Kimura disease: a rare cause of a recurrent cheek mass in a Jamaican man.

Kimura disease (KD) is a chronic, inflammatory, benign disorder endemic to Asia that typically manifests as a triad of painless masses in the head and neck region, elevated eosinophils and serum immunoglobulin. It usually affects young men in their second and third decades of life and is rarely seen outside of the orient. This is a report of a case of KD in a young man of African descent who presented with a cheek mass. KD was not included in our differential diagnosis, and this report highlights the need to consider this entity, which can be easily missed due to its rarity in the Western world. There is no cure for the disease, and management includes medical and surgical modalities, but local recurrence or relapse is not uncommon.

A case of metastatic malignant granular cell tumour of the scalp.

Granular cell tumours of the scalp are rare. Malignant transformation of these tumours is even more uncommon, making the diagnosis exceedingly difficult. The recommended treatment of surgical excision with negative margins is not easily achieved in this location, given the anatomy of the scalp.

A case of naevus sebaceus of Jadassohn of the scalp in Jamaica.

Naevus sebaceus (NS), also referred to as NS of Jadassohn, is a rare non-melanocytic congenital cutaneous hamartoma with mainly sebaceous differentiation. NS has pluripotent potential with the possible evolution of benign and/or malignant neoplastic transformation. Literature of clinical audit and retrospective analyses conclude that there is no need for prophylactic excision except for cases in which malignant transformation is suspected. Although malignant transformation is rare, there are psychosocial issues with which to contend. We present a case of a 5 year-old girl with a cerebriform mass to her right parietal scalp, which was present at birth.

Clinicopathological features and outcome of gastrointestinal stromal tumors in an Afro-Caribbean population.

OBJECTIVE: A retrospective observational study was done to describe the clinical and pathological profile of gastrointestinal stromal tumors (GISTs) in Afro-Caribbean patients at a tertiary care referral center over a 5-year period. RESULTS: Eighteen cases of GIST were identified over the period under review. Male to female ratio was 1.25:1, the mean age was 54.7 years, and abdominal pain (44%) and gastrointestinal bleeding (50%) were the predominant presenting symptoms. The majority of tumors were of gastric location (83%) and spindle cell morphology (66%). C-kit (CD117) positivity was found in 13 of 14 (93%) cases tested. Using current guidelines for assigning risk of aggressive behavior, 44% of tumors were considered high risk. Of the 10 patients with high-risk or intermediate-risk tumors, 4 died, 1 of which had developed resistance to imatinib therapy. CONCLUSION: In this group of patients, GISTs demonstrated predominantly gastric location and spindle cell morphology and a guarded outlook for more aggressive tumors, which is moderated in the long-term by imatinib resistance.

Sentinel lymph node biopsy for breast cancer using methylene blue dye manifests a short learning curve among experienced surgeons: a prospective tabular cumulative sum (CUSUM) analysis.

BACKGROUND: The benefits of sentinel lymph node biopsy (SLNB) for breast cancer patients with histologically negative axillary nodes, in whom axillary lymph node dissection (ALND) is thereby avoided, are now established. Low false negative rate, certainly with blue dye technique, mostly reflects the established high inherent accuracy of SLNB and low axillary nodal metastatic load (subject to patient selection). SLN identification rate is influenced by volume, injection site and choice of mapping agent, axillary nodal metastatic load, SLN location and skill at axillary dissection. Being more subject to technical failure, SLN identification seems to be a more reasonable variable for learning curve assessment than false negative rate. Methylene blue is as good an SLN mapping agent as Isosulfan blue and is much cheaper. Addition of radio-colloid mapping to blue dye does not achieve a sufficiently higher identification rate to justify the cost. Methylene blue is therefore the agent of choice for SLN mapping in developing countries. The American Society of Breast Surgeons recommends that, for competence, surgeons should perform 20 SLNB but admits that the learning curve with a standardized technique may be "much shorter". One appropriate remedy for this dilemma is to plot individual learning curves. METHODS: Using methylene blue dye, experienced breast surgeons performed SLNB in selected patients with breast cancer (primary tumor < 5 cm and clinically negative ipsilateral axilla). Intraoperative assessment and completion ALND were performed for standardization on the first 13 of 24 cases. SLN identification was plotted for each surgeon on a tabular cumulative sum (CUSUM) chart with sequential probability ratio test (SPRT) limits based on a target identification rate of 85%. RESULTS: The CUSUM plot crossed the SPRT limit line after 8 consecutive, positively identified SLN, signaling achievement of an acceptable level of competence. CONCLUSION: Tabular CUSUM charting, based on a justified choice of parameters, indicates that the learning curve for SLNB using methylene blue dye is completed after 8 consecutive, positively identified SLN. CUSUM charting may be used to plot individual learning curves for trainee surgeons by applying a proxy parameter for failure in the presence of a mentor (such as failed SLN identification within 15 minutes).

Spontaneous coronary artery dissection in a thirty two year old woman. A case report and a review of the literature

A case of spontaneous coronary artery dissection, an extremely rare condition, is reported in a thirty two year old woman. The pathological and clinical features as well as the management of this condition are discussed. Recent postulates with regard to aetiology and pathogenesis are emphasized. (AU)

Age - specific incidence of cancer in Kingston and St. Andrew, Jamaica, 1993-1997

A total of 4285 malignant neoplasms were recorded in Kingston and St. Andrew during the period 1993-1997. 2344 in females and 1941 in males. The crude incidence rate per 100,000 (CIR) for males was 121.6 and for females 129.2. Age standardized rates per 100,0000 (ASR) were 156.7 and 176.7 for males and females respectively. In males, the leading sites for cancer were prostate (619 cases), bronchus (265 cases) and large bowel (144 cases) while in females the leading sites were breast (627 cases) cervix uteri (376 cases) and large bowel (204 cases). The crude and age standardized incidence rates have remained stable as compared to those for the previous five year period (1988-1992). The leading sites for both males and females have also been maintained in the same order but there was a marked increase in prostate cancer (ASR 56.4 versus 36). Invasive cervial cancer has shown no significant change in incidence (ASR 25.2 versus 26.3) but the rate for in-situ cancers has decreased (ASR 27.4 versus 43.8). The incidence of cancer of the female breast has remained relatively stable (ASR 43.2 versus 47.1). The trends exhibited by both prostate cancer and in-situ cervical cancer probably represent the influence of screening methods for prostate cancer and ablative management for low grade dysplastic lesions of the cervix uteri respectively.(Au)

Angiomyofibroblastoma - a rare but distinct entity

A case of angiomyofibroblastoma of the vulva in a 23-year-old woman is presented. Clinical, histological and immunohistochemical features as well as the differential diagnosis and prognosis of this rare but distinct entity are discussed. Only about 65 cases are documented in the literature and to our knowledge this is the first case to be reported from the Caribbean(AU)