A histopathological study of carcinoma of the prostate in Port Harcourt, Nigeria.

OBJECTIVES: To determine the incidence of prostate cancer in Port Harcourt and the surrounding towns whose residents patronize the University of Port Harcourt Teaching Hospital for tertiary health care, histologically characterize the patterns of these cancers, and grade them according to the Gleason scheme. MATERIALS AND METHODS: Blocks and slides of prostate specimens received at the Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital between January 1997 and December 2006 were retrospectively selected for this study. The slides were studied using a binocular Olympus light microscope. Patients' age at presentation, presenting symptoms, and clinical diagnosis were sorted out from the request cards and the department's archival register. RESULTS: Carcinoma was diagnosed in 198 specimens (37.4%) of the 529 cases reviewed. Of these, 164 (82.8%) were clinical carcinoma (having been found in clinically suspected carcinoma cases for which trucut biopsies were undertaken), while 34 (17.2%) were incidental carcinoma cases (being found in prostatectomy biopsy cases of patients clinically diagnosed with nodular hyperplasia). All of the clinical carcinomas were adenocarcinomas predominantly moderately differentiated and of large acinar pattern. Also, all of the incidental carcinomas were adenocarcinomas predominantly well differentiated and of large acinar pattern. The Gleason scores (GSs) were varied but predominantly of high values, particularly with clinical carcinoma cases. The age range was 42 to 90 years and the mean was 70 years with a peak of 70 to 79 years. CONCLUSION: The incidence of prostate cancer in Port Harcourt is high relative to other Nigerian centers where similar studies have been carried out and compares well with the high incidence found among African American men. Histologically, all cases are acinar adenocarcinomas. Most patients present late with high GS carcinoma and therefore have poor prognosis. There is a need for enlightenment of the male populace on the high incidence of this deadly disease as well as for screening to reduce the number of patients presenting late and therefore improve prognosis.

Histopathologic characterisation of prostate diseases in Port Harcourt.

OBJECTIVE: To carry out histopathologic analysis of diseases of the prostate gland reported at the department of Anatomical Pathology of the University of Port Harcourt Teaching Hospital between January 1996 and December 2005. PATIENTS AND METHODS: This is a retrospective histologic analysis of prostate samples seen at the University of Port Harcourt Teaching Hospital. Where necessary, new slides were prepared from blocks of the samples. The request cards of the patients were also retrieved and scrutinized for age, presenting symptoms and clinical diagnosis. RESULTS: Prostate biopsies constituted 8.8% of all surgical specimens and 30.9% of all male specimens received during this study period. Only 529 (7.6%) of all prostate specimens where included for the review because the slides or blocks of the rest could not be traced. Of the 529 specimens reviewed, 301 (56.9%) were needle biopsies while 228 (43.1%) were prostatectomies. Three hundred and thirty one (62.6%) of the cases were nodular hyperplasia and 198 (37.4%) were invasive adenocarcinomas, thirty-four (17.2%) of the invasive adenocarcinomas were incidental carcinomas. There was prostatic intraepithelial neoplasia (PIN) in 79 (14.9%) cases. Prostatitis was found in 223 cases (42.2%) of the entire specimen studied. All cases of prostatitis occurred in association with nodular hyperplasia, invasive carcinoma or prostatic intraepithelial neoplasia (PIN). CONCLUSION: The burden of prostate diseases among adult males in Port Harcourt is high and malignant neoplastic diseases in the form of clinical and incidental carcinomas as well as premalignant diseases in the form of prostatic intraepithelial neoplasia (PIN) were quite common.

Histopathological characteristics of female breast carcinomas seen at the University of Port Harcourt Teaching Hospital, Port Harcourt Nigeria.

BACKGROUND: Breast carcinoma is an unpredictable disease in the sense that some patients may present with relatively early disease and die of widespread metastases within six months to one year, while others present with fairy advanced disease and yet survive longer. The aim of this study was to characterize breast carcinomas into prognostic groups using histological features. METHODOLOGY: A total of 269 breast carcinomas in females received during a five-year period (January 1991 to December 1995 inclusive) were analyzed. Archive records (request forms and microscopic slides) of all breast malignancies diagnosed in the department of Anatomical Pathology of University of Port Harcourt Teaching Hospital were retrieved and evaluated with respect to histological type, histological grades, and mononuclear cell infiltration within the primary tumour. The modified Bloom-Richardson system of microscopic grading of breast carcinoma was used. RESULTS: The majority of carcinomas showed scanty or absent tubule formation (43.1%) and 59% of cases showed numerous mitotic figures. Forty-nine percent of carcinomas show poorly differentiated or anaplastic nuclei. The final tumour grade (FG) which is the summation of tubular pattern, nuclear pleomorphism and mitotic grades of each of the tumours reveals that 53% fall in FG3, 26% in FG2while only 21% fall in FG1. The majority of the breast carcinomas in this study, 58%, show scanty or absent mononuclear infiltration. CONCLUSION: The majority of breast carcinomas in this study are poorly differentiated invasive ductal carcinoma, "not otherwise specified" which exhibit high proliferation ratio and are associated with poor host cellular immune reaction. These attributes translate to poor prognosis.

Soft tissue sarcomas in the Niger Delta Region of Nigeria (a referral hospital's study).

BACKGROUND: Soft tissue sarcomas are rare tumours in this environment. Recently, an upsurge in frequency was noticed that called for attention. The aim of this study is to study soft tissue sarcomas based on age, sex of patients, tumour sites and histologic types. METHODOLOGY: A 14 year retrospective study in University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt. Histological slides previously processed and stained with hematoxylin and eosin stains (H & E) were reviewed and re-evaluated. Special stains were also used for proper diagnosis of some tumours. The tumours were classified based on World Health Organization (WHO) classification of soft tissue tumours. RESULTS: Only 66 soft tissue sarcomas were used for this study which accounted for 2.8% of the total malignancies diagnosed during the period under review. The youngest was a 3 year old girl while the eldest was a 76 year old female. A total of 38 and 28 tumours were diagnosed in males and females respectively, giving a sex ratio of 1.4:1. Rhabdomyosarcoma was most frequent (39.4%) while the least was leiomyosarcoma (1.5%). These tumours are more frequent in the under 20 years (22.7%) and least in 70 years and above (7.6%). The lower limb was most affected (36.4%) while the least was the retroperitoneum (6.1%). The commonest predilection sites vary with different classes of these group malignancies. CONCLUSION: Soft tissue malignancies are globally uncommon but they constituted an integral part of malignant tumours causing serious morbidity and mortality in this environment. The recent upsurge noticed necessitated the need for regional studies in Nigeria in order to come up with a national epidemiologic data of these malignancies.

Knowledge, attitude, and practice of female health professionals regarding cervical cancer and Pap smear.

BACKGROUND: The objectives of this paper was to determine what female health professionals knew and felt about cervical cancer and Pap smear and their uptake of Pap smear. METHODS: A questionnaire survey of 144 female health professionals at two referral hospitals with facilities for Pap smear. RESULTS: Nurses constituted 52.8% of respondents followed by laboratory scientists (18.8%), doctors (14.6%) and pharmacists (13.9%). One hundred and thirty two (91.7%) respondents had heard of cervical cancer and 80.6% knew it was associated with vaginal bleeding. Twenty two percent could not list any risk factor A significantly greater proportion of doctors (100%) knew the purpose of a Pap smear compared to 59.2% of nurses, 50% of pharmacisits and 48.1% of laboratory scientists (p = 0.003). Only 13 respondents (9%) had everhad a Pap smear with doctors (p = 0.003) and divorced/separated women (p = 0.005) significantly more likely to have done so. Perceived non-availability of Pap smearservice was the main reason (51.3%) for not having had a Pap smear. However, 30.3% had not thought of it or did not consider themselves at risk of cervical cancer. CONCLUSION: Health professionals themselves need to be properly informed about cervical cancer and Pap smears because of their own needs as women and also to improve their effectiveness in educating and encouraging other women to have Pap smears. Available Pap smear services should be publicized and made more affordable.

An endometriotic cyst of the left ovary in pregnancy--a case report.

A case of an endometriotic cyst of the left ovary in a pregnant Nigerian woman is presented. Left ovarian cystectomy was performed at the 18th week of gestation. The patient had a spontaneous vaginal delivery of a 3.54kg live male baby.

Amoebic recto-vaginal fistula--a case report and review of literature.

A case of amoebic recto-vaginal fistula is presented, with a review of literature on this rare complication of intestinal amoebiasis. A temporary defunctioning sigmoid colostomy was necessary. This in combination with oral metronidazole and tetracycline resulted in spontaneous closure of the fistulous tract. Non-traumatic recto-vaginal fistula poses a major diagnostic problem especially in the tropics where many granulomatous infections are endemic and could mimic carcinoma.

Prospective study of coroner's autopsies in Benin City, Nigeria.

A prospective study of 726 cases of coroner's autopsies carried out over a period of two years (1st January, 1996 - 31st December, 1997) was reviewed. The causes and circumstances of death are defined and classified into natural and unnatural deaths. Fifty cases (6.3%) were children while the remaining 676 cases (93.1%) were adults in a male to female ratio of 2.6 to 1. The most common indications for coroner's autopsies were sudden unnatural deaths (SUDs) accounting for 485 cases (66.8%) and also sudden unexpected natural deaths (SUNDs) (241 cases) accounting for 33.2%. In the first category, road traffic accidents accounted for 86.7% of cases with deaths involving motor vehicle drivers and their passengers (41.8%); pedestrians (37.1%); and motorcyclists and their passengers (18.6%). The commonest causes of death in all road traffic accidents were craniocerebral injuries and haemorrhagic shock. In the second category the most common causes of sudden unexpected natural death were cardiovascular diseases resulting from complications of hypertension (54.7%) occurring in apparently healthy individuals. Other causes of death were pneumonia, pulmonary tuberculosis, typhoid fever and neoplastic diseases. This study showed that in Nigeria, with an increasing acquisition of dietary and life style habits of the developed western world, there is becoming a concomitant risk of deaths from road traffic accidents and sudden unexpected natural deaths from hypertensive cardiovascular disease.

Pattern of suicides in Ile-Ife, Nigeria.

This is a study of pattern of autopsy findings in cases of completed suicides, with respect to age, sex and methods employed over a period of 11 years and 2 months. Suicides are generally reported to be rare in the less developed countries. Yet sudden deaths of indetermined aetiology are a well-recognized entity. Besides, it has been established that depressive disorders, a major cause of suicides, hitherto thought to be rare in Africa, is now recognized to be fairly common, presenting in a rather subtle form with features of somatization. Suicides in Ife were found to be 0.4 per 100,000 population with a higher incidence in males with a ratio 3.6 to 1. The majority of the victims were in the third decade of life. The majority of suicides were committed with Gammalin 20 and the local Dane gun. Those who used the gun applied it to the head and neck region in 76% of the cases.

Pattern of homicides in Nigeria--the Ile-Ife experience.

Homicide victims were studied in Ife, Nigeria, between October 1977 and December 1988. Two hundred and two cases were analysed during the period. Male to Female ratio was 4.6:1. The peak age of victims was between 20 and 40 years; 37 percent were killed with firearms, 35 percent with cutting and piercing instruments and 18% by blunt force. These findings tally favourably with observations in other places.

African histoplasmosis (Duboisii) of the skull with neurological complication--a case report and review of literature.

A case of African histoplasmosis of the skull associated with neurological deficit has been reported. There was complete recovery of neurological features after excision of the lesion followed by a course of co-trimoxazole. A review of the available literature indicates the rarity of this particular mode of presentation. The reversibility of the neurological complications makes it important that clinicians increase their awareness of this treatable condition.

Hodgkin's disease in siblings: a case report.

Two male siblings (ages 12 and 16 years) presenting with Hodgkin's disease are reported. They were both diagnosed as stage IVB with identical histological type--lymphocyte depleted. The presence of identical sex, shared environment and the closeness of the time of onset suggested a combination of both environmental and genetic factors in the aetiology of the disease in these siblings.

Malignancies of the female genital tract at the University of Port Harcourt Teaching Hospital: a ten year review -- 1990-1999.

OBJECTIVES: To determine the relative frequencies of malignant disease of the female genital tract. DESIGN: A retrospective review of histopathology report. SETTING: University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. SUBJECTS: Women who had gynaecologic cancers. RESULTS: The cervix was the commonest site of malignant disease (63.1% ) followed by the endometrium, ovary, vulva and vagina. The age of the patients varied with the type of cancer as follows - endometrium (54.8 years), cervix (51.9 years), ovary (40.4 years), choriocarcinoma (30.6 years). CONCLUSION: There is an urgent need to establish a national community - based cervical cytology service to reduce the incidence of cervical cancer and its attendant morbidity and mortality.

Omental and mesenteric cysts in Nigerian children.

Omental and mesenteric cysts are rare intra-abdominal lesions which may be congenital, traumatic, neoplastic or infectious in origin. They give rise to non-specific clinical features and may be a cause of the surgical acute abdomen, especially in children. Correct preoperative diagnosis is infrequent but a high index of suspicion and use of ultrasonography when available would improve clinical diagnosis. Six omental and mesenteric cysts encountered in five children over a 10-year period (1978-87) are reported. All the cysts were congenital. Three patients presented with non-specific symptoms and two presented with acute abdomen. Correct preoperative diagnosis was made in two patients. All five patients had surgery. Two had enucleation of the cysts, two had excision of the cysts with adjacent bowel segment and one patient with two cysts had partial excision of the wall of the cysts with free internal drainage into the peritoneal cavity. All patients survived.

The pathological basis of chronic renal failure in Nigerians. An autopsy study.

With the aim of determining the relative prevalence of the diseases underlying chronic renal failure (CRF) in a large homogeneous black tropical population, the autopsy records of the Obafemi Awolowo University Teaching Hospital over a four year period were studied. Out of a total of 702 cases coming to autopsy during this period, 66 (9.4%) died as a result of CRF. The highest number of cases of CRF fell within the 31-40 year age group with a male/female ratio of 1.28:1. Chronic glomerulonephritis was responsible for 40.9% of cases, malignant nephrosclerosis 16.6%, benign nephrosclerosis 7.6% while endstage renal disease (ESRD) was responsible for 15.4%. A miscellaneous group of diseases was responsible for 19.7%, about half of which was due to chronic pyelonephritis. Rarer causes of CRF were diabetic nephropathy, multiple myeloma, systemic lupus erythematosus and analgesic nephropathy.