Homocysteine Levels in Nigerian Women with Pre-eclampsis/Eclampsia

Hyperhomocysteinaemia has been linked in various studies worldwide to the occurrence of cardiovascular disorders and endothelial cell injury. In Nigeria with one of the highest maternal/neonatal mortality and morbidity, it is significant to explore means of predicting pregnancy-induced hypertension. This study was carried out at the Lagos University Teaching Hospital which is a major referral center in the South-western part of Nigeria. It was set to determine the mean plasma homocysteine levels and corpuscular haemoglobin in pre-eclamptic/eclamptic Nigerian women. A total of 150 subjects consisting of 100 primigravidae and 25 diagnosed cases of pre-eclampsia/eclampsia and 25 non-pregnant females were enrolled in the study. 60 primigravidae were lost to follow up or had incomplete data. The mean value of homocysteine in the control group, and eclamptic group was 7.5±3.4 μmol/L and 16.1±6.5 μmol/L respectively. There is positive and significant correlation between plasma homocysteine in the eclamptic group and the mean MCV (r=0.97, p=0.01), and between plasma homocysteine, systolic and diastolic blood pressure of the eclamptic group (r=0.944, p=0.0001; r=0.98, p=0.0001). The study further supports earlier findings of increased homocysteine levels in the occurrence of pre-eclampsia/eclampsia. Keywords: Hyperhomocysteinaemia, Pre-eclampsia/eclampsia, Primigravidae, Cardiovascular disorde

Leiomyosarcomas of Vascular Origin in the Extremity

Between 1996 and 2006 a total of 278 patients with soft tissue Leiomyosarcoma were treated at our centre. We identified 16 patients (5.8%) where the tumour directly arose from the blood vessels. These tumours were studied to determine their prognosis and behaviour. All tumors were in the lower limbs: 11 from the femoral vein, 3 popliteal vein, and 2 from the posterior tibial vein. Mean tumour size was 10.4 cm (3 to 33). Histological grade was high in all patients. Surgical treatment was amputation in one, excision with or without vascular reconstruction in 12 followed by radiotherapy, and 3 patients had no surgery because of advanced disease at diagnosis. Seven out of the 16 patients (44%) had metastasis at diagnosis, and five patients without metastasis at diagnosis rapidly developed metastases at a median time of 5 months from diagnosis (2–30 months). The overall survival of the patients at 5 years was 25% which was considerably worse than those with nonvascular leiomyosarcoma. We conclude that patients with leiomyosarcoma of vascular origin have a very high risk of metastases and poor prognosis when treated in the conventional way

Preoperative surgical risk stratification in osteosarcoma based on the proximity to the major vessels

Aims The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels. Patients and Methods A total of 226 patients with high-grade non-metastatic osteosarcoma in the limbs were investigated. Median age at diagnosis was 15 years (4 to 67) with the ratio of male to female patients being 1.5:1. The most common site of the tumour was the femur (n = 103) followed by tibia (n = 66). The vascular proximity was categorized based on the preoperative MRI after neoadjuvant chemotherapy into four types: type 1 > 5 mm; type 2 ≤ 5 mm, > 0 mm; type 3 attached; type 4 surrounded. Results Limb salvage rate based on the proximity type was 92%, 88%, 51%, and 0% for types 1 to 4, respectively, and the overall survival at five years was 82%, 77%, 57%, and 67%, respectively (p Conclusion The proximity of osteosarcoma to major blood vessels is a poor prognostic factor for local control and survival. Amputation offers better local control for tumours attached to the blood vessels but does not improve survival. Limb salvage surgery offers similar local control if the tumour attachment to blood vessels is limited

‘‘Two-Week Waits”—Are They Leading to Earlier Diagnosis of Soft-Tissue Sarcomas?

Introduction. The ‘‘two-week wait” was established as a potential means of diagnosing malignant tumours earlier. This paper investigated whether these clinics are leading to earlier diagnosis of malignant soft-tissue lumps. Method. We identified all referrals to our centre from a database over a 4-year period. Results. 2225 patients were referred to our unit for investigation of a soft-tissue mass. 576 (26%) were referred under the ‘‘two-week wait” criteria. 153 (27%) of which were found to have a malignant or borderline malignant diagnosis. 1649 patients were referred nonurgently. 855 (52%) of which were diagnosed with a malignant or borderline lesion. The average size at diagnosis was 9.4 cm with no difference in size between the different referral routes. Conclusion. There is little evidence that the two-week wait clinic is leading to earlier diagnosis of soft-tissue sarcomas with the majority still being referred nonurgently

Primary Leiomyosarcoma of Bone: Analysis of Prognosis

Leiomyosarcoma of bone is just one of the variants of spindle cell sarcoma of bone characterised by the expression of desmin and other markers indicating a significant element of smooth muscle in the tumour, without osteoid production we have investigated the management and outcome of this rare type of primary malignant bone tumour. Method. Retrospective review of data stored on a prospective database. Results. In a database of 3364 patients with primary malignant bone sarcomas, 31 patients were identified with a primary leiomyosarcoma of bone. There were 12 males and 19 females with a mean age of 46 and tumour size of 8 cm. The most common site was the distal femur followed by the proximal tibia. Treatment was with chemotherapy and surgical resection. Seven of the patients had metastases at diagnosis. Surgery was carried out in 28 patients, 8 having amputation and 20 limb salvage. Three patients developed local recurrence, but half developed metastases. All patient disease-specific survival was 57% at five years and 44% at 10 yrs but for those without metastases was 82% and 60%, respectively. The only prognostic factors were metastases at diagnosis. Conclusion. Leiomyosarcoma of bone is a very rare primary malignant bone tumour affecting a predominantly older population. Despite the high incidence of metastases, survival is better than for other bone sarcomas for those without metastases at diagnosis

Chondroblastoma of bone in extremities. - A single centre study of 177 cases

Introduction Chondroblastoma is a rare benign bone tumour that usually occurs in children and young adults. They are cartilaginous tumours arising in the epiphysis or apophysis of a long bone. The tumour is classified as benign, although rare cases of pulmonary metastases have been reported. The aims of this study were to describe clinical, radiographic characteristics of chondroblastoma; to analyse the local recurrence rate and complications associated with surgery. Material and methods This retrospective study included 177 patients, who had been diagnosed with a chondroblastoma in extremity between 1990 and 2015. Results The most common site was proximal tibia 20%, followed by proximal humerus 19%, proximal femur 18%, distal femur 16% and foot 15%. One patient has died of the disease and one patient is alive after being operated for lung metastases. There was local recurrence in 25/177 (14%) patients. The median time to local recurrence was 10 months (range 3-158 months). The most common site for local recurrence was proximal tibia (22.2%). The proximal femur was the location in 32/178 (18%) of the cases. 18/32 (56%) were in the greater trochanter and 14/32 (44%) in the femoral head. The mean age was lower in tumours located in femoral head when compared to the greater trochanter; 19.5 years and 13.9 years respectively (p=0.004). Tumours located in greater trochanter were all curetted without further complications. Local recurrence was seen more often in femoral head tumours, though without statistical significance; 3/14 (21%) and none, respectively (p=0.073). Conclusions Chondroblastoma is a rare benign to intermediate grade bone tumour with a potential to metastasise. Femoral head chondroblastoma is rare, presenting 4.5% of all chondroblastoma cases. Around 50% of the chondroblastoma in femoral head. occur in patients with open growth plates.Peer reviewe

Elastofibroma Dorsi: An Uncommon Benign Pseudotumour

Elastofibroma dorsi is an uncommon benign soft tissue pseudotumour usually located at the lower pole of the scapula, deep to serratus anterior, and often attached to the periosteum of the ribs, presenting with long history of swelling and occasionally pain and discomfort. This lesion is usually seen in patients over the age of 50 years and is not uncommonly mistaken as a malignant tumour because of its size and location deep to the periscapular muscles. Review of the orthopaedic oncology database of 17 500 patients revealed that there were 15 patients with elastofibroma dorsi. There were 12 males and 3 females, mean age at diagnosis of 68.4 years range 51–79 years. The diagnosis was confirmed by MRI in 3 patients, excision biopsy in 3 patients, trucut biopsy in 8 patients and open biopsy in 1 patient. Eight patients had excision of the lesion which was symptomatic. There have been no recurrences. We highlight the clinical and radiological presentation of elastofibroma dorsi to increase awareness of its existence and management

A giant ectopic hidradenoma papilliferum in a Niger delta region of Nigeria

Hidradenoma papilliferum is a known example of adnexal skin tumours with apocrine differentiation. It is a rare benign tumour which tends to arise from areas with rich concentration of aporine glands such as anogenital region, vulval, perineal, axillae, and periumbilical areas. In this report, the tumour was found in the upper outer quadrant of left breast, being one of the ectopic sites for this tumour. Contrary to most reports where male preponderance was popular for ectopic hidradenoma papilliferum, the patient in this report is a 71-year-old female. Considering the location of this tumour in this report, the likely histopathological differential diagnoses such as tubular apocrine adenoma, clear cell (apocrine) adenoma, lipoma, intraductal papilloma and papillary carcinoma of the breast should be considered for exclusion. This is the first reported case of a giant ectopic hidradenoma papilliferum of the breast in a Niger Delta region of Nigeria which also highlights the role of fine needle aspiration and cytology in the diagnosis of breast lesions