Comparative analysis of breast cancer characteristics in young premenopausal and postmenopausal women in Ghana.

Breast cancer is increasingly common among young women in Ghana. BCa is heterogeneous with unique traits that impact causes, prognostic, and predictive outcomes of patients before and after menopause. However, limited evidence exists on differences between young premenopausal (YPM) and postmenopausal cases in Ghana. This study compared breast tumour characteristics between YPM women (under 35 years) and postmenopausal women. We conducted a prospective cross-sectional study involving 140 BCa-diagnosed women at the Breast Care Clinic of Komfo Anokye Teaching Hospital (KATH), Kumasi from November 2019 to June 2021. Thirty-one (22.1%) of participants were YPM and 109 (77.9%) were postmenopausal. The median ages for YPM and postmenopausal were 32.0 (range: 25.0-35.0) and 57.0 (48.0-86.0) respectively. Invasive carcinoma was the most common histological type (97.1%). Left tumour location was the most frequent in both groups (51.6% for YPM and 51.8% for postmenopausal). Lumps detected were frequently in the outer upper quadrant in both groups (61.3% and 56.0%). The majority of the YPM women (80.7%) and postmenopausal women (87.0%) had stage III and IV diseases. Most YPM (64.5%) and postmenopausal women (64.4%) exhibited triple-negative breast cancer (TNBC). Both YPM 13 (56.6%) and postmenopausal participants 40 (56.3%) exhibited a predominantly partial response to neo-adjuvant chemotherapy but YPM women (21.7%) experienced disease progression than the postmenopausal women (12.7%). The study highlights consistent tumour characteristics and advanced clinical stages at diagnosis in both groups with a higher prevalence of TNBC. TNBC and HER2+ subtypes respond better to Anthracycline-based neoadjuvant chemotherapy. Establishing Breast Care Clinics in district and regional hospitals for early detection is crucial and further studies are warranted to understand the higher TNBC prevalence in black Africans and re-evaluate breast education programs to address the persistently late presentations.

A gist on an obscure neoplasm in Ghana: gastrointestinal stromal tumours.

BACKGROUND: Gastrointestinal Stromal Tumour is a rare but potentially curable tumour of the gastrointestinal tract accounting for up to 1% of all gastrointestinal tumours. The discovery of Imatinib mesylate, a novel tyrosine kinase inhibitor has improved the chances even for unresectable, recurrent, or metastatic diseases. METHODS: This study sought to document the clinical and pathological characteristics of GISTs from two tertiary hospitals in Ghana that have undergone immunohistochemistry confirmation between 2014 and 2021. RESULTS: The median age of the subjects was 50 years with most of them (28.0%) being above 61 years. There were more females than males (64.0% vs. 36.0%). Abdominal mass and abdominal pain made up the majority of the clinical presentations. The majority of the subjects had partial gastrectomy (32.0%) which was followed by wedge resection (28.0%). Appendectomy and sleeve gastrectomy were the least performed procedures (8% each). Four of the 25 patients (16.0%) had resections of involved contiguous organs done with splenectomy being the most common procedure. The majority of GISTs were found in the stomach (68.0%) followed by the appendix (12.0%) and small bowel (12.0%). Gastrointestinal bleeding (55.8%) and abdominal pain (38.5%) were the most reported symptoms. Free resection margins were observed in 84.0% of the subjects and only 3/25 (12.0%) experienced tumour recurrence. CONCLUSION: GIST is a potentially curable tumour that once was obscure but currently gaining popularity. Surgical resection offers the hope of a cure for localized disease while targeted therapies is a viable option for recurrent, metastatic, or unresectable tumours.

Successful surgical management of intralobar pulmonary sequestration in Ghana.

Pulmonary sequestration occurs when a portion of lung tissue receives its blood supply from an anomalous systemic artery. Three main presentations, intralobar, extralobar and communicating bronchopulmonary foregut malformations, have been described. It is the second most common congenital lung anomaly. The intralobar variant is the most common type seen in 75% of cases, especially in late childhood. Imaging of choice for diagnosis are computed tomography scan and magnetic resonance imaging. Management involves surgical resection with ligation of the aberrant blood supply via thoracotomy or thoracoscopy. Endovascular therapy with coil embolization of the aberrant anomalous systemic artery as a standard therapy or as a hybrid therapy is an option. We present our successful surgical management of an infant diagnosed prenatally with congenital lung abnormality and confirmed postnatally as intralobar pulmonary sequestration.

Surgical management of traumatic diaphragmatic rupture: ten-year experience in a Teaching Hospital in Ghana.

Introduction: Diaphragmatic injuries may be associated with thoracoabdominal blunt or penetrating traumas. The diagnosis is often delayed, despite the availability of several medical imaging modalities. The surgical management remains controversial, in terms of the choice of surgical approach and the surgical repair technique. Aim: To evaluate the surgical management experience of traumatic diaphragmatic rupture in our institution over a ten-year period in the local setting of a tertiary hospital in Ghana. Material and methods: A retrospective review of the medical records of patients who had undergone surgery for traumatic diaphragmatic rupture. Results: A total of 35 cases of diaphragmatic rupture were seen from thoracoabdominal injuries. There were 29 (82.86%) males. The mean age was 36.25 ±12.98 years with a range of 16-65 years. There were 3 cases of right diaphragmatic rupture and 32 cases of left diaphragmatic rupture. Penetrating chest injury caused 18 (51%) of the ruptures. The leading cause of injury was road traffic accident, which constituted 48.57%, closely followed by stab (25.71%), gunshot injuries (14.29%) and impalement injury (11.48%). Seventeen (49%) patients had their diaphragmatic ruptures repaired via laparotomy and the remaining 18 (51%) via thoracotomy. The commonest herniated organ was the stomach. One patient died in theatre from cardiac arrest after failed intubation. Conclusions: Surgery is the treatment of choice in traumatic diaphragmatic rupture and it is repaired via laparotomy or thoracotomy based on the presence or absence of concomitant abdominal injury and the presence or absence of a cardiothoracic surgeon.

Portacath Implantation in Ghana: Initial Experience at the Komfo Anokye Teaching Hospital in Kumasi.

Current practice for chemotherapy in most oncology departments is the use of dedicated venous access for the continuous and frequent delivery of drugs, fluids and blood products, and the monitoring of the effects of treatment. The frequent venipuncture of peripheral veins is associated with various complications and discomfort to the patients. Permanent central venous access is therefore very important. Totally Implantable Vascular Access Device (TIVAD) is a type of central venous access that utilizes the central veins; the internal jugular vein, the subclavian or the femoral veins. It is a kind of permanent central venous access where a central venous catheter is connected to a subcutaneously buried port or septum which can be accessed at any time and has the ability to stay for almost 5 years. They are therefore the preferred form of long-term central venous access in patients treated by oncology departments. We share our initial experience of 5 patients in our institution. There were 4 females and one young boy who had been diagnosed with Hemophilia. Three of the patients had new implantation, one had removal of her 5-year-old TIVAD that had been implanted in another country and one had the TIVAD accessed when she had been referred to our hospital for breast surgery after neoadjuvant chemotherapy.

Pericardiectomy for constrictive pericarditis in a resource constraint setting.

INTRODUCTION: Constrictive pericarditis is the endpoint of the natural history of acute pericarditis of different aetiologies where a chronic inflammatory process results in a thickened, fibrotic and inelastic pericardium with consequent impairment of diastolic function and systemic congestion. AIM: To evaluate the clinical features, diagnosis, surgical management and outcome of patients with constrictive pericarditis as managed in a local setting of a tertiary hospital in Ghana. MATERIAL AND METHODS: A retrospective review of the medical records of patients who had undergone pericardiectomy for constrictive pericarditis at a teaching hospital. RESULTS: Ten patients underwent pericardiectomy for the period of study. There were 8 (80%) males and 2 (20%) females. The mean age was 20.4 ±17.2 years. Six of the patients 6 (60%) were in NYHA class III. Preoperative diagnostics included chest X-ray, echocardiography, and computed tomography scan. The surgical approach for the pericardiectomy was median sternotomy. The mean operative time was 159.9 ±43.0 min. The mean postoperative days spent before being discharged was 6.9 ±2.3 days. Nine (90%) of the patients were in NYHA class I after a mean follow-up of 19.3 ±16.7 months. One patient died 6 weeks after surgery with heart failure and one patient was lost to follow-up. CONCLUSIONS: Surgical pericardiectomy via median sternotomy is still the standard modality of treatment for constrictive pericarditis with excellent results even in resource constraint settings.

Giant primary scrotal lipoma in a low-resource setting: challenges with diagnosis and review of literature.

Lipoma is the commonest benign mesenchymal tumor composed of matured adipocytes. A literature search revealed few reported cases of giant scrotal lipoma. This article aims to report a giant scrotal lipoma weighing 1100 g and illustrate our challenges with the diagnostic process in a low-resource setting. A 28-year-old male presented with a huge right scrotal mass. Examination revealed the mass had no cough impulse. It was firm, non-tender and lobulated, with definite edges. Scrotal sonography was suspicious of lipoma. Intraoperatively, there was an encapsulated scrotal wall mass and an incidental inguinoscrotal hernia, content being the omentum. The scrotal mass was excised, hernia sac was ligated, and excised and the posterior wall was repaired. Histology confirmed the scrotal mass as a lipoma. Primary scrotal lipomas are rare but should be considered in the differential diagnosis of unusual scrotal masses. Ultrasonography is a useful diagnostic tool in resource-limited settings.