Multiple carcinomas in a woman with HIV infection: a case report and literature review.

Non-acquired immunodeficiency syndrome-defining cancers (NADCs) are malignancies in persons living with human immunodeficiency virus (PLWHIV) and are not primarily due to the host's immunodeficiency. There is renewed clinical interest in long-term morbidities in PLWHIV as well as malignancies that occur in this population. We herein describe a 36-year-old woman with a 2-year history of an anal wound and right breast mass. She had been diagnosed with HIV infection prior to the development of these lesions. Clinical and laboratory evaluations led to diagnoses of breast and anal cancers. Chemotherapy and antiretroviral therapy were begun, but the patient discontinued these treatments early and was lost to follow-up. NADCs will continue to be a major clinical issue as the global population ages. This presentation of two NADCs (breast and anal cancers) in a PLWHIV further highlights the burden of multiple malignancies on the depleted health of HIV-infected patients. Early identification and treatment of HIV upon patients' presentation to cancer care sites and screening for NADCs at HIV/AIDS care sites are recommended for improved outcomes.

Jejunojejunal intussusception induced by a gastrointestinal stromal tumor: a case report and literature review.

Intussusception is defined as the invagination of a proximal segment of the bowel into the adjoining or distal segment. In most adults with intussusception, there is a demonstrable lead point with a definite pathologic abnormality. The clinical features of intussusception include chronic intermittent abdominal pain, nausea and vomiting, constipation, and a palpable abdominal mass. The present case report describes a 62-year-old woman with a 2-week history of abdominal pain and 9-day history of vomiting. Clinical, imaging, and histologic evaluations revealed a jejunojejunal intussusception with a gastrointestinal stromal tumor as the lead point. A gastrointestinal stromal tumor should be considered as a possible lead point in adult patients with intussusception. The implication of reducing the intussusception prior to tumor resection requires further evaluation in view of the risk of venous embolism, including direct spread of malignant cells, in cases involving a large polypoid mass with a necrotic surface that extends to the serosa as shown by intraoperative examination. Accordingly, the rationale for adjuvant therapy with imatinib also requires further evaluation.

Retroperitoneal mixed neuroendocrine non-neuroendocrine neoplasm: A case report and review of literature.

The existence of both neuroendocrine and non-neuroendocrine histology in variable proportion in a lesion has been described by the World Health Organisation (WHO) as mixed neuroendocrine and non-neuroendocrine neoplasm (MiNEN). The pathogenesis of this tumour remains controversial but molecular studies point towards a common monoclonal origin. Tumours are classified as functioning and nonfunctioning based on substances secreted. The nonfunctioning tumours may be discovered due to its local effect. Presented is a 66-year-old male with an intra-abdominal mass, underwent laparotomy and excision biopsy with transient right lower limb lymphoedema. Histology confirmed retroperitoneal MiNEN with no evidence of tumour recurrence 12 months following surgery. MiNENs should be considered as a differential diagnosis in patients with intra-abdominal mass. Surgical resection is recommended as this may offer the best treatment option.

Extra-gastrointestinal stromal tumour of the lesser omentum presenting as a massive intra-abdominal swelling: A case report and literature review.

Extra gastrointestinal stromal tumour(EGIST) is rare and is regarded as gastrointestinal stromal tumour(GIST) that originates outside of the gastrointestinal tract. They originate from other intraabdominal tissues such as the omentum, mesentery and peritoneum. The cell of origin is the interstitial cell of Cajal(ICC), a pacemaker cell that controls gastrointestinal peristalsis and the tumor is characterized by the expression of KIT(CD117) a transmembrane tyrosine kinase receptor. Here, a 49-year-old female who presented with a 6 month history of abdominal pain, progressive abdominal swelling and the presence of an upper abdominal mass. She had surgical resection and adjuvant imatinib for the intraabdominal mass diagnosed on histology and immunohistochemistry as EGIST of the lesser omentum. Serial CT 14 months after surgery revealed no evidence of recurrence or metastasis. Clinicians should consider EGIST in the differential diagnosis of abdominal masses.

Bilateral plasma cell mastitis simulating breast cancer: a case report and literature review.

Plasma cell mastitis (PCM) is a chronic inflammatory disease of the breast. It is a benign entity mainly found in nonpregnant and nonlactating women. PCM presents with symptoms of inflammation, breast erythema, masses, and indurations. We herein describe a 26-year-old woman with a 2-year history of right breast swelling and a 1-year history of left breast swelling during pregnancy and lactation. She was clinically diagnosed with bilateral breast cancer, but a biopsy specimen revealed PCM. During pregnancy and lactation, PCM can present as bilateral lesions. Early presentation and diagnosis are crucial because PCM, a benign disease, can lead to remarkable morbidity if allowed to progress to an advanced stage.

Dermatofibrosarcoma protuberans: Case series in a tropical setting and review of literature.

Dermatofibrosarcoma protuberans (DFSP) is an infrequent cutaneous tumour that may involve subcutaneous fat and in some cases fascia, muscles and bone. The infrequent occurrence lessens its clinical awareness in addition to its clinical semblance to many common cutaneous lesions. It is characterized by proclivity for local recurrence. We evaluated the clinical presentation and treatment outcomes of six consecutive cases of DFSP with histologic diagnosis in the University of Calabar Teaching Hospital, Calabar seen between January 2013 and December 2022. This was compared with total cutaneous malignances in the same period. The six consecutive patients comprised of two males and four females (M = F: 1:2) whose ages ranged from 21 to 57 years (mean of 36.5 years) and accounted for 7% of cutaneous malignancies. The site distribution was trunk (back) involved in 3 (50%) of the patients, limbs 3 (50%); upper 1 (17%) and lower limb 2 (33%). Clinical presentation was in the form of firm cutaneous mass with some ulcerated lesions that bled and some fungated. 50 percent of the patients presented with recurrent lesions and in all there was no regional lymphadenopathy or evidence of metastasis. There was a patient with Neurofibromatosis- 1 who had a huge fungated limb lesion offered amputation, four had wide local excision and one incision biopsy. Follow up was poor and the period ranged from 2 to 14 months (mean 7 months). Dermatofibrosarcoma protuberans is an uncommon tumour with clinical semblance to other cutaneous lesions. Early presentation, preoperative histologic diagnosis will enhance the goal of ensuring adequate excision. Adjuvant therapy with Imatinib with or without adjuvant radiotherapy are recommended in the treatment plan in view of the frequency of late presentation with advanced recurrent lesions and poor follow up.

Huge sialolith of the submandibular gland: a case report and review of literature.

The formation of stone in the ductal system of the salivary gland is termed sialolithiasis, with the submandibular gland being the most commonly affected. The precise aetiology is unknown but certain factors peculiar to the submandibular gland accounts for its likelihood of developing a calculous disease. Stones are classified based on their dimension, and may be silent or present with symptoms attributable to the size, location and complications. Here, a 50-year-old female who presented with a painless swelling in the left submandibular region that had grown slowly over the previous year, is reported. Following clinical and radiologic evaluation, left submandibular stone disease was preoperatively diagnosed. The patient underwent sialoadenectomy with transient palsy of the marginal mandibular branch of the facial nerve. Histopathology confirmed sialolith (2.7 cm) with severe squamous metaplasia of the duct. This presentation demonstrates some peculiar features attributable to the size, vertical orientation and location of the stone, in addition to the compression of the gland, thick fibrous capsule and significant squamous metaplasia of the duct. These findings require further evaluation for optimal treatment in view of the emerging trends for managing sialolithiasis.

Giant simple hepatic cyst: a case report and review of relevant literature.

BACKGROUND: Giant cysts of the liver are uncommon. Symptoms are related primarily to the mass effect of the enlarging cyst. OBJECTIVE: To highlight the challenges of management of giant simple hepatic cyst in a resource limited setting. CASE REPORT: Presented is a 58-year-old seamstress with a 5-year history of an enlarging abdominal mass with easy satiety. Surgery revealed an exophytic giant simple hepatic cyst arising from liver segment IV that drained 4.6 litres of serous fluid. CONCLUSION: Simple hepatic cyst can attain giant dimensions and should be considered in the differential diagnosis of intraabdominal masses.

Recurrent benign schwannoma of the scalp: Case report.

INTRODUCTION: Schwannomas are benign neoplasm's arising from Schwann cells. Malignant change is rare. PRESENTATION OF CASE: A 42-yearold man presented with a 6-year history of a recurrent right sided multinodular scalp lesion. DISCUSSION: Surgery revealed multiple ovoid masses in a scalp lesion. Histology revealed benign schwannoma. CONCLUSION: Schwannoma may present as multiple lesions in a multilobulated scalp lesion and should be considered as differential diagnosis.

Major dermatological malignancies encountered in the University of Calabar Teaching Hospital, Calabar, southern Nigeria.

BACKGROUND: Dermatologic malignancies are among the most common forms of cancer. Sun exposure is the major risk factor in white people, while non-solar factors appear to be the leading risk factor in the darkly pigmented. METHODS: We examined 162 patients with histologic diagnosis of dermatological malignancy who consulted at the University of Calabar Teaching Hospital, Calabar from January 2000 to December 2009. RESULTS: The 162 patient cases observed during the study represent 12% of all cancers diagnosed within the same period. Squamous cell carcinoma (SCC) was the most common (n = 62; 38.3% followed by Kaposi sarcoma (KS) (n = 33; 30.9%). Others were malignant melanoma (MM) (n = 16; 9.9%), dermatofibrosarcoma protuberans (DFSP) (n = 11; 6.8%), and basal cell carcinoma (BCC) (n = 8; 4.9%). The lower limb was the most commonly afflicted site (n = 82; 48.8%) while the head and neck ranked second (n = 32; 22.0%); 146 patients (90%) were darkly pigmented and 16 (10%) were people with albinism. Some patients with SCC and MM consulted late for curative surgery. Surgery resulted in healing in patients with BCC, while the recurrent rate for DFSP was high. The endemic KS responded to cytotoxic chemotherapy but the result was poor for KS associated with human immunodeficiency virus. CONCLUSION: The pattern of dermatologic malignancy revealed in this study is different from that of European skin cancer. Health education, early implementation of preventive measures, early consultation, and treatment will improve outcome in our region.

Epigastirc hernia presenting as a giant abdominal interparietal hernia.

INTRODUCTION: Epigastric hernia is a rare form of ventral abdominal hernia. When neglected it can attain an impressive size causing it un-aesthetic effect in addition to diagnostic difficulties. PRESENTATION OF CASE: Presented is a 60-year-old female farmer with a 10-year history of a voluminous mass in the anterior abdominal wall. DISCUSSION: Surgery revealed an epigastric hernia presenting as an interparietal hernia. The hernia was an omentocele with a grossly distended hernia sac filled with about 2.5 l of serous fluid. No similar case has been found in the medical literature. CONCLUSION: Epigastric hernia can attain voluminous dimensions and present as a non-inguinal interparietal hernia.

Marjolin's ulcer: Sequelae of mismanaged chronic cutaneous ulcers.

OBJECTIVE: This study was to evaluate the current pattern and risk factors of Marjolin's ulcer in the authors' setting. SETTINGS AND PARTICIPANTS: Twenty-one patients with histological diagnosis of skin malignancy at the University of Calabar Teaching Hospital, Calabar, Nigeria. METHODS: Presented are patients with histologic diagnosis of Marjolin's seen in the University of Calabar Teaching Hospital, Calabar, Nigeria from January 2007 through December 2007. RESULTS: Five patients (3 men and 2 women) with Marjolin's ulcer whose ages ranged from 32 to 70 years (mean 46.6 years) accounted for 45.5% of squamous cell carcinoma. All the patients suffered traumatic injuries (4 lower limb injuries from road traffic accidents and 1 puncture wound of the upper limb) and the latency was 21.4 years. CONCLUSIONS: Chronic trauma-induced limb ulceration is the leading risk factor for Marjolin's ulcer. Health education, early detection, and proper management of chronic wounds would improve outcome.

Cutaneous metastatic carcinoma: diagnostic and therapeutic values.

OBJECTIVE: This study was to highlight the diagnostic and therapeutic values of cutaneous metastatic carcinoma. METHODS: Presented are patients with histologic diagnosis of cutaneous metastatic carcinoma seen in the University of Calabar Teaching Hospital, Calabar, Nigeria from 2000 to 2006. RESULTS: Six patients (2 men and 4 women) with cutaneous metastatic carcinoma whose ages ranged from 37 to 55 years presented during the study period and accounted for 6.5% of total cutaneous cancer and 0.6% of total malignancy. CONCLUSION: Cutaneous metastatic carcinoma exhibited a pattern of clinical significance. Clinicians are urged to renew interest in cutaneous nodules, chronic discharging sinuses, and ulcers.

Trauma in a Teaching Hospital Outpost: Comprehensive Health Centre, Okoyong, Cross River State, Nigeria.

BACKGROUND: Road traffic injuries and other forms of trauma have become a major health problem worldwide, but Africa is the worst hit. This study was designed to evaluate the characteristics of trauma injuries in order to offer solutions for planning in terms of policy formulation and implementation. PATIENTS AND METHODS: The Comprehensive Health Centre, Okoyong, is a rural outpost of the University of Calabar Teaching Hospital. Calabar is located about 45 km away in a rural community close to the highway. Trauma patients seen from January 2004 to December 2004 were studied. RESULTS: In total, 76 trauma patients were recorded. The ages ranged from 2 to 50 years (mean 26.1 years) with a male to female ratio of 3:1. Trauma was mainly due to road traffic injuries, 54 patients (71.1%) (motor vehicle - commercial in 28 patients and motorcycle in 26), followed by assault in 15 patients (19.7%). Laceration and abrasion accounted for 87.8% of injuries. The head and neck was the most common anatomical site injured in 49 patients (47%), followed by the lower limbs in 27 patients (26.0%). The injuries involved 39 passengers/pedestrians (72.3%), while a driver/14 cyclists (27.7%) ranked second. Mortality was 2.6%. CONCLUSION: Trauma was mainly due to road traffic injuries. The development of rural trauma systems and improvements in road and traffic infrastructure would reduce injury, morbidity, and mortality.

A Prospective Study of Blunt Abdominal Trauma at the University of Calabar Teaching Hospital, Nigeria.

BACKGROUND: Blunt abdominal trauma (BAT) usually results from motor vehicle accidents, assaults, and recreational accidents or falls. This communication is a 3-year report of an ongoing study aimed at providing the current BAT prevalence in our center. It is hoped that this would assist in a better design of prevention and emergency trauma response systems to cope with this epidemic. METHODS: All of the patients admitted to the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, from February 2005 to January 2008 were prospectively studied based on a questionnaire. Hemodynamic stability and sonography formed the basis for selecting patients for non-operative management (NOM); others were offered laparotomy. RESULTS: In total, 4,391 emergencies were seen during the study period, of which 1,654 (38%) were due to trauma. Seventy-nine patients with abdominal trauma accounted for 4.8% of trauma cases. Forty-two (53%) patients suffered BAT and their ages ranged from 14 and 56 years (mean 28.4 years), with a male:female ratio of 2.5:1. Road traffic accidents accounted for 13 (87%) and 26 (96%) patients in the NOM and laparotomy groups, respectively. The most commonly injured organ was the spleen in both groups: 8 (50%) and 15 (56%) in the NOM and laparotomy groups, respectively. Fifteen (36%) patients were managed successfully in the NOM group. CONCLUSION: Trauma was mainly due to road traffic injuries. Hemodynamic stability and ultrasonography effectively selected patients for NOM. The establishment of trauma systems, provision of ancillary diagnostic and monitoring facilities, well-designed roads and traffic infrastructure, and health education on road safety would reduce injury, morbidity, and mortality.

Skin cancers amongst four Nigerian albinos.

BACKGROUND: Albinism is an established risk factor for skin cancer in black Africans, and high levels of ultraviolet radiation increase the risk of the three major forms of skin cancer. METHODS: We present four albinos with histologic diagnoses of skin cancer who were seen at the University of Calabar Teaching Hospital, Calabar, Nigeria from January 2005 to December 2006. Skin cancer in these cases was compared with the total skin cancer affecting 29 patients during the study period. RESULTS: Twenty-nine patients presented with skin cancer during the study period. Four Nigerian albinos (two men and two women) with skin cancer accounted for 13.8% of the skin cancers observed during the 2-year period. They ranged in age from 22 to 40 years (mean, 27.8 years). The sites of the lesions included the head [squamous cell carcinoma (SCC) in two patients and basal cell carcinoma (BCC) in one patient] and the upper limb (melanoma). All tumors were excised; in addition, patients with SCC and melanoma received adjuvant chemotherapy. Two patients, one woman with SCC and the patient with melanoma, showed residual tumor because of inadequate excision. During the evaluation period between 14 and 18 months, the sites appeared to be healed with no evidence of recurrence in the male with SCC and female with BCC. CONCLUSION: Albinism and solar radiation are risk factors for skin cancer. Early implementation of public education strategies on prevention should improve outcome.

Cutaneous cancers in Calabar, Southern Nigeria.

Globally, cutaneous cancers are among the most common form of cancer. Among Africans, there are significant differences in the types of skin cancer compared to those documented in patients from other countries. We evaluated all the patients with a histological diagnosis of skin cancer presenting to the University of Calabar Teaching Hospital from January 2005 through December 2006. Twenty-nine patients (18 males and 11 females) with skin cancer were identified and these accounted for 8.0 percent of total malignancies. Their ages ranged from 16 to 70 years (mean 43.5 years). Kaposi sarcoma (KS) was the most common skin cancer. Kaposi sarcoma associated with HIV represented 81.8 percent of KS cases found. Squamous cell carcinoma (SCC) ranked second and malignant melanoma third. Of the skin cancers in our series, the most common site was the lower limb (55.2%), followed by the head and neck (24%). The 4 albinos accounted for 13.8 percent of the skin cancers found. Immunosuppression (KS), chronic ulcer, inflammation, albinism, and solar radiation were identified risk factors. Public education strategies on prevention, with an emphasis on early identification and surgical treatment of skin cancers are urged. In addition, treatment of and close observation of chronic ulcers are recommended.

A prospective study of burns trauma in children in the University of Calabar Teaching Hospital, Calabar, south-south Nigeria.

BACKGROUND: Burns are among the most devastating injuries seen in the emergency units. The epidemiology varies from one part of the world to another. This communication is a 3-year report of burns in children in an attempt to provide information on the current epidemiology of burns in this centre. METHOD: Children admitted into the University of Calabar Teaching Hospital, Calabar with burns were prospectively studied from February 2005 and January 2008. RESULTS: There were 56 patients (28 males and 28 females). The ages ranged from 9 days and 14 years (mean 3.5 years) and 19 (73.1%) were preschool children. There were 39 (69.6%) who sustained scald injuries while 17 (30.4%) suffered flame injuries. Twenty-six (46.4%) patients sustained burns with total burn surface area above 10%. CONCLUSION: Education of the public on burns prevention based on the factors highlighted, establishment of burns support groups dedicated to publicity on prevention and provision of financial aid would sustain strategies when adopted.

A Prospective Study of Penetrating Abdominal Trauma at the University of Calabar Teaching Hospital, Calabar, Southern Nigeria.

BACKGROUND: Abdominal injuries are on the increase in both developed and developing countries. The frequency of penetrating abdominal trauma (PAT) varies across the globe because it relates to industrialization, the weapons available, and the presence of military conflicts. This study sought to evaluate the current pattern and outcome of managementof PAT in Calabar, which is undergoing rapid urbanization, and with a focus on tourism. METHOD: Patients admitted to the University of Calabar Teaching Hospital, Calabar with PAT from February 2005 to January 2008 were prospectively studied. RESULTS: Seventy-nine patients presented with abdominal trauma, among which 39 (49%) were PAT. There were 37 males and two females, whose ages ranged from 5 to 54 years (mean 27.8 years). Stab wound (18; 46.1%) was the commonest injury, while gunshot wound (15; 38.5%) ranked second. Others were road traffic accident (two patients), fall, cow horn injury, shrapnel, and criminal abortion (a patient each). The commonest injury was evisceration of the omentum and small intestine, which occurred in 13 (36%) patients. Five (14%) patients suffered small intestinal perforations, while three (8%) had liver, splenic and colonic injuries, respectively. Others were rectal injury (four patients), mesenteric injury and perforated stomach (two patients each), and a patient with diaphragmatic injury. The outcome was fatal in two (5%) patients. CONCLUSION: Penetrating abdominal trauma is on the increase in Calabar. The pattern of injury revealed areas which, when effectively contained, will lead to an improvement in the safety of our environment.