Discrete Breast Masses in Female Children and Adolescents: Is there a Place for Non-operative Management by Pediatric Surgeons.

Background: The treatment of breast masses in female children and adolescents is controversial. While some advocate for early surgical removal others prefer the conservative non operative approach. The aim of this study is ascertain the evidence for the current protocol of early surgical removal in our centre. Materials and Methods: Retrospective observational study to highlight the epidemiology of discrete breast masses in female children and adolescents <18years seen at the Lagos University Teaching Hospital, Nigeria. Main outcome measure was to find out if there is a malignancy in excised tissue specimens. Results: Fifty three girls with 76 breast masses were evaluated. Median age at presentation was 16years (4 –17 years). Mean size of lumps was 3.6 cm (±2.1). All the breast masses had benign clinical characteristics and were confirmed histologically to be benign. There was no case of primary or secondary malignancy in any of the histological specimens. Family history, nipple discharge or ingestion of oral contraceptives did not affect presentation, diagnosis and outcome (p>0.05). Conclusion: This series show that breast masses in children and adolescents are almost always benign. It is advocated that conservative non-operative management (with close follow up with imaging such as breast ultrasound and/or MRI) should be adopted by paediatric surgeons in cases of breast masses in children except when surgery is specifically indicated. These indications which should be individualized include: cosmesis, bloody nipple discharge, persistent history of pain in the mass, rapid growth of the mass and malignancies with predilection for the breasts.

Glomus Tumours of the Hand in Lagos; Nigeria

"Background: Glomus tumours of the hand are uncommon intriguing tumours which cause significant morbidity. Few reports have documented the epidemiology and presentation in the West African subregion. The aim of this review is to identify the common baseline demographics; the presentation; evaluation; diagnosis and treatment outcome of glomus tumours of the hand in Lagos; Nigeria Methods: A 10 year retrospective review of the records of all patients seen with histopathologically diagnosed glomus tumor of the hand at the Lagos University teaching hospital was carried out noting the biodata; demographics; method of presentation and treatment of this condition.Results: 11 patients were seen over the study period .There were nine females and 2 males seen.The mean age of the patients was 41 years. The symptoms had been on for between 3 and 40 months .All patients seen had a positive Love test.Only one patient had associated bony erosion.All had complete excision with no recurrence at 6 months.Conclusion: Glomus tumor of the hand is an uncommon tumour often occurring in adult women. Clinical test (Love ""test"") will correctly identify the diagnosis.Surgical treatment was curative in all our cases. High index of suspicion is needed to make earlier diagnosis"

Polymorphism and virulence factors in the pathogenesis of amoebiasis

Amoebiasis is one of the world's most prevalent infectious diseases of developing world. E. histolytica and E. dispar are two morphologically identical but genetically distinct species. Infection with E. histolytica may be symptomatic and asymptomatic. E. dispar is non-pathogenic. Both innate and acquired immune responses limit amoebic infection while different strains of E. histolytica and its virulence have been described and virulence factors of E. histolytica such as cysteine proteinases; Gal/GalNAc-inhibitable lectin and ameobapore are known to be involved in E.histolytica pathogenesis. Proteolytic enzymes and cysteine proteases facilitate tissue invasion while Gal/GalNAc-inhibitable lectin aids adherence and amoebapores are involved in lysis of target cells. Three new strains of E. histolytica (Rahman; HK-9; and 200: NIH) have been described as well as the previously known strain (HM 1 IMSS). This review highlights the newly described strains and virulent factors involved in the pathogenesis of E. histolytica