Histopathological analysis of endometrial biopsies in Jos University Teaching Hospital (JUTH), Nigeria. A 5-year critical review.

AIMS: This study is aimed at giving an insight into the pattern and age distribution of endometrial analysis as seen at Jos University Teaching Hospital. METHODS: This is a retrospective reviewed cases of endometrial biopsies diagnosed between January 1998 to December 2002 in the Histopathological Department ofJos University Teaching Hospital RESULTS: A review of endometrial biopsies slides from 556 patients revealed that pregnancy related diagnosis was the commonest, representing 302 (54.3%) of histopathological diagnosis, followed by endometrial hyperplasia, accounting for 97 cases (17.5%) and majority of which was categorised as mild hyperplasias. Hydatidiform mole, which ranked third, constituted 58 (10.4%) of the cases studied. Choriocarcinoma was the leading malignancy representing 10 cases (45%) of the malignant tumours and 1.8% of all the endometrial biopsies. Endometrial adenocarcinoma, stromal sarcoma and metastatic cancer constituted 6 (1.0%), 3 (0.5%) and 3 (0.5%), respectively. CONCLUSION: The commonest endometrial pattern seen in JUTH over the study period was products of conception which peak in the third decade of life; primary malignancies of the endometrium are uncommon in JUTH and they represented just about 2%.

Multiple familial trichoepithelioma: a case report and review of literature.

OBJECTIVE: Multiple familial trichoepitheliomas are rare autosomal dominant skin disease that is rarely reported from this part of the world. The lesions resemble other types of skin diseases that present with papules and nodules. PATIENT AND METHOD: This is case report of a patient who presented with multiple facial papules and nodules. He wanted treatment to improve his facial (cosmetic) appearance. RESULTS: A 36 year old single male with a 25 years history of multiple facial papules and nodules. Similar lesions were present in other members of the family. He had several treatments including that for leprosy. Histologically the lesions showed keratinized stratified squamous epithelium overlying proliferating packets of basoloid cells with hyper chromatic nuclei, along with several keratin horn cysts and moderate stroma infiltrate of chronic inflammatory cells. Based on the history and the histology a diagnosis of multiple familial trichoepithelioma was made. CONCLUSION: For a diagnosis of multiple familial trichoepithelioma to be made in patients presenting with multiple facial papules and nodules a high index of suspicion is needed. This is more so if there is a history of similar lesions in the family.

Epidemiology of gastric cancer in Jos University Teaching Hospital Jos a 20 year review of cases.

BACKGROUND: Gastric cancer believed to be rare in the past in Africa, is now one of the leading cancer morbidity and mortality. It is now known gastric cancer is 2-3 times higher in males than females living in the same environment. We aim to describe the comprehensive histological characteristics of gastric cancer with age and sex distribution. METHODS: The study site was Jos University Teaching Hospital situated in the capital of Plateau State. The hospital has a bed capacity of 530. The study materials were obtained from all stained specimens of gastric cancer recorded in the histopathology laboratory of the teaching hospital between 1985 to 2004. The biopsy site was noted. These were divided into the following groups: Cardia, body and an thrum/pyloric regions respectively. Or the information included age and sex of the patients. RESULTS: There were a total of 205 gastric cancer histological confirmed, out of 5705 malignant tumours recorded in the same period. There were a total of 145 cases in male and 60 in females giving a male: female ratio 2.4:1. The highest frequencies of gastric cancers were located in the anthral and cardia regions which accounted for 79% of all the tumours. Well differentiated adenocarcinoma (intestinal type) was the most frequent histological subtypes 51.2%), this was followed by poorly and diffusely infiltrating carcinoma. Other cancers included signet ring carcinoma, Non-Hodgkin's lymphoma and leiomyosarcoma in that order. The study has also demonstrated H pylori at the background of intestinal type adenocarcinoma which was seen in the body and an thrum. CONCLUSION: The study has shown that gastric cancer is not only common but it occur more males than females. The high proportion of H pylori in our environment might indicate a possible aetiological association. Therefore eradication of H pylori might reduce the prevalence of gastric carcinoma.

Patterns of malignant salivary gland tumours in Jos University Teaching Hospital (JUTH), Jos: a ten-year retrospective study.

BACKGROUND: Salivary gland tumours are common head and neck tumours and more common in western world than Africans. Most salivary gland tumours are benign but the morbidity and mortality as expected is higher with malignant tumours. This study is aimed at describing the histological pattern, age, sex and site distribution of malignant salivary gland tumours in Jos University Teaching Hospital (JUTH) Jos from January 1998 to December 2007. METHODS: This is a descriptive study of all histologically confirmed malignant salivary gland tumours over a period of ten years. Fresh sections of tissue blocks of these lesions were made using the microtome (3 micrones). They were made into slides and stained with Hematoxylin and Eosin (H and E) and Periodic Acid Schiff (PAS) stains. The slides were reported independently by four pathologists. Diagnosis was made and classification done according to the World Health Organisation (WHO) classification of salivary gland tumours 3. Information such as age, sex and-site of distribution of these tumours was gotten from the patient's case files. The data was analyzed manually. RESULTS: Muco-epidermoid carcinoma accounted for the highest (32 cases) histologic type. Malignant salivary gland tumours occurred more within the age range 40 to 69 years with the age group 50-59 years accounting for the highest frequency (36 cases). Most of these malignant salivary gland tumours occurred more in the parotid gland, the minor salivary being the least site of occurrence. CONCLUSION: Mucoeperdermiod carcinoma is the commonest salivary gland tumour and that malignant salivary gland tumours in this study and it occurred more after the 5th decade of life.

Hepatocellular carcinoma in Jos, Nigeria.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common abdominal malignancy, representing 80-90% of primary liver malignancies around the world. There is a disturbing trend of increased incidence of HCC around the world. We therefore, determined the trend of HCC in Jos. METHODS: A ten-year retrospective review was done of all cases of HCC which diagnoses were histologically confirmed as recorded in the Cancer Registry of Jos University Teaching Hospital. The patients' clinical case notes (including surgical and radiological findings) were also reviewed. RESULTS: A total of 71 cases of HCC (31.3% of 227 liver biopsies in the same period) were diagnosed within the 10-year period. There were 46 males and 25 females with a male/female ratio of 1.8:1. The age range of the patients was 23 years to 75 years, with a mean age of 45.4 +/- 13.1 years. Seventy two percent (72%) of them were between ages 21 years and 50 years. Only 28% were between 51 years and 80 years. The highest rate of 12 (17.1%) was seen in the year 2004. CONCLUSION: The study showed that there was a high prevalence of HCC in Jos, and that HCC was more prevalent in the younger age group compared to what obtains in developed nations.

Relation between Helicobacter pylori, inflammatory (neutrophil) activity, chronic gastritis, gastric atrophy and intestinal metaplasia.

BACKGROUND: To determine the relation of Helicobacter pylori infection with chronic inflammation, atrophy, activity level and intestinal metaplasia. PATIENTS AND METHODS: A cross-sectional study of 100 consecutive patients with dyspepsia. These patients were fasted for 12 hours and gastroscopic biopsy specimens were obtained from their gastric mucosae. The specimens were histologically evaluated for H. pylori, inflammatory activity, chronic inflammation, gastric atrophy and intestinal metaplasia. RESULTS: There were 50 (50%) females and 50 (50%) males. The average ages of women and men were 36.3 +/- 11.5 and 42.9 +/- 12.8 respectively. Helicobacter pylori was found in 79%. Neutrophil activity was observed in 83%. Inflammation was found in 95%, glandular atrophy in 38%, intestinal metaplasia in 28% of the cases. Incidental (early gastric) cancer was found in 3%, dysplasia in 2% and reactive gastropathy in 7% of the cases. A statistically significant relationship was found between Helicobacter pylori colonization intensity and the degrees ofneutrophil activity, chronic inflammation and intestinal metaplasia. CONCLUSION: We concluded that Helicobacter pylori infection results in neutrophil activation and chronic gastritis, and that it has a role in the development of intestinal metaplasia. The greater the intensity of Helicobacter pylori infection, the greater the degrees of neutrophil activation, chronic gastritis and intestinal metaplasia.

Epidemiology of soft tissue sarcomas in Jos, North Central Nigeria.

BACKGROUND: Soft tissue sarcomas are a complex heterogeneous group of tumours that often cause a diagnostic problem. Special stains are often employed for further differentiation of these tumours. As a group, soft tissue sarcomas are not uncommon as previously believed. OBJECTIVE: To undertake a ten year retrospective study of soft tissue sarcomas in a Nigerian Teaching Hospital and to also discuss the pathology of the disease. METHODS: The study consisted of all records of histologically confirmed cases of soft tissue sarcomas from 1994 2003, seen at JUTH. The slides were retrieved and read separately by two pathologists. Special stain such as Reticulin, PTAH, Oilred O, were used to demonstrate basement membrane, muscle striation and lipids respectively. These aided confirmation of the diagnosis. Information extracted from patients' records included age, site of lesion and sex. RESULTS: A total number of 266 cases of soft tissue sarcomas were recorded out of 2353 histologically confirmed cancers. These accounted for 11.3% of all cancers. One hundred and eighty three occurred in males and 83 in females, with male, female ratio of 2:1. Kaposi sarcoma (KS), Rhabdomyosarcoma (RMS), Malignant Fibrous Histiocytoma (MFH), and Fibrosarcoma (FS) were the commonest histological subtypes accounting for 69 (25.9%), 63 (23.7%), 56 (21.1%) and 49 (18.4%) respectively; with Rhabdomyosarcoma occurring more in paediatric and adolescent age groups, while the rest subtypes were more prevalent in adults. The commonest sites affected were leg/foot 71 (26.7%), head/neck 68 (25.6%) and thigh 50 (19%). CONCLUSION: Soft tissue sarcomas constituted a significant proportion of cancers in our centre and are not uncommon as previously reported in the literature.

Gastric histopathological findings in mucosal biopsies of symptomatic patients in jos central Nigeria.

BACKGROUND: Dyspepsia is a common disease worldwide. It is a cause of great absenteeism from work with a lot of economic loss. In Jos, it is one of the most common complaints encountered in both general outpatient and specialist clinics. AIM: To evaluate the histopathological changes in gastric mucosa of patients presenting with symptoms of dyspepsia. METHODS: Cross sectional study. Gastric endoscopic biopsy specimens from 100 consecutive patients with symptoms of dyspepsia were histologically evaluated using the criteria of the updated Sydney system. RESULTS: There were 50 males and 50 females. Their overall mean age was 39.6 +/- 12.2 (S.D). The prevalence of Helicobacter pylori colonization was 79%. Males were 53.2% and females 46.8% respectively giving a sex ratio of 1.4:1. Gastritis, neutrophil activity, glandular atrophy and intestinal metaplasia were observed in 95%, 83%, 38% and 28% respectively. Gastric carcinoma was found in 3% ofthe patients. CONCLUSION: From our study, we conclude that the majority of our patients with dyspeptic symptoms have significant histopathological changes in their gastric mucosa with implications for the development of further gastric lesions, and that the most common cause of dyspepsia in our environment is Helicobacter pylori infection.

Meigs' syndrome presenting as haemorrhagic pleural effusion.

BACKGROUND: The association of a benign ovarian tumor with ascites and hydrothorax that resolve after tumor resection, known as Meigs syndrome is a rare clinical entity. Rarer still is the haemorrhagic form of the syndrome OBJECTIVE: To describe a case of benign ovarian tumour associated with ascites and bloody pleural effusion. METHODS: A thirty-seven year old woman was referred for the further management of a pleural effusion. A detailed clinical evaluation was carried out, including pleural fluid cytology, chest CT scan and laparatomy. Treatment included antituberculous therapy and finally ovariectomy. RESULTS: The physical examination and a pelvic ultrasonographic scan revealed ascites in addition to a right sided ovarian mass. A chest CT-scan did not show any intrathoracic mass. Repeated pleural fluid cytology showed mesothelial cells but was negative for malignancy. An ovariectomy was performed and histological examination revealed a thecoma fibroma. The pleural effusion and ascites resolved spontaneously thus confirming the diagnosis of Meigs' syndrome. CONCLUSION: Meigs' syndrome should be considered in the differential diagnosis in female patients with hemorrhagic pleural effusion.