Occult cancer with cervical lymph node metastasis: histologic profile of cervical lymph node and pan-endoscopic biopsies at university college hospital, Ibadan, Nigeria

Background: Occult cervical lymph node metastasis is a relatively rare oncologic disease presenting as a neck lump without an obvious mucosal lesion. Most cases arise from the upper aerodigestive tract and affect all ages. It is often a diagnostic dilemma when there is no facility to carry out a thorough evaluation.Methods: A prospective study of all patients with neck lump with unknown primary tumor site evaluated within the periods, January 2010 to December 2012 at the ENT/Head and Neck Department of University College Hospital, Ibadan. The patients went through clinical, radiological and endoscopic assessments. Fine Needle Aspirate and Cytology (FNAC) of neck node and random pan-endoscopic specimens obtained were cytological and histological analysed.Results: The prevalence of cervical nodal metastasis with unknown primary site was 9.7%. We found no gender predilection in the study. Majority of the patients with occult cervical node metastases were in the third decade of life. The histological yield of pan-endoscopy biopsy specimen was 72%. Undifferentiated nasopharyngeal squamous (39%) cell carcinoma was the commonest diagnosis following random biopsy during pan-endoscopy.Conclusion: Despite limitations arising from lack of FDG PET, the yield from pan-endoscopy biopsy specimen was appreciable. Inadequate immunohistological stains and lack of FDG PET scan may have diminished the histological yield of the blind pan-endoscopy biopsy specimens.Keywords: Cervical nodal metastasis with unknown primary site, pan-endoscopy biopsy, occult cancerJos Journal of Medicine, Volume 7 No.

Primary osteogenic sarcoma of the breast

BACKGROUND: Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is extremely rare. It can arise as a result of osseous metaplasia in a pre-existing benign or malignant neoplasm of the breast or as non-phylloides sarcoma from the soft tissue of a previously normal breast. CASE PRESENTATION: A 40 year-old Nigerian woman was clinically diagnosed to have carcinoma of the left breast. The histology report of core-needle biopsy of the mass showed a malignant neoplasm comprising islands of chondroblastic and osteoblastic stromal cells. This report changed the diagnosis from carcinoma to osteogenic sarcoma of the breast. She had a left modified radical mastectomy, however there was significant post surgery skin deficit. A latissimus dorsi musculocutaneous flap was used to cover the anterior chest wall defect. Sections from the mastectomy specimen confirmed the diagnosis of osteogenic sarcoma. She died six months after mastectomy. CONCLUSION: A diagnosis of osteogenic sarcoma of the breast was made based on histology report and after excluding an osteogenic sarcoma arising from underlying ribs and sternum. This is the second documented case of primary osteogenic sarcoma of the breast coming from Nigeri

Waist–Hip Ratio and Breast Cancer Risk in Urbanized Nigerian Women

Background: The aim of this study was to examine the relationship between waist–hip ratio and the risk of breast cancer in an urban Nigerian population. Methods: Between March 1998 and August 2000, we conducted a case–control study of hospital-based breast cancer patients (n = 234) and population-based controls (n = 273) using nurse interviewers in urban Southwestern Nigeria. Results: Multivariable logistic regression showed a significant association between the highest tertile of waist–hip ratio and the risk of breast cancer (odds ratio= 2.67, 95% confidence interval = 1.05–6.80) among postmenopausal women. No association was found in premenopausal women. Conclusion: The present study, the first in an indigenous African population, supports other studies that have shown a positive association between obesity and breast cancer risk among postmenopausal women

Amyloid angiopathy of the floor of the mouth: a case report and review of the literature

Amyloidosis is a rare disease characterised by the deposition of insoluble extracellular fibrillar proteins in various tissues of the body. The pattern of manifestation is organ dependent and also on whether the disease is localised or systemic, primary or secondary

Lymphomas in sub-Saharan Africa - what can we learn and how can we help in improving diagnosis, managing patients and fostering translational research?

Approximately 30 000 cases of non-Hodgkin lymphoma (NHL) occur in the equatorial belt of Africa each year. Apart from the fact that Burkitt lymphoma (BL) is very common among children and adolescents in Africa and that an epidemic of human immunodeficiency virus (HIV) infection is currently ongoing in this part of the world, very little is known about lymphomas in Africa. This review provides information regarding the current infrastructure for diagnostics in sub-Saharan Africa. The results on the diagnostic accuracy and on the distribution of different lymphoma subsets in sub-Saharan Africa were based on a review undertaken by a team of lymphoma experts on 159 fine needle aspirate samples and 467 histological samples during their visit to selected sub- Saharan African centres is presented. Among children (age), BL accounted for 82% of all NHL, and among adults, diffuse large B-cell lymphoma accounted for 55% of all NHLs. Among adults, various lymphomas other than BL, including T-cell lymphomas, were encountered. The review also discusses the current strategies of the International Network of Cancer Treatment and Research on improving the diagnostic standards and management of lymphoma patients and in acquiring reliable clinical and pathology data in sub- Saharan Africa for fostering high-quality translational research

Analysis of serum and salivary immunoglobulin M in patients with orofacial epithelial cancers

Context: The physiological changes in the humoral immune system of patients with orofacial epithelial cancers (OECs) are considered key factors in the pathogenesis, prognosis, and management of these individuals. Aim: This study assessed the serum and salivary immunoglobulin M (IgM) levels in patients with OECs. Settings and Designs: This is a cross-sectional study of the serum and salivary IgM profile among patients with OEC and healthy controls. Materials and Methods: There were 78 subjects comprising 30 patients with untreated OEC, 18 patients with OEC receiving treatment and 30 healthy, age and gender matched individuals. The serum and salivary samples from the participants were analyzed for IgM using the enzyme linked immunosorbent assay technique. Results: The mean value of serum IgM in OEC patients receiving treatment was significantly lower compared to untreated OEC patients and healthy controls (P = 0.01). However, the mean serum IgM among untreated OEC patients was not significantly different compared with healthy controls. In contrast, the salivary IgM level did not show any significant difference among the three groups (P = 0.06). Furthermore, there was no correlation between the serum and salivary levels of IgM among the subjects. Conclusion: The findings from this study suggest that serum IgM levels in OEC patients receiving treatment might be good biomarker while salivary IgM may not be reliable as a marker in these individuals