Sa Olatoke

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.

Establishing a Cancer Research Consortium in Low- and Middle-Income Countries: Challenges Faced and Lessons Learned

PurposeThere is an increasing effort in the global public health community to strengthen research capacity in low- and middle-income countries, but there is no consensus on how best to approach such endeavors. Successful consortia that perform research on HIV/AIDS and other infectious diseases exist, but few papers have been published detailing the challenges faced and lessons learned in setting up and running a successful research consortium.MethodsMembers of the African Research Group for Oncology (ARGO) participated in generating lessons learned regarding the foundation and maintenance of a cancer research consortium in Nigeria.ResultsDrawing on our experience of founding ARGO, we describe steps and key factors needed to establish a successful collaborative consortium between researchers from both high- and low-income countries. In addition, we present challenges we encountered in building our consortium, and how we managed those challenges. Although our research group is focused primarily on cancer, many of our lessons learned can be applied more widely in biomedical or public health research in low-income countries.ConclusionsAs the need for cancer care in LMICs continues to grow, the ability to create sustainable, innovative, collaborative research groups will become vital. Assessing the successes and failures that occur in creating and sustaining research consortia in LMICs is important for expansion of research and training capacity in LMICs.

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.

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.

Health-Seeking Behavior and Barriers to Care in Patients With Rectal Bleeding in Nigeria

Purpose Colorectal cancer (CRC) incidence rates are steadily increasing in Nigeria. Organized screening is still largely unused because of financial and logistical barriers; most CRCs are detected by symptoms. One symptom of CRC is rectal bleeding. This study sought to determine health-seeking behavior and barriers to care in patients with rectal bleeding in Nigeria. This study also surveyed physicians to determine major breakdowns in access to care. Methods The recruitment process for this study involved patients referred for colonoscopy because of rectal bleeding as well as response to a media advertisement for a free colonoscopy. Physicians were recruited at the African Research Group for Oncology meeting. Patient responses were scored on the basis of knowledge of rectal bleeding. The physician questionnaire was supporting information and mainly descriptive in nature. Results A total of 82 patients and 45 physicians participated in this study. Less than 40% of patients knew that rectal bleeding could be caused by cancer. Major barriers to care were resolution of the symptom (42%), no consideration of the bleeding as problematic (40%), and financial constraint (22%). Education was strongly correlated with knowledge of rectal bleeding and health-seeking behavior. Although physicians regularly saw patients with rectal bleeding, most of them provided a differential diagnosis of hemorrhoids and few referred patients for colonoscopy. Conclusion General awareness about the signs of colorectal cancer is lacking. This demonstrates the strong need for patient education programs about this issue. Physicians should also receive additional training on differentiation of a potential cancer diagnosis from something more benign, such as hemorrhoids.

Direct current electrotherapy for internal haemorrhoids: experience in a tertiary health institution.

Introduction Haemorrhoids disease is one of the most frequently occurring disabling conditions of the anorectum. We re-present the method, advantages and results of using direct current electrotherapy in the treatment of haemorrhoids. Methods Symptomatic grades 1, 2 or 3 internal and mixed haemorroids were treated. Exposure and evaluation was with an operative proctoscope which visualized one-eighth of the anal canal at a time. All diseased segments were treated per visit, indicators of successful treatment were, darkening of the treated segment, immediate shrinking of the haemorrhoid and ceasation of popping sound of gas release at the probe tip. Patients were followed up for two weeks. No bowel preparations, medications, anesthesia nor admission was required. Results Four hundred and fifty six segments were exposed, 252(55.3%) were diseased. eight patients with either grades 2 or 3 diseases required two treatment visits. The most common symptom was rectal bleeding (94.7%), followed by prolapsed but manually reduced hemorrhoids (68%). Prolapse of tuft of haemorrhoidal tissue with spontaneous return was seen in 59.6%, anal pain in 29.8%, and itching in 3.5%. the median number treated segments per patient was 4. No complication was encountered. All patients treated remained symptom free at a mean duration of follow up of 16 months. Conclusion Direct current electrotherapy is an effective, painless and safe out-patient treatment method for grades 1 to 3 internal and mixed hemorrhoid disease.

Relationship between tumour size and response to neoadjuvant chemotherapy among breast cancer patients in a tertiary center in Nigeria

Background Tumour biology, physiologic features such as growth fraction and physical features such as size may influence response of breast cancer to neoadjuvant chemotherapy. Molecular biology is an established basis for predicting response and selecting neoadjuvant chemotherapy. Whether physical characteristics such as size should influence chemotherapy regimen is inconclusive and has not been adequately studied in developing countries. Aim To determine the relationship between breast tumour size and response to neoadjuvant chemotherapy and hence define the role of tumour size during selection of neoadjuvant chemotherapy regimen for locally advanced breast cancer. Method Records of women managed at the University of Ilorin Teaching Hospital, Ilorin Nigeria, with neoadjuvant chemotherapy (NAC) for locally advanced breast cancer were reviewed between January 2013 and June 2015. Data was analyzed as 2 subgroups; primary tumour ≥100mm as group 1 and primary tumour ≥100mm as group 2. Primary outcome was 50% reduction in tumour size. Comparison was by chi-square test of independence at p value 0.05. Results 57 records were reviewed (group1=24, group2=33). Majority (37( 65%)) were premenopausal. Mean age was 47.9 ± 13.1 (range 28–85). NAC was either taxane or anthracycline based regimen. Median chemotherapy dose was 4 (range 2–6). Widest diameter of tumours was 30mm to 180mm (mean 96 ±3.8mm, median 100mm). Mean tumour diameter for groups 1 and 2 was 7.2 ±1.6mm and 12.2± 2.9mm respectively. 50% reduction in tumour size was 45.8% and 6.0% for groups 1 and 2 respectively (p=0.0001) Conclusion There was relationship between breast tumour size and response to neoadjuvant chemotherapy at a cut-off of 10mm. Well-designed prospective studies are required to confirm this relationship.

Angiodysplasia of the colon: a report of two cases and review of literature.

Angiodysplasias of the colon are enlarged and fragile blood vessels in the colon result in occasional loss of blood from the lower gastrointestinal tract. It may be observed incidentally at colonoscopy or patients may present with lower gastrointestinal bleeding. The objective of this case report is to highlight two cases of colonic vascular ectasia seen using a Pentax video colonoscope at the Endoscopy unit of Crescent hospital, Ilorin. The first patient is an 85-year-old man, who presented with constipation, left-sided abdominal pain, and weight loss of two weeks duration. There was no anorexia, abdominal swelling, diarrhea, or hematochezia. Abdomino-pelvic ultrasonography showed normal findings. Colonoscopy done, reaching the ileo-cecal valve and caecum, showed an area of dilated tortuous blood vessel (vascular ectasia) in the wall of the descending colon approximately 45 cm from the anal verge, with no features of bleeding. No ulcers or mass lesion was seen. Colonoscopy showed angiodysplasia of the colon. The second patient is a 30-year-old female trader who presented with two days history of massive hematochezia of about 7 episodes prior to presentation with an estimated blood loss per episode of about 300 ml. There were clinical features of shock. Packed cell volume at presentation was 14%. She was transfused with 4 units of fresh whole blood. Post stabilization, colonoscopy was done 5 days after bleeding had stopped, which revealed an area of erosion with mucosal blood clot about 27 cm from the anal verge. An area of angiodysplasia was seen. No hemorrhoids or mass lesion was seen anywhere in the colon. Angiodysplasia is an uncommon finding in Ilorin. These are the first reported cases of angiodysplasia of the colon from Ilorin, Nigeria.

A symptom-based model to predict colorectal cancer in low-resource countries: Results from a prospective study of patients at high risk for colorectal cancer: LMIC Colorectal Cancer Prediction Model

Colorectal cancer (CRC) rates in low‐resource countries, which typically lack CRC screening programs, are rising. This study determined whether a risk model for patients with rectal bleeding could identify patients with curable CRC.