Signet ring cell lymphoma of the small bowel: a case report

Gastrointestinal lymphoma of the bowel is uncommon compared to adenocarcinoma. Signet ring cell lymphoma [SRCL] is a rare variant of non-Hodgkin's lymphoma that is characterized by clear cytoplasm with displaced nuclei to the periphery giving a signet ring appearance. Small bowel involvement has not been previously reported. We report the rare case of a 78-year-old female who presented with short history of fever, loss of appetite, nausea, vomiting, mild weight loss with abdominal discomfort and was later diagnosed to have SRCL of the ileum

Oesophageal ulcers secondary to doxycycline and herpes simplex infection in an immunocompetent patient

Oesophageal ulcerations are generally rare occurrences that are most commonly associated with gastro-oesophageal reflux disorder. Other causes include medications and infections in immunocompromised patients. Among the medications used in daily practice, doxycycline is most commonly implicated. Multiple aetiologies are generally uncommon. We report a case of mid-oesophageal ulcerations secondary to doxycycline and herpes simplex virus infection in an immunocompetent patient.

Rising incidence of breast cancer in Brunei Darussalam

Introduction: Breast cancer is one of the most common cancers in women and the incidence rates are reported to be increasing. This study looks at breast cancer in Brunei Darussalam in particular the incidence rates, the demographic and types of breast cancers over a 27-year-period (1984 to 2010). Materials and Methods: The Cancer Registry maintained by the State Department of Pathology was retrospectively reviewed. Over this period there were a total of 874 cases of breast cancer diagnosed, nine of which were men (1.1%) and these were excluded from analysis. The crude incidence rates, Age Standardised Rates (ASR) and the age specific incidence rates were calculated based on population projections. Age was unavailable from 1984 and 1985 and these two years were excluded from ASR analyses. Results: The mean age at diagnosis was 48.7 ± 11.7 years old. The ethnic distribution showed predominantly Malays (69.1%) followed by Chinese (20.1), ‘Others’ (9.1%) and Indigenous group (1.5%). The types of cancers were predominantly ductal (84.9%), followed by lobular (5.5%), Malignant Phyllodes tumour (4.4%), ‘Others’ (4.6%) and papillary (0.7%). Breast accounted for 17.6 to 26.6% of all female cancers from 2001 to 2010. 22.3% of breast cancers occurred in the young patient group (less than 40 years old). The crude rates increased from 11.0 per 100,000 women (1984-1986) to 40.7 per 100,000 women (2008-2010) and the ASR increased from 14.7 per 100,000 (1987-1989) to 43.9 per 100,000 women (2008-2010). The ASR for the Chinese increased markedly from 1992-1995 peaking in 2002-2004 followed by a declining trend whereas the trend is increasing in the Malays. Conclusions: Our study showed that the overall incidence of breast cancers in Brunei Darussalam is increasing. Chinese had higher incidence rates than the Malays. The age adjusted incidence rate is approaching the rates reported by the more developed Southeast Asian nations. Importantly, young breast cancer accounts for a fifth of the patients.

Breast cancer in Brunei Darussalam - Incidence and the role of evaluation of molecular markers

Introduction: Molecular markers determined by immunohistochemistry are routinely used for predicting and prognosticating cancers including breast cancer. Molecular markers for breast cancer such as oestrogen and progesterone receptors, Her2, p53, pS2, Bcl2, EGFR, Ki67, CD34 and Cathepsin D have been used in Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital. This study assessed the ethnic variations in breast cancer incidence as well as the relationships between expression of these markers with tumour stage and grade and patient survival in Brunei Darussalam . Materials and Methods: Records of breast cancer patients between 2001 and 2009 were retrieved and abstracted from the Cancer Registry maintained by the Department of Pathology at the RIPAS Hospital. These were reviewed and analysed using appropriate statistical methods. Results: Overall, the mean age at diagnosis was 49.2 years. The incidence rate of breast cancer among Chinese (56.4 per 100,000 per year) was significantly higher than Malays (27.8) and the other ethnic groups (12.3). The expression of oestrogen and progesterone receptors and pS2 was significantly greater in the more differentiated tumours while that of Ki67 and p53 in tumours and CD34 in blood vessels within the tumour was significantly greater in the less differentiated tumours. Positivity for oestrogen receptor was significantly associated with the absence of metastases in regional lymph nodes. Expression of oestrogen and progesterone receptors in tumour cells was significantly associated with enhanced patient survival, while the detection of CD34 in blood vessels within tumours was associated with poorer survival. Survival trends seen for other markers were not statistically significant. Conclusions: The different incidence of breast cancer among the different ethnic groups merits more detailed investigation of the responsible genetic, social and environmental factors. Oestrogen and progesterone receptors and CD34 are confirmed as useful markers for prognosis among our population with breast cancer. Expression of p53, Ki67 and pS2 may also be useful. These markers will be helpful in determining treatment options and for patient education.