Ganiyu A Rahman

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.

Serial pathologic fractures of five long bones on four separate occasions in a patient with primary hyperparathyroidism, challenges of management in a developing country: a case report

Multiple pathologic fractures secondary to parathyroid adenoma is rarely recognized and reported in the tropics. Inadequate evaluation causes worsened disability and increased psychological stress. We present a 27-year-old Nigerian male student with recurrent unexplained pathological fractures of the long bones. Primary Hyperparathyroidism was later diagnosed and he benefited from a unilateral parathyroidectomy. Primary hyperparathyroidism secondary to parathyroid adenoma is difficult to diagnose and needs a high index of suspicion. Surgery and good post-operative biochemical control of serum calcium produce satisfying outcomes.

Pattern of rhabdomyosarcoma in Nigerian children.

BACKGROUND Soft-tissue sarcomas are uncommon tumors that are infrequently seen in most surgical practices. They represent 6.5% of all cancers in children < 15 years of age and are the fifth leading cause of cancer death in that age group. This study was conducted to show the prevalence and pattern of distribution of rhabdomyosarcoma among children in a black African population. METHODS We retrospectively reviewed 232 cases of soft-tissue sarcomas that were managed for a period of 22 years (1985-2006). Materials were obtained from the clinical records, operation notes and histopathology reports of the patients. The records of patients with rhabdomyosarcoma were analyzed in details. RESULTS The result showed the age peak incidence for the total soft-tissue sarcomas occurring between the third and sixth decades of life. Rhabdomyosarcoma constitutes 9.5% of the total number of patients managed, and 54.5% of these patients are age < 20 years. CONCLUSION We conclude that parents must be educated about the need to look out for any mass on their children that persists for > 4 weeks so as to reduce the delayed and advanced stage of presentation.

Socio-demographic and clinical profile of immuno-histochemically confirmed breast cancer in a resource limited country.

INTRODUCTION Breast cancer is the most common cancer in females. It is the most common cause of cancer-related death among women with fatality rates highest in low-income countries. The aim of this study is to determine the socio-demographic and clinical profile of patients with immunohistochemically confirmed breast cancer in a Nigerian tertiary health institution. METHODS Patients with immunohistochemically confirmed breast cancer were reviewed. The information retrieved was entered into a proforma designed for the purpose of the study. Data was analysed using SPSS version 18.0. RESULTS The peak incidence of age at presentation was in the 5th decade. More than 50% of the patients were premenopausal and perimenopausal at presentation. Only 11% of the patients presented with breast lumps less than 2 cm in size. Women in the age group 50-59 years are more likely to present with larger breast lumps than women in other groups. More than 50% had clinically palpable lymph node at presentation. Mastectomy (simple mastectomy and modified radical mastectomy) and adjuvant chemotherapy were the main form of treatment. Most of the cases were estrogen receptor negative with majority of them having basal-like subtype. CONCLUSION Most of the patients in this study were not only young but presented with locally advanced disease. Population screening, adequate health education, improved accessibility and availability of heath care will go a long way to improve the outcome of these patients.

Extent of Surgery for Differentiated Thyroid Cancer: Recommended Guideline

Cancer is a major public health problem in many parts of the world.1 Thyroid cancer is one of the least deadly cancers. The 5-year survival rate for all thyroid cancer is about 97%. Thyroid cancer is different from many other adult cancers in that it is commonly diagnosed in young people. Nearly 2 of 3 cases are found in people between the age of 20 and 55.2 The age–and gender-adjusted incidence of thyroid cancer has increased faster than that of any other malignancy in recent years. The American cancer Society in recent estimate for thyroid cancer in the United States (2010) showed that about 44, 670 new cases of thyroid cancer will occur (33,930 in women and 10,740 in men). Thyroid cancer will cause about 1, 690 deaths (960 women and 730 men).3 Over the past three decades, the incidence of thyroid cancer (TC) has significantly increased worldwide, rising from a rate of 3.6 /100,000 in 1973 to 8.7/100,000 in 2002, without any change in the mortality rate.4 The increase is almost exclusively due to a rise in papillary cancer rates, this being attributed to both environmental radiation and increased diagnostic scrutiny.5 In areas which have not been afflicted by nuclear fallout, the annual incidence of TC ranges from 2.0 to 3.8/100,000 in women and from 1.2 to 2.6/100,000 in men.6 Significant differences in TC incidence have been reported among various regions, with Hawaii, the Philippines and Iceland presenting the greatest incidence worldwide. This phenomenon possibly suggests that common environmental influences in these regions may be responsible for the strikingly high rates.7,8 The aim of this communication is to highlight the guideline for surgical treatment of well differentiated thyroid cancer. Classification and Pathology Thyroid cancer can arise from epithelial and non-epithelial tissue. Thyroid follicular epithelial-derived cancers are: papillary, follicular and anaplastic. Other malignant diseases of the thyroid include medullary thyroid cancer, primary lymphoma, sarcomas and metastases to the thyroid gland. Papillary and follicular cancers are considered differentiated cancer. Papillary carcinoma is more common but in population with low dietary iodine intake, follicular and anaplastic predominate.9

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

Soft tissue sarcoma of the thigh: Need for angiography in the developing countries

BACKGROUND Soft tissue sarcomas (STS) are relatively rare tumors that are seldom seen in many surgical practices. In the developing countries, most patients present lately to the tertiary center either because of poverty, ignorance, or poor management by the primary health workers that first come into contact with these patients. METHODS We bring you five patients with large STS thighs that were managed by unity between the years 2005 and 2007. RESULTS Three of these patients are deceased, and one of the two surviving patients has amputation below the knee. The two surviving patients lost view after 3 months. CONCLUSION Although angiography has been relegated to the background by the advent of modern techniques such as tomography imaging by computer (CT) and imaging by magnetic mirroring (IRM), in the developing countries angiography remains important as one pri-opiratoire of surgical guide in the thigh STS.

Circumareolar Incision‑subdermal Tunneling Dissection for Excision of Multiple Breast Fibroadenomata

Excision of multiple fibroadenomas (MF) in separate breast quadrants presents difficulties of number and location of incision(s) and extent of tissue dissection and may be associated with more complications and poorer cosmetic outcome. This is a report of excision of MF in multiple quadrants of the breast using a modification of subcutaneous dissection technique dubbed the circumareolar incision and subdermal tunneling (CAST) dissection. After exposure of the superficial fascia with circumareolar incision, subdermal cone-wise dissection was made to allow mobilization of the segment bearing the lump(s). The lump(s) were enucleated and removed. MF were removed from four breasts in three young unmarried females. The first patient had multiple adenomas removed from three quadrants of both breasts: 14 on the right and six on the left. The second patient had excision of three lumps in three separate quadrants, and the third patient had excision of two lumps in two separate quadrants. All patients had edema and bruising. One breast had wound infection and dehiscence. There were no skin necrosis, no nipple loss, and no breast distortion. All ensuing scars were camouflaged. CAST dissection was used for excision of MF in multiple quadrants of the breast with preservation of excellent cosmetic outcome of a single circumareolar incision.