Cutaneous Malignancies Presenting as Superficial Ulcers

Epidermal skin cancers are the most common cancers in humans. Epidermal skin cancers present a unique opportunity for effective intervention with both early detection and primary prevention. They are amenable to clinical diagnosis by simple visual inspection and to pathologic diagnosis by minimally invasive biopsy. Our objective is to show that the cutaneous malignancies are common in our environment and frequently present as superficial ulcer. This is a 4-year retrospective histopathological analysis of cutaneous malignancies diagnosed between January 2006 and December 2009 in the Department of Pathology, Federal Medical Centre, Keffi, Nasarawa State. The specimens were fixed in 10% buffered formalin, processed in paraffin wax and stained with haematoxylin and eosin. The slides were studied and the lesions were characterized by two consultant pathologists who were blinded and they agreed on the diagnosis. Twenty-one cases were reviewed in this analysis. The age range was between 20-79 years old with the mean age of 59.5 years old. The male to female ratio was 1.1：1. The peak age of distribution was in the fourth decade. In this review, the most common malignancy was squamous cell carcinoma; followed by malignant melanoma and basal cell carcinoma. The lower extremity was the commonest site with 11 （52.2%） cases; this was followed by the head and neck region with 7 （33.1%） cases, while one （4.7%） case with each presented in the anterior chest wall, elbow and at an unspecified site. Cutaneous malignancies are common in our environment; and the early sign is that of chronic non-healing ulcer. So there is need for high index of suspicion on the part of the Clinicians and Pathologists. Early identification of high-risk lesions can allow for more rapid therapeutic intervention, reducing the likelihood of metastasis and death.     

TRAITEMENT DES FRACTURES DE L''''OLECRANE PAR SUTURE PERCUTANEE

The authors devised a method of percutaneous suture for treating fracture of olecranon. There are two operative technics for percutaneous suture: one is the suture through two skin holes and another the suture through four skin holes. 40 cases of fracture of olecranon were resorted to the method of percutaneous suture. Suture with steel wire through two skin holes was used in 3 cases and suture with steel wire through four skin holes in 37 cases. Most of the fractures had satisfactory reduction and all the fractures healed well. 33 cases had been followed for more than one year, the late results were excellent in 20, good in 8, fair in 4 and poor in 1. The operative technic of the percutaneous suture is simple and less traumatic to the local tissues. The late functional recovery is not inferior to that of open reduction with internal fixation.     

Features of a Chinese family with cerebral cavernous malformation induced by a novel CCM1 gene mutation

Background Familial cerebral cavernous malformations （CCMs）, characterized by hemorrhagic stroke, recurrent headache and epilepsy, are congenital vascular anomalies of the central nervous system. Familial CCMs is an autosomal dominant inherited disorder and three CCM genes have been identified. We report a Chinese family with CCMs and intend to explore clinical, pathological, magnetic resonance imaging （MRI） features and pathogenic gene mutation of this family. Methods Totally 25 family members underwent brain MRI examination and clinical check. Two patients with surgical indications had surgical treatment and the specimens were subjected to histopathological and microstructural examination. In addition, polymerase chain reaction （PCR） and direct sequencing were performed with genomic DNA extracted from 25 family members＇ blood samples for mutation detection. Results Brain MRI identified abnormal results in seven family members. All of them had multiple intracranial lesions and four cases had skin cavernous hemangioma. T2-weighted sequence showed that the lesions were typically characterized by an area of mixed signal intensity. Gradient-echo （GRE） sequence was more sensitive to find micro- cavernous hemangiomas. There was a wide range in the clinical manifestations as well as the age of onset in the family. The youngest patient was an 8-year-old boy with least intracranial lesions. Histopathological and microstructural examination showed that CCMs were typically discrete multi-sublobes of berry-like lesions, with hemorrhage in various stages of illness evolution. They were formed by abnormally enlarged sinusoids and the thin basement membranes. A novel T deletion mutation in exon 14 of CCM1 gene was identified by mutation detection in the seven patients. But unaffected members and healthy controls did not carry this mutation. Conclusions The clinical manifestations were heterogenic within this family. We identified a novel mutation （c.1396delT） was the disease-causing mutation for this family and extended the mutational spectrum of CCMs.     

Evaluation of Circulating Antisperm Antibody in Infertile Women with Polycystic Ovary Syndrome

Objective To evaluate levels of the circulating antisperm antibody (ASA) in infertile women with polycystic ovary syndrome (PCOS). Methods Forty-six infertile women with PCOS were enrolled into this study. The serum was screened by the indirect immunobead test for ASA type IgG and IgA according to the WHO laboratory manual. Results Of the 46 patients assessed for ASA-IgG, 3 cases had immunobead binding which were 20%, 27% and 35%, respectively, and the sub-positive rate was 6.5%. No case had the clinical positive level according to the WHO criteria (50% or more of the motile sperm with immunobead binding). ASA-IgA was not detected in all cases. Conclusion The circulating ASA is not associated with the pathogenesis of infertile women with PCOS.     

Supplementary inferior phrenic artery embolization in the interventional treatment of hemoptysis

Background Transcatheter bronchial artery embolization （BAE） is widely used for the treatment of hemoptysis and the immediate success rate is high, but there are still some hemorrhage recurrences. One of the common reasons for failure of BAE is collateral branches as blood supply. The inferior phrenic artery （IPA） is one of the most common collateral branches that is scarcely reported. Our purpose was to observe manifestations of IPA supplying to hemoptysis and evaluate the efficacy and safety of IPA embolization. Methods Angiography during interventional treatment of 178 hemoptysis patients in the past 7 years confirmed that IPA hemorrhage resulted in hemoptysis in 25 patients （26-67 years old） who had： lung cancer （11 patients）, bronchiectasis （11 patients）, chronic lung inflammation （2 patients）, and pulmonary tuberculosis （1 patient）. Among the 25 patients, 7 patients had twice interventional operations within one week and 6 patients still experienced intraoperative hemoptysis after conventional embolization of the bronchial artery, the internal thoracic artery, and the intercostal artery, then had the second interventional operation immediately. The total number of cases were 191. Selective embolization of the IPA was performed using polyvinyl alcohol microspheres, gelatin sponge particles, and microcoil. The safety and clinical significance of IPA embolization were evaluated. The Pearson X2 test and Fisher＇s exact probability test were used in this study. Results Selective IPA angiography showed increased diameter of the IPA, disorganization of the branches, and varying degrees of angiogenesis. In 11 cases, contrast material was seen in vessels supplying the tumor and in the tumor. In 9 cases, contrast material had leaked into the area supplied by the IPA; in 8 cases, non-specific flake-like deposits of contrast material were seen; and in 14 cases, abnormal communication or shunt was visualized. Lesions were closely related to the pleura in 25 patients. Fifteen lesions were close to the diaphragmatic pleura, seven close to the mediastinal pleura, and three close to the lateral pleura of the lower lung. Eleven cases had inferior thoracic pleural thickening and adhesions. The IPA was embolized in 25 cases, and the success rate of hemostasis was 100%. The IPA was not embolized in the other 166 cases, and the success rate of hemostasis was 92.17 %. In the 25 cases with IPA embolization, the involvement of the IPA in the blood supply of the hemoptysis was correlated with the duration of the disease （P=0.0344）. The involvement of IPA in the blood supply of the hemoptysis was not correlated with the characteristic of the lung lesions （benign or malignant） （P=1.0000）. Duration of follow-up was 8 months to 5 years. Hemoptysis recurred in four patients 1,2, 3, and 6 months after interventional operation, respectively, and was controlled by conservative treatment. Twenty-one patients had no recurrence of hemoptysis. Conclusions Bleeding from the IPA can result in hemoptysis and failure of BAE in the treatment of hemoptysis. If IPA hemorrhage contributes to hemoptysis, supplementary IPA embolization may be a safe and effective treatment.     

Radiographic manifestations and pathologic basis of parosteal osteosarcoma. Analysis of 17 cases.

The authors reviewed the radiographic manifestations of 17 cases of parosteal osteosarcoma, with pathologic correlation in 15. There were two types of parosteal osteosarcoma radiologically. The majority of cases were type I with uniformly dense masses which had regular borders. They often adhered to the cortex and showed no evidence of soft-tissue invasion which correlated with low-grade pathologic malignancy and a relatively benign clinical course. Type II involved the bone, soft-tissue and the medullary cavity. These lesions were poorly differentiated and frequently accompanied by metastatic lesions.

     

Fine needle aspiration cytology in tumoral calcinosis cases ＆ review of literature

Objective:To investigate them by the non-invasive technique of fine needle aspiration cytology(FNAC).Methods: In this study cases were described in which FNAC was indicative of tumoral calcinosis.Total numbers of cases studied were 18.Male to female ratio was 1∶8.11 cases(61.11%) were less than 20 years of age.3 cases had history of trauma in the past(16.67%).8 cases had lesions located in the hip region(44.44%).Results:The size of lesion varied from 2.5 to 4 cm.In none of the case diagnosis of tumoral calcinosis was considered clinically.All other investigations were normal and no significant family or medical history was present.Cytology in all cases showed only abundant acellular calcium.The patients on follow up were clinically well with no changes.Conclusion:The cases are interesting,since the cytohistological findings in the aspirate sample are strongly indicative of tumoral calcinosis.     

Diffuse panbronchiolitis complicated with thymoma: a report of 2 cases with literature review

Objective Diffuse panbronchiolitis, a distinct clinical entity of unknown etiology, has been reported originally and primarily in Japanese and rarely in non-Japanese populations. Macrolide therapy is effective for this once dismal disease. Diffuse panbronchiolitis complicated with thymoma is uncommon; only 2 cases have been reported to date. The aims of this study were to describe the clinical profiles, assess the response to macrolide therapy, and to discuss the possible pathogenesis of diffuse panbronchiolitis in this setting.Methods The clinical profiles, macrolide therapy response of diffuse panbronchiolitis complicated with encapsulated thymoma in 2 historically confirmed cases were described and discussed with the 2 cases reported in the literature: one complicated with encapsulated thymoma, another with invasive thymoma.Results Of the 2 cases, both had negative PPD skin testing and abnormal serum levels of various immunoglobulins, 1 had positive anti-nuclear antibody, but none had elevated cold h     

Evaluation on Antisperm Antibody of Infertile Men with Absolute Immotile Sperm

Objective To investigate the level of antisperm antibodies(ASA) in infertile men with absolute immotile sperm(AIS).Methods Thirteen men with AIS were enrolled into this study. Sperm immotility of ejaculates from these infertile men was proven by two or three consecutive semen analyses. Sperm vitality was assessed by the eosin exclusion. Serum and seminal plasma were screened by the indirect immunobead test(IBT) for ASA type IgG and IgA according to the WHO laboratory manual.Results Semen samples from these patients showed ejaculate volume, pH, and sperm count in the normal range. Sperm vitality, sperm concentration, and sperm abnormal forms in these cases were 40.2 ± 11.1%, 45.0 ± 11.9 × 106/ml, and 97.8 ± 1.4%,respectively. No case had the positive or sub-positive level of ASA type IgG and IgA in samples of both serum and seminal plasma.Conclusion ASA is not associated with the pathogenesis of AIS-associated infertility.     

Tumours of the Scalp： A Review of Ten Cases

Background： The scalp is a common site for the development of tumours. Most of these tumours are benign; among the malignant ones, squamous cell carcinoma （SCC）） and basal cell carcinoma （BCC） predominate. In Ghana patients with scalp turnouts do not report to hospital unless they are symptomatic. Data on the condition is therefore scanty. Patients and Methods： The objective of the study was to document the hospital prevalence and the management outcome of patients with scalp tumours. Patients with turnouts of the scalp reporting at the Reconstructive Plastic Surgery and Burns Unit （RPSBU） at Komfo Anokye Teaching Hospital （KATH） who were managed by the author between June 2003 and June 2009 were entered into the study. The patients were examined clinically and the diagnosis confirmed by biopsy. The scalp tumours were excised and the defect closed directly, skin grafted, or repaired with a flap as appropriate. Results： Ten patients with eleven scalp tumours were managed during the study period from June 2003 to June 2009, made up of four males and six females. Their ages ranged from 16 to 70 years, with a mean age of 41.7 years. Two benign scalp turnouts, a sebaceous cyst and a sebeceoma were located in the frontal region; five cases of SCC and one case of basosquamous cell carcinoma （BSC） in the parietal region, two cases of SCC in the temporal region, and one case of SCC in the occipital region of the scalp. Eight of the tumours developed de novo from the scalp; one developed from a chronic burn scar （Marjolin＇s ulcer）; two tumours developed from the scalp of a patient with xeroderma pigmentosum. Two patients had excision and direct closure of the defect; six had excision and skin grafting; two had excision and flap repair. One patient had block dissection of the left cervical lymph nodes, and two patients had adjuvant radiotherapy. Conclusions： Most tumours of the scalp presenting at the RPSBU at KATH are SCC which developed de novo. Chronic burn scars and xeroderma pigmentosum were some of the aetiological factors identified. Early lesions can be cured by excision and skin grafting.