Oral Amelanotic Melanoma

Malignant melanomas of the mucosal regions of the head and neck are extremely rare neoplasms accounting for less than 1of all melanomas. Approximately half of all head and neck melanomas occur in the oral cavity. Less than 2of all melanomas lack pigmentation; in the oral mucosa however; up to 75of cases are amelanotic. No etiologic factors or risk factors have been recognized for oral melanomas. Some authors have suggested that oral habits and selfmedication may be of etiological significance. Oral melanoma is rare but it is relatively frequent in countries like Japan; Uganda; and India. It is rarely identified under the age of 20 years. In Australia where cutaneous melanomas are relatively common primary melanoma of the oral mucosa is rare. The surface architecture of oral melanomas ranges from macular to ulcerated and nodular. The lesion is said to be asymptomatic in the early stages but may become ulcerated and painful in advanced lesions. The diagnosis of amelanotic melanoma is more difficult than that of pigmented lesions. The neoplasm consists of spindle-shaped cells with many mitotic figures and no cytoplasmic melanin pigmentation. Immunohistochemistry using S-100; HMB-45; Melan-A and MART-1 will help in establishing the correct diagnosis. Radical surgery with ample margins and adjuvant chemotherapy are appropriate management protocol for malignant melanoma. Oral melanoma is associated with poor prognosis but its amelanotic variant has even worse prognosis because it exhibits a more aggressive biology and because of difficulty in diagnosis which leads to delayed treatment

Metastatic breast cancer in a Nigerian tertiary hospital

Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome. Objective: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital. Method: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria were reviewed. Results: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81years with a mean age of 45.9 years. Only 3(6 of 202) were males. Twothirds had more than one secondary site on initial evaluation and the commonest sites were liver (63); lung parenchyma (51); pleura (26) and contralateral breast in 25. On immunohistochemistry; basal like tumours were found in 46.1. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27. Conclusion: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation

Clinicopathological review of schistosomalappendicitis in south western Nigeria.

Background: Gastrointestinal schistosomiasis may involve the appendix and there is no specific clinical picture associated with the same. Methods: The clinical records and histopathological slides of all patients diagnosed with schistosomal appendicitis between January 1989 and December 2006 in Ile-Ife, south west Nigeria, were reviewed. Result: Of 956 patients who had appendectomy at the Obafemi Awolowo University Teaching Hospital within the study period, 22 (2.3%) had histopathological diagnosis of schistosomal appendicitis. Eighteen (81.8%) were male whilst 4 (18.2%) were female. Their ages ranged between 15 and 63 years with a mean of 28.2 (+5.6) years. The mean duration of right lower quadrant abdominal pain was 4.2 years. Appendiceal and periappendiceal adhesions were noted intraoperatively in 17 (77.3%) and the appendix was adjudged grossly inflamed in 9 (40.9%) patients. Submucosal fibrosis and eosinophilia were the common histopathological findings aside from submucosal oviposition. All patients received antischistosomal drugs and one patient developed adhesive intestinal obstruction 9 months after surgery. Conclusion: Schistosomal appendicitis may present acutely but diagnosis is only reliably made at histopathological examination. Adequate follow-up is however required to ascertain long-term outcome