Adekunle Y Abdulkadir

Unusual Cutaneous Metastatic Follicular Thyroid Carcinoma

Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer (TCs) after papillary carcinoma, but it is ranked first in producing distant metastases among TCs. It accounts for 10 - 20% of all thyroid malignancies and is most often seen in patients over 40 years of age. Distant metastases at the time of diagnosis are reported in 11 - 20% of the patients and may be the reason for presentation. There have been less than 30 reported cases of cutaneous metastases from FTC in the English Literature, a majority affecting the scalp. We present an unusual aggressive, hypervascular FTC in a 58-year-old man with a previous diagnosis of multinodular goiter. The difficulty in gaining his acceptability of orthodox management resulted in the development of multiple giant scalp and right facial metastatic masses associated with lytic calvarial destruction and the involvement of frontal and right maxillary sinuses. These imposed serious challenges in managing him in a resource-poor community.

Giant neoplastic omental cyst masquerading as ascites: a case report

IntroductionCystic lesion of the omentum and mesentery are rare. The incidence of both cyst types has been variously reported to vary from 1/27,000-100,000 hospital admission. Omental cysts occur three to ten times less frequently than mesenteric cyst. Preoperative diagnosis is infrequently made because of lack of characteristic symptoms and signs.Case presentationWe present our diagnostic and management challenges in a 43-year-old man with an unusually giant omental cyst confirmed as fibrosarcoma at histology. The cyst gave the abdomen an anteroposterior diameter of about 74 cm that could not be penetrated sufficiently by X-ray photons to produce diagnostic image even at maximum attainable output. Patient benefited from surgical excision. The removed cyst contained about 35 litres of fluid.ConclusionNeglected omental cysts as in this case may grow to enormous size, undergo malignant transformation and poses serious diagnostic and surgical challenges.

Orocervical foetus-in-foetu with prenatal sonographic diagnosis: a case report

IntroductionFoetus-in-foetu is a very rare congenital abnormality where a malformed foetus is included within the body of another foetus. Less than 200 cases have been reported with over 80% occurring in the abdomen. Only three cases of cervical foetus in foetu have been reported. The present case of giant orocervical foetus-in-foetu appears to be an index case.Case presentationThis is a report of an extremely rare orocervical foetus-in-foetu with grotesque oddity diagnosed on prenatal ultrasonography at 35 weeks gestational age in a 28-year-old, G2P1+0, Nigerian woman who was unsure of her last menstrual date or month. The included foetus had two eyes, cranium, nose, long bones and a spine. The mothers attempts at vaginal delivery rather than the elective Caesarean delivery she was offered resulted in obstructed labour and intrauterine foetal demise.ConclusionGiant cervical foetus-in-foetu is extremely rare. It could result in obstructed labour if vaginal delivery is attempted.

Lipomatous lesions around the shoulder: Recent experience in a Nigerian hospital.

We present four cases of shoulder lipomas in two females and two males in their fourth to fifth decades of life. All four lipomas were big. Three were subcutaneous and one was intermuscular. None of them were associated with any functional limitation of the affected shoulder. Subcutaneous or intermuscular lipomas around the shoulder do not appear to affect shoulder functions. Complete surgical excision is rewarding and was achieved under local anesthesia in all our patients with no incidence of recurrence.

Fetus in Fetu: A Rare presentation in an Adult female.

A report of Fetus in fetu (FIF) by Murtaza et al.1 in Oman Medical Journal 25 (2010) was an interesting presentation. One must congratulate the authors for a good presentation. There are however some areas to be highlighted for the benefit of the scientific world. The patient presented by Murtaza A at al.1 is not the oldest patient in the literature to date. Hoeffel at al.2 review shows that only four of 88 reported cases (4.5%) have been described in patients 10 years of age or older, with the oldest reported case occurring in a 47 year old man.3 The patient presented by Murtaza A et al.1 was 30 years old. Various authors up to 2007 have quoted less than 100 reported cases as aftermath of Hoeffel at al.2 extensive review published in 2000, which documented 88 cases. A similar but more recent review of reported FIF from 1806 to 2007 by Rahman GA et al.4 isolated one hundred and sixty (161) cases with the ages of diagnosis ranging from 16 Weeks in utero to the oldest of 47 years. Braimoh et al.5 in 2008, described comprehensively the distribution of the 170 published cases of FIF by site of occurrence (1806 to July 2008) and found the occurrence of abdominal location in 80.3%. Unlike the Hoeffel et al with 4.5% above the age of 10 years, Rahman GA et al.’s review had twelve of the 160 reported cases (7.5%) described in patients 10 years of age and above.4 Interestingly the patient reported by Murtaza A et al.1 is from Nagpur, India. In the 2007,4 review 25.6% of cases were from Asia with 37.5% of cases from Asian Countries coming from India. It was found to be rare in Africa, where only three cases were reported before 2007 (all from South Africa). However, two cases were reported from Nigeria in 2008.5,6 The West African sub region with largest population of blacks and the largest twinning rate in the world had no documented case before 2007.4 The size of cases excised weighed between 13 grams and 2000 grams,4 the case reported by Murtaza A et al.1 is one of the largest. We agree with Murtaza A et al1 that computer tomography (CT) is a very useful imaging modality but may not be the most reliable. Although there has been limited report on the use of magnetic resonance imaging (MRI) in the diagnosis of FIF probably due to the rarity of the entity, MRI, which has major advantages of allowing imaging in the saggital and coronal planes and capability to identify insufficiently calcified vertebrae and vertebral axis7 seems to be the ideal technique for demonstrating the wide range of tissue within such lesion. In reviewing the literature, most case reports up to 1980 showed that the preoperative diagnosis of FIF was made only in 16.7% of cases and in fact up to mid-1990s, fewer than a quarter of the cases were diagnosed prior to surgery2 because CT and MRI scans were not performed. Both of which, have enhanced the accuracy of preoperative diagnosis.7

Fulminant tuberculosis: Simultaneous shoulder and pulmonary involvement

Fulminating tuberculosis (TB) of the shoulder joint and lung occurring concurrently is rare. A case diagnosed by plain radiograph in a 60-year-old peasant who had left shoulder swelling, pain and limitation of movement of this joint for six months is presented. This is for radiologist and clinicians to be wary of TB in cases of non-resolving osteoarticular infection especially in TB endemic regions. Despite growing advances in radiological methods, plain radiograph should remain a valuable investigation. The patient had satisfactory response to 12-month anti-tuberculous regimen.

Ulnar Hemimelia with Oilgodactyly: Report of Two Cases

We present two sporadic cases of complete ulnar hemimelia, a rare congenital defect. In one case, ulnar hemimelia was associated with tridactyly and elbow malrotation with radiohumeral synostosis; in the second case, ulnar hemimelia was assciated with mono-metacarpal bidactyly and anterior cubital webbing of the elbow with fixed flexion. To the best of our knowledge, there is dearth of information on these combinations of anomalies in the literature and their management remains a challenge.