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.

Retinoblastomas in Ibadan Nigeria: II--Clinicopathologic features.

Retinoblastomas are primary malignant intraocular neoplasms of childhood displaying photoreceptor differentiation. The present study reviews clinicopathological features of these neoplasms in Ibadan, Nigeria. Clinical, surgical pathology, and histological material of 44 histologically verified cases of retinoblastoma indexed in the Cancer Registry, University of Ibadan were analyzed. Retinoblastomas accounted for 1.1% of all malignant neoplasms and were equally frequent in male and female children. The mean age of our patients at the time of diagnosis was 32.3 months, which exceeds a corresponding age of 16-21.5 months recorded among Caucasian children. Leukocoria was the most common clinical manifestation. Eighteen percent of our patients had bilateral neoplasms. These patients were significantly younger than those with unilateral retinoblastomas. Flexner-Wintersteiner rosettes occurred in 61% and optic nerve involvement in 78% of the cases and the sites of predilection were regional lymph nodes, scalp, jaw, brain, skull, long bones, and gum.

Carcinoma of the oesophagus in Ibadan.

This was a retrospective analysis of 177 histologically confirmed cases of oesophageal carcinoma seen in the University College Hospital, Ibadan, Nigeria over a period of 30 years. Oesophageal carcinoma constituted 0.6 per cent of all malignant neoplasms and 1.4 cases per 1000 surgical biopsies during the study period. Dysphagia and weight loss were the most common clinical manifestations. Ninety three patients presented within one year of onset of clinical symptoms. The peak age incidence occurred in the seventh decade of life. Sex distribution was equal. The middle third of the oesophagus was the most common location of the neoplasm and the vast majority (94.5%) were squamous cell carcinomas. Achalasia of the cardia and Barrett's oesophagus were not associated with oesophageal carcinoma in this study. Regional lymph nodes and lungs were the most common sites of metastasis. Surgical complications included mediastinitis and bronchopneumonia, both occurring within seven days postoperatively. Late clinical presentation and high postoperative mortality are responsible for the persistently poor prognosis of oesophageal carcinoma despite significant advances in the diagnosis and management of these neoplasms.

Cervicovaginitis emphysematosa mimicking carcinoma of the cervix: a case report.

Cervicovaginitis emphysematous is a rare self-limiting disease in which multiple gas-filled cysts are present in the submucosa of the upper vagina and ectocervix. We report a case in a 40 year-old trader who presented with clinical features suggestive of carcinoma of the cervix. It is hoped that this case report will heighten the awareness of clinicians and pathologists in the recognition of this unusual condition.

A prospective study of coroner's autopsies in University College Hospital, Ibadan, Nigeria.

The present study reviews 876 consecutive coroner's autopsies performed in the Department of Pathology, University College Hospital, Ibadan over a two-year period (1 February 1991 to 31 January 1993). The hospital autopsy rate during the study period was 36.2%, and 62.5 per cent of these post-mortems were medico-legal cases. The most common indications for coroner's autopsies were sudden natural deaths (55.6%), followed by accidental deaths (35.3%). The proportions of maternal (4.3%), homicidal (3.1%) and suicidal (0.3%) deaths were much lower. The male to female ratio was 1.7 to 1. Ninety-one (10.4%) of the cases fell within the paediatric age group and the peak age incidence for these cases was in the 5-14 years age group. The remaining 785 (89.6%) cases were adults and the peak age incidence for these cases was in the fourth decade of life. The most common cause of sudden natural death was cardiovascular disease, of which hypertension constituted the majority of cases. Other major causes of sudden death included pneumonia, meningitis, typhoid fever and neoplastic diseases. Road traffic accidents accounted for 78 per cent of accidental deaths followed by falls (13.3%) and burns (4.6%). Abortions, post-partum haemorrhage and eclampsia were the major causes of maternal deaths in the present study. Homicidal deaths were eight times more frequent in male than female victims and the commonest mode of death was gunshot injuries. Suicidal deaths remain extremely uncommon in African patients, as confirmed by our study.

Rhinosporodium: case report.

This is the first reported case of rhinosporidiosis in Ibadan, Nigeria. A review of literature shows that the patient came from northern Nigeria where the first case was reported in the country. The organism is difficult to culture and the diagnosis was based on microscopy and histological examination of the polyp. We present the case of recurrent rhinosporidiosis in a 16 year old girl a year after polypectomy in Zaria, northern Nigeria.

A twenty-year review of malignant colorectal neoplasms at University College Hospital, Ibadan, Nigeria.

PURPOSE: Colorectal malignancies are less common in developing than developed nations because of lower per capita income and higher dietary fiber consumption. This clinicopathologic study attempts to determine changes in the pattern of these neoplasms in Ibadan, Nigeria, during the last two decades. METHODS: The present study is based on the clinical Cancer Registry records and gross and morphologic surgical pathology findings of 526 patients with histologically verified malignant colorectal neoplasms received in the Department of Pathology, University College Hospital, Ibadan, between 1971 and 1990. RESULTS: Colonic malignancies increased by 81 percent, whereas rectal malignancies decreased 16.1 percent in frequency (P < 0.05). The modal ages were 55 to 60 years and 45 to 50 years for colonic and rectal neoplasms, respectively, in contrast to reported peak occurrence in the seventh decade among Caucasians. Colonic neoplasms were predominantly right-sided (34.3 percent cecal), abdominal mass and pain being major clinical manifestations. This differs from the pattern in American Negroes, among whom colonic carcinomas are predominantly left-sided, dyschezia being an important presentation. As in most other studies, adenocarcinomas were the predominant neoplasms. CONCLUSIONS: Further work is required to determine prognostically significant features of colorectal cancer in our environment.

Seminoma arising in cryptorchid testes in Nigerian males.

Histological slides of seventy four patients with testicular malignancy found in the records of the cancer registry, University College Hospital, Ibadan over a thirty-five year period (1960-1994) were reviewed. Three (4%) cases occurred in undescended testes. Overall, eighteen (24.3%) patients were found to have seminomas. All the tumours seen in undescended testes (100%) were seminomas while about seventeen percent of seminomas were seen in undescended testes. There was a statistically significant difference between the mean ages of those with seminomas (37.6 years) and those with non-seminomatous testicular cancers (30.3 years); t = 1.69; p < 0.05. The numbers seen corroborate the fact that testicular cancers are not very common in this environment. The incidence of undescended testes is not established in this environment either. However, it seems that 100% of tumours arising in undescended testes are seminomas. It is recommended that abdominal testes seen after puberty should be removed and older patients presenting with abdominal masses should have a differential diagnosis of testicular cancer entertained.

A fatal case of paraquat poisoning in a Nigerian.

A fatal case of paraquat poisoning in an adolescent girl is reported. Death resulted from respiratory failure because of extensive interstitial and intra-alveolar fibrosis.

Simultaneous bilateral malignant breast neoplasms in Nigerian women.

This study reviews the clinicopathological features and survival of 18 Nigerian women with simultaneous bilateral breast cancer. Twelve (67%) of these patients had bilateral Burkitt's lymphoma of the breast. The average age of these patients was 22 years, and all of the women were pregnant or lactating at the time of initial clinical presentation. The remaining six patients (33%) had bilateral malignant epithelial neoplasms, with lobular carcinoma being present in four cases. The average age of patients with bilateral malignant epithelial tumors was 37 years. None of the 18 patients with simultaneous bilateral breast cancer survived for up to 2 years after diagnosis, indicating that bilateral synchronous breast cancer in Nigerian women is a rapidly progressive and aggressive disease.

A review of teratomas in Ibadan.

Teratomas accounted for 3.4 cases per 1,000 surgical biopsies received in the Pathology Department of UCH Ibadan, between 1960 and 1985. The commonest site of teratomas was in the ovaries which accounted for 83.2% of the cases, followed by the sacrococcygeal region which accounted for a further 6.3%. Other sites of occurrence included the neck, testes, mediastinum, abdominal cavity and buccal cavity in descending order of frequency. Rare sites of occurrence were extracranial, intracranial, uterine cervix and intraocular regions. There was a female to male ratio of 18 to 1 and the average age of the patients was 25.8 years. Sixty per cent of ovarian and mediastinal teratomas contained hair and sebaceous material permitting their gross identification. Eighty-eight per cent of the teratomas reviewed histologically were classified as mature, a further 8% were immature, and 4% were malignant.

Retinoblastomas in Ibadan: treatment and prognosis.

This study reviews the influence of different clinicopathological features of retinoblastoma on outcome and prognosis in 44 Nigerian patients. Twenty-five of the patients had a fatal outcome. These patients were younger and more frequently had bilateral retinoblastomas, orbital tumour recurrence and tumour metastases, compared to patients who had disease free survival. Postoperative tumour recurrence occurred in eleven patients and was commoner in patient who had tumour metastases. Tumour metastases occurred in eighteen of the patients. Though there has been an improvement in the prognosis of retinoblastoma at Ibadan with the advent of radiotherapy, the outlook for children with this neoplasm in this environment is still bleak in comparison with what obtains in developed countries.

Congenital malformations: a review of 672 autopsies in Ibadan, Nigeria.

The postmortem findings in 672 Nigerian children with lethal congenital malformations are reviewed. Eighty-six percent of the patients were less than 1 year of age and the male-to-female sex ratio was 1.3:1. The alimentary tract was the most common anatomic site involved (30%), intestinal and biliary atresia being the two lesions most frequently identified in this location. Twenty-six percent of the children had cardiovascular malformations, of which ventricular septal defect, patent ductus arteriosus, and tetralogy of Fallot were most important. There was an accentuated male predominance among cases with urogenital malformations due to the high frequency of posterior urethral valve. Hydrocephalus, spina bifida, and anencephaly were the most common lesions observed in the craniospinal axis. One-fifth of the children had complex malformations of multiple organ systems, 20% of which were associated with chromosomal anomalies, rubella, and other malformation syndromes.

Childhood teratomas in Ibadan, Nigeria.

Childhood teratomas are uncommon neoplasms worldwide. They are nonetheless important because their exact histogenesis has not yet been resolved. The weight of the evidence points to a germ cell origin for these neoplasms. Eighteen percent of 407 teratomas reviewed in the Department of Pathology, University College Hospital, Ibadan, Nigeria, between 1960 and 1985 occurred in children up to 15 years of age. There was a bimodal peak age incidence among these children, the first being due to sacrococcygeal and the second to ovarian teratomas. The female to male ratio was 5:1. The two most common sites of occurrence were the sacrococcygeal region and the ovaries. Eighty-one percent of all childhood teratomas were mature, 15% were immature, and 4% were malignant. Both malignant neoplasms arose in the sacrococcygeal region and occurred in patients relatively older than those with benign sacrococcygeal teratomas. These two malignant teratomas contained yolk sac elements.

Benign cystic ovarian teratomas with prostatic tissue: a report of two cases.

We report two cases of the rare occurrence of prostatic epithelium in ovarian teratomas with associated transitional epithelium in one of the cases. This association of prostatic tissue with urothelium tends to reinforce the well-established embryogenetic derivation of the prostate from the urogenital sinus. Local hormonal events may influence the formation of prostatic tissue from female urothelium. The histologic and immunohistological differences between adult prostate as seen in our cases and female paraurethral (Skene's) glands are discussed.

Pulmonary metastatic malignant tumours in Ibadan, Nigeria: 10 years autopsy review.

This study reports the findings of a ten year review of autopsy records at the University College Hospital, Ibadan, Nigeria of patients who died of malignant tumour metastases to the lungs and pleurae. During the study period 1977 to 1986, a total of 3,549 autopsies were performed out of which 339 cases 10.5 pc died of malignant tumours. One hundred and thirteen of these tumours (33.3 pc) metastasised to the lungs and pleurae among other sites. Further analysis of these 113 patients showed that 49 were male and 64 females giving a male:female ratio of 1:1,3. In addition, the ages of the patients ranged between 9 months and 90 years with a mean of 38.3 years. The uterus was the commonest organ from which pulmonary metastases occurred (28.3 pc), with choriocarcinoma being the predominant historical type of uterine tumour. The liver was the next most common organ 26.5 pc with male to female ration of 3:3,1. Twenty other organs were also identified, the breast, kidney and oesophagus 7 pc each; pancreas ovary and thyroid 3 pc each being the most important. Other organs are adrenals, foot, neck, cervix and rectum--2 pc each.

Problems in the management of mycosis fungoides in Nigeria.

The management of Nigerian patients with cutaneous T-cell lymphoma (CTCL) is beset with various problems which are presented in this study. These problems include dearth of specialists medical personnel, shortage of radiotherapy facilities, high cost of chemotherapy drugs which an average patient cannot afford to buy. Cases of eight patients seen and managed over a 21 years period (1968-1989) were analysed. However, many CTCL cases might have been missed since we have acute shortage of medical specialists to carry out accurate diagnosis of this disease in Nigeria. The patients reviewed, received radiotherapy, and cytotoxic chemotherapy. Radiotherapy was found to be the optimum treatment for patients with stages I and II CTCL, who in this study had recurrence free periods of 30 to 60 months post radiotherapy. The authors recommend systemic cytotoxic chemotherapy and local radiotherapy for patients with late stages of CTCL as mainstay of treatment.

Primary liver cell carcinoma presenting as extrahepatic biliary obstruction.

Two cases of primary liver cell carcinoma simulating extra-hepatic biliary obstruction are presented. In order to avoid false diagnosis and preventable laparotomy, it is suggested that peritoneoscopy and target liver biopsy should be preferred to blind liver biopsy in the investigation of biliary obstruction.