Tuberculous Lymphadenitis in South-Eastern Nigeria; A 15 Years Histopathologic Review (2000-2014).

BACKGROUND: The human immunodeficiency virus (HIV) pandemic has brought about a resurgence in tuberculosis (TB), especially in developing countries. Previous studies on TB lymphadenitis (TBLN) in South-Eastern Nigeria were done before the advent of the HIV pandemic making a review pertinent. AIM: To evaluate the role of TBLN as a cause of superficial lymphadenopathy in the post-HIV/acquired immune deficiency syndrome (AIDS) era of South-Eastern Nigeria. MATERIALS AND METHODS: This is a 15 years (2000-2014) retrospective review of all superficial lymph node biopsies (SLNBs) received at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria. RESULTS: One hundred and seventy-two cases of TBLN were identified in this study constituting 14.6% (172/1,180) of SLNBs received at our Hospital's Morbid Anatomy Department during the 15 years period under review. Twenty-eight cases of TBLN were clinically screened for HIV, 23 of which tested positive, representing 82.1% (23/28) of clinically screened cases. Acid fast bacilli demonstration was positive in 15.1% (26/172) of cases using Ziehl-Neelsen stain. 48.8% (84/172) of TBLN cases were males, and 51.2% (88/172) were females with most (22) cases received in 2012 and least (5) cases in 2000. Most TBLN occurred in the 21-25 years age group with a total of 21.5% (37/172) of cases and a male to female ratio of 1:1.5 The most common biopsy site for TBLN was the cervical group followed by the axillary and inguinal groups with 73.8% (127/172), 14% (24/172), and 4.7% (8/172) of cases, respectively. CONCLUSIONS: There is a remarkable decline in the prevalence of TB lymphadenitis in South-Eastern Nigeria indicating a change in trend from the pre- to the post-HIV/AIDS era with slightly more females now presenting with TBLN and most TB lymphadenitis patients now presenting with associated HIV/AIDS disease. There is an urgent need to provide modern diagnostic facilities in our medical laboratories.

Giant primary synovial sarcoma of the anterior mediastinum: A case report and review of literature.

Primary synovial sarcoma is a very rare tumor of the mediastinum, which is unreported in the entire subcontinent of West Africa, and presents daunting challenges from diagnosis to management with lack of standard management strategies. We present a case of primary monophasic synovial sarcoma of the anterior mediastinum, in a 22-year-old Nigerian lady who presented with cough, chest pain, and pleural effusion. Chest X-ray (CXR) and computed tomography on admission showed a left-sided huge mass in the left anterior mediastinum with no metastasis to the contralateral pleural cavity. Complete resection of the mediastinal tumor was done and histologic and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. However, 10 months postoperation she represented with chest pain, productive cough and a repeat CXR showed multiple left pulmonary nodules. She received two cycles of docetaxel and gemcitabine chemotherapy, but declined further treatment until her demise 8 months later.

Hurthle cell tumor of the thyroid gland: report of a rare case and review of literature.

This article presents a case of Hurthle cell adenoma (HCA) of the thyroid gland with a review of literature on Hurthle cell tumors. This case presented is that of a 57-year-old woman with a recurrent thyroid swelling. She previously underwent a right hemithyroidectomy for thyroid mass 10 years prior. A left lobectomy was done and microscopic examination revealed a HCA of the thyroid. The patient was discharged on thyroid replacement therapy and has remained healthy after more than 24 months of follow-up. The literature review highlights the criteria for diagnosis, the role of imaging and fine needle aspiration cytology (FNAC) in preoperative diagnosis.

Pattern of second primary malignancies in thyroid cancer patients.

Many factors, including relatively young age of thyroid cancer diagnoses and improved survival, have led to increased concerns about the occurrence of second primary malignancies. This paper describes the pattern of occurrence of second primary malignancies in patients who were treated for malignant thyroid neoplasms in an Indian hospital. There were 21 affected patients of the approximately 4500 seen over 25 years. Most of the second primary cancers are solid tumors, and when nonthyroid cancers are the second tumors, ductal carcinoma of the female breast is the most common. Most of these tumors have very short detection intervals (including synchronous occurrences), suggesting that therapy with internal radiation was not contributory to the tumor development. When thyroid malignancies were the second primary cancers, they usually follow radiotherapy to the head and neck region for treatment of the first primary tumor and tend to be of aggressive histologic types than the common well differentiated thyroid carcinomas.

Chronic thromboembolic pulmonary hypertension with pulmonary infarction occuring in a hypertensive.

We present a 72-year-old man and a known hypertensive with poor drug compliance seen here on 22-03-06, with a 4-year history of progressive dyspnoea, associated with cough and a wheeze. On examination he was chronically ill looking with altered state of consciousness, pale, centrally cyanosed, febrile (T-38 degrees C), in respiratory distress (RR-33 pm). Significant chest radiological findings include marked aortic unfolding and cardiomegaly, with biventricular involvement. Numerous nodular opacities in both lung fields especially the Right side with right apical opacification/thickening. Treatment as appropriate was instituted but unfortunately the patient succumbed after thirty days on admission and an autopsy carried out revealed multiple pulmonary infarcts with pulmonary thrombo-embolism.

Chronic thromboembolic pulmonary hypertension with pulmonary infarction occuring in a hypertensive.

We present a 72-year-old man and a known hypertensive with poor drug compliance seen here on 22-03-06,with a 4-year history of progressive dyspnoea, associated with cough and a wheeze. On examination he was chronically ill looking with altered state of consciousness, pale, centrally cyanosed, febrile (T-38 degrees C), in respiratory distress (RR-33pm). Significant chest radiological findings include marked aortic unfolding and cardiomegaly, with biventricular involvement. Numerous nodular opacities in both lung fields especially the Right side with right apical opacification/thickening. Treatment as appropriate was instituted but unfortunately the patient succumbed after thirty days on admission and an autopsy carried out revealed multiple pulmonary infarcts with pulmonary thrombo-embolism.

Dilated alcoholic cardiomyopathy and incidental lymphoma occuring in a 56 year old man who was being managed for hypertensive heart disease in Enugu Nigeria--a rare finding.

We present a case of dilated alcoholic cardiomyopathy occurring in a 56-year-old Nigerian male. He admitted to taking alcoholic beverage, approximately 2-3 bottles of different brands of beer per day for about 30 years, but stopped three years ago on medical advice. He had a history of progressively worsening dyspnoea and encephalopathy, from decreasing ejection fraction. This resulted in a poor blood supply to the vital centers of the brain. Autopsy confirmed a dilated cardiomyopathy with an incidental fairly advanced B cell lymphoma involving the liver and spleen. The latter was thought to be a coincidental finding.

Gastrointestinal stromal tumours at the University of Nigeria Teaching Hospital Enugu, Nigeria: an immunohistochemical study of GIT mesenchymal tumours.

Mesenchymal tumours of the gastrointestinal tract (GIT) are uncommon. Recent progress in the understanding of the biology and origin of these tumours has led to their reclassification. A new subclass designated Gastrointestinal Stromal Tumours (GIST) is diagnosed based on the presence of a mutational over expression of c-kit protein that is thought to be critical in the pathogenesis of these tumours. This new class oftumours may form the majority of gastrointestinal mesenchymal tumours. Even though the diagnosis of GIST is mainly based on positive staining with CD117, a minority of tumours with histological characteristics of GIST are CD117 negative and are classified as CD117 negative GIST. In this first review of mesenchymal GIT tumours from Nigeria, we present 11 cases ofmesenchymal tumours of the gastrointestinal tract seen within a six-year period at our centre. Immunohistochemistry was performed on 7 of them in which histological appearances suggested GIST. Only two cases had all the criteria defined in the consensus conference on the diagnosis of GIST. Our findings, albeit in a very small sample, contrasts with what obtains in developed countries in the proportion of GIT mesenchymal tumours that are truly GIST. This raises a question to be answered on the true nature and proportion of gastrointestinal strumal tumours among GIT tumours in Nigerian patients.

Giant Seminoma following ipsilateral orchidectomy: a rare finding. Case report.

Giant intrascrotal recurrent seminomas are rare in the surgical literature, probably due to widespread information about self-detection. A recent European study has reported a reduction in the primary tumour size at presentation. These findings are at variance with the situation in sub-Saharan Africa. We present a 32-year-old patient who presented with an 8-month history of progressive, painless left hemiscrotal swelling, no lower urinary tract symptoms and no evidence of metastatic disease. The patient had undergone a left inguinal orchidectomy 2 years prior to the onset of the current swelling, on account of a suspected testicular tumour. Histology was, however, returned as 'sections of testis showing haemorrhagic necrosis with areas of fibrosis. No malignancy seen. Diagnosis consistent with long standing torsion'. The patient had excision of the mass via an inguinoscrotal incision, with primary wound closure and drainage, and had good post-operative recovery. Histopathology subsequently reported seminoma. We discuss a rare case of giant intrascrotal recurrent seminoma in a young African patient and comment on the surprising absence of metastatic symptoms and the management in the absence of new imaging techniques. We emphasize the value of extirpation in such cases and the need for thorough sectioning of histopathological specimens. We also note that seminoma should be considered in the differential diagnosis of scrotal swelling even in the absence of the testes (after orchidectomy).

Spectrum of childhood malignancies in Enugu, Nigeria (1999-2004).

A retrospective analysis of childhood malignancies in Enugu, Nigeria was carried out using data obtained from the Cancer Registry of the University of Nigeria Teaching Hospital (UNTH), Enugu between 1st January 1999 and 30th June 2004. A total of 79 childhood cancers were recorded during the period. There were 48 males (60.8%) and 31 females (39.2%) with a male female ratio of 1.5:1. The three commonest malignancies were lymphomas 33 (41.2%), sarcomas 12 (15.2%) and nephroblastomas 12 (15.2%). The less common tumours included the leukaemias 6(7.6%), retinoblastomas 6 (7.6%), neuroblastomas 4 (5.1%), and carcinomas 2 (2.5%). Burkitt's lymphoma remains the commonest specific childhood malignancy in this environment constituting 19 (57.6%) of all the lymphomas and 24.1% of all the cancers seen.