Incidental histopathological diagnosis of tonsilar actinomycosis: A report of four cases.

Actinomycosis of the tonsils is uncommon even though the causative organisms are normal commensal of the oropharyngeal tract that may colonise the tonsillar crypts with resultant infection in apparently healthy individuals. Diagnosis is often incidental in tonsillectomy specimens sent to the pathology laboratory for varied diseases. This is a 10-year study of tonsillectomy specimens diagnosed with actinomycosis. Specimens were formalin-fixed and paraffin processed and stained with haematoxylin and eosin, gromott methenamine silver and periodic acid-Schiff. Four cases of tonsillar actinomycosis were diagnosed from a total of 772 tonsillectomy specimens. Histologically, characteristic oeosinophilic granules with peripheral radial protuberances surrounded by microabscesses were seen. Tonsillar actinomycosis is often an incidental diagnosis; however, a high index of suspicion should be entertained in patients with recurrent tonsillitis and/or tonsillar hypertrophy of unknown cause.

Concurrent giant tumoral pseudoangiomatous stromal hyperplasia necessitating bilateral mastectomy.

Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign mesenchymal tumor of the breast. Majority occur as diffuse lesions, and diagnosis is often incidental or in a background of other breast pathologies. Bilaterality with multiple tumoral masses in giant breasts is a rarity. We report a 34-year-old nonlactating female with 2-year history of rapid progressive painless bilateral enlargement of the breasts following surgical excision of ill-defined breast lumps which were not subjected to histopathological evaluation a year earlier. Examination revealed bilateral nontender giant breasts extending to the umbilical area with masses which were not attached to overlying skin, Grade 2 pressure ulcers on the lateral posterior breast aspects bilaterally and peau d'orange. There were no other palpable masses or lymph nodes. A clinical assessment of bilateral gigantomastia was made. Bilateral mastectomy revealed giant PASH which was confirmed with positive immunohistochemical reactivity for CD34 and vimentin. No other breast pathologies were seen with extensive sectioning. Diffuse multiple breast lesions with incomplete excision are associated with rapid growth in PASH as seen in this case. The presence of concurrent bilateral giant tumoral masses without any underlying breast pathology is a novelty. The mainstay of treatment in this case is mastectomy despite its benign nature.

L'hyperplasie stromale pseudoangiomateuse (PASH) est une tumeur mésenchymateuse bénigne rare du sein. La majorité se produisent comme des lésions diffuses, et le diagnostic est souvent fortuit ou dans un contexte d'autres pathologies mammaires. La bilatéralité avec de multiples masses tumorales dans les seins géants est une rareté. Nous rapportons une femme âgée de 34 ans, non lactante, ayant des antécédents de gonflement bilatéral rapide, progressif et indolore des seins, après une excision chirurgicale de morceaux de sein mal définis qui n'ont pas été soumis à une évaluation histopathologique un an plus tôt. L'examen a révélé des poitrines géantes non contendantes bilatérales s'étendant à la zone ombilicale avec des masses qui n'étaient pas attachées à la peau sus-jacente, des ulcères de pression de grade 2 sur les côtés latéraux de la poitrine et de la peau d'orange. Il n'y avait pas d'autres masses ou ganglions lymphatiques palpables. Une évaluation clinique de la gigantomastie bilatérale a été faite. La mastectomie bilatérale a révélé un PASH géant qui a été confirmé avec une réactivité immunohistochimique positive pour le CD34 et la vimentine. Aucune autre pathologie mammaire n'a été observée avec une section étendue. Les lésions mammaires diffuses multiples avec une excision incomplète sont associées à une croissance rapide du PASH comme on le voit dans ce cas. La présence simultanée de masses tumorales géantes bilatérales sans pathologie mammaire sous-jacente est une nouveauté. Le pilier du traitement dans ce cas est la mastectomie malgré sa nature bénigne. Mots-clés: hyperplasie bilatérale, mammaire, géante, pseudo-angiomateuse, tumoral.

Sensitivity of Computed Tomography-guided Transthoracic Biopsies in a Nigerian Tertiary Institution.

INTRODUCTION: The indications for open biopsies for intrathoracic lesions have become almost negligible. This development was made possible by less invasive maneuvers such as computed tomography-guided (CT-guided) biopsy, thoracoscopy or video-assisted thoracoscopy, and bronchoscopy. CT-guided percutaneous lung biopsy was first reported in 1976. AIM OF STUDY: The aim of the study is to report our experience with CT-guided transthoracic biopsy. MATERIALS AND METHODS: Patients with clinical and radiological evidence of intrathoracic mass were counseled and consent obtained for the procedure. They were positioned in the gantry, either supine or prone. A scout scan of the entire chest was taken at 5 mm intervals. The procedure was carried out by the consultants and senior registrar. Following visualization of the lesion, its position in terms of depth and distance from the midline was measured with the machine in centimeter to determine the point of insertion of the trucut needle (14-18-G). The presumed site of the lesion was indicated with a metallic object held in place with two to three strips of plasters after cleaning the site with Povidone-iodine. After insertion, repeat scans were performed to confirm that the needle was within the mass. A minimum of 3 core cuts was taken to be certain that the samples were representative. The results were analyzed by the determination of means and percentages. RESULTS: Twenty-six patients underwent this procedure between 2011 and 2015. There were 15 males and 11 females (M:F = 1.4:1). The age range was between 30 and 99 years with a mean of 55 years. Histological diagnosis was obtained in 24 of the patients giving sensitivity of 92.3%. There were 3 mild complications giving a rate of 11.5%. The complications included a case of mild hemoptysis and two patients who had mild pneumothoraces which did not require tube thoracostomy. CONCLUSION: CT-guided biopsy is a reliable procedure for obtaining deep-seated intrathoracic biopsies with high sensitivity and minimal complication rate.

Sensitivity of computed tomography-guided transthoracic biopsies in a Nigerian tertiary institution

Introduction: The indications for open biopsies for intrathoracic lesions have become almost negligible. This development was made possible by less invasive maneuvers such as computed tomography-guided (CT-guided) biopsy, thoracoscopy or video-assisted thoracoscopy, and bronchoscopy. CT-guided percutaneous lung biopsy was first reported in 1976. Aim of Study: The aim of the study is to report our experience with CT-guided transthoracic biopsy. Materials and Methods: Patients with clinical and radiological evidence of intrathoracic mass were counseled and consent obtained for the procedure. They were positioned in the gantry, either supine or prone. A scout scan of the entire chest was taken at 5 mm intervals. The procedure was carried out by the consultants and senior registrar. Following visualization of the lesion, its position in terms of depth and distance from the midline was measured with the machine in centimeter to determine the point of insertion of the trucut needle (14­18-G). The presumed site of the lesion was indicated with a metallic object held in place with two to three strips of plasters after cleaning the site with Povidone-iodine. After insertion, repeat scans were performed to confirm that the needle was within the mass. A minimum of 3 core cuts was taken to be certain that the samples were representative. The results were analyzed by the determination of means and percentages. Results: Twenty-six patients underwent this procedure between 2011 and 2015. There were 15 males and 11 females (M:F = 1.4:1). The age range was between 30 and 99 years with a mean of 55 years. Histological diagnosis was obtained in 24 of the patients giving sensitivity of 92.3%. There were 3 mild complications giving a rate of 11.5%. The complications included a case of mild hemoptysis and two patients who had mild pneumothoraces which did not require tube thoracostomy. Conclusion: CT-guided biopsy is a reliable procedure for obtaining deep-seated intrathoracic biopsies with high sensitivity and minimal complication rate

Renal metastasis from prostate adenocarcinoma: a potential diagnostic pitfall.

Renal metastasis from prostatic origin is an uncommon event. Advanced prostate cancer locally invades the seminal vesicles, bladder and regional lymph nodes. Other metastatic sites are the lung, bone and other visceral organs. We present a 55-year old, Hausa man from Northern Nigeria who was managed as a case of infected renal cyst which later turned out to be a metastatic prostatic adenocarcinoma with a rare pattern of widespread bony metastases.Renal metastasis from prostate adenocarcinoma is a rare occurrence, however, high level of suspicion is needed in order to avoid potential diagnostic pitfall.

Cutaneous umbilical metastases in post-menopausal females with gynaecological malignancies.

Gynaecological malignancies frequently metastasize to contiguous structures, internal organs and bones. Cutaneous metastasis as a primary or recurrent presentation of these malignancies is rare and only a few cases have been reported in the literature. A twenty year (1991-2010) retrospective search for umbilical metastasis from gynaecological malignancies in our departmental case records showed only four cases. Four post-menopausal females presented with painful cutaneous umbilical (Sister Joseph's) nodules. The clinical examinations of all four patients revealed well delineated nodules of varying sizes and degrees of ulceration. Other findings were matted axillary and inguinal lymph node enlargement, intra-abdominal and pelvic masses, vaginal discharge and vaginal bleeding. Incisional tissue biopsies from the nodules were processed in paraffin wax and stained with haematoxylin and eosin. Histology of the sections showed pigmented skin overlying metastatic malignant tumours consistent with adenocarcinoma from the endometrium and ovary in three cases, and squamous cell carcinoma, large cell keratinizing from the cervix uteri in the fourth case. Gynaecological cancers have a global spread and varied geographic distribution. Cervical cancer is the commonest in our setting and patients often present to hospital with advanced stage disease. Ovarian and endometrial cancers are infrequent and their diagnosis may be delayed by non- specificity of presenting clinical symptoms from other benign tumours at these sites. Although umbilical metastasis is commonly associated with gastro-intestinal malignancies, its presence may be the first harbinger of occult gynaecologic cancer.

Yolk sac tumour of the penile shaft: a rare primary extra-gonadal presentation.

Germ cell tumours (GCTs) commonly involve the ovaries, testes, and other midline structures in children and adolescents and comprised a variety of tumours that have a common histiogenetic origin. The yolk sac tumour (YST) variant is the most common one seen in over 80% of testicular GCTs in children. Other sites of occurrence of these tumours include the mediastinum, prostate, retroperitoneum, and sacrococcygeal region. Penile malignancies account for less than 10% of male malignancies in the elderly, while its occurrence in children is rare. We present the case of a 5-year-old child with YST of the penile shaft and uninvolved testes.

Cutaneous manifestations of deep mycosis: an experience in a tropical pathology laboratory.

BACKGROUND: Cutaneous manifestations of deep mycotic infection are fraught with delayed or misdiagnosis from mainly cutaneous neoplastic lesions. AIM: This study is designed to present our experience of these mycoses in a pathology laboratory in the tropics. MATERIALS AND METHODS: A clinicopathologic analysis of deep mycotic infections was conducted over a 15 years period Formalin fixed and paraffin wax processed biopsies were stained with hematoxylin and eosin, periodic acid Schiff (PAS), and Grocott's methenamine silver (GMS) for the identification of fungus specie. Patients' bio-data and clinical information were obtained from records. RESULTS: Twenty males and seven females presented with 6 months to 6 years histories of varying symptoms of slow growing facial swellings, nodules, subcutaneous frontal skull swelling, proptosis, nasal blockage, epistaxis, discharging leg sinuses, flank mass, convulsion and pain. Of the 27 patients, four gave antecedent history of trauma, two had recurrent lesions which necessitated maxilectomy, two presented with convulsion without motor dysfunction while one had associated erosion of the small bones of the foot. None of the patients had debilitating illnesses such as diabetes mellitus, tuberculosis, and HIV infection. Tissue histology revealed histoplasmosis (10), mycetoma (9), subcutaneous phycomycosis (6), and phaeohyphomycosis (2). CONCLUSION: Deep mycoses may present primarily as cutaneous lesions in immunocompetent persons and often elicit distinct histologic inflammatory response characterized by granuloma formation. Diagnosis in resource constraint setting can be achieved with tissue stained with PAS and GMS which identifies implicated fungus. Clinical recognition and adequate knowledge of the pathology of these mycoses may reduce attendant patient morbidity.

Malignant tumours of childhood in Zaria.

BACKGROUND: The increased prevalence of hitherto uncommon tumours in children in our geographic setting formed the basis for this study. This study aimed to determine the current histopathologic distribution pattern of paediatric malignancies in Zaria. MATERIALS AND METHODS: An eight year (2000-2007) consecutive analysis of malignant tumours in children ages 0 to 15 years in a referral University laboratory. All tissue biopsies were fixed in 10% formalin and processed in wax. Tumours were characterised histologically into tissues of origin and categorised into three age groups; <1 year, 1-5 years and 6-15 years. RESULT: 189 children with malignant tumours were analysed. They showed a male preponderance (M: F; 1.2: 1.0) and their ages ranged from 5 days to 15 years. Tumours of mesenchymal origin were the commonest (115: 60.8%) while epithelial tumours including germ cell tumours accounted for 74 (39.2%) cases. The age group 1-5 years had the highest epithelial tumours while age group 6-15 years had the most tumours with 102 (54%) cases overall. The five commonest tumours over-all were rhabdomyosarcoma, Burkitt lymphoma, retinoblastoma, non-Hodgkin's lymphoma and nephroblastoma. Germ cell tumours affected the ovary predominantly and two of the endodermal sinus tumour cases were seen in the testis of an eighteen month child and sacrococcygeum of a 5 year old girl, respectively. Of the six immature teratoma cases, four were cutaneous in distribution. The vascular tumours included epithelioid haemangioendothelioma, haemangioblastoma and Dabska tumour and they accounted for (5.8%) of all tumours seen. The commonest sites of occurrence of these tumours were the oculo-orbital, jaw, head and neck regions with 82 cases (43.4%) while lymph nodes were involved in 31 (16.4%) cases. CONCLUSION: The distribution and occurrence of malignant tumours in children is age related. Lymphomas were the commonest tumours overall while retinoblastoma and Burkitt lymphoma were the commonest tumours affecting children below 5 years and 6-10 years old, respectively, in our centre. The head region and lymph nodes were the sites of predilection for majority of these tumours.

Human dicrocoeliasis presenting as a subcutaneous mass.

Human infection by Dicrocoelium dendriticum, a zoonotic liver fluke, is uncommon and soft tissue manifestation is extremely rare. The infection has no specific clinical signs or symptoms and diagnosis may be missed completely, thus treatment may be delayed. Diagnosis in humans is by identification of the eggs in the stool, while a living or dead fluke is rarely seen. The present report concerns the case of a 7-year-old child who presented with recurrent right flank subcutaneous nodules containing a live fluke on excision, and tissue histology showed characteristic brown operculated ova of D dendriticum. This is the first extraintestinal soft tissue presentation in such a setting. It is important to know the life cycle and natural habitat of this rare human parasite in order to make a correct diagnosis and institute early treatment in patients who have become infected.

Ruptured tubal hydatidiform mole.

OBJECTIVE: Ruptured ectopic gestation is a life threatening medical emergency especially in developing countries. However, the occurrence of hydatidiform mole in ruptured tubal pregnancy is uncommon. MATERIAL AND METHODS: A consecutive analysis of patients with hydatidiform mole in ruptured tubal gestation over a 9-year period in a tertiary hospital. RESULTS: Of a total of 101 females with ectopic gestations, only five had ruptured tubal hydatidiform mole. The ages ranged from 20-37years and they all presented with acute abdominal symptoms which necessitated emergency surgical intervention. Intra-operative findings revealed ruptured/ leaking tubal gestation. The excised tissue specimens showed hydatidiform mole characterized by circumferential trophoblastic proliferation, hydropic degeneration and stromal karyorrhexis. Patients' serial HCG levels were monitored before discharge. CONCLUSION: Ruptured tubal hydatidiform mole is uncommon and strict histologic criteria are important in diagnosis. Serial HCG levels must be monitored in individual patients to forestall development of malignant trophoblastic disease.

Malignant tumours of childhood in Zaria

Background: The increased prevalence of hitherto uncommon tumours in children in our geographic setting formed the basis for this study. This study aimed to determine the current histopathologic distribution pattern of paediatric malignancies in Zaria. Materials and Methods : An eight year (2000-2007) consecutive analysis of malignant tumours in children ages 0 to 15 years in a referral University laboratory. All tissue biopsies were fixed in 10formalin and processed in wax. Tumours were characterised histologically into tissues of origin and categorised into three age groups; 1 year; 1-5 years and 6-15 years. Result : 189 children with malignant tumours were analysed. They showed a male preponderance (M: F; 1.2: 1.0) and their ages ranged from 5 days to 15 years. Tumours of mesenchymal origin were the commonest (115: 60.8) while epithelial tumours including germ cell tumours accounted for 74 (39.2) cases. The age group 1-5 years had the highest epithelial tumours while age group 6-15 years had the most tumours with 102 (54) cases overall. The five commonest tumours over-all were rhabdomyosarcoma; Burkitt lymphoma; retinoblastoma; non-Hodgkin's lymphoma and nephroblastoma. Germ cell tumours affected the ovary predominantly and two of the endodermal sinus tumour cases were seen in the testis of an eighteen month child and sacrococcygeum of a 5 year old girl; respectively. Of the six immature teratoma cases; four were cutaneous in distribution. The vascular tumours included epithelioid haemangioendothelioma; haemangioblastoma and Dabska tumour and they accounted for (5.8) of all tumours seen. The commonest sites of occurrence of these tumours were the oculo-orbital; jaw; head and neck regions with 82 cases (43.4) while lymph nodes were involved in 31 (16.4) cases. Conclusion : The distribution and occurrence of malignant tumours in children is age related. Lymphomas were the commonest tumours overall while retinoblastoma and Burkitt lymphoma were the commonest tumours affecting children below 5 years and 6-10 years old; respectively; in our centre. The head region and lymph nodes were the sites of predilection for majority of these tumours

Huge filarial elephantiasis vulvae in a Nigerian woman with subfertility.

Filariasis is a helminthic infection caused by tissue nematodes. It is estimated that at least 120 million people are infected worldwide and another 1 billion are "at risk" of infection. The prevalence is increasing due to uncontrolled urbanization in many of the endemic countries. The geographical distribution is determined mainly by climate and the distribution of the mosquito vector. We report a case of huge filarial elephantiasis of the vulva, in a 40-year-old multipara with background history of secondary infertility. She had excision of the elephantoid vulva lesion under general anaesthesia. A nontender irreducible pedunculated mass (25 cmx21 cm) with a large stalk arising from the right groin down to the ipsilateral labia majora was removed. A similar mass on the left groin, measuring 10 cmx6 cm was removed. Diagnosis was confirmed at histopathologic analysis of the excised masses. Patient was placed on diethyl carbamazine.