Choriocarcinoma in northwestern Nigeria: a histopathological review.

AIMS AND OBJECTIVES: Gestational choriocarcinoma is a malignant form of gestational trophoblastic disease with a highly aggressive biologic behavior and responds well to chemotherapy. The objective of this study is to analyse the various histological features of this neoplasm as seen in Ahmadu Bello University Teaching hospital, ( ABUTH ) Zaria, determine its incidence, and compare with other studies. MATERIALS AND METHODS: The bench registers were used to retrieve the request forms, slides, and tissue blocks. The slides were all stained with standard haematoxylin and Eosin. The histological criteria published by Gehrig and van Lee was used to diagnose the tumours and grading of the cases from grade I to III. RESULTS: Forty three cases were studied and these formed 4.9% of all products of conception and 37.7% of all gestational trophoblastic diseases. The peak age of incidence was in the third and fourth decades of life with vaginal bleeding as the leading mode of presentation. Extensive histopathological analysis and grading revealed haemorrhage, necrosis diamorphic appearance and pleomorphism as the most frequent features. CONCLUSION: Gestational choriocarcinoma is a common problem in Zaria, North- Western Nigeria with an incidence of 1 in 1039 deliveries. Haemorrhage, necrosis, diamorphic appearance and pleomorphism were the most frequent histological features. Health education and early detection are of paramount importance in reducing morbidity and mortality.

Cisplatin chemotherapy for haemostasis in bleeding cervical cancer: experience from a resource-poor setting.

BACKGROUND: Cervical cancer is the commonest cancer in northern Nigeria. There are only two radiotherapy centers in the north and four centres in the south, each with only one megavoltage machine for a population of over 140 million. The number of patients requiring radiotherapy for various malignancies is beyond the available facilities and expertise leading to long waiting time and disease progression with its attendant sequelae. This is the basis of using other orthodox treatment modalities as first line. PATIENTS AND METHODS: Between January 2006 and December 2007, 116 patients with histologically confirmed cervical cancer with vaginal bleeding as the predominant symptom were treated. Patients presenting with torrential haemorrhage were excluded from this study as they constitute oncologic emergencies. Patients were interviewed with a structured pro forma on a 3-weekly basis during chemotherapy schedules to assess and evaluate per vaginal bleeding and discharge. Dose of chemotherapy was 70 mg/m² every 3 weeks. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: The median age was 49 years (27-80 yrs). 62 patients were having per vagina bleeding for more than 6 months before commencement of chemotherapy (range 1-60 months). 49 patients had blood transfusion before chemotherapy, average of 2.7 pints of blood transfused per patient. 84 had at least FIGO stage IIIA disease. Squamous cell carcinoma is the commonest histology type followed by adenocarcinoma with 95 and 16 patients respectively. 81 patients had complete cessation of per vagina bleeding with 69 having complete cessation on or before 4th course of chemotherapy (9th week) and complete cessation of per vagina discharges was seen in 52 patients. 115 patients had a performance status KPS of below 80 prior to chemotherapy, and after completing 6 cycles, 100 patients had KPS of 80 and above. CONCLUSION: In resource-poor setting, Cisplatin based chemotherapy can be used by medical, gynaecological oncologists and general practitioners to control vaginal bleeding and improve the quality of life of patients pending radiotherapy. For optimal treatment with chemoradiotherapy, government and non-governmental agencies must do all it takes to remedy the problems of shortage of resources.

Sociodemographic and clinicopathologic characterization of cervical cancers in northern Nigeria.

OBJECTIVE: To evaluate the sociodemographic and clinicopathological characteristics of patients with cervical cancer seen in a tertiary referral center in northern Nigeria. MATERIALS AND METHODS: Between January 2002 and December 2004, 70 consecutive patients with histologically confirmed cervical cancer, with a median age of 48 years (range, 30-75 years), were interviewed on the basis of a structured pro forma. RESULTS: Of these patents, 39 (56%) had had no formal education, and 36 (51%) were unemployed housewives. Sixty (86%) had become sexually active before 17 years of age; 44 (63%) were in polygamous families, and 25 (36%) patients were in at least a second marriage. There was an average of 6.8 live births per patient. Vaginal bleeding was seen in all patients, and 55 (79%) had vaginal discharges; 50 (71%) had a bulky cervical mass, and 46 (66%) presented with at least Stage IIIA disease. Squamous cell carcinoma was the commonest histology. The three HIV-seropositive patients were young and had advanced disease. CONCLUSION: Sociodemographic factors, such as low socioeconomic level, early age at first sexual intercourse and multiple sexual partners, place women at high risk of developing cervical cancer in northern Nigeria. Late presentation with advanced disease predominates.

Lingual harmatoma in an infant.

Lingual tumours are uncommon in infants and harmatomas are rarely reported. A 5-month-old boy presented with a growth on the dorsum of the tongue which had been present from birth. The growth produced no respiratory or feeding difficulties. It was confirmed to be a harmatoma after complete excision. There has been no recurrence.

Histopathologic analysis of epidermal skin tumours and tumour-like lesions in Ahmadu Bello University Teaching Hospital, Zaria.

OBJECTIVE: A histopathologic analysis of epidermal skin tumours and tumour-like lesions seen between 1991 - 2000 in the Department of Pathology, Ahmadu Bello University Teaching Hospital [A.B.U.T.H], Zaria is presented. PATIENTS AND METHOD: These tumours were classified according to World Health Organisation's International Histological Classification for Skin Tumours and were tabulated. RESULTS: A total of 350 such lesions comprising 9.9% of all cutaneous neoplasms seen within the study period were collected. Overall, they have a male to female ratio of 1.7:1. Malignant tumours constituted 72.5%; benign tumours 18.3% and tumour-like lesions 9.2%. The commonest malignant lesion was squamous cell carcinoma, which constituted 68.3% of all the lesions with a male to female ratio of 1.7:1. Epidermal cyst comprised 16.3% with a male to female ratio of 1.5:1. CONCLUSION: It is concluded that epidermal tumours and tumour-like lesions are not uncommon in Zaria and they show a male preponderance with squamous cell carcinoma being the commonest epidermal tumour and it also predominantly affects males.

Small intestinal leiomyoma in childhood: a case report.

A 6-year old girl presented with a painless, progressive abdominal mass for 4 weeks without alteration in bowel habits. Physical examination showed a non-tender, irregular and mobile abdominal mass. Abdominal ultrasonography was unable to define the exact origin of the mass. An ileal tumour was found at laparotomy necessitating resection and anastomosis. Histology confirmed an intestinal leiomyoma. The patient has remained well at 3.5 years of follow up. Leiomyomas of the small intestine are rare in childhood. This report discusses the presentation, diagnosis and management of this condition by briefly reviewing the literature.

Tuberculosis myocarditis: a case report.

A 35-year old man presented with fever, weight loss, drenching night sweats and symptoms of cardiac failure for three months. Examination revealed wasting, peripheral oedema, bilateral pleural effusion and constrictive pericarditis. A diagnosis of constrictive pericarditis with bilateral pleural effusion probably due to tuberculosis was made. Human immunodeficiency virus antibodies and six sputum for acidfast bacilli were negative. Electrocardiograph revealed low voltages globally and echocardiography showed global myocardial hypokinesia. He had pericardiectomy, pericardial and pleural histology was non-specific inflammatory reaction but myocardial histology showed granulomatous changes of tuberculous myocarditis. We suggest that in experienced hands myocardial biopsy could be useful in making the diagnosis.

Childhood vascular tumours in Zaria, Nigeria.

Vascular neoplasms are commonly seen in early childhood and are considered by some as harmatomas. We studied 58 vascular tumours in children aged 16 years and below from the files of Pathology department of the Ahmadu Bello University Teaching Hospital, Zaria seen over a ten year period (1984-1995). The histological slides were reviewed and the cases classified according to WHO criteria into benign tumours--Hemangiomas and lymphangiomas; and malignant tumours--hemangiopericytomas, angiosarcomas and Kaposi's sarcoma(KS). Additional information about age and sex were retrieved from the patients' request card and folder. Four patients with malignant tumours had had tests for HIV antibodies. The 58 tumours in the study form 3.2% of all tumours seen in the Department over the study period. There were 52 benign and 6 malignant tumours. The benign group was made up of 44 hemangiomas and 8 lymphangiomas, with a male to female ratio of 1.1:1, and an age range of 4 days to 16 years with a mean of 6.3 years. The malignant group comprised 4 KS all in the lymphnode and 2 hemangiopericytomas on the chest wall and scalp respectively, with a male to female ratio of 2:1 and an age range of 4 to 12 years with a mean of 6.8 years. All the four children with malignant tumours who had HIV antibodies test were negative. It is concluded that hemangiomas in Zaria are relatively common and they share similar characteristics with those seen elsewhere. There does not seem to be a relationship between malignant vascular tumours in children and AIDS infection.

Benign prostatic hyperplasia and prostate carcinoma in native Africans.

OBJECTIVE: To study the factors associated with morbidity and mortality in benign prostatic hyperplasia (BPH) and carcinoma of the prostate in native Africans. PATIENTS AND METHODS: A prospective study was conducted from 1993 to 1998 at the Ahmadu Bello University Teaching Hospitals, Zaria, Nigeria. During this 5-year period 686 patients were investigated and treated for symptoms and signs of prostatism. They were followed up for a mean (range) of 19.5 (1-60) months. RESULTS: BPH was found in 588 and clinical carcinoma in 98 patients. Adequate results, including a histological diagnosis, were available for 640 patients; there were 545 patients with BPH and 95 patients with histologically diagnosed prostate cancer. Treatment consisted of open prostatectomy for BPH, and subcapsular orchidectomy and/or open bladder-neck wedge resection for patients with prostate cancer and bladder neck obstruction. Within 6 months of surgery, four of 545 (0.7%) patients with BPH and 25 of 95 (26. 3%) with prostate cancer had died. Two-thirds of the patients with cancer presented with paraparesis or paraplegia. CONCLUSIONS: BPH and prostate cancer cause significant morbidity and mortality in African men. There is a need for health education about the early recognition of symptoms. Provision of facilities for transurethral prostatectomy would minimize the complications of surgery and ensure better use of the meagre resources available for health care.

Sublingual gastric duplication cyst causing respiratory obstruction: case report.

A four-month old girl presented with difficulty in feeding and respiratory obstructrion from a sublingual cyst. Respiratory obstruction was relieved by needle aspiration of the cyst, followed 14 days later by complete excision. Histology of the cyst wall confirmed it to be a gastric duplication cyst. Though the gastric mucosa has a high propensity to deviate to ectopic sites, sublingual location is uncommon. The treatment of such cysts is preferably complete excision. However, when the cyst wall is closely associated with vital structures, cyst mucosectomy or partial excision with stripping of the mucosa of the residual part may suffice.

Suppurative granulomatous eosinophilic panniculitis: case report.

A case of 12 year-old Nigerian male is presented. He had an unusual variant of Weber-Christian disease and manifested massive subcutaneous indurations and nodules limited to the cheeks, lips, left pectoral, infraclavicular and supraclavicular areas. A wedge biopsy revealed suppurative granulomatous eosinophilic panniculitis. Despite exhaustive investigations, no obvious trigger of the panniculitis could be identified. Response to corticosteroids and to empirical trials with other drugs was poor, and the outcome was fatal. We believe this is the first report from Nigeria of this rare variant of Weber-Christian panniculitis in the paediatric age, and draw attention to the life-threatening nature of this disorder.

Retrorectal cystic harmatoma (tailgut cyst) in an infant: case report.

We report the case of a day old infant who presented with a large cystic swelling in the sacroccoygeal area distorting the gluteal folds and displacing the anus anteriorly. Rectal examination revealed less than twenty five per cent of the lesion in retrorectal space, plain x-rays did not show any calcification. The infant had excision surgery at seven days of age and did well thereafter. Although most TGC cases were reported in adults the present case fulfills the anatomical and histological criteria for diagnosis, and it may be the first such case in a child less than one month old.