Intestinal obstruction secondary to cecal endometriosis.

Endometriosis of the gastrointestinal tract is rare and occurs in <1% of all patients undergoing major gynecological surgeries. Bowel involvement has been reported in 3%-37% of all women of childbearing age with endometriosis. Total obstruction of the gastrointestinal tract occurs in <1% of cases of endometriosis with bowel obstruction. This case report is that of a 42-year-old female who presented with a 6-month history of change in bowel habits in favor of increasing constipation. This was associated with cyclical lower abdominal pains, abdominal swelling, and weight loss. Examination revealed hyperactive bowel sounds with scant fecal matter on rectal examination. An impression of intestinal obstruction was made and she had an emergency laparotomy. Dilated ileum and a hard, constricting cecal mass were found intraoperatively. She had a right hemicolectomy and ileo-transverse anastomosis, with progressive improvement postoperatively. Histology of the resected bowel segment confirmed cecal endometriosis. In conclusion, cecal endometriosis is a rare cause of intestinal obstruction. A high index of suspicion is required for diagnosis, especially if the woman is premenopausal with a history of abdominal pain that worsens with menstrual periods. Outcome is good with appropriate surgical intervention.

Malignant Breast Tumour in a 13-Year Old Girl.

We report a case of primary malignant fibrous histiocytoma of the breast in a 13-year old girl. She has had wide local excision of the tumour and six cycles of adjuvant cytotoxic chemotherapy. Four years after treatment, she was free from local recurrence; however, the presence of distant metastasis could not be assessed because of inadequate imaging investigations.

Clinicopathological study of male breast cancer in Nigerians and a review of the literature.

BACKGROUND: Breast cancer is rare in men, accounting for approximately 1% of all cases of breast carcinoma. OBJECTIVE: To evaluate the incidence, presentation, histopathological types, management and outcome of male patients with breast cancer treated at the University of Benin Teaching Hospital, Benin City, Nigeria. METHODS: A 20 year (1987-2006) retrospective study of all male patients with breast cancer was done. Clinic demographic data regarding age, sex, clinical information, treatment and follow up were obtained from request cards and case files. Slides were retrieved from the archives of the Department of Pathology and reviewed. RESULTS: Sixteen cases of male breast cancer were encountered. This comprised 18.4% of the breast lesions in males and 2.8% of all breast cancers seen in the Department during the 20 year study period. The ages of patients ranged from 35-90 years with a mean age of 64.4 years. Delay in patient presentation to physician ranged from 14-49 months. Clinically, patients presented mostly with a self-detected lump (87.5%), or ulceration (68.8%), nipple discharge (43.8%) and nipple bleeding (25.0%). Unilaterality was observed in 87.5% of cases were while 12.5% of cases were bilateral (metachronous). Invasive ductal carcinoma (81.25%) was the predominant histological type of cancer. Stage IV disease was most commonly encountered (43.8%). Eleven (68.8%) patients had modified radical mastectomy. Only 31.3% patients came for follow-up, for a median duration of 10 months. CONCLUSION: Male breast cancer is rare and patients present late with advanced disease. Education needs to be intensified to increase awareness of the disease.

Gastric carcinoma--a big challenge in a poor economy.

BACKGROUND: Gastric carcinoma is usually characterized with significant morbidity and mortality mainly because of late presentation. Late presentation of gastric carcinoma is a prominent feature in developing and poor countries. AIM OF STUDY: The purpose of this study is to present our experience with the pattern and outcome of gastric tumors at the University of Benin Teaching Hospital, Benin City, Nigeria; with emphasis on late presentation of the patients. PATIENTS AND METHODS: The case files of the patients that were managed at the University of Benin Teaching Hospital for gastric tumors over a 5-year period (January 2004 to December 2006) were analyzed for biodata, symptoms and signs of disease, findings at operation, treatment offered, and outcome of treatment. RESULTS: The male/female ratio was 2.3:1, with the youngest patient being 38 years while the oldest patient was 76 years old. Upper abdominal pain and a palpable mass per abdomen were the commonest symptoms and signs, respectively. Alcohol ingestion was the commonest identifiable risk factor. Only 30.4% of the patients presented within a year of the onset of symptoms. The gastric antrum was affected in over 78% of the cases, and adenocarcinoma was found in about 90% of the patients. Partial gastrectomy with gastrojejunostomy was the commonest procedure carried out. The mortality rate was 39.1%, and of the patients that died, 66.7% occurred within a year from time of diagnosis. CONCLUSION: Most of the cases of gastric carcinoma presented in this study presented late with associated significant mortality. Health education is advised with a view to encouraging early presentation.

Histopathological Study of Thyroid Cancer in a Nigerian Tertiary Hospital

Background: Thyroid cancers are rare but are reported as the most common endocrine malignancies. There is a regional variation in the incidence. Aim: To evaluate the incidence and histological pattern of thyroid cancer with respect to age and sex. Methods: A 20-year (1986-2005) retrospective study of thyroid neoplasms at the University of Benin Teaching Hospital; Benin City. Nigeria. Results: A total of 46 malignant tumours were diagnosed constituting 8.6of all thyroid lesions and 1.3of the malignant tumours seen during the period of study. Thyroid cancer was more prevalent in females with a female to male ratio of 1.9:1. Papillary carcinoma (47.8) was the most common histological type of thyroid cancer; followed by follicular carcinoma (30.4); anaplastic carcinoma (13.0); and Medullary carcinoma (8.7); in order of frequency. While papillary carcinoma was the most common histological type of thyroid cancer in females; follicular carcinoma was the predominant form of thyroid cancer in males. Papillary carcinoma was most prevalent in the third decade of life while follicular carcinoma was more frequent after the fourth decade of life. Anaplastic carcinoma occurred in the 6th decade. Conclusion: There is need for an increased level of awareness of the disease and the provision of cancer registries

A 20-Year Clinicopathological Analysis of Tuberculous Mastitis in Nigerians

Background: Tuberculosis is a global problem with high incidence in endemic areas such as Nigeria. A resurgence of tuberculosis attributed to an increase in the incidence of AIDS was observed in many countries in the last decade. A corresponding increase in the incidence of extrapulmonary tuberculosis including tuberculous mastitis was also documented in tuberculous endemic areas Aim: To present the experience of tuberculous mastitis from the Department of Pathology; University of Benin Teaching Hospital; Benin City; Nigeria. 1987 to 2006. Methods: A retrospective study of cases of tuberculosis of the breast from 1987 to 2006 as found in the records of the Pathology Department was done. Results: Twenty-four cases of tuberculosis of breast were seen during the 20 year period of study. All patients were females. They presented with a lump; mostly in the right breast (70.8). All cases were histologically confirmed. Five (20.8) patients were lactating at the time of presentation. Only 3 (12.5) of the 24 cases were suspected clinically as tuberculous mastitis. There was co-existing fibrocystic disease; fibroadenoma and carcinoma in 3 (12.5); 2 (8.3); and 1 (4.2) patient respectively. All patients had satisfactory results on antituberculosis treatment. Co-existing fibroadenoma and carcinoma were treated by excision biopsy and simple mastectomy respectively. Conclusion: Although the incidence of the tuberculous mastitis is low; it is often misdiagnosed. There is need for a high index of suspicion in making the diagnosis in young women with breast lumps in whom malignancy has been excluded

Management of Pregnancy Associated Breast Cancer

Background: The peak age incidence for breast cancer in developing countries is 35-45 years; which is part of the reproductive years of our women. As women defer child- bearing on account of education and careers; the incidence of pregnancy associated breast cancer is expected to increase. Aim: This study presents 4 cases of pregnancy associated breast cancer (PABC) to illustrate the challenges and dilemma in the management of these patients. Methods: The clinical features; stage of presentation of the disease; treatment and outcome of treatment of 4 patients with PABC are reviewed. Results: There were live births of normal babies by all 4 patients; but 100mortality as all the 4 patients with PABC died within 18 months of delivery from metastatic breast cancer. Conclusion: Seventy to 80of non-pregnant patients present with advanced breast cancer. PABC as illustrated by these 4 cases presented at worse stages of the advanced cancer. The late stage at diagnosis of PABC and the desire by the patients to have normal live birth at term have worsened prognosis for the PABC patients in our environment. Recommendation: Multidisciplinary team approach by midwives; obstetricians; surgeons and counselors using BSE; CBE and screening at ante-natal clinics for early detection and diagnosis. Counselors to assist patients take decision in the best interest of patient and unborn baby to reduce morbidity and mortality