ABSTRACT
Leiomyomas are benign soft tissue neoplasms that arise from smooth muscles. Leiomyosarcomais a malignant lesion of smooth muscle origin. This is a rare lesion in the uterus with 1-2 % of its benign counterpart, leiomyoma, transforming into the lesion. It is often aggressive and could develop at any site where the smooth muscle is found. We present a case of a 48-year-old farmer with pelvic mass with Ultra-sonography(USS) suggestive of leiomyoma. Hysterectomy was done and histologic diagnosis of leiomyosarcoma (LMS) was made. The patient was discharged 7 days post operation but was lost to follow up. Uterine LMS is an aggressive tumour, therefore, a high index of suspicion is needed especially for huge uterine nodules and such patients must be closely monitored for adequate management
ABSTRACT
Aim: The study aimed to determine the diagnostic values for lactate dehydrogenase (LDH) and serum ascites albumin gradient (SAAG) with maximum sensitivity and minimum false positivity so as to differentiate malignancy-related ascites from non-malignant ascites in South West region of Nigeria. Study Design: This is a cross sectional study to determine the correlation between ascitic fluid LDH and SAAG and malignant and non-malignant ascites. Place and Duration of Study: This study was carried out at the clinics of gastroenterology, surgery, and obstetrics/gynecology at the Lagos University Teaching Hospital (LUTH), between August 2011 and July 2013. Methods: A total of 75 patients with ascites admitted into Lagos University Teaching Hospital (LUTH) from 2011 to 2013 were enrolled for the study. Thirty seven (7males, 30 females) had malignancy-related ascites while 38(18 males, 20 females) had non-malignant ascites. Levels of LDH and SAAG were determined in all patients with ascites. Statistical analysis was performed using SPSS software application (version 15.0) and p˂0.05 was considered statistically significant and results expressed as mean ± standard deviation. Results: A total of 75 patients were recruited for the study. Twenty-five of them (33.3%) were males while 50(66.7%) were females. The mean age for both sexes was 59.03±13.54 years. Using Receiver Operator Characteristic (ROC) curve, cut-off levels were 11.5 for SAAG and 310 IU/l for LDH. These cut-offs divided the malignant from the non-malignant group. Higher levels of ascitic LDH were seen in the malignant group (900.67±918.45 IU/l) when compared to the non-malignant group (199.29±194.53 IU/l). This was statistically significant (P<0.05). The diagnostic accuracy of LDH was 90.7%. SAAG was lower in the malignant (6.74±4.84 g/L) group when compared to the non-malignant (13.56±7.50 g/L). This was also statistically significant (P<0.05). The diagnostic accuracy of SAAG was 73.3%. Conclusion: It was concluded that measurement of ascitic fluid LDH and SAAG were relevant in differentiating malignant from non-malignant ascites. The determined cut-off values for LDH and SAAG in this study provides the distinctive differential diagnosis between malignant and nonmalignant ascites. Routine analysis of serum and ascitic fluid albumin and LDH will resolve the problem of malignant and non-malignant ascites especially in low-resource areas or in the developing world.
ABSTRACT
Background : Carcinoid tumours have long been known to be a morphologically distinct class of rare intestinal tumours. The prevalence vary with geographical area; most are clinically silent and are found incidentally at surgery. They may occasionally cause intestinal or vascular obstruction necessitating emergency surgery following which the dia- gnosis is made. We report this first case of intestinal carcinoid seen in this centre in over twenty years. Methods: The case report discussed here is an intestinal carcinoid in- volving the distal ileum. Results:Clinical presentation was recurrent abdominal pain with a tender mass in the periumbilical region extending to the right iliac fossa with noisybowel sounds. Plain abdominal x-ray; barium meal and abdominal Ultrasonography were not diagnostic. A laparatomy on account of intestinal obstruction was performed which revealed a tan yellow tumour extending into the mesentery. Histology revealed carcinoid tumour.Conclusion : Carcinoid tumours should be considered in patients presenting with recurrent abdominal pain or mass or intestinal obstruction. Localization of the tumour is impor- tant since the diagnosis of all carcinoids without systemic features from hormone production depends on the histological structure and staining properties