Objective: Breast cancer in Africans is reported to have poor clinical outcome. Whereas hypoxia-inducible factor-1α (HIF-1α) expression has been linked to treatment failure and poor prognosis in breast cancer, there is a lack of reports about HIF-1α expression in Africans. The aim of this study was to evaluate HIF-1α expression in relation to vascular endothelial growth factor (VEGF) expression, angiogenesis, and other tumor characteristics in an African population. Method: In total, we analyzed 192 breast cancers by immunohistochemical staining. We determined microvessel density (MVD), proliferating microvessel density (pMVD), and vascular proliferation index (VPI) in the most vascularized areas as well as expression of HIF-1α and other biomarkers using tissue microarrays. Results: Expression of HIF-1α (in 128/182 tumors; 70 %) was associated with VEGF expression (p<0.0005), MVD (p =0.037), high tumor grade (p=0.001), high Ki-67 proliferative rate (p<0.0005), and p53 expression (p=0.032). Conclusion: There is a high expression of HIF-1α in this series of breast cancer which is strongly associated with VEGF expression and increased MVD. More studies are required to assess the therapeutic implications of HIF-1α expression in this population. The patient underwent lumpectomy. The gross specimen had a tan grey firm nodule of 25×15×15 mm. Histological examination revealed a proliferation made of signet ring cell and glandular structures, with islands of goblet cells. Immunohistochemistry revealed strong positive staining with CK7 and CK20, and a sparse positive staining with synaptophysin and chromogranin.ER, PR and HER2 were negative. The patient underwent appendicectomy with a final diagnosis of breast localization of a primary occult appendiceal GCC. Conclusion: The differential diagnosis between primary carcinoid tumor of the breast and signet ring cell carcinoma metastatic to the breast is often controversial in surgical pathology. Diagnoses need to be made correlating clinical and histological examination in difficult cases in which there is not a diagnosis of carcinoid tumor elsewhere. Their histological appearance may mimic ductal adenocarcinoma of the breast. The distinction is important due to differences in management and prognosis.