MRI evaluation of diffuse subcutaneous neurofibroma of the lower limb in a low resource setting.

An unusual type of neurofibroma predominantly seen in children and young adults is diffuse neurofibroma. We present a 25-year-old female with recurring soft tissue masses in her right lower limb. MRI showed areas of T 1 iso-intensity and T 2 hyperintensity relative to skeletal muscle within the subcutaneous fat. These masses show marked enhancement post gadolinium administration. Histological examination of the excised mass showed diffuse neurofibroma. The rare nature of this tumour and the limited literature describing the imaging features make the diagnosis relatively difficult for a radiologist.

Sonographic evaluation of axillary lymph nodes in women with newly diagnosed breast cancer at the university college hospital Ibadan, Nigeria.

BACKGROUND: Axillary lymph node (LN) status of patients with breast cancer is important in the surgical management. Sonographic evaluation of axillary LNs in newly diagnosed breast cancer is required to predict prognosis. OBJECTIVE: The purpose of this study was to describe the morphologic features by sonographic evaluation of the cortices and sinuses as well as patterns of blood flow of axillary LNs and correlate same with the clinical staging in women with newly diagnosed breast cancer in a tertiary referral centre. PATIENTS AND METHODS: This was a prospective and descriptive study of 106 newly diagnosed female breast cancer patients recruited from the surgical outpatient clinic of the University College Hospital, Ibadan, during a period of 9 months in 2015. All 106 patients had clinical evaluation, sociodemographic documentation and ultrasound scans of the breast and axillae performed. RESULTS: The mean age of patients was 48.1 (±11.1) years with age range 20-82 years. Most patients have a negative family history of breast cancer as seen in 97 (91.4%) of them. Abnormal cortex-hilum area ratio was more frequent in the right (66.7%) than the left (41.2%) axillary LNs. Longitudinal-transverse ratio was abnormal in 93.5% and 86.3% of LNs in the right and left axillae, respectively. Slit-like hilum, eccentric cortical thickening, replaced node and rat-bite appearance, respectively, were found in 40.7%, 10.4%, 48.4% and 44.4% of LNs in the right axilla. The peripheral flow type was demonstrated in 46.8% and 48.1% of LNs in the right and left axillae, respectively. CONCLUSION: Ultrasonography is a good diagnostic tool that can be employed with reasonable accuracy in the initial assessment of axillary involvement in breast cancer. Although the assessment of tumour size and clinical staging leaves little doubt as to the stage of breast cancer disease, sonographic evaluation of the breast and the axilla painted a more ominous picture.

Pregnancy related breast diseases in a developing African country: Initial Sonographic Evaluation.

Benign diseases are more common than malignant diseases in pregnant and lactating women. Fibroadenomas are the most commonly identified benign breast tumour in pregnant and lactating women. Pregnancy related breast cancer is defined as breast cancer that occurs during pregnancy or within 1 year of delivery. Its incidence is estimated at 1 in 3000 to 1 in 10 000 pregnancies. Several reproductive factors like age at menarche, age at menopause, age at full-term pregnancy, parity, age at any birth and spacing of pregnancies, breast feeding, characteristics of the menstrual cycle, infertility, spontaneous and induced abortions, characteristics of the menstrual cycle and infertility are some of the factors that have been incriminated as risk factors for breast cancer. We sought to describe the predominant breast pattern, sonographic array of pregnancy related breast diseases in women referred to the breast imaging unit in the department of Radiology at the University College Hospital, Ibadan south west Nigeria. Socio-demographic characteristics in these women were also evaluated. Archived images were reviewed and documented and data was analysed with SPSS version 17 and presented with descriptives. In this descriptive study, we retrospectively retrieved the sonomammographic records of 21 women (pregnant or lactating) referred to and imaged in the department of radiology, University college hospital Ibadan, between 2006 and 2013. Diagnostic breast sonograms performed by MO and ATS; Consultant radiologists with 7-10 years' experience utilized a 7-10 MHz transducer of the General electric GE Logiq P5 machine for the scans. Twenty-one women with ages between 22-42 years (Mean 31.4 ± 5.4 SD) pregnant or lactating were referred to the radiology department for sonomammographic evaluation. Majority of the women were in the 3rd decade. Referral was mainly (11) by family Physicians from the general outpatient clinic, 5 were self-referred, 2 from radiotherapy department, 2 from obstetrics and gynaecology department and 1 from the surgical outpatient clinic. Nineteen (89.5%) were lactating and breastfeeding while 2 (10.5%) were pregnant. Nipple discharge (89.5%) was the predominant presenting complaint in the study. They were all married with the majority attaining menarche at age 14.6 ± 2.1 SD years. Most of the women were multi-parous 17(89.5%) and possessed higher level of Education 17 (81.0%). Twenty (96.0%) women had no previous breast disease while only 1 (4.0%) woman had a positive family history of breast cancer. They weighed between 44-102 kg (mean 69.84 kg ± 15.33 SD). Their mean height was 159.8 cm. Waist hip ratio was between 0.69-0.93 (Mean 0.83). The heterogeneous fibroglandular pattern was predominant in 15 (71.4%) women. Final BIRADS assessment of 2 was most frequent (11/21) 52.4% while 19.0% were assigned to BIRADS categories 0 and 1 (4/21). Histological diagnosis of Invasive ductal carcinoma was made in the 3 women with final BIRADS of 5 breast diseases found in most pregnant and lactating women were benign. It is important to note that malignant breast lesions can also occur in this group of women who may assume that the changes noted in their breast are due to lactation.

Bilateral breast cancer among three Yoruba women in a Nigerian teaching hospital.

Breast cancer is the most common cancer among females in Nigeria. Bilateral breast cancer can occur synchronously or metachronously. We report three different cases of bilateral breast cancer in three female patients managed by the Ibadan Multidisciplinary Breast Tumour Board, domiciled at the University College Hospital (UCH), over a 3-year period. Two of these patients had synchronous bilateral breast cancer and developed cancer in the second breast during the course of management. These case reports may therefore stimulate further research on the clinicopathological features and the progression of bilateral breast cancer among females, especially in our environment. Our patients were premenopausal and the immunochemistry of the tumours showed a triple-negative immunophenotype. The other features of presentation, investigation, diagnosis and follow-up care are the highlights of this presentation.

Sonographic breast pattern in women in Ibadan, Nigeria.

BACKGROUND: Sonographic breast density pattern like mammography is dependent on the relative proportion of connective and glandular tissue. Breast density is a marker for breast cancer risk and has received wide spread interest in many countries in recent times. AIMS AND OBJECTIVES: This paper aims at describing the sonographic breast pattern in women in Ibadan using the American College of Radiology in its breast imaging reporting and data system (ACR-BI-RADS) lexicon. It will also estimate the prevalence of the different sonographic breast patterns and attempt to find any association between the breast patterns and various demographic variables in the women studied. MATERIALS AND METHODS: A prospective, descriptive study of the sonographic breast pattern in 573 women carried out at the Department of Radiology, University College Hospital, Ibadan. Nigeria. Breasts scans were performed with an Aloka SSD and Logiq P5 machine. RESULTS: A total of 573 women were recruited into the study. Their age ranged between 14 and 74 years (mean = 38.91 ± 12.51 years and median = 38 years). The modal age group was 30-39 years (26.9%). The women attained menopause between 35 and 59 years (mean = 46.2 ± 5.1 years) while the median age for menopause was 47 years. The majority of the women studied were either obese or overweight (66.9%). Sixty-one (10.6%) women had a positive family history of breast cancer with the heterogeneous fibroglandular (60.7%) breast pattern being commonest in this high risk group; and in the entire study population (52.7%). Significant associations between the sonographic breast pattern, age, menopausal status, parity, body mass index (BMI), and waist-hip ratio (WHR) was found. BI-RADS 2 breast pattern appeared to decrease with increasing age while BI-RADS I breast pattern increased with increasing age (P < 0.001). CONCLUSION: Ultrasonography like mammography, can define the parenchymal breast pattern accurately. Strong correlation exists between parenchymal breast pattern and demographic, parity variables, and breast cancer risk factors.

Mammographic parasitic calcifications in South West Nigeria: prospective and descriptive study.

INTRODUCTION: Lymphatic filariasis caused by nematode parasite Wuchereria bancrofti and Brugia Malayi is endemic in the tropics. In Nigeria, 25% of the population is infected. Lymph edema and elephantiasis are the predominant manifestations. Its infrequent manifestation is in the breast. This paper discusses the epidemiology, reviews literature, imaging options and mammographic appearances of these parasitic nematodes. METHODS: This prospective descriptive study reports on 39 cases of parasitic calcifications seen during mammography in the Radiology Department, University College Hospital between 2006 and 2012 in Ibadan, South West Nigeria. Each mammogram was reported by MO and ATS: assigned a final Bi-RADs category. Parasitic calcifications were further evaluated for distribution, and types of calcification. RESULTS: A total of 527 women had mammography done between 2006 and 2012. Thirty-nine women (7.4%) had parasitic breast calcifications. The ages of the women ranged between 38-71 years--mean of 52.36±8.72 SD. Twenty-three (59%) were post-menopausal, 16(41%) were pre-menopausal. The majority (31; 79.5%) were screeners while 8(20.5%) were follow up cases. Approximately half (51.3%) of the women had no complaints. Pain (23.1%) was the commonest presentation in the remaining half. Solitary calcifications were predominant (20) while only 3 cases had 10 calcifications. Left sided calcifications (53.8%) were the majority. Calcifications were subcutaneous in 2/3rds of the women (66.7%) while the Yoruba tribe (84.6%) was principal. CONCLUSION: Parasitic breast calcifications can be misdiagnosed on mammography for suspicious micro-calcification. This publication should alert radiologists in a tropical country like Nigeria to increase diagnostic vigilance thereby preventing unnecessary anxiety and invasive work-up procedures.