Introduction: Lung cancer has been the leading cause of cancer deaths in Brunei Darussalam for the past five years. This study is the first to supply data for the 5-year survival of patients diagnosed with non-small cell lung cancer (NSCLC) in Brunei Darussalam. Materials and Methods: From 2002 to 2009, 302 patients diagnosed with NSCLC were identified from the National Cancer Registry of Brunei Darussalam. Demographic and clinical data were retrospectively retrieved from the clinical notes. All deaths and dates of death were obtained and crosschecked with the National Birth and Death Registry at the Immigration Department. Data were analysed using SPSS statistical software and 5-year Kaplan -Meier survival curves were derived and analysed using Log Rank test. Predictors of 5-year survival were analysed using Cox regression analysis. Results: Mean age of the 302 patients was 64.9 ± 12.8 (27.4–90.6 years) with male to female ratio of 194:108. Racial distribution consisted of 84.4% (n=255) Malay, 12.5% (n=38) Chinese and 3.1% of other racial origin (indigenous and foreign nation- als). Histological types of NSCLC consisted of 67.9% (n=205) adenocarcinoma, 16.2% (n=49) squa- mous cell carcinoma, 6.3% (n=19) large cell carcinoma, 5.3% (n=16) bronchioalveolar carcinoma and 4.3% of other origin. Only 13.9% of patients underwent surgical resection. At completion of follow-up, only 47 (15.5%) patients were still alive. There were 255 deaths. Overall 5-year survival for the whole group was 3.6% with a median survival time of 6.5 ± 0.9 months (95% CI: 4.7-8.4 months) but ac- cording to stage of disease was 60.9% for Stage IA, 29.9% for Stage IB, 10.0% for Stage IIB, 7% for Stage IIIB and 3% for Stage IV. Significant prognostic factors were younger age at diagnosis, surgical resection, tumour types and tumour stages. Conclusion Overall 5-year survival of patients diagnosed with NSCLC in Brunei Darussalam is still generally poor but comparable to previously reported data. Significant prognostic factors were younger age at diagnosis, surgical resection, tumour types and tu- mour stages.

Ovarian cancer is the second most common cancer in women and up to a fifth of all ovarian tumours are metastatic in origin. Among these metastatic tumors, the most common primaries are the gastroin- testinal tract and breast. We report the case of a 66-year-old lady who presented with recent onset vague lower abdominal pain and distension who on evaluation was diagnosed to have bilateral ovarian metastases from a pancreatic primary. This case highlights the importance of considering metastasis and to include a pancreatic primary in the differential diagnosis of patients with bilateral ovarian tu- mours.

Chronic canaliculitis is an uncommon disease with a protracted course. Its management is prolonged and difficult. An elderly lady was diagnosed to have left lower chronic purulent canaliculitis. Conserva- tive treatment alone did not effect a complete cure. Canaliculotomy with removal of sulphur granules and canalicular curettage also had to be performed to achieve a permanent cure. Unlike many cases of canaliculitis, this patient presented numerous complications confined to the canaliculus. To the best of our knowledge, this is the first report of Actinomyces naeslundii (A. naeslundii) causing chronic puru- lent canaliculitis and associated complications. A. naeslundii canaliculitis should be considered in the differential diagnosis of chronic conjunctivitis with epiphora.

Introduction: Development of renal cell carcinoma (RCC) is a life threatening complication of long- term haemodialysis. Studies have shown that approximately one third or more of patients on long-term haemodialysis of more than three years will develop acquired cystic kidney disease (ACKD), and 20- 50% of patients with ACKD, particularly with complex cysts of Bosniak types IIF, III and IV, may even- tually transform into RCC. This study looks at the incidence of haemodialysis related RCC in Brunei Da- russalam. Material and Methods: Cases of RCC registered in the Department of Pathology registry from January 2000 to December 2010 were identified and retrospectively reviewed. Results: A total number of 5,287 malignancies were reported during this period of which 74 were RCC, giving an overall incidence of 1.4%. Out of these 74 cases, 6.8% (n=5) was found to be RCC transformed from ACKD associated with long-term haemodialysis. There was a male preponderance (4:1), four Malay men and one Chinese lady with a median age of 51 years (37-66) at diagnosis. The duration of haemodialysis prior to the development of RCC ranged from 4 to 16 years. The common presenting signs and symp- toms were cystic mass in kidney 60% (n=3), haematuria and metastatic RCC in urinary bladder 20% (n=1), metastasis to the neck glands 20% (n=1). The right kidney was affected in four (80%) and one on the left (20%). Conclusion Our study showed that ACKD associated RCC accounted for 6.8% of all RCC, and the duration to RCC development ranged from four to 16 years. There was a preponderance in males. Radiological screening may need to be considered for patients at risk.

Oesophageal ulcerations are generally rare occurrences that are most commonly associated with gastro-oesophageal reflux disorder. Other causes include medications and infections in immunocompromised patients. Among the medications used in daily practice, doxycycline is most commonly implicated. Multiple aetiologies are generally uncommon. We report a case of mid-oesophageal ulcerations secondary to doxycycline and herpes simplex virus infection in an immunocompetent patient.
Anti-Bacterial Agents ; adverse effects ; Doxycycline ; adverse effects ; Endoscopy, Gastrointestinal ; Esophageal Diseases ; etiology ; pathology ; Esophagus ; pathology ; virology ; Female ; Herpes Simplex ; complications ; Humans ; Middle Aged ; Ulcer ; etiology ; pathology

Introduction: Molecular markers determined by immunohistochemistry are routinely used for predicting and prognosticating cancers including breast cancer. Molecular markers for breast cancer such as oestrogen and progesterone receptors, Her2, p53, pS2, Bcl2, EGFR, Ki67, CD34 and Cathepsin D have been used in Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital. This study assessed the ethnic variations in breast cancer incidence as well as the relationships between expression of these markers with tumour stage and grade and patient survival in Brunei Darussalam. Materials and Methods: Records of breast cancer patients between 2001 and 2009 were retrieved and abstracted from the Cancer Registry maintained by the Department of Pathology at the RIPAS Hospital. These were reviewed and analysed using appropriate statistical methods. Results: Overall, the mean age at diagnosis was 49.2 years. The incidence rate of breast cancer among Chinese (56.4 per 100,000 per year) was significantly higher than Malays (27.8) and the other ethnic groups (12.3). The expression of oestrogen and progesterone receptors and pS2 was significantly greater in the more differentiated tumours while that of Ki67 and p53 in tumours and CD34 in blood vessels within the tumour was significantly greater in the less differentiated tumours. Positivity for oestrogen receptor was significantly associated with the absence of metastases in regional lymph nodes. Expression of oestrogen and progesterone receptors in tumour cells was significantly associated with enhanced patient survival, while the detection of CD34 in blood vessels within tumours was associated with poorer survival. Survival trends seen for other markers were not statistically significant. Conclusions The different incidence of breast cancer among the different ethnic groups merits more detailed investigation of the responsible genetic, social and environmental factors. Oestrogen and progesterone receptors and CD34 are confirmed as useful markers for prognosis among our population with breast cancer. Expression of p53, Ki67 and pS2 may also be useful. These markers will be helpful in determining treatment options and for patient education.

Introduction: Breast cancer is one of the most common cancers in women and the incidence rates are reported to be increasing. This study looks at breast cancer in Brunei Darussalam in particular the incidence rates, the demographic and types of breast cancers over a 27-year-period (1984 to 2010). Materials and Methods: The Cancer Registry maintained by the State Department of Pathology was retrospectively reviewed. Over this period there were a total of 874 cases of breast cancer diagnosed, nine of which were men (1.1%) and these were excluded from analysis. The crude incidence rates, Age Standardised Rates (ASR) and the age specific incidence rates were calculated based on population projections. Age was unavailable from 1984 and 1985 and these two years were excluded from ASR analyses. Results: The mean age at diagnosis was 48.7 ± 11.7 years old. The ethnic distribution showed predominantly Malays (69.1%) followed by Chinese (20.1), ‘Others’ (9.1%) and Indigenous group (1.5%). The types of cancers were predominantly ductal (84.9%), followed by lobular (5.5%), Malignant Phyllodes tumour (4.4%), ‘Others’ (4.6%) and papillary (0.7%). Breast accounted for 17.6 to 26.6% of all female cancers from 2001 to 2010. 22.3% of breast cancers occurred in the young patient group (less than 40 years old). The crude rates increased from 11.0 per 100,000 women (1984-1986) to 40.7 per 100,000 women (2008-2010) and the ASR increased from 14.7 per 100,000 (1987-1989) to 43.9 per 100,000 women (2008-2010). The ASR for the Chinese increased markedly from 1992-1995 peaking in 2002-2004 followed by a declining trend whereas the trend is increasing in the Malays. Conclusions Our study showed that the overall incidence of breast cancers in Brunei Darussalam is increasing. Chinese had higher incidence rates than the Malays. The age adjusted incidence rate is approaching the rates reported by the more developed Southeast Asian nations. Importantly, young breast cancer accounts for a fifth of the patients.