Abstract Objective: The use of high-resolution computed tomography (HRCT) has improved the management of non-small cell lung cancer (NSCLC), but has also increased the detection of indeterminate satellite nodules. Obtaining differential diagnosis of nodules less than 10 mm is difficult but essential for choosing optimal therapeutic strategies. Here, we evaluated the characteristics of small satellite nodules in patients with operable NSCLC and examined the optimal diagnostic and therapeutic approach in patients with small satellite nodules. Methods: Using data from a prospective database, all surgically treated patients diagnosed with NSCLC from 2008 to 2011 were retrospectively reviewed. Patients presenting with small pulmonary non-GGO nodule(s) were identified. Results: A total of 1206 patients underwent complete resection for NSCLC, out of which 45 patients presented with 60 nodules less than 10 mm on thoracic CT. Twenty-six nodules (43%) were malignant, 31 (52%) were benign, and 3 (5%) were of undetermined nature. Tumor histology (adenocarcinoma vs. nonadenocarcinoma), TNM stage (advanced stage vs. early stage), and nodule size (6–10 vs. ≤ 5 mm) were associated with nodule malignancy. The incidence of metastatic nodules in patients with stage III NSCLC was significantly higher than that in patients with stage I NSCLC. In contrast, the incidence of multiple primary lung cancers in patients with stage I NSCLC was significantly higher than that in patients with stage III NSCLC. Conclusion: Differential diagnosis of indeterminate satellite lesions in patients with operable NSCLC is critical. Surgery should be performed cautiously in patients with stage III NSCLC having nodules larger than 5 mm.
Keywords: lung cancer; satellite nodule; diagnosis; surgery; computed tomography

Abstract Objective: The introduction of several classes of targeted therapeutics for the treatment of chronic myelogenous leukemia (CML) raises the question of whether male fertility is affected and the degree of this affection, if any, among the different generations of tyrosine kinase inhibitors (TKIs). Additionally, when two drugs are equally effective, the drug with less toxic effect on fertility is favourable. Our aims were to evaluate semen parameters and pituitary gonadal function before and four months after starting TKIs namely, dasatinib, nilotinib, and imatinib in patients with CML. Design: Prospective study. Setting, patients and interventions: We studied the effect of TKIs' first generation (imatinib) and second generation (dasatinib and nilotinib) on semen parameters and endocrine functions in 20 eugonadal male patients with CML, aged between 35 to 51 years. They were receiving imatinib (400 mg) once daily, dasatinib (100 mg) once daily or nilotinib (300 mg) twice daily as upfront therapy. We assessed the serum gonadotropins (LH and FSH) and testosterone (T) secretion and sperm parameters before and after four months of using these TKIs. Results: Four months after starting TKIs, serum testosterone, LH and FSH concentrations decreased significantly. The total sperm count (SC), total and rapid progressive sperm motility, and % sperms with normal morphology decreased significantly versus pre-treatment. After 4 months of therapy, dasatinib had comparatively the least deleterious effects on SC, ejaculate volume (SV), sperm motility and % of sperms with normal morphology (%NM) compared to imatinib and nilotinib. Significant correlations were found between serum T concentrations and semen parameters before and after TKIs therapy including SC (r = 0.658 and r = 0.73 respectively, p < 0.001), rapid progressive motility (r = 0.675 and r = 0.758, respectively; p < 0.001), and the % NM (r = 0.752 and r = 0.834, respectively; p < 0.001). After TKIs therapy, LH were correlated significantly with T concentrations, SV and SC (r = 0.434, 0.439 and 0.376, respectively; < p: 0.01). Conclusions: Our study showed that CML patients treated with TKIs have significant decrease of sperm parameters and decreased serum concentrations of serum T, LH and FSH. These potentially toxic effects on spermatogenesis are less prominent in patients treated with dasatinib compared to imatinib and nilotinib. The mechanisms and pathways for these effects need further human and/or experimental studies.
Keywords: chronic myelogenous leukemia (CML); tyrosine kinase inhibitors (TKIs); spermatogenesis; pituitary-gonadal axis

Abstract Background: Breast cancer markers are becoming increasingly important in breast cancer research due to their impact on prognosis, treatment and survival. The present retrospective study was carried out to quantify the proportion of estrogen (ER), progesterone (PR), and human epithelial receptor 2 (HER2) expressions and their association with tumour grade, age, and tumour size in breast cancer patients in Nigeria. Materials and methods: The paraffin embedded tissue sections were analysed for breast cancer markers using monoclonal antibody SP1 for ER and SP2 for PR and polyclonal antibody ErbB2 for HER2. Results: A total of 286 breast cancer paraffin wax tissue sections were analysed for ER, PR and HER2 expression. Of all the tissue samples examined, 20 (7%) were ER-positive, 6 (2.1%) were PR-positive, 11 (3.8%) were HER2-positive whereas 248 (87%) were triple-negative breast carcinoma. ER- and PR-positivity was associated with early grade I and II tumours (P < 0.010-0.009) and tumour sizes of < 50mm (p < 0.001). HER2-positivity was positively (P < 0.009) associated with grade II tumours and negatively (P < 0.0001) associated with grade III tumours. Triple-negative breast cancer was associated with grade III tumours (P < 0.0001) and larger tumour sizes of > 50mm (P < 0.0001). Conclusion: A small proportion of Nigerian women with breast cancer are ER/PR-positive which are associated with less aggressive, better prognosis and benefit from endocrine therapy. An even smaller proportion of patients with aggressive tumors were HER2-posivite but responsive to Herceptin treatment. Unfortunately, a very high proportion of cases were triple-negative which is associated with very aggressive tumours and no targeted treatment, which may explain the high mortality rates from breast cancer in Nigeria.
Keywords: estrogen; progesterone; HER2; breast carcinoma; Nigerian; tumour grade; tumour size

Abstract About 10% of metastatic urothelial carcinoma overexpress oncogenic HER2/neu receptor. Recent preliminary data suggest that patients with this particular molecular subset could benefit from trastuzumab therapy, which specifically targets the receptor and thus inhibits downstream activation pathway. Here we report a case illustrating this clinical benefit, with complete response reported as third line therapy in a heavily pretreated patient with diffuse metastatic urothelial carcinoma of the bladder. It also highlights the usefulness of 18-Fluorodeoxyglucose Positron Emission Tomography (18-FDG PET) as a biomarker for response to trastuzumab.
Keywords: trastuzumab; bladder cancer; HER-2/neu receptor; 18-FDG PET