RACS and its Fellows: a contribution to sustainable healthcare improvement in South East Asia.

The question of whether small non-government organizations with comparatively small budgets can make a substantial contribution to sustainable improvement in health care in low- and middle-income countries is crucial to funding global surgical projects. The Royal Australasian College of Surgeons and its Fellows have partnered with local organizations and clinicians to deliver a wide range of projects in South East Asia. These projects have proved sustainable and have increased healthcare capacity in these nations. This provides strong evidence that small non-government organizations such as the Royal Australasian College of Surgeons can make a major contribution to global surgeryI.

Primary lymphoma of the thyroid: diagnostic and therapeutic considerations.

BACKGROUND: Primary thyroid lymphoma is uncommon and accounts for less than 2-5% of all thyroid malignancies. The aim of the present study was to review our experience and management of primary thyroid lymphoma and to discuss the diagnostic and therapeutic considerations. METHODS: Eleven women and six men with primary thyroid lymphoma were diagnosed and managed in our department between October 1998 and March 2006. The clinical course and pathological spectrum of this disorder affecting the thyroid gland were reviewed. RESULTS: Twelve patients had a prior history of thyroid disease. Clinical symptoms included a rapidly enlarging neck mass (88%), dyspnoea (65%), dysphagia (53%) and hoarseness of voice (35%). Five patients were hypothyroid at the time of diagnosis. Fifteen patients underwent fine-needle aspiration cytology (FNAC). Six patients had an initial diagnosis of lymphocytic thyroiditis. FNAC results were highly suggestive of thyroid lymphoma in only five patients. In the remaining patients, FNAC results showed a follicular lesion in two patients and were inconclusive in the other two patients. A further incisional biopsy was performed in five patients, and a diagnosis of non-Hodgkin's lymphoma (NHL) was confirmed in four patients and inconclusive in one. Five patients had a core biopsy. Four revealed NHL and one had lymphocytic thyroiditis. Nine patients underwent surgery; three of whom had emergency debulking of the tumour for acute airway obstruction. A final diagnosis of thyroid lymphoma was confirmed in all these patients. Sixteen patients had B-cell and one had T-cell NHL. Fifteen patients received combination chemotherapy with or without irradiation. All tumours dramatically decreased in size soon after initiation of treatment. Overall survival was 82%, with a mean follow-up of 19 months. CONCLUSION: The diagnosis of primary thyroid lymphoma should be considered when dealing with rapidly growing goitres. The role of FNAC in diagnosing thyroid lymphoma is limited but it is still useful in the initial work-up. Nevertheless, surgical intervention is often required to establish the diagnosis and relieve critical airway compression. A combination of chemotherapy and irradiation is the mainstay of management.

Spectrum of breast cancer in Malaysian women: overview.

Breast cancer is the most common cancer among Malaysian women. Nonetheless, in Malaysia there is a marked geographical difference in the incidence of breast cancer with advanced stage of presentation. The breast clinic in Kuala Lumpur Hospital diagnosed approximately 150 to 200 new cases of breast cancer a year. This number, however, represents only 12.0% to 15.0% of all breast disease seen annually in Kuala Lumpur Hospital. Between 1998 and 2001, of a total of 774 cases of newly diagnosed breast cancer in Kuala Lumpur Hospital, only 5.0% (40/774) were impalpable breast cancers. The peak age group for the three major ethnic distributions (Malay, Chinese, and Indian) ranged from 40 to 49 years. The mean tumor size at presentation was 5.4 cm (range: 1-20 cm), and the advanced stage of breast cancer is observed to be highest among the Malay ethnic group. Although it appears that the incidence of breast cancer in Malaysia is lower than in the developed countries, the difference may be attributable to the difficulty in getting accurate statistics and to underreporting of cases. Nonetheless, from the available data, it is clear that breast cancer continues to be the most common cancer among Malaysian women. The strongly negative social-cultural perception of the disease, made worse by the geographical isolation of many rural areas, accounts for the delayed diagnosis and the often advanced stage of disease at presentation. A prospective population-based study is called for to verify the demographic patterns of breast cancer, particular in Malaysia and other developing countries. The findings of such a study may have implications for future breast screening programs and for facilitating the understanding of differing risks of breast cancer among women around the world.

Chronic granulomatous mastitis: diagnostic and therapeutic considerations.

To review the clinical presentation, histopathological features, and optimal treatment of chronic granulomatous mastitis, the authors conducted a retrospective study of 25 women admitted to a teaching hospital in Malaysia between January 1998 and December 2000 who met the required histologic criteria. The primary outcome measures were morbidity and recurrence of the disease. Thirteen patients presented with a breast mass clinically mimicking breast cancer, and 12 patients had breast induration and abscess formation. In addition, 8 of these patients had recurrent breast disease. Clinical and imaging diagnosis has often been difficult and inconclusive, so histopathology remains the optimal diagnostic tool. Of interest, 50% of patients experience recurrences, and long-term follow-up is therefore necessary. The authors concluded that, because chronic granulomatous mastitis is a rare benign breast condition that may be misdiagnosed as breast carcinoma, complete resection should be accomplished whenever possible. Steroid therapy may be an adjuvant for optimal treatment. Awareness among surgeons and pathologists should also be emphasized to avoid unnecessary misdiagnosis and treatment.