Reconstruction of the chest wall after excision of a giant malignant peripheral nerve sheath tumor.

Primary chest wall tumors are uncommon and constitute 0.2-2% of all tumors. Metastatic tumors and tumors of local extension are more common. Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on the chest wall not stated in the literature. The incidence in the general population is 0.0001% while the risk is approximately 4600 times higher in patients with type I neurofibromatosis and 3-13% of them will finally develop into MPNST, usually after latent periods of 10-20 years. Clinically, these tumors are aggressive, locally invasive, and highly metastatic. Excision of giant chest wall tumor leaves a defect that is reconstructed using musculocutaneous flaps with or without a mesh. We report the case of a 24-year-old man who presented at the surgical outpatient clinic with 7 months history of persistent left sided chest pain minimally relieved by analgesics, 5 months of cough and worsening dyspnoea, and 3 months history of anterior chest swelling on the left side of the manubrium. Following evaluation and investigations, the tumor was excised and the residual defect closed with methylmetacrylate sandwiched between two prolene meshes and overlaid with both pectoralis major muscles. The histology of the excised mass revealed MPNST He made an uneventful postoperative recovery, but died barely 3 months later from widespread pulmonary metastases. A review of the literature revealed that such tumors hardly ever reach such large-size as in our case.

Comparative study of visual inspection of the cervix using acetic acid (VIA) and Papanicolaou (Pap) smears for cervical cancer screening.

UNLABELLED: This article is a comparative study of two screening methods for pre-invasive lesions of the cervix. The Papanicolaou (Pap) smear, an old and tested screening method, is compared with the findings from visual inspection of the cervix following acetic acid (VIA) wash. VIA is a new screening method being advocated by the World Health Organization as an alternative to Pap smear in low-resource settings. OBJECTIVE: The objective of this article is to compare the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of VIA and Pap smear. METHODS: This was a comparative study carried out in the postnatal clinic of Ahmadu Bello University Teaching Hospital, Zaria. Pap smear samples were taken by the researcher. Samples were fixed in 95% ethyl alcohol and taken to the Pathology Department for interpretation. The cervix was then painted with 3-5% VIA and observed for aceto-white lesions. Suspected areas were biopsied and transported to the Pathology Department for interpretation. Patients with positive Pap smear results were also called back for biopsy. Biopsy served as the reference standard. RESULTS: There were 351 samples that were suitable for statistical analysis. The sensitivity of VIA was 60%, specificity 94.4%, positive predictive value 50%, negative predictive value 99.4%, and accuracy was 98.6%. Pap smear had a sensitivity of 60%, specificity of 100%, positive predictive value of 100%, negative predictive value of 99.4%, and accuracy of 99.4%. CONCLUSIONS: VIA had a comparable result with Pap smear. It should be incorporated into our national screening programme to complementthe cervical cytology in low-resource settings similar to ours.