Malignant tumors of the upper aerodigestive tract as seen in a Nigerian tertiary health institution.

BACKGROUND: Cancers of the upper aerodigestive tract constitute a diverse heterogeneous group of malignant neoplasms with unique epidemiological, pathological, and treatment considerations. Only few studies have been conducted so far on these tumors in Nigeria. This study aims to study in greater detail, the pathological features of these cancers in Nigerian patients. MATERIALS AND METHODS: The surgical specimens of patients diagnosed with malignant tumors of the upper aerodigestive tracts in the Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Ile-Ife, Nigeria, over a 10-year period, formed the basis of this study. Analysis was done for differences in proportion using the Chi-square test (P is significant at < 0.05) by SPSS version 15. RESULTS: There were a total of 62 cases. The overall mean age was 50.7 years, while the age range was from 3 years to 90 years. The male to female ratio was 3.1:1. A majority of the patients (67.7%) were older than 40 years. About 30.6, 27.4, and 16.1% of cases occurred in the larynx, nasopharynx, and nasal cavity, respectively, while 93.5% of the tumors were carcinomas. Squamous cell carcinoma was the most common histological variety. Nonepithelial tumors were not seen below the age of 20 years. CONCLUSION: This study shows that malignant upper aerodigestive tract tumors seen in our environment are mainly diseases of adulthood that tend to occur about seven to nine years earlier than in other populations. Squamous cell carcinoma is the predominant histological variety. Although the larynx is the most frequent anatomic site, the nasopharynx and nasal cavity are more commonly affected than the oral cavity unlike in other populations. Nonepithelial tumors are extremely rare below the age of 20 years.

Carcinoma head of the pancreas masquerading as hepatocellular carcinoma: a case report.

BACKGROUND: Cancer of the pancreas is the primary malignant tumour of the pancreas commonly seen in the elderly. Hepatitis B virus infection is not a known marker of the disease, but patient with carcinoma head of the pancreas presenting with epigastric mass with positive hepatitis B infection in the region of the world with high endemicity for hepatitis B virus infection may cause diagnostic pitfall. OBJECTIVE: To present a case of carcinoma head of the pancreas masqueradingas hepatocellular carcinoma METHODS: A review of the case note, autopsy findings including gross and microscopic examinations and literature was done. RESULTS: An elderly woman with history of weight loss and cigarette smoking.There was an epigastric mass and the liver was enlarged. The serum hepatitis B antigen was positive. Autopsy revealed an ill-defined mass in the head of the pancreas with metastasis to the liver. CONCLUSION: Things are not always what they seem.

Neglected giant fibroadenoma of the breast presenting like a fungating breast cancer in a premenarchal Nigerian teenager.

BACKGROUND: Giant fibroadenoma of the breast is a type of rare benign breast tumour which can grow to a giant size, It is even rarer for this benign tumour to grow rapidly, ulcerate spontaneously and present like a fungating breast tumour in a way mimicking breast cancer. Carcinoma of the breast on the other hand has been on the increase so much that it has assumed an epidemiological dimension. In developing country such as Nigeria late presentation of breast cancer has remained a rule rather than exception and it is very common for patient to present with fungating breast lesion. STUDY DESIGN: This is a case presentation of a 14 year old premenarchal girl presenting with a massive ulcerating and fungating left breast mass that was initially thought to be a fungating locally advanced breast carcinoma on clinical examination. Further examination of the morphology of the resected surgical specimen and histological examination confirmed it to be giant fibroadenoma of the breast. RESULTS: The giant fungating breast tumour successfully managed by partial mastectomy and breast reconstruction with an excellent result and a high degree of patient satisfaction was achieved. CONCLUSION: Though a rare clinical entity benign breast tumour can present like a fungating breast cancer and this must be bore in mind especially in young adolescent patients presenting with ulcerating breast tumour.

Gastric precancerous lesions among Nigerians with chronic gastritis.

AIMS AND OBJECTIVES: To investigate the frequency of precancerous lesions in H. pylori gastritis in Nigerians MATERIALS AND METHODS: Previously, the slides of all endoscopic gastroduodenal biopsies seen at the Pathology Department of Obafemi Awolowo University Teaching Hospital, Ile-Ife between 1994 and 2003 were reviewed and published. The current review examined interplay of intestinal metaplasia, glandular atrophy and epithelial dysplasia with H.pylori. The H.pylori, intestinal metaplasia and glandular atrophy were graded based on updated Sydney classification scheme while Vienna classification was used for dysplasia. RESULTS: Out of 1036 biopsies seen during the study period, 135 (13%) had associated precancerous lesions. Intestinal metaplasia was the commonest (9.2%), followed by severe atrophic gastritis (4.3%) and low grade dysplasia (0.7%) occurring either alone or in various combinations. Most of these lesions were seen in patients above 40 years of age and over 80% were H.pylori positive. CONCLUSION: Frequency of precancerous lesions is low among Nigerians with H.pylori gastritis. Intestinal metaplasia was the commonest lesion and was mostly type I with relatively low risk for gastric cancer development. The relatively high prevalence H.pylori infection among these cases could have resulted from repeated infection and most were localised to the corpus relative to the antral region where the precancerous lesions were seen.

Correlation between endoscopic suspicion of gastric cancer and histology in Nigerian patients with dyspepsia.

Gastric mucosal biopsies of 77 dyspeptic patients whose endoscopic features were suggestive of cancer and 56 patients with uncomplicated duodenal ulcer (DU) were subjected to histopathological analysis. Gastric cancer was confirmed in 18 (23.4%) of the 77 patients but not in 59 (76.6%). 4 (5.2%) of the 18 patients had early gastric cancer (EGC). Histopathological findings in the stomach biopsy of the 59 patients in whom cancer could not be confirmed were compared with those of the 56 patients with DU. Intestinal metaplasia (IM) was present in 32.2% of the 59 cases with endoscopic suspicion of gastric cancer and in 16.1% of the 56 DU controls (P < 0.05). Mucosa-associated lymphoid tissue (MALT) occurred in 28.8% of the cancer-resembling cases and in 12.5% of the DU patients (P < 0.05). The difference in the prevalence of gastric mucosal atrophy and Helicobacter pylori infection between the two groups (83% vs. 71.4%) did not reach statistical significance (P > 0.10). All 18 patients with gastric cancer were positive for Helicobacter pylori and the prevalence of the infection approached 95% in those with IM and MALT. This study shows that IM and MALT present with endoscopic appearances that resemble that of gastric cancer and that along with the latter, their main aetiological agent is Helicobacter pylori.

Chronic hepatitis in Nigerian patients: a study of 70 biopsy-proven cases.

BACKGROUND: Liver cirrhosis and hepatocellular carcinoma are known sequelae of chronic hepatitis. Early diagnosis and treatment of chronic hepatitis could delay or even abort progression to terminal liver disease. STUDY DESIGN: Prospective study of 70 consecutive patients with features of early liver disease or discovered with HBsAg (or anti-HCV) during pre-employment and/ or pre-donation screening at Ile-Ife, Nigeria. All the patients had liver biopsy and the histology evaluated with the Knodell Histological Activity Index. RESULT: Fifty-three patients had symptomatic disease (M: F ratio, 1.5:1) while 17 were asymptomatic (M: F ratio, 3:1). The mean ages were 49.04 (SD+/-16.78) and 29.82 (SD+/-6.13) for the symptomatic and the asymptomatic patients respectively (P< 0.005). Major symptoms were right upper abdominal pain (68%), weight loss (51%) and fatigue (41.5%). Alcohol consumption was significantly related to symptomatic chronic hepatitis (P< 0.01). Over 50 % of patients with asymptomatic chronic hepatitis had abnormal liver scan and liver function tests. All the asymptomatic cases and 77.4 % of the symptomatic group had HBsAg while only 1 patient (symptomatic) was anti-HCV positive. On liver histology, all the patients with asymptomatic chronic hepatitis had a Knodell score of< or = 8 and none had fibrosis. Over half of the symptomatic patients had a Knodell score of > or = 9 (56.6%) and stage 2 or 3 fibrosis (51 %). CONCLUSION: Asymptomatic chronic hepatitis patients tend to be younger and of the male sex. Symptomatic chronic hepatitis may signal the onset of significant fibrosis and alcohol abuse may accelerate this process. Serum ALT and liver scan are useful initial screening tests for asymptomatic patients with hepatitis B or C viral markers.

Burkitt's lymphoma of the head and neck region in a Nigerian tertiary hospital.

BACKGROUND: Burkitt's lymphoma is endemic in Nigeria; it forms about 39% of all childhood cancers. In recent times more of these cases are being seen presenting first to the Ear Nose and Throat clinic. OBJECTIVE: This study is designed to look at the pattern of presentation of head and Neck Burkitt's lymphoma at a Nigerian Tertiary hospital and to evaluate current treatment modality. DESIGN: It is a retrospective study of all confirmed Burkitt's lymphoma of the head and neck region seen at the Obafemi Awolowo University Teaching Hospital Ile Ife (OAUTHC) between 1986 and 2002. PATIENTS AND METHODS: The medical records of all the patients with the histopathologically confirmed Burkitt's lymphoma over a 17-year period (1986-2002) were evaluated. The proportion of the tumor affecting the Head and neck region were noted. The data extracted were entered into a questionnaire and analysis of data was done using the SPSS 10.0 software. RESULTS: A total of 196 cases of Burkitt's lymphoma were seen over the period out of which 140 (71.4%) were in the head and neck region. There was a male preponderance with the incidence of 72% and 28% in females. The peak age incidence was found to be within the first decade of life. The most common sites that were affected are; the jaw (65.9%), nasal and paranasal sinuses (12.2). Majority of the patients presented with advanced disease. Combination Chemotherapy comprising Cyclophosphamide, Oncovin, Methotrexate and Prednisolone (COMP) was the mainstay of management. The treatment outcome was only favorable in 36.6%. Default rate was (11.7%) while the mortality rate was (12.6%). Relapse\recurrence was found in (5.1%) of cases. Frank drug resistance was found in (2.6%). Blindness was found to be a major morbidity associated with this disease. Septicemia and severe anemia were found to be the major causes of mortality. Some complications of treatment were noted. DISCUSSION: The importance of the findings in this work was discussed in line with the existing literature. CONCLUSION: Head and neck remain the mostly affected parts in Burkitt's lymphoma in this environment. Presentation with advanced disease is the bane. This partly explains high morbidity and mortality in affected children.

Dying by default, the biology of apoptosis: a review.

Apoptosis differs from necrosis in that no inflammatory changes occur. The understanding of apoptosis was greatly improved by the discovery of a natural model of apoptosis in Caenorhabditis elegans, a nematode worm. The study of this worm led to the discovery of two sets of genes, the prosuicide genes and the antisuicide genes which control apoptosis. Apoptosis is an active process that involves w activation of specific enzymes. The understanding of the molecular biology of apoptosis may in future lead to the availability of a potent weapon to use against cancer and to modify cell death that occurs in the neurodegenerative disorders.

Invasive squamous cell carcinoma of the limbus: case report.

Limbal squamous cell carcinoma is uncommon worldwide. Its early stages of presentation may look like the commoner limbal mass, pterygium. We report a case of invasive squamous cell carcinoma which was initially diagnosed as inflamed pterygium. A high index of suspicion is required to prevent delay in the diagnosis of an invasive condition that can destroy the eye completely. Treatment modalities are reviewed.

Intracranial neoplasms in Ibadan, Nigeria.

OBJECTIVE: To determine the pattern of histopathological variants of intracranial neoplasms, relative distribution of the variants in the age groups and also to determine the gender differences that exist in these tumours. DESIGN: Case control study. SETTING: Department of Pathology, University College Hospital, Ibadan, Nigeria. PATIENTS: Two hundred and ten histologically confirmed cases of intracranial neoplasms seen during eleven-year period (1980 to 1990) were analysed. INTERVENTIONS: Slides of tumours stained with haematoxylin and eosin, reticulin and phosphotungstic acid haematoxylin. RESULTS: Two hundred and ten intracronial neoplasms comprising 172 primary and 48 secondary neoplasms were seen. One hundred and thirty five neoplasms occurred in adults and 75 in children. There was no gender difference, the ratio being 1:1. Gliomas accounted for the largest group of tumours followed by metastases to the brain. Of the gliomas, astrocytoma was the commonest. Craniopharyngiomas were found to be common in children. Germ cell tumours were found to be uncommon. CONCLUSION: Gliomas are the commonest group of intracranial neoplasms in both adults and children. This is followed by metastatic tumours. Tumours of the sella turcica are predominantly found in children. Involvement of the brain in disseminated Burkitt's lymphomas is predominantly found in Africans as the Burkitt's tumour is uncommon in non Africans.

Insulinoma in pregnancy presenting as a seizure disorder: a case report.

We present the clinical course and problems in the management of a 30 year old Nigerian lady who was admitted with fasting hypoglycaemia due to a pancreatic islet cell tumour (insulinoma) during the first trimester of pregnancy. Her case was initially misdiagnosed as idiopathic epilepsy. The outcome was fatal mainly because the poor clinical state of the patient limited our treatment options. This condition though uncommon, is potentially easily recognisable and treatable, as long as there is a high index of suspicion.

Abdominal tuberculosis with fatal gastro-intestinal haemorrhage.

We describe a patient who presented with chronic diarrhoea and features of malabsorption, suspected clinically to be due to abdominal tuberculosis and who developed fatal haematochezia a few days into a therapeutic trial of antituberculous chemotherapy. At autopsy, multiple tuberculosis ulcers were found in the jejunum, ileum and descending colon.

Actinic keratosis: a case of sun damage in the tropics.

Sun damaged to the skin in the tropics is not an uncommon event. There is need for a high index of suspicion especially in patients with outdoor occupations. Prompt diagnosis and therapy will prevent progression to a cancerous state. We report a case of cutaneous horns secondary to actinic keratosis, a pre-cancerous condition relatively uncommon in Black skin. The importance of histological support in its diagnosis cannot be over-emphasized.

Upper gastrointestinal findings and incidence of Helicobacter pylori infection among Nigerian patients with dyspepsia.

Gastroscopy is the preferred method of diagnosis of upper gastrointestinal (UGI) disorders which often present with dyspepsia. Since the discovery of helicobacter pylori (H. pylori) as an important aetiological agent in gastroduodenal disease, investigation for this organism during UGI endoscopy has become a standard clinical practice. We have studied a large number of Nigerian patients with dyspeptic symptoms referred for endoscopy for the spectrum of gastroduodenal diseases and the incidence of H. pylori infection. Detection of H. pylori was done on gastric muscosal biopsies either by the Campylobacter-Like Organism (CLO)-urease test or by histropathology. A total of 834 patients were studied out of which 268 were investigated for H. pylori. A hundred and ninety-five patients (73%) were positive for H. pylori and the peak age was in the fourth decade. Duodenal ulcer (DU) was the most common endoscopic finding (38.7%). The incidence of H. pylori infection was 76% among patients with DU, gastritis, gastroduodenitis and gastric outlet obstruction. However, all the anterior and pyloric channel Duus tested for H. pylori were positive gastric ulcer (GU) was diagnosed in only 4.7% of patients but 82% of them tested for H. pylori were positive. H. pylori was significantly associated with GU occurring with gastritis. Gastric carcinoma was diagnosed in 52 patients (6.2%) and 50% of those tested for H. pylori were positive. This study shows that H. pylori plays an important role in the aetiopathogenesis of peptic ulcer disease among Nigerian patients and that the diagnosis of anterior and pyloric channel Duus or gastroesophageal polyp disease may be an indicator of massive H. pylori infection.

Idiopathic Parkinson's disease: a review of clinical types and pathology.

Parkinsonism occurs in a variety of disorders, involving the central nervous system. The basic pathology in this disorder is the destruction of the pigmented neuronal pathway of the brain stem. The major site of damage is the nigrostriatal pathway. There is associated cytoplasmic neuronal changes, the most specific is the formation of an intracytoplasmic inclusion body, the Lewy body. This varies from other forms of neurofibrillary degeneration. Other neuropathological changes which may be age related are also found. This paper is an overview of the idiopathic Parkinson's disease.

Primary hepatocellular carcinoma in Ile-Ife, Nigeria: a prospective study of 154 cases.

Primary hepatocellular carcinoma is a tumour with a dismal prognosis. In recent times, however, great advances have been made in its management. This 13-year prospective study done at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, was an attempt to appraise the outlook of the disease in Nigeria at the turn of the 21st century. Primary hepatocellular carcinoma affected mainly middle-aged Nigerians (peak age-group = 40-59 years), predominantly males (M:F = 2:1) and, in a sizeable proportion (78%), it co-existed with cirrhosis. Significant risk factors found were scarification marks (87%), anicteric hepatitis (71.3%), abuse of medicinal herbs and analgesics (68.6%) and injection from quack doctors (51%). Blood test for HBsAg was positive in 61% of patients. The mean duration of symptoms. before diagnosis was 12.64 weeks (SD 13.77) while, on the average, patients died within 14.0 weeks (SD 13.0) of illness, usually of liver failure (67.7%). Only symptomatic treatment could be offered in 148 patients (96.1%) while chemotherapy was merely attempted in 5 (3.25%). Majority of the patients (59.8%) were either discharged against medical advice or lost to follow-up. This study shows that Nigerian patients presenting with primary hepatocellular carcinoma already have advanced disease and this makes treatment and survival hopeless. Universal immunisation with HB vaccine should be implemented in Nigeria without further delay and health education should be directed against socio-cultural practices which are aetiological risk factors for primary hepatocellular carcinoma.

A pathological review of intracranial tumours seen at the University College Hospital, Ibadan between 1980 and 1990.

The pattern of intracranial neoplasms in Ibadan Southwestern Nigeria appears to have evolved over three decades since the establishment of neurosurgical facility in 1962. Metastatic tumours to the intracranial compartment were the commonest neoplasms (23%); choriocarcinoma and multicentric involvement of the brain in Burkitt s lymphoma accounted for the great majority of the metastases. Well-differentiated glial tumours are now being increasingly recognized in Ibadan, Nigeria. Glial tumours accounted for 20% of neoplasms, second in frequency to metastases. Pituitary adenomas and meningiomas accounted for 17.1% and 11.4% respectively. Germ cell tumours are however uncommon in Ibadan Nigeria having a low frequency (1.4%). A notable difference exists in the tumours found in children and adults. Astrocytomas accounted for the largest single group of neoplasms in children while metastatic tumours are the dominant group in adults. Continued improvement in neurosurgical facilities may improve diagnosis and cause more tumours to be verified histologically. This will contribute to the evolving pattern seen in Ibadan Southwestern Nigeria.

Giant fibroadenoma presenting like fungating breast cancer in a Nigerian teenager.

BACKGROUND: Giant fibroadenoma of the breast is a rare benign breast tumour which seldom grows to a giant size, it is even rarer for this benign tumour to grow rapidly, ulcerate spontaneously and present like a fungating breast tumour in a way mimicking breast cancer. CASE PRESENTATION: This is a presentation of a 14 year old premenarchal girl with a massive ulcerating and fungating left breast mass that was initially thought to be a fungating locally advanced breast carcinoma on clinical examination. Further examination of the morphology of the resected surgical specimen and histological examination confirmed it to be giant fibroadenoma of the breast. It was successfully managed by partial mastectomy and breast reconstruction with an excellent result and a high degree of patient satisfaction was achieved. CONCLUSION: Though a rare clinical entity benign breast tumour can present like a fungating breast cancer and this must be bore in mind especially in young adolescent patients presenting with ulcerating breast tumour.