Unraveling cervical cancer screening dilemmas: histopathological insights from VIA and LEEP at bugando medical centre, Mwanza.

BACKGROUND: The single-visit strategy, also known as the "screen-and-treat" approach, is widely used to screen for cervical cancer in low- and middle-income countries. The screen-and-treat approach leads to unnecessary or inadequate treatment. Thus, a study was conducted to determine the histopathological patterns of aceto-white lesions on visual inspection with acetic acid (VIA) in patients who underwent a Loop Electrosurgical Excision Procedure (LEEP) at Bugando Medical Centre between January 2016 and December 2020. METHOD: A 5-year retrospective cross-sectional case record review was conducted on 329 women who had LEEP at Bugando Medical Centre following a positive VIA cervical screening test. A standard data abstraction form was used to collect patient information. Missing client information records and LEEP without histopathological results were exclusion criteria. For statistical analysis, STATA version 15 was used; in descriptive statistics, frequency, mean, and standard deviation were used. The Chi2 and Fisher's exact tests were used to investigate the relationship between patient characteristics and histopathological patterns, and a P-value of 0.05 was considered statistically significant in multinomial models. RESULTS: This study looked at 329 patients who had LEEP following a VIA positive but were not eligible for cryotherapy. Our study participants had a mean age of 40 ± 8.2 SD. There were 203 (61.7%) patients with benign lesions, including 4 with schistosomiasis and 2 with cervical tuberculosis. The precancerous lesions were discovered in 100 cases (30.4%), and 26 (7.9%) already had invasive cervical cancer. Out of 100 patients with precancerous lesions, 58 (17.6%) and 42 (12.8%) have high- and low-grade squamous intraepithelial (HSIL and LSIL) lesions, respectively. The presence of a precancerous lesion was found to be associated with age 31-40 years (P-value 0.042) and HIV positivity (P-value 0.004). CONCLUSION: Most patients in this study had benign cervical lesions, which do not require LEEP treatment. Nonetheless, a considerable percentage of invasive cervical malignancies and rare benign diseases such as schistosomiasis and cervical tuberculosis were identified. A screen-and-treat approach within well-equipped tertiary hospitals like Bugando Medical Centre should explore alternative options instead of relying solely on straight LEEP.

Ovarian schistosomiasis: challenges of a neglected ectopic involvement of blood flukes. Case report and review of literature.

Introduction: Female genital schistosomiasis (FGS), infection of Schistosoma spp. trematode in the gynaecological apparatus, is the most neglected sexual and reproductive health condition in sub-Saharan Africa with an estimated of 20-120 million cases. The ectopic entrapment of Schistosome eggs after oviposition can occur in 0.5% of cases in fallopian tubes and ovaries. The case: We report a case of 38-years-old woman assessed for a 10 year history of infertility. On ultrasound, multiple cystic formations were observed in the ovary. Histology after oophorectomy to exclude malignancy showed granulomatous formations surrounding Schistosoma spp. eggs in proximity of corpus luteus and haemorragicum. Discussion: Ectopic Schistosome oviposition, seen in the ovary and fallopian tubes as in our case, can be a potential cause of reproductive organ damage and complications such as infertility, ectopic pregnancy, miscarriage, premature birth, low birth weight, and even maternal death. Conclusions: More studies are needed on ovarian FGS and its impact on women fertility to guide specific interventions targeting vulnerable population of childbearing age, contributing to the NTD WHO 2030 aim of eliminating schistosomiasis as a matter of public health.