 7.
Massive ascites as a presentation in a young woman with
endometriosis: a case report.
Sait KH
1
.
1
Department of Obstetrics and Gynecology, King Abdulaziz University Hospital,
Jeddah, Saudi Arabia.
56

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J Family Community Med. 2008 Sep;15(3):127-31.
Ovarian dysgerminoma in two sisters.
Aldhafery BF
1
.
1
Department of Radiology, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia.
57
Saudi Med J. 2008 Mar;29(3):444-6.
Primitive neuroectodermal tumor of the ovary.
Anfinan NM
1
, Sait KH, Al-Maghrabi JA.
1
Department of Obstetrics & Gynecology, King Abdulaziz University Hospital, Jeddah,
58
59
Saudi Med J. 2009 Sep;30(9):1208-12.
Attitudes, knowledge, and practices in relation to cervical cancer and its
screening among women in Saudi Arabia.
Sait KH
1
.
1
Department of Obstetrics & Gynecology, King Abdul-Aziz University Hospital, Jeddah 21589, PO Box
80215, Kingdom of Saudi Arabia.
Arch Gynecol Obstet. 2009 Nov;280(5):823-5. doi: 10.1007/s00404-009-0992-5. Epub 2009 Feb 26.
Cisplatinum and docetaxel for ovarian cancer in pregnancy.
Rouzi AA
1
, Sahly NN, Sahly NF, Alahwal MS.
1
Department of Obstetrics and Gynecology, King Abdulaziz University, PO Box 80215, Jeddah
21589, Saudi Arabia.
60

21
Lab Invest. 2009 Oct;89(10):1115-27. doi: 10.1038/labinvest.2009.75. Epub 2009 Jul 27.
Bortezomib-mediated expression of p27Kip1 through S-phase kinase protein
2 degradation in epithelial ovarian cancer.
Uddin S
1
, Ahmed M, Hussain AR, Jehan Z, Al-Dayel F, Munkarah A, Bavi P, Al-Kuraya KS.
1
Department of Human Cancer Genomic Research, King Fahad National Centre for Children's Cancer and
Research, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
61
Mol Cancer. 2009 Sep 18;8:74. doi: 10.1186/1476-4598-8-74.
Overexpression of leptin receptor predicts an unfavorable outcome in Middle
Eastern ovarian cancer.
Uddin S
1
, Bu R, Ahmed M, Abubaker J, Al-Dayel F, Bavi P, Al-Kuraya KS.
1
Department of Human Cancer Genomic Research, Research Center, Department of Pathology, King Faisal
Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
62
63
Mol Cancer. 2009 Jul 28;8:51. doi: 10.1186/1476-4598-8-51.
PIK3CA alterations in Middle Eastern ovarian cancers.
Abubaker J
1
, Bavi P, Al-Haqawi W, Jehan Z, Munkarah A, Uddin S, Al-Kuraya KS.
1
Department of Human Cancer Genomic Research, Research Center, King Faisal Specialist
Hospital and Research Center, Riyadh, Saudi Arabia.
Cutis. 2009 Jul;84(1):33-8.
Cutaneous metastasis of uterine adenocarcinoma: a case report and
Selim AA
1
, Shaheen S, Lockshin N, Khachemoune A.
1
Biotechnology Center, King Fahd University of Petroleum & Minerals, Dhahran, Saudi Arabia
64

22
Surg Technol Int. 2010 Apr;19:141-3.
Robotic-assisted ovarian transposition before radiation.
Al-Badawi I
1
, Al-Aker M, Tulandi T.
1
King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
65
Ann Saudi Med. 2010 Sep-Oct;30(5):397-400. doi: 10.4103/0256-4947.68550.
Prevalence of abnormal cervical cytology among subfertile Saudi w
omen.
Al-Jaroudi D
1
, Hussain TZ.
1
Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
daljaroudi@kfmc.med.sa
66
67
Hematol Oncol Stem Cell Ther. 2010;3(3):161-2.
Carcinosarcoma of the uterus in a woman with Down
syndrome.
Al-Badawi IA
1
, AlOmar O, Kornfeld I.
1
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
ibadawi@kfshrc.edu.sa
Int J Cancer. 2010 Jan 15;126(2):382-94. doi: 10.1002/ijc.24757.
Cyclooxygenase-2 inhibition inhibits PI3K/AKT kinase activity in
epithelial ovarian cancer.
Uddin S
1
, Ahmed M, Hussain A, Assad L, Al-Dayel F, Bavi P, Al-Kuraya KS, Munkarah A.
1
Shahab@KFSHRC.edu.sa
68

23
Int J Gynecol Cancer. 2010 Aug;20(6):1082-6. doi: 10.1111/IGC.0b013e3181e2ace5.
Laparoscopic ovarian transposition before pelvic irradiation:
a Saudi tertiary center experience.
Al-Badawi IA
1
, Al-Aker M, AlSubhi J, Salem H, Abduljabbar A, Balaraj K, Munkarah A.
1
i_albadawi@yahoo.com
69
Arch Gynecol Obstet. 2010 Nov;282(5):529-33. doi: 10.1007/s00404-009-1346-z. Epub 2010 Jan 5.
Ovarian tumors associated with pregnancy: a 20-year experience in
a teaching hospital.
Gasim T
1
, Al Dakhiel SA, Al Ghamdi AA, Al Ali M, Al Jama F, Rahman J, Al Suleiman SA, Rahman MS.
1
Department of Obstetrics and Gynecology, College of Medicine, King Faisal University, Dammam, Saudi Arabia.
70
71
Int J Gynecol Pathol. 2010 Jul;29(4):343-50. doi: 10.1097/PGP.0b013e3181cd6552.
High- grade endometrial carcinoma: serous and grade 3 endometrioid
carcinomas have different immunophenotypes and outcomes.
Alkushi A
1
, Köbel M, Kalloger SE, Gilks CB.
1
Department of Pathology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.
Reprod Biol Endocrinol. 2010 Mar 11;8:24. doi: 10.1186/1477-7827-8-24.
A massive ovarian mucinous cystadenoma: a case report.
Kamel RM
1
.
1
Department of Obstetrics and Gynaecology, Faculty of Medicine, Jazan University, Saudi
Arabia.
72

24
Int J Womens Health. 2011;3:219-26. doi: 10.2147/IJWH.S23046. Epub 2011 Jul 26.
Early experience with the da Vinci surgical system robot in
gynecological surgery at King Abdulaziz University Hospital.
Sait KH
1
.
1
Obstetrics and Gynecology Department, Faculty of Medicine, Gynecology Oncology Unit,
King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
73
Saudi Med J. 2011 May;32(5):495-503.
Treatment planning for high dose rate brachytherapy of cervical cancer based
on total dose constraints.
Bahadur YA
1
, Constantinescu CT, Hassouna AH, El-Sayed ME.
1
Department of Radiology, King Abdulaziz University Hospital, PO Box 80215, Jeddah 21589, Kingdom of
Saudi Arabia.
74
75
Int J Gynecol Cancer. 2011 Jul;21(5):907-10. doi: 10.1097/IGC.0b013e318214219f.
Detection and genotyping of human papilloma virus in cervical
cancer specimens from Saudi patients.
Al-Badawi IA
1
, Al-Suwaine A, Al-Aker M, Asaad L, Alaidan A, Tulbah A, Fe Bohol M, Munkarah AR.
1
Lab Invest. 2011 Jan;91(1):124-37. doi: 10.1038/labinvest.2010.136. Epub 2010 Jul 26.
HGF/c-Met pathway has a prominent role in mediating antiapoptotic signals through AKT
in epithelial ovariancarcinoma.
Bu R
1
, Uddin S, Bavi P, Hussain AR, Al-Dayel F, Ghourab S, Ahmed M, Al-Kuraya KS.
1
Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research
Center, Riyadh, Saudi Arabia.
76

25
Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):388-93. doi: 10.1016/j.ejogrb.2011.06.018. Epub 2011
Jul 7.
Antibiotic use and risk of gynecological cancer.
Tamim HM
1
, Musallam KM, Al Kadri HM, Boivin JF, Collet JP.
1
King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health
Sciences, Riyadh, Saudi Arabia.
77
Saudi Med J. 2011 Sep;32(9):913-8.
Conservative treatment of ovarian cancer. Safety, ovarian function preservation,
reproductive ability, and emotional attitude of the patients in Saudi Arabia.
Sait KH
1
.
1
Gynecology Oncology Unit, Obstetrics and Gynecology Department, Faculty of Medicine, King Abdulaziz
University and King Abdulaziz University Hospital, PO Box 80215, Jeddah, Kingdom of Saudi Arabia.
78
79
Food Chem Toxicol. 2011 Dec;49(12):3281-6. doi: 10.1016/j.fct.2011.09.023. Epub 2011 Sep 24.
Catechin hydrate inhibits proliferation and mediates apoptosis of
SiHa human cervical cancer cells.
Al-Hazzani AA
1
, Alshatwi AA.
1
Dept. of Botany and Microbiology, King Saud University, Saudi Arabia.
BMC Syst Biol. 2011 Nov 3;5:183. doi: 10.1186/1752-0509-5-183.
Network analysis of microRNAs and their regulation in human
ovarian cancer.
Schmeier S
1
, Schaefer U, Essack M, Bajic VB.
1
Computational Bioscience Research Center (CBRC), 4700 King Abdullah University of Science and Technology
(KAUST), Thuwal 23955-6900, Kingdom of Saudi Arabia.
80

26
Mol Med. 2011;17(7-8):635-45. doi: 10.2119/molmed.2011.00046. Epub 2011 Mar 21.
Overexpression of fatty acid synthase in Middle Eastern epithelial ovarian
Carcinoma activates AKT and Its inhibition potentiates cisplatin-induced
apoptosis.
Uddin S
1
, Jehan Z, Ahmed M, Alyan A, Al-Dayel F, Hussain A, Bavi P, Al-Kuraya KS.
1
Human Cancer Genomic Research, Research Center, Riyadh, Saudi Arabia.
81
Gynecol Oncol. 2011 Jun 1;121(3):522-6. doi: 10.1016/j.ygyno.2011.01.033. Epub 2011 Feb 24.
Prevalence and genotypes' distribution of human papillomavirus in
invasive cervical cancer in Saudi Arabia.
Alsbeih G
1
, Ahmed R, Al-Harbi N, Venturina LA, Tulbah A, Balaraj K.
1
Radiation Biology Laboratory, Biomedical Physics Department, King Faisal Specialist Hospital and Research
82
83
Saudi Med J. 2011 Nov;32(11):1155-60.
Knowledge, attitudes, and practices regarding cervical cancer screening
among physicians in the Western Region of Saudi Arabia.
Sait KH
1
.
1
Department of Obstetrics & Gynecology, Faculty of Medicine, King Abdulaziz University, Kingdom of Saudi
Arabia.
BMC Syst Biol. 2011 Sep 19;5:144. doi: 10.1186/1752-0509-5-144.
In Silico discovery of transcription factors as potential diagnostic biomarkers
of ovarian cancer.
Kaur M
1
, MacPherson CR, Schmeier S, Narasimhan K, Choolani M, Bajic VB.
1
Computational Bioscience Research Center, King Abdullah University of Science and Technology,
Thuwal 23955-6900, Kingdom of Saudi Arabia.
84

27
Brachytherapy. 2011 Nov-Dec;10(6):498-502. doi: 10.1016/j.brachy.2011.03.004. Epub 2011 Jun 2.
In vivo diode dosimetry vs. computerized tomography and digitally reconstructed
radiographs for critical organ dose calculation in high-dose-rate brachytherapy of
cervical cancer.
Hassouna AH
1
, Bahadur YA, Constantinescu C, El Sayed ME, Naseem H, Naga AF.
1
Department of Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia.
ashrafhassouna@hotmail.com
85
J Pediatr Adolesc Gynecol. 2011 Feb;24(1):25-8. doi: 10.1016/j.jpag.2010.06.005. Epub 2010 Aug 14.
Ovarian tumors in children and adolescents--a clinical study of 52 patients in
a university hospital.
Al Jama FE
1
, Al Ghamdi AA, Gasim T, Al Dakhiel SA, Rahman J, Rahman MS.
1
Department of Obstetrics and Gynecology, College of Medicine, University of Dammam and King Fahad
University Hospital, Al-Khobar, Saudi Arabia.
86
87
J Cytol. 2011 Oct;28(4):173-7. doi: 10.4103/0970-9371.86343.
Cytological pattern of cervical Papanicolaou smear in eastern
region of Saudi Arabia.
Balaha MH
1
, Al Moghannum MS, Al Ghowinem N, Al Omran S.
1
Department of Obstetrics and Gynecology, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia.
Arq Bras Endocrinol Metabol. 2011 Oct;55(7):490-3.
Incidental finding of ovarian teratoma on post-therapy scan for
papillary thyroid cancer and impact of SPECT/CT imaging.
Jammah AA
1
, Driedger A, Rachinsky I.
1
Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
dranwarjammah@hotmail.com
88

28
J Obstet Gynaecol. 2011 Aug;31(6):555. doi: 10.3109/01443615.2011.587052.
Cervical angioleiomyoma.
Al-Sannaa GA
1
, Al-Manea M.
1
Department of Histopathology, Regional Lab and Blood Bank, Dammam, Saudi Arabia.
89
Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):388-93. doi: 10.1016/j.ejogrb.2011.06.018. Epub 2011
Jul 7.
Antibiotic use and risk of gynecological cancer.
Tamim HM
1
, Musallam KM, Al Kadri HM, Boivin JF, Collet JP.
1
King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health
Sciences, Riyadh, Saudi Arabia.
90
Ann Saudi Med. 2012 Sep-Oct;32(5):541-3. doi: 10.5144/0256-4947.2012.26.5.1110.
Sarcomatoid carcinoma of the cervix.
Nageeti TH
1
, Jastania RA.
1
Department of Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia.
92
91
Medicine International 2011:3 25–29
Molecular tests to detect human papillomavirus infection in patients with
cervical dysplasia and invasive cervical cancer in Saudi Arabia
Sait K, Gazzaz FS
Department of Obstetrics & Gynecology, Faculty of Medicine, King Abdulaziz University, Kingdom of
Saudi Arabia.

29
J Cancer Res Clin Oncol. 2012 Jul;138(7):1173-86. doi: 10.1007/s00432-012-1182-6. Epub 2012 Mar 15.
Analysis of molecular cytogenetic alterations in uterine leiomyosarcoma by
array-based comparative genomic hybridization.
Raish M
1
, Khurshid M, Ansari MA, Chaturvedi PK, Bae SM, Kim JH, Park EK, Park DC, Ahn WS.
1
Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
93
Saudi Med J. 2012 Jan;33(1):61-5.
Histopathological pattern of ovarian neoplasms and their age distribution in
the western region of Saudi Arabia.
Abdullah LS
1
, Bondagji NS.
1
Pathology Department, King Abdul-Aziz University, College of Medicine, PO Box 80215, Jeddah 21589,
94
95
Med Oncol. 2012 Dec;29(4):2944-8. doi: 10.1007/s12032-012-0194-z. Epub 2012 Mar 10.
Pure dysgerminoma of the ovary: a single institutional experience of 65
patients.
A L Husaini H
1
, Soudy H, El Din Darwish A, Ahmed M, Eltigani A, A L Mubarak M, Sabaa AA, Edesa W, A L-
Tweigeri T, Al-Badawi IA.
1
Department of Oncology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
Ann Saudi Med. 2012 Nov-Dec;32(6):588-92. doi: 10.5144/0256-4947.2012.588.
Ovarian volume assessment in relation to histologic findings and sex hormone levels in
women with postmenopausal bleeding and thickened endometrium.
Elfayomy AK
1
, El Tarhouny SA.
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Taibah University, Al Madinah 30001, Saudi
Arabia.
96

30
Saudi Med J. 2012 Jun;33(6):634-9.
Pattern of cervical smear abnormalities using the revised Bethesda
system in a tertiary care hospital in Western Saudi Arabia.
Altaf FJ
1
, Mufti ST.
1
Department of Anatomic Pathology, Faculty of Medicine, King Abdulaziz University Hospital, PO Box 51241,
Jeddah 21543, Kingdom of Saudi Arabia.
97
J Immunoassay Immunochem. 2012;33(3):223-33. doi: 10.1080/15321819.201
.634472.
Plexin D1: new potential biomarker for cervical cancer.
Shalaby MA
1
, Hampson L, Oliver A, Hampson I.
1
Biochemistry Department, King Saud University Girls Department, Kingdom of Saudi Arabia-Riyadh.
98
99
J Biomed Opt. 2012 Sep;17(9):98001-1. doi: 10.1117/1.JBO.17.9.098001.
Fluorescence spectra of blood and urine for cervical cancer detectio.
Masilamani V
1
, Alsalhi MS, Vijmasi T, Govindarajan K, Rathan Rai R, Atif M, Prasad S, Aldwayyan AS.
1
King Saud University, College Of Science, Department of Physics and Astronomy, P.O. Box 2455,
Riyadh, Kingdom of Saudi Arabia
Ann Saudi Med. 2012 Jan-Feb;32(1):27-31.
Evaluation of adjuvant therapy in women with uterine papillary
serous cancer.
Al Husaini H
1
, Soudy H, Darwish A, Ahmed M, Eltigani A, Edesa W, Abdelsalam M.
1
Department of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi
100

31
The Open Women’s Health Journal, 2012, 6, 1-5
Cervical Cancer Prevention in Saudi Arabia: It is Time to Call for Action!
Khalid Sait1, James Bentley2, Nisrin Anfinan*, 1and Patti Power3
1Gynecology Oncology Unit, King Abdulaziz University, Jeddah, Saudi Arabia
2Gynecology Oncology Unit, Dalhousie University, Halifax, Nova Scotia, Canada
3Gynecology Oncology Unit, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
101

32
In Gynecological Cancer
in Saudi Arabia 2013 – 2015

33
In Gynecological Cancer in Saudi Arabia 2013 - 2015
Prevalence of high-risk human papillomavirus infections in healthy Saudi women
attending gynecologic clinics in the western region of Saudi Arabia.
Bondagji NS
1
, Gazzaz FS, Sait K, Abdullah L.
Cervical Cancer Prevalence at King Abdulaziz University Hospital.
Fadwa J. Altaf1, Ghadeer A. Mokhtar2 and Faris M. Altaf3
HPV prevalence and genetic predisposition to cervical cancer in
Saudi Arabia. Alsbeih G
1
, Al-Harbi N, El-Sebaie M, Al-Badawi I.
Prevalence of human papillomavirus in women from Saudi
Arabia. Turki R
1
, Sait K, Anfinan N, Sohrab SS, Abuzenadah AM.
Five-year outcome of concurrent radiotherapy and chemotherapy in Saudi women
with locally advanced cervicalcancer: single-institution experience.
Al Asiri M
1
, Tunio M, Al Hadab A, Mohamed R, Bayoumi Y, Al Saeed E, Al Arifi M, Al Amro A.
A detailed study of patients and tumor characteristics of epithelial ovarian cancer in
Saudi women.
Al-Badawi IA
1
, Munkarah AR, Tulbah A, Babic II, Al Husaini H, Ahmad S.
Methanolic extract of Nigella sativa seed inhibits SiHa human cervical cancer Cell
proliferation through apoptosis.
Hasan TN
1
, Shafi G, Syed NA, Alfawaz MA, Alsaif MA, Munshi A, Lei KY, Alshatwi AA.
40
45
50
57
62
69
74

34
Naringin induces death receptor and mitochondria-mediated apoptosis in human
cervical cancer (SiHa) cells.
Ramesh E
1
, Alshatwi AA.
Hypermethylation of P15, P16, and E-cadherin genes in ovarian cancer.
Moselhy SS
1
, Kumosani TA, Kamal IH, Jalal JA, Abdul Jabaar HS, Dalol A.
Comprehensive laparoscopic surgical staging of ovarian dysgerminoma in
a 10-year-old girl—A case report
Anfinan N
Supraclavicular lymphadenopathy: initial manifestation of metastasis in
carcinoma of cervix. Tunio MA
1
, Al Asiri M, Mohamed R, Al-Dandan S.
Poorly differentiated ovarian sertoli-leydig cell tumor in a 16year - old single woman:
a case report and literaturereview.
Abu-Zaid A
1
, Azzam A, Alghuneim LA, Metawee MT, Amin T, Al-Hussain TO.
HPV DNA And Liquid Base Cervical Cytology Co-Testing For Cervical
Cancer Screening In Saudi Females Of Different Age Groups
Abdullah Layla S, Gazzaz Faten S, Sait Khalid H, Bondagji Nabeel S
Gestational trophoblastic disease in the western region of Saudi Arabia (single-
institute experience).
Anfinan N
1
, Sait K
2
, Sait H
1
.
78
88
95
98
101
107
115

35
Uterine sarcoma. Clinico-pathological characteristics and outcome.
Sait HK
1
, Anfinan NM, El Sayed ME, Alkhayyat SS, Ghanem AT, Abayazid RM, Sait KH.
Uterine leiomyosarcoma metastasizing to the heart.
Tunio MA, Al-Asiri M, Fareed MM.
Expression of Thyroid Transcription Factor-1 (TTF-1) in Endometrial Carcinoma.
Jaudah Al-Maghrabi1(MD, FRCPC), Nisrin Anfinan2,3 (MD, FRCSC), Khalid Sait 2,3 (MD, FRCSC), Hesham
Sait2,3(MD), Mahmou Al-Ahwal4 (MD, FRCPC), Hussain Basalamah2,3 (MD, FRCSC).
HPV Infection in Cervical and Other Cancers in Saudi Arabia: Implication for Prevention
and Vaccination.
Alsbeih G
1
.
Coronary sinus metastasis from cervical carcinoma.
Al-Ebrahim KE
1
.
Human papillomavirus prevalence and type distribution among
women attending routine gynecologicalexaminations in Saudi Arabia.
AlObaid A, Al-Badawi IA, Al-Kadri H, Gopala K, Kandeil W, Quint W, Al-Aker M, DeAntonio R.
The Trend of Prophylactic Oophorectomy During Hysterectomy for Benign
Disease at Different age Groups Single Institute Experience
Anfinan N,
119
127
129
133
6
139
142
151

36
Incidence of malignant ovarian germ cell tumors (MOGCTs)in Saudi Arabia.
Abu-Zaid A
1
, Nazer A
2
, Alomar O
3
, Azzam A
4
, Al-Eid HS
5
, Elhassan TA
6
, Al-Badawi IA
7
.A
Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic
lymph node, locally advanced cervical cancer?
Asiri MA
1
, Tunio MA
1
, Mohamed R
2
, Bayoumi Y
2
, Alhadab A
1
, Saleh RM
3
, AlArifi MS
1
, Alobaid A
4
.
Five years treatment outcomes of postoperative radiotherapy in Saudi women with
uterine cancers: singleinstitutional experience.
Al Asiri M
1
, Tunio MA
2
, Bayoumi Y
3
, Mohamed R
3
, Al Saeed E
4
, Al Hadab A
1
, Al Amro A
1
.
Gestational trophoblastic neoplasia: treatment outcomes from a single
institutional experience.
Al-Husaini H
1
, Soudy H, Darwish A, Ahmed M, Eltigani A, Edesa W, Elhassan T, Omar A,
Elghamry W, Al-Hashem H, Al-Hayli S, Madkhali I, Ahmad S, Al-Badawi IA.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for management
of recurrent/relapsedovarian granulosa cell tumor: a single-center experience.
Al-Badawi IA
1
, Abu-Zaid A, Azzam A, AlOmar O, AlHusaini H, Amin T.
Ovarian surface epithelium receptors during pregnancy and estrus cycle of rats with
emphasis on steroids andgonadotropin fluctuation.
Saddick SY
1
.
Single versus multichannel applicator in high-dose-rate vaginal brachytherapy
optimized by inverse treatment planning Yasir A. Bahadur, MD1, Camelia Constantinescu, PhD2, Ashraf H.
Hassouna, MD3,4, Maha M. Eltaher, MD1,4, Noor M. Ghassal, BSc2, Nesreen A. Awad, MD1,4
161
164
174
182
189
199
205

37
Incidence rate of ovarian cancer cases in Saudi Arabia: an observational
descriptive epidemiological analysis ofdata from Saudi Cancer Registry 2001-2008.
Alghamdi IG
1
, Hussain II
2
, Alghamdi MS
3
, Alghamdi MM
4
, Dohal AA
4
, El-Sheemy MA
5
.
Knowledge of Saudi female university students regarding cervical cancer and acceptanc
e of the human papillomavirus vaccine.
Al-Shaikh GK
1
, Almussaed EM, Fayed AA, Khan FH, Syed SB, Al-Tamimi TN, Elmorshedy HN.
Cervical cancer detection by time resolved spectra of blood components.
Kalaivani R
1
, Masilamani V
2
, AlSalhi MS
2
, Devanesan S
3
, Ramamurthy P
4
, Palled SR
5
, Ganesh KM
5
.
Evaluating the association between p53 codon 72 Arg>pro polymorphism and risk of o
vary cancer: a meta-analysis.
Alqumber MA
1
, Akhter N
1
, Haque S
2
, Panda AK
3
, Mandal RK
4
.
Comparative Study of Alterations in Tri-iodothyronine (T3) and Thyroxine (T4) Hormone Levels
in Breast and Ovarian Cancer Mahmood Rasool,
1
Muhammad Imran Naseer,
2
Kalsoom Zaigham,
3
Arif Malik,
4
Naila Riaz,
5
Rabail
Alam,
6
Abdul Manan,
7
Ishfaq Ahmed Sheikh,
8
and Muhammad Asif
9
Knowledge, perception, and attitudes about cancer and its treatment among healthy
relatives of cancer patients:single institution hospital-based study in Saudi Arabia.
Eldeek B1
, Alahmadi J, Al-Attas M, Sait K, Anfinan N, Aljahdali E, Ajaj H, Sait H.
Lumbosacral plexus delineation, dose distribution, and its correlation with radiation
induced lumbosacralplexopathy in cervical cancer patients.
Tunio M
1
, Al Asiri M
1
, Bayoumi Y
2
, Abdullah O Balbaid A
1
, AlHameed M
3
, Gabriela SL
1
, Amir O Ali A
1
.
214
221
229
235
242
247
258

38
Assessment of air pockets in high-dose-rate vaginal cuff brachytherapy
using cylindrical applicators
Ashraf Hassouna, MD1,2, Prof. Yasir Abdulaziz Bahadur3, Camelia Constantinescu, PhD1
Perception of patients with cancer towards support management services and use of complementary
alternative medicine – a single institution hospital based study in Saudi Arabia.
Sait KH
1
, Anfinan NM, Eldeek B, Al-Ahmadi J, Al-Attas M, Sait HK, Basalamah HA, Al-Ama N, El-Sayed ME.
Vulvar extra uterine endometrial stromal sarcoma: A case report and literature review.
Zaza KJ1, Arafah MA2
, Al-Badawi IA3
.
Human Papilloma Virus Early Proteins E6 (HPV16/18-E6) and the Cell Cycle Marker P16
(INK4a)are Useful Prognostic Markers in Uterine Cervical Carcinomas in Qassim Region-
Saudi Arabia. Omran OM1
, AlSheeha M.
Uterine perforation and its dosimetric implications in cervical cancer high-dose-rate
brachytherapy Yasir A. Bahadur, MD1, Maha M. Eltaher, MD1,2, Ashraf H. Hassouna, MD2,3, Mohammad
A. Attar, MD1, Camelia Constantinescu, PhD4
Human papillomavirus genotyping and integration in ovarian cancer Saudi
patients Al-Shabanah OA, Hafez MM1, Hassan ZK, Sayed-Ahmed MM, Abozeed WN, Al-Rejaie SS, Alsheikh AA.
265
270
278
283
293
301

39
Chemo sensitizing effect of aqueous extract of sweet fennel in
Cisplatin treated HeLa cells
Abstract presented in Chicago on 28-31 March 2015,Annual Meeting on Women's Cancer
Wafaa S.Ramadan a, Khalid H. Saitb , Nisreen M. Anfinanb and Hesham Sait c
a Department of Anatomy, Faculty of Medicine, King Abdulaziz University
bGynecology Oncology Unit, Faculty of Medicine, King Abdulaziz University Hospital
c Medical student, Faculty of Medicine, King Abdulaziz University
1
Outcome of Cervix Uteri Cancer Patients Treated With or Without
Concurrent Chemotherapy and radiotherapy Incorporating High Dose Rate
Brachytherapy: A Retrospective Single Institution Study In Saudi Arabia
Abstract presenting in Quebec on 09-12 July 2015,Annual Clinical and Scientific Conference
Mohamed E. El Sayed1,6, Yasir A. Bahadur1,3, Ehab E. Fawzy 1,7,Bakr Ben Sadiq2, Azza M. Nasr 5,6,Rayed Dada8 , Khalid H. Sait 4and Nisreen
M.Anfian4
2
Assessment of knowledge, awareness and attitudes towards cervical
cancer and its screening among women in Makkah – Saudi Arabia
Abstract presented in 24th Saudi Obstetrics & Gynecology Society Annual Meeting Intercontinental Hotal,Jeddah31st Mars
– 2nd April,2015 Jeddah ,KSAHani A. Aziz Jokhdar, Mohammed A. Garout, Enas H. AlFalogy, Rahma A. ALZahrany, Weaam S. Al-
Harbi, Wafaa I. Bahwaini, Hibah S.Alharbi
3

original
article
Ann Saudi Med 2013 January-February www.annsaudimed.net 13
C
ervical cancer is the third most common cancer
affecting females and the fourth leading cause
of cancer death in females worldwide, account-
ing for 9% (529800) of the total newly diagnosed can-
cer cases and 8% (275100) of the total cancer deaths
among females in the year 2008. More than 85% of
these cases and deaths occur in developing countries.1
The incidence of cervical cancer is low in Saudi
women. According to the 2007 Saudi cancer registry
report, cervical cancer is the thirteenth most frequent
cancer in Saudi women. The incidence rate in Saudi
Arabia is one of the lowest in the world at 1.9 cases per
100 000 women, accounting for 2.2% of diagnosed cas-
es of cancer in Saudi women.2
Although cervical cancer
is both preventable and curable, most women in Saudi
Arabia present at advanced stages that require extensive
Prevalence of high-risk human papillomavirus
infections in healthy Saudi women attending
gynecologic clinics in the western region of
Saudi Arabia
Nabeel Salem Bondagji,a
Faten Salah Gazzaz,b
Khalid Sait,a
Layla Abdullahc
From
the
a
Faculty
of
Medicine
King
Abdulaziz
University,
Obstetrics
and
Gynecology,
Jeddah,
Saudi
Arabia,
b
King
Abdulaziz
University,

Laboratory
Medicine,
Jeddah,
Saudi
Arabia,
c
King
Abdulaziz
University,
Pathology,
Jeddah,
Saudi
Arabia
Correspondence:
Dr.
Nabeel
Salem
Bondagji
·
Faculty
of
Medicine
King
Abdulaziz
University,
Obstetrics
and
Gynecology,
P.O.
Box
80215

Jeddah
21589
Saudi
Arabia
·
T:+966(2)6408310,
F:+966(2)6408316
·
bondagji_nabeel@hotmail.com
Ann
Saudi
Med
2013;
33(1):
13-17
DOI:
10.5144/0256-4947.2013.13
BACKGROUND
AND
OBJECTIVES:
Infection
with
human
papillomavirus
(HPV)
is
the
major
cause
of
cervical

cancer.
There
is
little
published
data
on
the
prevalence
of
HPV
infection
among
Saudi
women.
The
aim
of
this

study
was
to
determine
the
prevalence
of
HPV
in
a
group
of
women
in
the
western
region
of
Saudi
Arabia.
DESIGN
AND
SETTING:
A
prospective
study
of
Saudi
women
seeking
gynecologic
care
at
King
Abdulaziz

University
Hospital
from
March
2010
to
January
2011.
PATIENTS
AND
METHODS:
Four
hundred
eighty-five
Saudi
women
of
different
age
groups
attending
gynecol-
ogy
clinic
were
tested
for
high-risk
HPV
DNA.
HPV
DNA
was
detected
in
cervical
scrapes
using
Hybrid
Capture

2
(HC2)
high-risk
HPV
DNA
test.
The
prevalence
of
HPV
DNA
positivity
in
different
age
groups
was
calculated.

RESULTS:
Out
of
the
485
specimens,
27
(5.6%)
were
positive
for
the
high-risk
HPV.
The
highest
percentage
was

among
women
aged
60
years
and
older.
Patients
in
the
age
group
40-49
years
were
more
likely
to
accept
HPV

testing
with
a
total
of
188
patients.
CONCLUSION:
The
prevalence
of
HPV
in
this
group
of
Saudi
women
is
similar
to
what
was
reported
in
some

Arab
countries
and
lower
than
that
reported
in
developed
countries.
This
information
could
be
used
to
help
in

establishing
a
primary
screening
program
using
HPV
DNA
testing
in
Saudi
Arabia.
chemoradiation therapy.3,4
This is due to the lack of a
proper screening program.5
Cervical cancer is caused by
sexual exposure to an oncogenic type of the human pap-
illomavirus (HPV), usually types 16 and 18.6-9
The FDA has approved the Digene Hybrid Capture
2 High-Risk HPV DNA Test as a cervical screening
test for HPV infection.10
There are clear benefits for
the use of HPV DNA testing in the triage of equivocal
smears, low-grade smears in older women and in the
post-treatment surveillance of women after treatment
for cervical intraepithelial neoplasia. However, there are
still issues regarding how best to test in primary screen-
ing.11
The most resourceful and cost-effective screening
techniques include visual inspection of the cervix after
applying acetic acid or Lugol iodine and DNA testing
for human HPV DNA in cervical cell samples.12
A

original
article PAPILLOMAVIRUSINSAUDIWOMEN
Ann Saudi Med 2013 January-February www.annsaudimed.net14
recent clinical trial from India in a low-resource area
concluded that a single set of HPV DNA testing was
associated with a 50% reduction in the risk of devel-
oping advanced cervical cancer and associated deaths.13
Currently, little is known about the prevalence and type
of distribution of HPV in Saudi Arabia. Introduction
of appropriate screening for cervical cancer in Saudi
Arabia requires extensive work to find whether HPV
infection is a significant healthcare problem.In addition,
baseline information on HPV prevalence and genotype
distribution is highly desirable to evaluate the impact
of prophylactic HPV vaccines in the near future. This
study aimed to evaluate the feasibility of using HPV
testing as a primary screening for cervical cancer by de-
termining the prevalence in a group of Saudi women
and assessing the prevalence among different age groups
to evaluate the feasibility of using HPV DNA testing
as a primary screening test for cervical cancer.
PATIENTS
AND
METHODS
This was a prospective cohort hospital-based study of
all Saudi women attending gynecology clinics at King
Abdulaziz University Hospital from March 2010 to
January 2011 who fulfilled the inclusion criteria of be-
ing sexually active and of childbearing or postmeno-
pausal age. Exclusion criteria included virginity, preg-
nancy, known cases of HPV, cervical precancerous le-
sions or cervical cancer, positive cytology on Pap smear,
patient refusal to participate in the study and nonSaudi
nationality. Women who were eligible for the study
consented to participation after being counseled by one
of the gynecologist in the clinics and given the liberty
to participate or decline; only women who signed the
consent form were included in the study. The women
then had the traditional Pap smear using the wet mount
technique and the Hybrid Capture 2 (HC2) reagents
and materials for HPV detection (Digene Corporation,
USA). Pap smear results were reported according to
the Bethesda system for reporting of cervical cytol-
ogy.14
Smears with no abnormalities or one with reac-
tive changes were considered normal while all smears
of atypical squamous cell of undetermined significance
(ASC-US) or higher were considered as abnormal.
The specimen collection was done via cells taken
from the cervix with the Digene cervical sampler kit,
then placed into the Digene liquid collection medium.
The specimen collection was performed by a gynecolo-
gist after taking a detailed history and performing a
physical examination including pelvic examination. The
Digene HPV HC2 test used in the study detects the
high/intermediate risk HPV types (16, 18, 31, 33, 35,
39, 45, 51, 52, 56, 58, 59, and 68). The target DNA
hybridizes with a specific high-risk HPV RNA probe-
forming RNA/DNA hybrids which are captured onto
the surface of a microplate well coated with antibod-
ies specific for RNA/DNA hybrids. Fixed hybrids
are then reacted with alkaline phosphatase conjugated
antibodies specific for the RNA/DNA hybrids, which
are then identified with a chemiluminescent substrate,
where several alkaline phosphatase molecules unite to
each antibody. Multiple united antibodies bind to each
captured hybrid give considerable signal amplification.
Light is released when the substrate is broken by the
bound alkaline phosphatase, then measured as relative
light units (RLUs) on a luminometer and its strength
indicates the presence or absence of target DNA in the
specimen. The interpretations of the test results were
carried out according to the manufacturer’s instruc-
tion. The women were classified into groups based on
their age (19-29 years), (30-39), (40-49), (50-59) and
(60 years and older). Data were collected and analyzed
using SPSS statistical package version 16. The insti-
tutional human ethics committee for King AbdulAziz
University Hospital approved the study protocol
based on the international recommendations on hu-
man subject research and according to principles of the
Helsinki declaration.
RESULTS
During the study period, 6585 women were seen in the
gynecology clinics for different clinical complaints. The
majority of cases had menstrual cycle abnormalities fol-
lowed by pelvic pain, vaginal discharge, urinary inconti-
nence and dyspareunia in order of frequency. Applying
the inclusion criteria, 1649 patients were eligible. Out
of 1649 eligible women, 1164 were excluded from the
study for the following reasons: 704 refused to partici-
pate in the study after counseling, 429 were pregnant
or seen for pregnancy complications, and 16 had tech-
nical difficulties in collecting or processing the sample
according to the study protocol, 15 for previous posi-
tive HPV, cervical carcinoma or cervical precancerous
lesions. The commonest cause for refusal to participate
was the psychological fear of the impact of positive test
on the patient’s physical and social life.
Four hundred and eighty-five women participated
in the study. The age range was 19 to 91 years with a
mean age of 44.7 years. The majority of women were
multiparous, 403 (83%). The parity ranged from 1 to
9 with a mean of 3.5. Four hundred and seventeen
women (86%) were married, 44 (9%) divorced and 24
(5%) were widows.The Pap smear was abnormal in 118
(24.3%) women and normal in 367 (75.7%).
Of 485 patients, 458 (94.4%) were negative for

original
articlePAPILLOMAVIRUSINSAUDIWOMEN
HPV infection while 27 (5.6%) were positive (Table
1). The detection rate of HPV, DNA varied according
to age showing the highest rate among women age 60
years and older. Furthermore the study showed that 16
women of 334 patients in the reproductive age group
(19-49 years) tested positive for HPV DNA with a de-
tection rate of 4.8% compared to 11 of 151 postmeno-
pausal women (50 years and older) with a detection
rate of 7.3%. The highest number of tested patient was
reported in the group 40-49 years old with 188 women
(32% of the collected samples).
DISCUSSION
The unduly high burden of cervical cancer in develop-
ing countries is mostly due to a lack of screening pro-
grams that allows detection of precancerous and early
stage cervical cancer.15,16
Out of the 30 to 40 known
HPV genotypes that infect the mucosa of the female
genital tract, eight types (16, 18, 45, 31, 33, 52, 58, and
35) are accountable for 95% of cervical cancers and two
genotypes (16 and 18) are responsible for 70 percent
of the cervical cancer cases.17
The HPV vaccine pro-
tects against the most common strains of HPV infec-
tions (HPV types 16 and 18). Effective utilization of
the available vaccine depends on the prevalence and
the genotype of HPV in the targeted population. The
estimated global HPV prevalence was 11.7%. It was
estimated to be 24.0% in Sub-Saharan Africa, 21.4%
in Eastern Europe, and 16.1% in Latin America. The
age-specific HPV prevalence distribution showed a first
peak at younger ages (<25 years) in Latin America and
older ages (≥45 years) in North America and Africa.18
In two recent studies from Saudi Arabia on the
HPV genotype associated with cervical cancer,Alsbeih
et al19
showed that 81% of cervical cancers specimens
tested in their institution in the central part Saudi
Arabia were associated with HPV infection, the ma-
jority 78.7% (70/89) of HPV-positive tumors were
infected with HPV-16/18. Al-Badawi et al20
reported
similar finding with 95.5% detection of HPV in cervi-
cal cancer specimens, the most common HPV geno-
type detected being HPV-16 (63.4%), followed by
HPV-18. These two studies clearly show that the most
prevalent HPV genotype in Saudi women with cervi-
cal cancer were 16 and 18 which is no different than
was reported globally.17
The role of high-risk HPV DNA testing is grow-
ing and HPV DNA testing, either alone or in combi-
nation with cervical cytology, has been shown in many
studies to be more sensitive than cervical cytology alone
in detecting low- or high-grade cervical lesions.21-23
In
addition, HPV DNA testing has been proposed both
as a primary screening method (either as an adjunct or
instead of Pap smear) and as a method to triage Pap
smear results that are equivocal.24-26
Many studies have documented the use of HPV
DNA testing as a primary screening tool. In a
Canadian randomized control trial on 10154 women,
Mayrand et al27
compared HPV DNA testing with
conventional Pap smear and concluded that HPV
testing has greater sensitivity for the detection of cer-
vical intraepithelial neoplasia than the conventional
Pap smear. Ronco et al,28
in a large randomized con-
trolled Italian trial that included two groups of wom-
en, 47,001 were assigned to the cytology group and
47,369 to the HPV testing group. They concluded
that HPV-based screening is more effective than cy-
tology in preventing invasive cervical cancer, by detect-
ing persistent high-grade lesions earlier.
In a low-resource setting, a single round of HPV
DNA testing was associated with a significant reduc-
tion in the numbers of advanced cervical cancers and
deaths from cervical cancer. This was clearly demon-
strated in a randomized trial of 131746 women aged 30
to 59 years in rural India that compared a single lifetime
screening with one of three screening modalities with
standard care; the screening modalities were HPV test-
ing using the Hybrid Capture HC2, cervical cytology,
or visual inspection of the cervix with acetic acid.29
The current study reported a prevalence of 5.6% of
the high/intermediate-risk HPV types (16, 18, 31, 33,
35, 39, 45, 51, 52, 56, 58, 59, and 68) in Saudi women
attending gynecology clinics for different complains.
The only other reports from Saudi Arabia identified
through a PubMed search were by Al-Muammar et al30
and Gazzaz.31
In a small number of patients attend-
ing family medicine clinics in Riyadh, Saudi Arabia,
Muammar et al30
reported a high prevalence of HPV
infection, reaching 31.6% with the majority of cases be-
Table
1.
Result of negative and positive HPV DNA in cervical
specimens by Hybrid Capture 2.

Age
group

(years)

n
Number
of

negative

patients
(%)
Number
of

positive

patients
(%)
19-29 54 53 (98.1) 1 (1.9)
30-39 92 87 (94.6) 5 (5.4)
40-49 188 178 (94.7) 10 (5.3)
50-59 108 101 (93.5) 7 (6.5)
≥60 43 39 (90.7) 4 (9.3)
19-91 485 458 (94.4) 27 (5.6)

original
article PAPILLOMAVIRUSINSAUDIWOMEN
Ann Saudi Med 2013 January-February www.annsaudimed.net16
ing HPV-16 followed by 18. The age distribution was
not mentioned in that study.
The prevalence in the current study (5.6%) is similar
to that reported by Gazzaz31
(5%) and much lower than
the one reported by Al-Muammar et al30
(31.6%). The
current study showed a prevalence peak on relatively
older women (>60 years), which might be explained
by the lack of screening program and earlier testing in
those women. A report from Egypt on 5453 women32
showed a prevalence of 4.0% for HPV among Egyptian
women included in the study. These figures are in ac-
cordance with our figure, but the age distribution for
HPV positivity was younger in the Egyptian women
compared to our results. The prevalence of HPV IN
1026 Lebanese women aged 18-76 years33
was 4.9%
with 3% for high risk HPV type 16 DNA with peak
at 60-69 years of age, which was similar to our results.
Comparing our positive results (5.6%) with those
from other countries such as the United States34
(26.8%) and China21,35
(13.5%-17.6%) show that the
prevalence of cervical HPV infection among females in
Saudi Arabia is relatively low. In addition, the age dis-
tribution shows a marked difference. The current study
shows a prevalence peak in women in the age group 60
years and older compared to a prevalence peak in the
age group of 20 to 24 years in the United States.34
The current study shows a low detection rate (1
case, 1.9%) of HPV DNA positivity in women un-
der the age of 30 years. Our findings concurs with the
findings of Kjaer et al36
in their study to determine
the absolute risk of cervical abnormalities in women
with normal cytology and a positive high-risk Hybrid
Capture 2 (HC2) test, which showed that the rate of
development of a cervical lesion to be 17.7% in younger
women compared to 24.5% in older women. In another
study by Khan et al37
from the United States to explore
the risk of cervical precancerous lesions in women with
normal cytology and positive testing for HPV DNA
type 16 and 18 showed that women 30 years of age and
older had a higher risk of developing cervical lesions
than younger women.
Datta et al38
measured the Pap test results and high-
risk HPV prevalence by Hybrid Capture 2 assay in
9657 women age 14 to 65 years receiving routine cervi-
cal screening and concluded that high-risk HPV was
widespread among women receiving cervical screening
in the United States. They suggested that many women
30 years of age or older with normal Pap tests would
need follow-up if Hybrid Capture 2 testing is added to
cytology screening.
In the present study HPV infection among females
in a Saudi community was done on a larger number
than that was done by Gazzaz31
and Muammar et al.30
The current study provides a unique opportunity to
gather an idea about baseline data on cervical HPV
prevalence among females in the western region of
Saudi Arabia. The protocol and methodology applied
in the current study was successful and could be used in
a larger nationwide research.
The prevalence of HPV in this group of Saudi
women in the western region of Saudi Arabia is similar
to what is reported in some other Arab countries and
lower than what is reported in developed countries and
some parts of Asia. This information can be used in es-
tablishing a proposal for using HPV testing by hybrid
capture as a primary screening for cervical cancer in
Saudi Arabia. Multicenter population prevalence data
for HPV on a larger scale in women in Saudi Arabia
is required before the implementation of routine HPV
vaccination in this country.

original
articlePAPILLOMAVIRUSINSAUDIWOMEN
1.
Jemal A,Bray F, Center M,Ferlay J, Ward
E,Forman D.Global cancer statistics. CA CANCER
J CLIN 2011; 61:69– 90.
2.
Saudi Cancer Registry cancer incidence and
survival reports Saudi Arabia 2007. National Saudi
Cancer Registry. Riyadh (KSA): Ministry of Health.
Available at: http://www.scr.org.sa/reports/
SCR2007.pdf.
3.
El Dosoky M, Ismail N, Dagastani M. Preinvasive
cervical carcinoma in Saudi Arabia. Lancet 1995
Mar 11; 345(8950): 650.
4.
Manji M. Cervical cancer screening program in
Saudi Arabia: action is overdue. Ann Saudi Med
2000 Sep-Nov; 20(5-6): 355–357.
5.
Kitchener HC, Symonds P. Detection of cervical
intraepithelial neoplasia in developing countries.
Lancet 1999 Mar 13; 353(9156): 856-857.
6.
Zur Hausen H. Human papillomaviruses in the
pathogenesis of anogenital cancer. Virology 1991
Sep; 184(1): 9–13.
7.
Bosch FX, Manos MM, Munoz N, et al. Preva-
lence of human papillomavirus in cervical cancer:
a worldwide perspective. International biological
study on cervical cancer (IBSCC) Study Group. J
Natl Cancer Inst 1995 June 7; 87(11): 796–802.
8.
Walboomers JM, Jacobs MV, Manos MM, et
al. Human papillomavirus is a necessary cause of
invasive cervical cancer worldwide. J Pathol 1999
Sep; 189(1): 12–19.
9.
Munoz N, Bosch FX, de Sanjose S, et al. Epide-
miologic classification of human papillomavirus
types associated with cervical cancer. N Engl J
Med 2003 Feb 6; 348(6): 518–527.
10.
US Food and Drug Administration. FDA News.
FDA approves expanded use of HPV test. www.
fda.gov/bbs/topics/news/2003/new00890.html. Ac-
cessed July 14, 2003.
11.
Cuzick J, Arbyn M, Sankaranarayanan R, Tsu V,
Ronco G, Mayrand MH, Dillner J,et al. Overview of
human papillomavirus-based and other novel op-
tions for cervical cancer screening in developed
and developing countries. Vaccine. 2008 Aug 19;
26 Suppl 10:K29-41.
12.
Sherris J, Wittet S, Kleine A, et al. Evidence-
based, alternative cervical cancer screening ap-
proaches in low-resource settings. Int Perspect
Sex Reprod Health. 2009; 35:14 7-154.
13.
Sankarana rayanan R, Nene BM, Shastri SS,
et al. HPV screening for cervical cancer in rural
India. N Engl J Med. 2009; 360: 1385-13 94.
14.
Solomon D, Davey D, Kurman R, Moriarty A,
O’Connor D, Prey M et al. The 2001 Bethesda Sys-
tem: terminology for reporting results of cervical
cytology. JAMA 2002; 287:2114-2119.
15.
Parkin DM, Almonte M, Bruni L, Clifford G, Cu-
rado MP, Pineros M. Burden and trends of type-
specific human papil lomavirus infections and re-
lated diseases in the Latin America and Caribbean
an region. Vaccine. 2008; 26(suppl 11):L1-L 15.
16.
Mathew A, Geoge PS. Trends in incidence and
mortality rates of squamous cell carcinoma and
adenocarcinoma of cervix– worldwide. Asia n Pac
J Cancer Prev. 2009; 10:645-6 50.
17.
Kahn JA. HPV vaccination for the prevention
of cervical intraepithelial neoplasia. N Engl J Med
2009; 361:271.
18.
Bruni L, Diaz M, Castellsagué X, Ferrer E,
Bosch FX, de Sanjosé S.Cervical human papillo-
mavirus prevalence in 5 continents: meta-analysis
of 1 million women with normal cytological find-
ings. J Infect Dis. 2010 Dec 15; 202(12):1789-99.
19.
Alsbeih G, Ahmed R, Al-Harbi N, Venturina LA,
Tulbah A, Balaraj K. Prevalence and genotypes’
distribution of human papillomavirus in invasive
cervical cancer in Saudi Arabia. Gynecol Oncol.
2011 Jun 1; 121(3):522-6.
20.
Al-Badawi I, Al-Suwaine A, Al-Aker M, Asaad
L, Alaidan A. Tulbah A,et al. Detection and Geno-
typing of Human Papilloma Virus in Cervical Can-
cer Specimens from Saudi Patients. Int J Gynae-
col Cancer: 2011; 21: 907-910.
21.
Wu RF, Dai M, Qiao YL, Clifford GM, Liu ZH,
Arslan A, et al. Human Papillomavirus infection
in women in Shenzhen City, People’s Republic of
China, a population typical of recent Chinese ur-
banisation. Int J Cancer 2007, 121:1306-1311.
22.
ASCUS-LSIL Traige Study (ALTS) Group. A
randomized trial on the management of low-grade
squamous intraepithelial lesion cytology interpre-
tations. Am J Obstet Gynecol 2003; 188:1393.
23.
Cuzick J, Clavel C, Petry KU, et al. Overview of
the European and North American studies on HPV
testing in primary cervical cancer screening. Int J
Cancer 2006; 119:1095.
24.
Kim JJ, Wright TC, Goldie SJ. Cost-effective-
ness of human papillomavirus DNA testing in the
United Kingdom, The Netherlands, France, and
Italy. J Natl Cancer Inst 2005; 97:888.
25.
Denny LA, Wright TC Jr. Human papillomavirus
testing and screening. Best Pract Res Clin Obstet
Gynaecol 2005; 19:501.
26.
Koliopoulos G, Arbyn M, Martin-Hirsch P, et
al. Diagnostic accuracy of human papillomavirus
testing in primary cervical screening: a system-
atic review and meta-analysis of non-randomized
studies. Gynecol Oncol 2007; 104:232.
27.
Mayrand MH, Duarte-Franco E, Rodrigues I, et
al. Human papillomavirus DNA versus Papanico-
laou screening tests for cervical cancer. N Engl J
Med 2007; 357:1579.
28.
Ronco G, Giorgi-Rossi P, Carozzi F, Confortini M,
Dalla Palma P, Del Mistro A et al. Efficacy of human
papillomavirus testing for the detection of invasive
cervical cancers and cervical intraepithelial neo-
plasia: a randomized controlled trial. Lancet Oncol.
2010 Mar; 11(3):249-57.
29.
Sankaranarayanan R, Nene BM, Shastri SS,
Jayant K, Muwonge R, Budukh AM et al. HPV
screening for cervical cancer in rural India. N Engl
J Med. 2009 Apr 2;360(14):1385-94.
30.
Al-Muammar T, Al-Ahdal MN, Hassan A, Kes-
sie G, Dela Cruz DM, Mohamed GE. Human papil-
loma virus-16/18 cervical infection among women
attending a family medical clinic in Riyadh. Ann
Saudi Med. 2007 Jan-Feb; 27(1):1-5.
31.
Gazzaz FS. Molecular Testing of Human Pap-
illomavirus (HPV) in Cervical Specimens. Saudi
Med J 2007; Vol. 28 (12): 1810-1818.
32.
El-All HS, Refaat A, Dandash K.Prevalence of
cervical neoplastic lesions and Human Papilloma
Virus infection in Egypt: National Cervical Cancer
Screening. Infect Agent Cancer. 2007 Jul 4; 2:12.
33.
Mroueh AM, Seoud MA, Kaspar HG, Zalloua
PA.Prevalence of genital human papillomavirus
among Lebanese women Eur J Gynaecol On-
col. 2002; 23(5):429-32.
34.
Dunne EF, Sternberg M, McQuillan G, Swan
DC, Patel SS, Markowitz LE. Prevalence of HPV in-
fection among females in the United States. JAMA
2007 Feb 28; 297(8):813-819.
35.
Li LK, Dai M, Clifford GM, Yao WQ, Arslan A,
Li N, Shi JF,et al. Human Papillomavirus infection
in Shenyang City, People’s Republic of China: A
population-based study. Br J Cancer 2006, 95:1593-
1597.
36.
Kjaer S, Høgdall E, Frederiksen K, Munk C, van
den Brule A, Svare E, et al. The absolute risk of
cervical abnormalities in high-risk human papil-
lomavirus-positive, cytologically normal women
over a 10-year period. Cancer Res 2006; 66:10630.
37.
Khan MJ, Castle PE, Lorincz AT, Wacholder
S, Sherman M, Scott DR et al. The elevated 10-
year risk of cervical precancerous and cancer in
women with human papillomavirus (HPV) type 16
or 18 and the possible utility of type-specific HPV
testing in clinical practice. J Natl Cancer Inst 2005;
97:1072.
38.
Datta SD, Koutsky LA, Ratelle S, Unger ER,
Shlay J, McClain T et al. Human papillomavirus in-
fection and cervical cytology in women screened
for cervical cancer in the United States, 2003-2005.
Ann Intern Med. 2008 Apr 1; 148(7):493-500.
REFERENCES

Journal of American Science 2013;9(5) http://www.jofamericanscience.org
375
Cervical Cancer Prevalence at King Abdulaziz University Hospital
Fadwa J. Altaf1
Ghadeer A. Mokhtar2
and Faris M. Altaf3
1
Professor of Pathology and Consultant Pathologist, Department of Pathology, King Abdulaziz University. Principle
investigator of "Cervical cancer research"fjaltaf@yahoo.com
2
Ghadeer A. Mokhtar Associate Professor and Consultant Pathologist, Department of Pathology King Abdulaziz
University.
3
Faris MS. Altaf. PhD. Medical School, Umm Al-Qura University
Abstract: Introduction: Cervical cancer (CC) is the tenth most frequent cancer in females in Saudi Arabia.
Squamous intra epithelial changes are increasing in the recent years in many reports from different regions of the
Kingdom. However, no information on the frequent histopathological types of CC. Objective: The objective of this
study is to identify the most frequent histopathological types of CC diagnosed at King Abdulaziz University
Hospital (KAUH) and to compare it with literature. Methods: A retrospective study was designed to reclassify all
cases that were diagnosed as CC by using the World Health Organization (WHO) classification system at the
Department of Pathology of KAUH from January 1990- September 2012. We identified and reclassified 167 cases.
Results: The most frequent type was Squamous cell carcinoma (83%) followed by adenocarcinoma (7.7%) and then
adenosquamous (3.6%). The Non keratinizing and keratinizing squamous cells are of nearly equal distribution in
frequency and age (32%) versus (30%) with mean age of 50 years versus 54 years. Adenocarcinoma tends to be
presented at slightly earlier age. Conclusion: Cervical carcinoma occurs in matching frequency with major
histological type and age group in literature although the keratinizing and non keratinizing are almost similar in
prevalence which is different than other reports. Lack of CC screening program and research in this area obscure a
lot of information of the natural history of this health problem in this part of the world.
[Fadwa J. Altaf Ghadeer A. Mokhtarand Faris M. Altaf. Cervical Cancer Prevalence at King Abdulaziz
University Hospital. J Am Sci 2013;9(5):375-379]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 47
Key words: Cervical cancer, Saudi Arabia, Human Papilloma virus. Squamous intraepithelial lesions
1. Introduction:
Our understanding of CC has changed a lot after
series of publications in this aspect. It is well
documented in the literature that CC has many risk
factors; top of the list is Human Papilloma Virus
infection (HPV) (1). The viral infection will cause
series of cytological changes in cervical epithelium
that can be detected by cytological examination of the
cervix by Pap smear. Its incidence was the second
cancer of the females in Western Societies in the
early sixties, and nowadays it drops down to eight (2-
6). In the United State of America, according to the
National Cancer Institute (NCI), it is estimated that
11,270 women were diagnosed with cancer of the
cervix uteri in 2009; about 4,070 women died of it
(7). Its incidence is higher in Hispanics and black in
comparison to Asian/Pacific Islander and Whites.
The mortality rate was higher in Black American in
comparison to the other ethnic groups. The median
age of diagnosis of cervical cancer was 48 years.
In Canada, Incidence rates of cervical cancer
have declined dramatically over the last 3 decades,
from 19.4 per 100 000 women in 1971 to 8.4 per 100
000 women as estimated in 2000 (8). Dr Liu et al.,
reported that the overall age-adjusted incidence rates
of cervical squamous cell carcinoma declined by
51%, from 13.39 per 100 000 women in 1970–1972
to 6.56 per 100 000 women in 1994–1996.
Conversely, incidence rates of adenocarcinoma and
adenosquamous carcinoma increased considerably,
from 1.30 and 0.15 per 100 000 women respectively,
in 1970–1972, to 1.83 and 0.41 per 100 000 women
respectively, in 1994–1996. Further analysis showed
that the observed increase in overall incidence rates
of adenocarcinoma and adenosquamous carcinoma
was mainly in women aged 20–49 years (9).
In Saudi Arabia (SA), the World Health
Organization ( WHO) currently estimates that
women population of 6.5 million are at age 15 years
and older, and they are at risk of developing cervical
cancer, which ranks as the 11th
most frequent cancer
among females in SA in general.
It is the 8th
most frequent cancer among women
between 15 and 44 years of age (10). According to
Saudi cancer registry of 2001(NCR) report,
carcinoma of cervix rank number tenth preceded by
cancer of breast, thyroid, leukemia, lymphoma, brain,
colon, oral cavity, ovary and Hodgkin lymphoma. Its
prevalence is 3% and Age Specific Rate (ASR) is
2/100,000 female population (11). No recent data
from NCR of cervical cancer prevalence in their 2006
report.
WHO recognize more than 30 histological types
of CC (12). In this study we tried to reevaluate all the

376
cases of carcinoma of cervix by reclassifying them
based on WHO histopathology classification (12&13)
2.Material and Methods:
We used the data base of Phoenix System which
is available in Anatomical pathology laboratory, to
identify the cases with cervical biopsies that had
cervical cancer diagnosis or carcinoma in situ in the
archives of the Department of Pathology King
Abdulaziz University Hospital. We also used the
manual search of the old cases (from 1995-1990).
The list of the cases and the slides were prepared for
the pathologist (authors) to examine them. We
excluded cervical biopsies with the diagnosis of
cervical intraepithelial neoplasia( CIN I& CIN II),
endometrioid carcinoma of endometrial type that
presented as cervical mass, or even adenocarcinoma
of cervix (endometrioid ) type that cannot be
differentiated histopathologically from endometrial
type based on the material submitted.
The hematoxcilin and eosin stained (H&E)
slides of each case were reviewed and reclassified
according to modified World Health Organization
(WHO) of invasive carcinoma of the uterine cervix
by two of the authors (FA &GM).
3.Results:
A total of 167 cases were found with the
diagnosis of carcinoma of cervix. Some cases had
single histopathology diagnosis (n=147), others had
multiple specimen over a period of time (n=20), but
the diagnosis was based on one specimen and they
are counted as one case. The different histological
types that we identified were tabulated in table II.
Table I: Modified World Health Organization (WHO) histological classification of invasive carcinomas of the
uterine cervix
1- Squamous cell carcinoma – Keratinizing / Non-keratinizing
Microinvasive squamous cell carcinoma
Invasive squamous cell carcinoma
Verrucous carcinoma
Warty (condylomatous) carcinoma
Papillary squamous cell (transitional) carcinoma
Lymphoepithelioma-like carcinoma
2- Adenocarcinoma
Mucinous adenocarcinoma
Endocervical type
Intestinal type
Signet-ring type
Endometrioid adenocarcinoma
Endometrioid adenocarcinoma with squamous metaplasia
Clear cell adenocarcinoma
Minimal deviation adenocarcinoma
Endocervical type (adenoma malignum)
Endometrioid type
Well-differentiated villoglandular adenocarcinoma
Serous adenocarcinoma
Mesonephric carcinoma
3- Other epithelial tumors
Adenosquamous carcinoma
Glassy cell carcinoma
Clear cell adenosquamous carcinoma
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Adenoid basal carcinoma
Typical carcinoid tumor
Atypical carcinoid tumor
Large cell neuroendocrine carcinoma
Small cell carcinoma
Undifferentiated carcinoma

377
Table II: KAU cases Histolopathological type identified, mean age & Frequency
Std. DeviationMean Age%NHistological Types
14.5493750.703732.154Squamous cell carcinoma, non-keratinizing
13.5153154.235330.151Squamous cell carcinoma, keratinizing
30.00000.61Microinvasive squamous cell carcinoma
29.00000.61Invasive squamous cell carcinoma
11.9865544.250019.632Carcinoma in-situ / CIN III
.40.00000.61Invasive papillary squamous cell carcinoma
.58.00000.61In-situ adenocarcinoma
10.3572548.00007.112Invasive adenocarcinoma endocervical type
11.9065847.83333.66Adenosquamous carcinoma
6.3639656.50001.22Papillary serous adenocarcinoma
16.2634651.50001.22Mucoepidermoid carcinoma
.0000070.00001.22Invasive adenosarcoma
38.00000.61Small cell carcinoma
.46.0000.61Undifferentiated carcinoma
13.7305350.204899.4167Total
4.Discussion:
The most common histological types of Cervical
Carcinoma in the literature is the squamous cell
carcinoma (SCC) accounted for 75-80% of CC with a
mean age 55 years. The next common type is
adenocarcinoma 20-25%, followed by
adenosquamous and small cell carcinoma (12, 13).
Majority of SCC are non- keratinizing, which means
it lakes squamous pearls but individual cell
keratinization is evident in most of the cases. The
keratinized SCC contains squamous pearls and may
also show individual cell keratinization. The risk
factors of CC are as for squamous intraepithelial
changes (SILs). WHO recognizes three major types
of Cervical Carcinoma (CC) and 31 histological
subtypes, as demonstrated in table I (12).
There are many reports from different provinces
of the Kingdom mainly from Western region, and
they are all hospital based studies (10&16-19). These
reports indicate there is a definite increase in the
prevalence of cervical epithelial changes in PS from
(1.6 % to 7.9% and recently 17.3%). Which reflect an
increase in the incidence of HPV infection.
Study from the Eastern province also indicates
an increase of squamous epithelial changes (SIL) up
to 4.9% seen in PS (20).
Few studies had looked at the presence of HPV
in cytology by molecular methods (21) and found 5%
of the cervical smears have oncogenic HPV.
Al-Muammar et al., looked also at HPV DNA
in cytology specimen and correlates it with PS. Of
the 120 samples used in their study, 38 (31.6%) were
found positive by PCR for HPV-16 or HPV-18 or
both (22). When they correlated that finding with the
cytology they found 10 cases (8.3%) showed minor
cytological changes (reactive and reparative changes,
inflammatory cellular changes, and low-grade squa-
mous epithelial lesions [LGSL]) in the Pap smear
test. Of these 10, only 6 were HPV-infected (1 HPV-
16, 1 HPV-18, and 4 HPV-16/18), making the
prevalence of HPV 60% (6/10) in those with
cytological changes and 5% (6/120) in all subjects.
Very much similar result to Gazaz study in the
Western region 6% HPV DNA detected in cervical
cytology (21).
Al Hebishi et al., looked at the prevalence of
HPV virus DNA in 100 cases that have the diagnosis
of cervical cancer. They concluded that eighty-nine
percent of cervical cancers in Saudi Arabia were
associated with HPV infection, and 78.7% (70/89) of
HPV-positive tumors were infected with HPV-16/18,
which caused the cancer to appear 5 years earlier
than the combined HPV-negative and other HPV
genotypes (P=0.013). (23)
We did not find a single study in Saudi Arabia
that looked at the frequency of the histological types
of cervical cancer and to compare it to literature.
We found no much difference in the prevalence
between the non Keratinizing and keratinizing
squamous cell carcinoma 32&31%. In addition no
big differences in their mean age as well 51 versus 54
years. The literature review reveal there is difference
in the prognosis in the treatment of the 2 groups when
radiotherapy is a modality of treatment. Keratinizing
SCC is less sensitive to radiotherapy in comparison to
non keratinizing SCC and subsequently to survival
(24).
The in situ cancer of squamous component in
our study represent 20% (32/167) with mean age of
44 years, which is younger than the invasive SCC and
still older than literature, the reason of this could be
due lack of detection earlier as a result of absence of
cervical cancer screening program or it could be

378
related to the disease natural history in this part of the
world.
Invasive adenocarcinoma represented 7% of our
cases. It is presenting few years earlier than invasive
SCC (48 years) but no big age difference as reported
in literature
Liu et al., (9) reported in their study that several
reports from Sweden, United States, and Australia
have reported an increase of incidence of invasive
cervical adenocarcinoma, although the overall
incidence of cervical cancer has declined. It accounts
for 10%–15% of all cervical cancers and it has been
increasing in young women (age range 29-49yrs.).
The cause of the increase is unclear, but the possibly
of Changes in sexual habits and increased
transmission of HPV, but it are of concern because
some studies have shown a poorer prognosis for
patients with cervical adenocarcinoma than for those
with squamous cell carcinoma. At the time of
diagnosis, adenocarcinoma tends to be larger and
exhibits a propensity for early lymphatic and
hematogenous metastasis (25).
We identified 2 cases of serous carcinoma
(1.2%) with average age of 56 years and both of them
present with stage IV disease. It is a rare type of
endocervical adenocarcinoma. Serous carcinoma of
the cervix occurs much less frequently than serous
carcinoma of the endometrium. Only one series with
a significant number of patients has been reported
and it contained only 17 cases (26). In one study,
serous carcinoma did not appear to be associated with
HPV infection. (27)
Serous carcinoma of the cervix occurs over a
wide age range, but there appears to be a bimodal
distribution, with a peak <40 years and another >65
years. (26) The typical clinical presentation is with
abnormal vaginal bleeding or an abnormal Pap smear.
Treatment has been the same as for other types of
cervical carcinoma. In the largest series 6 of 15
patients died of carcinoma, an outcome similar to that
observed in adenocarcinoma of the cervix overall.
Serous carcinoma can occur as a pure type or a
second type of cervical adenocarcinoma can be
admixed.
Since serous carcinoma of the endometrium is
much more common than serous carcinoma of the
cervix, endocervical spread of an endometrial serous
carcinoma must be excluded before a diagnosis of
serous carcinoma of the cervix is made (26).
Papillary squamous cell carcinoma is a type of
squamous cell carcinoma that grow in thin and thick
papillae with fibrovascular core and the epithelium
mimicking that of high grade squamous
intraepithelial lesion. (28). typically this tumor occurs
in women in the late reproductive period or
postmenopausal age group. Mirhashemi et al reported
presence of HPV antibodies in 50% of their cases.
(29)
Declaration:
The authors declare that the study and
manuscript have no conflict of interest and is not
supported/funded by any Drug Company.
Acknowledgement:
This project was funded by the Deanship of
Scientific Research (DSR), King Abdulaziz
University, Jeddah, under grant no. (259/140/1431).
The authors acknowledge with thanks DSR technical
and financial support.
Corresponding Author:
Fadwa Jameel Altaf
Professor of pathology and consultant pathologist
King Abdulaziz University. Jeddah Saudi Arabia.
P.O. Box 51241, SA 21543.
Email. fjaltaf@yahoo.com
References:
1. Papanicolaou GN, Traut HF. The diagnostic value
of vaginal Smears in carcinoma of the uterus.
1941. Arch Pathol Lab Med 1997 ; 121: 211-224.
2. Pettersson F, Bjorkholm E, Naslund I. Evaluation
of screening for cervical cancer in Sweden: trends
in incidence and mortality 1958–1980. Int J
Epidemiol 1985; 14:521-7
3. Anderson GH, Boyes DA, Benedet JL, Le Riche
JC, Matisie JP, Suen KC, et al., Organisation and
results of the cervical cytology screening program
in British Columbia, 1955–85. BMJ 1988;
296:975-8.
4. Quinn M, Babb P, Jones J, Allen E, on behalf of
the United Kingdom Association of Cancer
Registries. Effect of screening on incidence of
and mortality from cancer of the cervix in
England: evaluation based on routinely collected
statistics. BMJ 1999; 318:904-7.
5. Bergstrom R, Sparen P, Adami HO. Trends in
cancer of the cervix uteri in Sweden following
cytological screening. Br J Cancer 1999; 81:159-
66.
6. Miller AB, Lindsay J, Hill GB. Mortality from
cancer of the uterus in Canada and its relationship
to screening for cancer of the cervix. Int J Cancer
1976; 17:602-12.
7. Howlader N, Noone AM, Krapcho M, Neyman N,
Aminou R, Altekruse SF, Kosary CL, Ruhl J,
Tatalovich Z, Cho H, Mariotto A, Eisner MP,
Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds).
SEER Cancer Statistics Review, 1975-2009
(Vintage 2009 Populations), National Cancer
Institute. Bethesda, MD,
http://seer.cancer.gov/csr/1975_2009_pops09/,
based on November 2011 SEER data submission,

379
posted to the SEER web site, 2012. Cervical
Cancer Incidence
8. National Cancer Institute of Canada. Canadian
Cancer Statistics 2000. Toronto. The Institute
2000.p.17-38
9. Shiliang Liu, Robert Semenciw, Yang Mao
Cervical cancer: the increasing incidence of
adenocarcinoma and adenosquamous carcinoma
in younger women. JAMA 2001.17 AVR: 164(8).
10. Altaf F.J, Mufti ST, Pattern of cervical smear
abnormalities using the revised Bethesda system
in a tertiary care hospital in Western Saudi
Arabia. Saudi Med J 2012; Vol. 33 (6)
11. Altaf- FJ, Cervical Cancer Screening with Pattern
of Pap Smears Review of Multicenter Studies.
Saudi Med J 2006; Vol 27 (10)
12. Wright TC, A. Frenczy and RJ Kurman. Chapter
8. Carcinoma and Other Tumors of the Cervix.
Blaustein Gynecological pathology 2002
13. Clement PB, Young RH. Atlas of Gynecologic
Surgical Pathology. Saunders Elsevier. Second
Edition 2008.Chapter 5&6, pages, 96-138.
14.Benedet JL, Bender H, Jones H III et al., FIGO
staging classification and clinical practice
guidelines in the management of gynecological
Oncology. Int J. Gynaecol Obstet 70:209-262.
2000
15. Coutlee F, Ratnam S, Ramanakumar AV, Insinga
RR, Bentley J, Escott N, Ghatage P, Koushik A,
Ferenczy A, Franco EL. Distribution of human
Papillomavirus genotype in cervical
intraepithelial neoplasia and invasive cancer in
Canada. J Med Virol.2011; 83(6):1034-41
16. Altaf FJ. Pattern of cervical smear cytology in the
Western Region of Saudi Arabia. Ann Saudi Med.
2001; 21:92–6
17. Jamal A, Al-Maghrabi JA. Profile of Pap smear
cytology in the Western region of Saudi Arabia.
Saudi Med J. 2003; 24:1225–9.
18. Elhakeem HA, Al-Ghamdi AS, Al-Maghrabi JA.
Cytopathological pattern of cervical Pap smear
according to the Bethesda system in Southwestern
Saudi Arabia. Saudi Med J. 2005; 26:588–92.
19. Abdullah LS. Pattern of abnormal Pap smears in
developing countries: a report from a large
referral hospital in Saudi Arabia using the revised
2001 Bethesda System. Ann Saudi Med. 2007;
27:268–72.
20. Balaha M H , M S Al Moghannum, NAl
Ghowinem, S. Al Omran Cytological pattern of
cervical Papanicolaou smear in eastern region of
Saudi Arabia J Cytol. 2011; 28(4): 173–177.
21. Gazaz FS. Molecular testing of human Papilloma
in cervical specimen. Saudi Med J 2007; 28:1810-
1818.
22. Al-Muammar T. , M N Al-Ahdal, A. Hassan, G.
Kessie, D.MD.Cruz, G. E Mohamed. Human
papilloma virus-16/18 cervical infection among
women attending a family medical clinic in
Riyadh. Ann Saudi Med .2007;27(1):1-5.
23. Alsbeih G. , R. Ahmed,
N. Al-Harbi, L.
A.Venturina, A. Tulbah, K.Balaraj Prevalence
and genotypes' distribution of human
papillomavirus in invasive cervical cancer in
Saudi Arabia. Gynecologic Oncology. Volume
121, Issue 3, 1 June 2011, Pages 522–526.
24. Kumar S, Shah JP, Bryant SC, Media AN· Rouba
Ali-Fehmi ·John M. Malone Jr · Robert T. Morris
Prognostic significance of keratinization in
squamous cell cancer of uterine cervix: a
population based study. Arch Gynecol Obstet
(2009) 280:25–32
25. DiSaia. Adenocarcinoma of the cervix: Clinical
Gynecologic Oncology, 6th ed., 2002
26. Gilks, C. B. & P. B. Clement. "Papillary serous
adenocarcinoma of the uterine cervix: a report of
three cases." Modern Pathology 5: 426-431. 1992.
27. Pirog EC, Kleter B, (2000). "Prevalence of human
papillomavirus DNA in different histological
subtypes of cervical adenocarcinoma." American
Journal of Pathology 157(4): 1055-1062.
28. Randall ME, Andersen WA, Mills SE, Kim JC,
Papillary squamous cell of uterine cervix. A
clincopathological study of nine cases. Int J
Gynecol Pathol 1986; 5: 1-10.
29. Mirhashemi R. Ganjel-Azar P. Nadji M. Papillary
squamous cell carcinoma of uterine cervix: an
immunohistochemical appraisal of 12 cases.
Gynecol Oncol 2003; 90:657- 661
3/12/2013

RESEARCH ARTICLE Open Access
HPV prevalence and genetic predisposition to
cervical cancer in Saudi Arabia
Ghazi Alsbeih1,4*
, Najla Al-Harbi1
, Medhat El-Sebaie2
and Ismail Al-Badawi3
Abstract
Background: Cervical cancer incidence is low in Saudi Arabian women, suggesting low prevalence to HPV
infection due to environmental, cultural and genetic differences. Therefore, we investigated HPV prevalence and
genotype distribution in cervical cancer as well as the association with 9 genetic single nucleotide polymorphisms
(SNPs): CDKN1A (p21) C31A, TP53 C72G, ATM G1853A, HDM2 promoter T309G, HDM2 A110G, LIG4 A591G, XRCC1
G399A, XRCC3 C241T and TGFβ1 T10C, presumed to predispose to cancer.
Methods: One hundred cervical cancer patients (90 squamous cell carcinoma and 10 adenocarcinoma) and 100
age/sex-matched controls were enrolled. SNPs were genotyped by direct sequencing and HPV was detected and
typed in tumors using the HPV Linear Array Test.
Results: Eighty-two cases (82%) were positive for HPV sequences. Seven HPV genotypes were present as single
infections (16, 18, 31, 45, 56, 59, 73) and five double infections (16/18, 16/39, 16/70, 35/52, 45/59) were detected.
Most common genotypes were HPV-16 (71%), 31 (7%), and 18, 45, 73 (4% each). Only XRCC1 SNP was significantly
associated with cervical cancer (P=0.02, OD=1.69; 95% CI= 1.06–2.66). However, nested analysis revealed a
preponderance of HPV-positivity in patients harboring the presumed risk allele TP53 G (P=0.06). Both XRCC1 and
TP53 SNPs tended to deviate from Hardy-Weinberg equilibrium (HWE; P=0.03-0.07).
Conclusions: HPV prevalence (82%) in cervical cancer is at the lower range of the worldwide estimation (85 - 99%).
While XRCC1 G399A was significantly associated with cervical cancer, TP53 G72C showed borderline association only
in HPV-positive patients. Deviation from HWE in HPV-positive patients indicates co-selection, hence implicating the
combination of HPV and SNPs in cancer predisposition. Thus, SNPs could be more relevant biomarkers of
susceptibility to cervical cancer when associated with HPV infection.
Keywords: Cervical cancer, Human papillomavirus (HPV), Predisposition, Single nucleotide polymorphism (SNP)
Background
Cancer of the uterine cervix is the 3rd most frequent
malignancy affecting women worldwide and the seventh
overall, with an estimated 530,000 new cases in 2008
[1,2]. Among all the known risk factors, human papillo-
mavirus (HPV) stands as a main cause, and high-risk
HPV infections play a major role in the pathogenesis of
cervical cancer with an estimated prevalence between
85% to 99% [3-7]. More than 85% of the global burden
occurs in developing countries, where it accounts for
13% of all female cancers. This is due to the lack of
proper screening program that has helped reducing
cervical cancer incidence and mortality rates by 70% in
developed countries [8,9].
In contrast to the global view, the incidence of cervical
cancer is very low in Saudi Arabia, ranking number 11
between all cancers in females and accounts only for
2.4% of all new cases [10], despite the lack of national
screening programs. The actual reason for this low inci-
dence is unknown. The closed society and standards of
mores could reduce women exposure to HPV infection
[11-14]. In addition, male circumcision is associated with
a reduced risk of penile HPV infection and a reduced
risk of cervical cancer in their female partners [15]. The
prevalence of HPV infection among women and its
* Correspondence: galsbeih@kfshrc.edu.sa
1
Biomedical Physics, King Faisal Specialist Hospital & Research Centre, Riyadh,
Saudi Arabia
4
Research Centre, Biomedical Physics Department, KFSHRC, MBC-03, P.O. Box
3354, Riyadh 11211, Saudi Arabia
Full list of author information is available at the end of the article
© 2013 Alsbeih et al.; BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Alsbeih et al. Infectious Agents and Cancer 2013, 8:15
http://www.infectagentscancer.com/content/8/1/15

Gynecological cancer researches 1436 h – 2015g

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