Breast cancer in men in black Africa: a report of 73 cases.

Seventy-three Nigerian men with breast cancer seen over a 20-year period were studied to evaluate the pattern of the disease in one black African population. An annual incidence of 1.2 per 100,000 of the population was calculated; the proportion in relation to the disease incidence in women was 3.75%. Two-thirds of the patients were aged 50-65 years; the mean was 54.1 (SEM 2.3). Three patients linked their disease with trauma while seven had pre-existing gynaecomastia. More than 90% of the patients presented with advanced disease (stages III and IV), with bulky tumours (3.5-13.5 cm diameter), fixation to muscle (76.7%), skin involvement (65.6%) and nodal invasion (91.8%). Carcinomas of no special type (infiltrating ductal and undifferentiated cancers (76.7%)) dominated the histopathology, which included one case of lobular carcinoma.

Benign breast disease in Nigerian women: a study of 657 patients.

A 15-year combined retrospective (222 patients) and prospective (435 patients) evaluation of the pattern of benign breast disease in one region of the African tropics has been completed. Fibroadenoma constituted the largest group (55.6%), followed by mammary dysplasia (fibrocystic disease with fibroadenosis: 29.3%) and sclerosing adenosis (7.9%). Approximately one-third of women were under 20 years and two-thirds under 25. For the 435 patients in the prospective study, a late mean [SEM] age at menarche of 15.3 (2.1) years (controls: 14.2 [2.5], NS; early first full-term pregnancy: 20.4 [1.6] years, (controls: 21.1 [1.1], NS; parity 3.6 [1.7], (controls: 4.1), NS; and prolonged breast feeding (17.6 [2.2] months) did not appear to constitute risk factors to the development of benign breast disease among Nigerian women.

Abdominal tuberculosis: a study of 881 cases.

A retrospective study of the epidemiological pattern of abdominal tuberculosis in Ibadan, Nigeria during the 30-year period 1960-1989 has been completed. Among 881 cases seen (355 men and 526 women), children under 10 years represented 10.5% of cases but 78% of all cases were under 40 years. Women accounted for 64% of this number. The peak age incidence was 21-30 years (30.1%). Over 40 years of age, the female incidence fell (9%), so that the male incidence became greater (12%). The population-adjusted annual incidence during the 30-year period showed a gradual decline during the first two decades but a rising trend in the last decade is now evident. The clinical and pathological features were similar to those previously described, but delay in presentation varied between 1 and 14 1/2 months with a mean (SEM) of 5.2 (1.3) months.

Leucocyte alkaline phosphatase activity in solid malignant tumours.

Quantitation of leucocyte alkaline phosphatase activity has been found to be a useful index in the diagnosis and the monitoring of activity in a variety of disease states. Low levels are found in some haematological disease conditions, but elevated values are found in acute stress states, in pyogenic infections, myocardial infarction, trauma, diabetes mellitus etc. Studies on the pattern of activity in solid neoplasms are scanty and the published results are often contradictory. Observations made on nine different groups of solid neoplasms suggest that certain malignant tumours are associated with elevated LAP activity levels. These high levels fail to return to normal values following treatment even when there are no clinical signs of residual tumour or of recurrence. The results suggest that while LAP quantitation has a useful role in the detection of certain malignant neoplasms, it is not a sensitive tool for monitoring tumour reactivity of quiescence.

The management of male breast cancer in Nigerians.

The outcome in 57 male patients with breast cancer has been analysed. Four patients with early disease had simple mastectomy (one case) and radical mastectomy (three cases). All four completed a 12-cycle cyclophosphamide/methotrexate/5-fluorouracil (CMF) course of chemotherapy. Two required orchiectomy after 23 and 38 months, respectively. Two patients were alive at 79 and 63 months. Fifty-three others with advanced disease had simple mastectomy (10 cases), radical mastectomy (38 cases) and no surgery (five cases), but only 33 completed chemotherapy and 11 were submitted to orchiectomy for recurrence after a mean interval of 19 months. Two patients were alive at 63 and 69 months, respectively. The overall survival rate was 7%. It is considered that in addition to late presentation (mean (SEM): 16.4 (2.1)) months and advanced disease (93%), ineffectiveness of the CMF regimen in male patients may have contributed to the poor survival rate in these Nigerian patients.

Breast cancer in Nigerian women.

A combined retrospective (1971-1980) and prospective (1981-1990) study of the epidemiology, clinical characteristics and pathology of breast cancer in a black African population was carried out. There were 1946 biopsy-proven cases, with a rate frequency of 33.6 per 100,000 patients per year. The age range was 14-96 years but 70 per cent of patients were between 26 and 50 years old. The cumulative frequency of cancer was 0.8 per cent at age < 20 years and 3.3 per cent at age < 25 years; the peak age range for disease was 36-45 years. Of 1842 evaluable patients, 17.2 per cent presented with stages I or II cancer and 73.8 per cent with stage III disease. The dominant histopathological type was infiltrating ductal cancer (49.2 per cent), followed by undifferentiated anaplastic carcinoma (33.3 per cent). Burkitt's lymphoma occurred in five patients and developed concurrently and rapidly during lactation in four. The prospective study did not demonstrate that age at menarche or first full-term pregnancy, duration of breast feeding or parity were risk factors in black women.

Fibrous histiocytomas in the tropics.

Sixty patients with fibrous histiocytomas - malignant fibrous histiocytomas and benign histiocytomas - presenting at University College Hospital, Ibadan over a 10-year period have been evaluated retrospectively. A malignant:benign tumour ratio of 2.8:1, a male:female ratio of 1:1, and a predilection for malignant histiocytomas to occur early (16-25 years) in contrast to benign histiocytomas (26-35 years) were noted. While the trunk accounted for one-third of cases, the extremities accounted for two-thirds of all patients. A long history of slow growth (from 6 months to 11 years) of a large bossellated tumour anywhere in the body, with a tendency to recurrence after excision and potential for metastasis, constitute the main characteristics of this tumour.

Diverticular disease of the colon in black Africa.

Diverticular disease of the colon, previously believed to be rare among Africans, is now an emerging disease entity in many areas of the African tropics. Fifteen patients, the majority of whom were overweight (73%), under 50 years of age (73%) and who have remained on the bulky diet traditional to much of Africa, are reported. The findings suggest that factors previously uncommon in the area may now be operating to cause the disease in the population, and the highly processed food products of the supermarkets may be an important contributor to the development of this new disease entity.

Schistosomiasis of the testis.

Bilhazial orchitis is still rare in many countries, and when it presents, difficulties in diagnosis arise. Since it stimulates testicular cancer, misdiagnosis invariably leads to orchiectomy, an unfortunate event in the young patient.

Perforated typhoid enteritis. The problem of intestinal fistula.

Typhoid enteritis with perforation is still a major problem in many hospital centres in the tropics and post-operative intestinal fistula accounts for much of the morbidity and mortality among those who survive the septicaemic phase of the disease. In poorly equipped hospitals with limited resources, early aggressive re-exploration to close the intestinal fistula when the patient is still strong is advocated in preference to conservative treatment which is prolonged, of uncertain outcome and liable to be abandoned especially where the patient is poor and unable to provide the material for fluid replacement and nutritional support over a long period of time.

Tamoxifen in the management of advanced breast carcinoma in Nigerian women.

Twenty-nine Nigerian women with advanced breast carcinoma treated with Tamoxifen (Nolvadex ICI) at a dosage of 20 mg twice daily have been reviewed. Eight of 26 evaluable patients had objective response (31%). No statistically significant association was found between response rate and menopausal status, previous chemotherapy or disease free interval. The drug was well tolerated with a low incidence of side effects. This study suggests that Tamoxifen is a useful drug in the adjuvant management of patients with advanced breast carcinoma in Nigeria.

Carcinoma of the oesophagus.

A 10-year review of oesophageal cancer in Ibadan, Nigeria, is presented Seventy-two patients representing a mean annual incidence of 0.31 per 100 000 of the population were found. The age range was 27-96 years, with a mean of 57 years for men and 65 for women. Dysphagia, weight loss and anaemia were the significant features in the majority and 40 per cent of the patients presented between 4 and 12 months (mean 7.5 months). None of the commonly used dietary ingredients could be implicated in the causation of this tumour in which squamous cell cancer accounted for 88.5 per cent of all types. The middle third was the commonest site of tumour formation (45 per cent) while the lower third accounted for 40 per cent. A low operability rate of 32 per cent is recorded and only 21 per cent were suitable for oesophagectomy. Survival among this group was 50 per cent at 1 year, 20 per cent at 3 years and 10 per cent at 4 years.

Caverno-saphenous shunt in the treatment of priapism.

The painful pathological condition of the penis, priapism, is usually associated with serious destructive changes which lead to impotence if treatment is with-held or delayed. Conservative therapy is slow, uncertain and usually ineffective. Early surgical decompression of the corpora cavernosa, repeated if necessary, is essential if impotence is to be averted. Two unusual cases of this condition recently seen at the University College Hospital, Ibadan, in which treatment had been delayed for periods previously thought to be too long for recovery are herein presented and the management described. It is advised that failure of the initial surgical operation calls for early re-operation to establish a new shunt.