Gastrointestinal Stromal Tumours at the University of NigeriaTeaching Hospital Enugu; Nigeria: an Immunohistochemical Study of GITMesenchymal Tumours

Mesenchymal tumours of the gastrointestinal tract (GIT) are uncommon. Recent progress in the understanding of the biology and origin of these tumours has led to their reclassification. A new subclass designated Gastrointestinal Stromal Tumours (GIST) is diagnosed based on the presence of a mutational over expression of c-kit protein that is thought to be critical in the pathogenesis of these tumours.This newclass of tumoursmay form the majority of gastrointestinal mesenchymal tumours. Even though the diagnosis of GIST is mainly based on positive staining with CD117; a minority of tumours with histological characteristics of GIST are CD117 negative and are classified asCD117 negativeGIST. In this first reviewof mesenchymalGITtumours fromNigeria;we present 11 cases ofmesenchymal tumours of the gastrointestinal tract seen within a six-year period at our centre. Immunohistochemistry was performed on 7 of themin which histological appearances suggested GIST. Only two cases had all the criteria defined in the consensus conference on the diagnosis ofGIST. Our findings; albeit in a very small sample; contrastswith what obtains in developed countries in the proportion of GIT mesenchymal tumours that are truly GIST. This raises a question to be answered on the true nature and proportion of gastrointestinal strumal tumours among GITtumours inNigerian patients

Delays in Presentation and Treatment of Breast Cancer in Enugu; Nigeria

To assess the delays and define the causes of delay in presentation and treatment of breast cancer patients inEnugu;Nigeria. Across-sectional survey of breast cancer patients using a semi structured questionnaire. SurgicalOncology unit;University ofNigeriaTeachingHospitalEnugu; (UNTH-E);Nigeria. 164 consecutively presenting breast cancer patients seen between June 1999 andMay 2005. Most of the patients (82.3) reported for initial evaluation at a modern health facility while 17.5reported first toAlternative practitioners. Forty six patients (26.4) presented within a month of noticing the symptoms while 72 (45.3) delayed more than 3 months. In contrast; 18 (17) were seen at the site of definitive treatment within one month of seeking help at the initial hospital while 73.4had a delay of more than 3months after the initial hospital contact. Institutional or physician induced delayswere present in 46.2of the caseswhile patient related delayswere present in 79.2of cases.Only use of alternative practitioners for initial treatmentwas significantly related to delays ofmore than threemonths before presentation (p= 0.017). For breast cancer prevention programs in Nigeria to succeed; they must in addition to breast awareness and screening programs; address the institutional bottlenecks; the dearth of knowledge among primary care physicians and improve referrals fromalternative practitioners and prayer houses