The comparison between cytological and histological grading of breast cancers in a Nigerian tertiary hospital

Background: Breast cancer is one of the most common cancers in Nigeria. The tumour grade is an important prognostic factor and is also important in treatment of patients. Fine needle aspiration cytology can be used as an initial diagnostic tool for planning definitive management. Grading of tumours on cytology further guides therapeutic decisions. The aim of this study is to compare the correlation between the cytological and histological grading of malignant breast lumps using the Robinson's cytological grading system and Nottingham histological grading system respectively. The Objectives are, to determine the age distribution of breast cancer in our environment, to grade breast cancers cytologically using the Robinson's cytological grading system and to grade breast cancers histologically using the Nottingham histological grading system.Methods: This was a one year prospective study that involved 30 patients who had malignant smears on fine needle aspiration cytology of their breast lump. These smears were graded using the Robinson's cytological grading system and compared with the Nottingham histological grading systems of same lumps obtained from either tissue biopsies or mastectomies.Results: The mean age of the study participants was 50.23±10.11 years with a range of 35-70 years. Most (56.7%) malignat smears were of cytologic grade 3. The histological grade was 2 in 16(53.3%) and 3 in 14(46.7%) of the same breast tissue samples. The grade 2 tumours had the highest concordance rate of 83.3%. The absolute concordance rate between Robinson's cytological and Nottingham histological grading system of breast cancers was 73.3%.Conclusion: The Robinson's cytological and Nottingham histological grading systems showed good correlation.Keywords: Breast Cancer, fine needle aspiration cytology, cytological grading, histological gradin

Stepping on the ladder of integration: perspectives of foundational science teachers at a medical school on a discipline-based curriculum

Objective: This study explored the perspectives of foundational science teachers on the integration of courses within a discipline-based curriculum.Design: A qualitative enquiry based on an interpretive paradigm framework. Data were obtained through three focus group discussions conducted among the teachers from the departments of anatomy, physiology, and biochemistry of the institution. The transcript data obtained were analysed using the process of thematic analysis.Setting: The study was conducted in the College of Health Sciences, Obafemi Awolowo University Ile-Ife, (CHS, OAU) Nigeria.Participants: All twenty-six foundational science teachers were invited to participate in the discussion, but only twenty-one participated in the study.Result: The perspectives of the foundational teachers were grouped into four themes upon agreement by the authors. The themes were: (1) knowledge of integration, (2) perception of the need for and benefits of integration, (3) enablers and barriers to integration, and (4) suggestions. Participants believed integration was necessary to foster a better understanding of courses and would encourage interdisciplinary teaching. They also believed integration would reduce curriculum overload in basic medical science courses. Several logistic issues were perceived as barriers.Conclusion: This study revealed that the teachers support the integration of courses in the curriculum to enhance teaching while encouraging students’ participation and understanding. Full understanding and commitment of teachers are necessary for the effective integration of the curriculum. Institutional and infrastructural support is required for the success of such a proposed curriculum

A huge low-grade fibromyxoid sarcoma of small bowel mesentery simulating hyper immune splenomegaly syndrome: a case report and review of literature

Introduction: Low-grade fibromyxoid sarcoma (LGFMS) is a rare non epithelial tumour. It usually arises from the smooth muscles of the extremities. It is, however, occasionally reported to arise from other regions of the body. Case report: We report the case of a 32 year old man who complained of a progressive abdominal swelling of 4 months duration. There was associated abdominal discomfort and weight loss. Abdominal examination revealed a non-tender intra abdominal mass filling the abdomen completely. Abdominal ultrasound suggested a massive splenomegaly. Abdomina Computerized Tomography (CT) scan was not done due to financial constraints. At laparotomy, a large, pearl-coloured mass was found within the mesentery of the proximal jejunum, with dilated, tortuous vessels. It was resected along with the overlying 60cm of jejunum. It weighed 7.5kg. Histology and immunohistochemistry confirmed the diagnosis of lowgrade fibromyxoid sarcoma. Post-operative period was uneventful and there were no features of recurrent after 2 year of follow up. Conclusion: LGFMS may cause a diagnostic dilemma, especially in a third world setting where preoperative diagnosis is hampered by lack of facilities and poverty. A high index of suspicion is needed for preoperative diagnosis, which is necessary for proper planning of the operation