Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report.

INTRODUCTION AND IMPORTANCE: Advanced prostate cancer often presents with lower urinary tract symptoms together with features of cancer on digital rectal examination. The commonest sites of metastasis include bone, liver and lungs. Metastasis to axillary lymph nodes is extremely unusual particularly as initial presentation of the disease. CASE PRESENTATION: We report an atypical case of a 40-year male patient presented with left axillary mass and normal initial urological evaluation. Histopathology and immunohistochemistry of the biopsies from the axillary mass and prostate confirmed the diagnosis of prostate adenocarcinoma. The patient declined anti-androgen monotherapy treatment and succumbed two months after establishment of the diagnosis. CLINICAL DISCUSSION: Prostate cancer contributes significantly to the overall global cancer burden. Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer and only a few cases have been reported in the literature. Therefore, clinical diagnosis of patients presenting with axillary lymphadenopathy may cause diagnostic delay. Careful physical and imaging examinations combined with pathological analysis are essential in the diagnosis of advanced prostate cancer with unusual presentation. CONCLUSION: In theory, prostate cancer can cause metastatic spread to any part of the body. However, metastasis to axillary nodes has not been frequently noticed. Our report highlights the importance of considering prostate cancer among differential diagnoses in Afro-Caribbean males presenting with symptoms suggestive of chest and abdomino-pelvic cancer.

Building Clinical Clerkships Capacity in a Resource-limited Setting: The Case of the Kilimanjaro Christian Medical University College in Tanzania.

BACKGROUND: The shortage of medical doctors in sub-Saharan Africa (SSA) has resulted in increased enrolment in medical schools, which has not been matched with increased faculty size or physical infrastructure. This process has led to overcrowding and possibly reduced quality of training. To reduce overcrowding at its teaching hospital, the Kilimanjaro Christian Medical University College introduced eight-week peripheral clerkship rotations in 2012. We explore students' perceptions and attitudes towards peripheral hospital placements. METHOD: The clerkship rotations were conducted in eight hospitals operating in the northern Tanzania, after evaluating each hospitals' capabilities and establishing the optimum number of students per hospital. Paper-based surveys were conducted after student rotations from 2014 to 2016. RESULTS: Overall student satisfaction was moderate (strength of consensus measure (sCns), 77%). The three cohorts exhibited improving trends over three years with respect to satisfaction with clinical skills and attitude towards placements. student-preceptor interaction was rated highly (sCns 81-84%). The first cohort students expressed concerns about limited laboratory support, and poor access to Internet and learning resources. Specific interventions were undertaken to address these concerns. CONCLUSIONS: Student experiences in peripheral rotations were positive with adequate satisfaction levels. Opportunities exist for medical schools in SSA to enhance clinical training and relieve overcrowding through peripheral clerkship rotations.

Contribution of noncommunicable diseases to medical admissions of elderly adults in Africa: a prospective, cross-sectional study in Nigeria, Sudan, and Tanzania.

OBJECTIVES: To describe the nature of geriatric medical admissions to teaching hospitals in three countries in Africa (Nigeria, Sudan, Tanzania) and compare them with data from the United Kingdom. DESIGN: Cross-sectional cohort study. SETTING: Federal Medical Centre, Idi-Aba, Abeokuta, Nigeria; Soba University Hospital, Khartoum, Sudan; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; and North Tyneside General Hospital, North Shields, United Kingdom. PARTICIPANTS: All people aged 60 and older urgently medically admitted from March 1 to August 31, 2012. MEASUREMENTS: Data were collected regarding age, sex, date of admission, length of stay, diagnoses, medication, date of discharge or death, and discharge destination. RESULTS: In Africa, noncommunicable diseases (NCDs) accounted for 81.0% (n=708) of admissions (n=874), and tuberculosis, malaria, and the human immunodeficiency virus and acquired immunodeficiency syndrome accounted for 4.6% (n=40). Cerebrovascular accident (n=224, 25.6%) was the most common reason for admission, followed by cardiac or circulatory dysfunction (n=150, 17.2%). Rates of hypertension were remarkably similar in the United Kingdom (45.8%) and Africa (40.2%). CONCLUSIONS: In the elderly population, the predicted increased burden of NCDs on health services in Africa appears to have occurred. Greater awareness and some reallocation of resources toward NCDs may be required if the burden of such diseases is to be reduced.