Sub-classification of Breast Masses by Fine Needle Aspiration Cytology.

OBJECTIVE: The aim of this study is to evaluate the accuracy of sub-classification of breast diseases using Fine Needle Aspiration cytology (FNAC). MATERIALS AND METHODS: A one-year prospective study of 180 consecutive patients with palpable breast lesions who underwent FNAC and subsequently open surgical biopsy for histological confirmation. FNAC was used to sub-classify breast lesions and then correlated with histological diagnosis. RESULTS: A total of 180 patients were enrolled into the study but only 110 patients with histology report were used for test validity. Seventeen (15.5%) smears were C1; while 46 (41.8%), 5 (4.5%), 4 (3.6%) and 38 (34.6%) were C2, C3, C4 and C5, respectively. FNAC achieved sensitivity of 90.0%, specificity of 95.5%, false positive rate of 5.3%, false negative rate of 8.7%, positive predictive value of 94.7%, negative predictive value of 91.3% and overall diagnostic accuracy of 92.9%. Only 86 (78.2%) of the 110 smears could be sub-classified into different disease conditions of the breast on cytology. FNAC accurately sub-classified 25(78.1%) of fibroadenoma and 28(87.5%) of invasive ductal carcinoma. CONCLUSION: FNAC can reasonably sub-classify fibroadenoma, invasive ductal carcinoma and mastitis but there is still a challenge with lobular carcinomas, metaplastic carcinomas, papillary carcinomas and fibrocystic changes.

The clinical and pathological features of hepatocellular carcinoma in Nnewi, Nigeria.

BACKGROUND: Hepatocellular carcinoma (HCC) remains the commonest malignancy of the liver. In spite of the recent advances in treatment, prognosis is still abysmal especially in developing countries. This article aims to review the clinical and pathological features of HCC in a tertiary hospital at Nnewi. METHOD: This was a cross-sectional study. Patients with HCC seen at the Medical Out-patient Department or admitted into the Medical wards of the Nnamdi Azikiwe University Teaching Hospital Nnewi were recruited. The study lasted from June 2007 to May, 2008. Subjects were clinically evaluated and blood samples collected for HBsAg, anti-HCV and HBeAg assays. RESULTS: The prevalence of HCC was 2.4%. Of the 60 patients studied, 38 were males and 22 were females with a male to female ratio of 2:1. Their ages ranged from 19-86 years with a mean age of 50.62 +/- 17.54. The mean duration of symptoms before presentation was 16 weeks and the mean duration from onset of symptoms to death is 20 weeks. Common presenting symptoms were painful right hypochondrial mass, abdominal swelling, weight loss, early satiety and fatigue while coagulopathy, ascites and hepatic encephalopathy were the most common complications. Multiple lesions affecting both lobes of the liver was seen in 48 patients on ultrasound, 36.6% were positive for HBsAg of which 41% were HBeAg positive. HCV antibodies were present in 8.3% of the patients. Well differentiated HCC of the pseudo-glandular variety was the most common histological type. CONCLUSION: HCC affects middle aged Nigerians. Though well differentiated, it presents late with clinical features of advanced disease leading to death within six months. It is more often associated with chronic HBV than HCV infection.

Sarcoma botyroides of the cervix in a HIV positive 45-year-old woman: a case report.

UNLABELLED: Embryonal rhabdomyosarcomas (Sarcoma botyroides) are malignancies of connective tissue with abnormal cells which are thought to arise from skeletal muscle progenitors. It is a rare childhood malignant solid tumour and occurs in children mostly less than 10 years. It can occur at any age but two commonest peaks are 1-5 years (when approximately 66.6% occur) and 15-19 years accounting for the rest. Sarcoma botyroides which usually occurs in the vagina in childhood is rare in the female reproductive tract of adult women especially those over the age of 40. We report here a case of a 45-year-old HIV-positive woman who presented with profuse bleeding from the vagina with severe anaemia. Macroscopically, a cauliflower polypoid growth was seen protruding from the cervix into the vagina. Histopathological studies confirmed a diagnosis of sarcoma botyroides. CONCLUSION: The need for a high index of suspicion of sarcoma botyroides of the cervix must be borne in mind when making a diagnosis on all cervical polypoidal masses. Also the importance of looking out for lesions and malignancies on all HIV positive patients cannot be over-emphasized.