Factors associated with vulvar cancer from 2005 to 2021 in Togo, sub-Saharan Africa.

BACKGROUND: vulvar cancer, once predominantly diagnosed in older women, is increasingly being diagnosed in younger individuals, due to Human Papillomavirus (HPV) infection. Our study aimed to describe the epidemiological and histopathological aspects of vulvar cancer in Togo and its associated factors. METHODS: This was a cross-sectional study, conducted on vulvar cancer cases histologically diagnosed at the Pathological Laboratory of Lomé over a period of 17-years (2005-2021). Parameters investigated included age, occupation, risk factors, sample nature, macroscopic tumor aspects, histological types, therapeutic intervenions, and prognostic outcomes. RESULTS: A total of 32 cases of vulvar cancer were collected, yieding an annual frequency of 1.88 cases. The average age of the patients was 48±14.12 years with extremes of 27 years and 82 years. Housewives accounted for the largest proportion of cases (37.5%). Among the 32 cases, 27 had identifiable risk factors, with HPV infection being the most prevalentr (33.3%). The ulcero-budding aspect was most frequently observed, and squamous cell carcinoma was the most common histological type, with the majority being well differentiated (89.3%). Statistically significant associations were found between risk factors and histological types, risk factors and degrees of differentiation, as well as between histological types and good differentiation of vulvar cancers. The 3-year survival was estimated at 78.13%. CONCLUSION: The incidence of vulvar cancer is increasing in Togo, particularly among young, primarily due to HPV infection.

Factors Associated With Esophagus Cancers in Togo, Sub-Saharan Africa.

Background: Esophagus cancer is cancer of poor prognosis, of often late diagnosis. The objective of this study was to describe the factors associated with esophagus cancers in the Togolese population. Methods: It was a retrospective descriptive, cross-sectional study, on esophagus cancers histologically diagnosed at the Pathological Laboratory of Lomé over a period of 31 years (1990-2021). Results: We have collected 144 cases of esophagus cancer. The average age of patients was 57 ± 12 years, and the sex ratio was 2.34. The most applicant service was the service of Hepato Gastroenterology of CHU Campus (30.6%). Alcohol (57.6%), tobacco (45.8%) were the most present risk factors. Biopsies were the most addressed (97.2%). The average duration of symptom evolution was 6.42 months and the main symptom at the time of diagnosis was dysphagia (36.8%). The location of cancer was the lower third for 71.5% of cases. At histology, epidermoid carcinoma was the dominant type (90.3%). Male sex was statistically associated with the occurrence of epidermoid carcinoma and female sex with the occurrence of adenocarcinoma (P < .001). Alcohol, smoking, and consumption of hot foods were statistically associated with the occurrence of epidermoid carcinoma in this study (P < .05). Conclusion: Esophagus cancer remains a serious condition for late diagnosis. These are mainly epidermoid carcinomas and having alcohol and tobacco as risk factors. The awareness of the population on the main risk factors would reduce the incidence of oesophagus cancers within the Togolese population.

Factors associated with late diagnosis of breast cancer in women in Togo, Sub-Saharan Africa.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer in women worldwide. The objective of this study was to identify factors associated with late diagnosis of breast cancer in Togolese women. METHODS: We conducted a prospective cross-sectional study with descriptive and analytical purposes on cases of breast cancer in women in 2021, in Togo. The patients included in this study were women followed in the gynecology department for stages III and IV breast cancer. RESULTS: We included 62 cases of breast cancer. The average age of the patients was 38.6 ± 12.5 years with extremes of 17 and 76 years. The breast nodule was the most common reason for consultation in 75.8% of cases. The histological types diagnosed were invasive carcinoma of non-specific type (58; 93.55%), mucinous carcinoma (3; 4.84%) and lobular carcinoma (1; 1.61%). For the stage of the cancer, 43 patients were stage III (69.4%) and 19 stage IV (30.6%). In multivariate analysis, the factors associated with late diagnosis of breast cancer were: fear of diagnosis (aOR = 1.29; p = 0.0014), long delay in diagnosis (aOR = 2.62; p = 0.0001) and failure to perform breast self-examination (aOR = 1.68; p = 0.0022). CONCLUSION: The fear of the diagnosis, the absence of self-examination of the breasts and the use of traditional treatment and self-medication in first intention constituted the essential factors of the late diagnosis of breast cancer. Strategies should be put in place at the national level to impact on these factors for an early diagnosis of breast cancer.

Prostate cancers in men under the age of 50: about a series in Togo, Sub-Saharan Africa.

BACKGROUND: Prostate cancer is a public health problem and increasingly diagnosed in men under 50 years of age. This cancer occurs much more in subjects of advanced age, generally over sixty. The aim of the study was to describe the epidemiological, clinical and histopathological aspects of prostate cancer in men under the age of 50 in Togo. METHODS: It was a retrospective descriptive, cross-sectional study of histologically confirmed cases of prostate cancer in young adults at the Pathological Laboratory of Lomé over a period of 10 years (2011-2020). RESULTS: In total, 29 cases of prostate cancer in patients under 50 years of age. The proportion of prostate cancers in men under 50 was 0.7% of all prostate cancers, The average age of the patients was 45 years with extremes of 35 and 49 years. Twelve patients had a family history of prostate cancer, with a statistically significant relationship between the existence of a family history of prostate cancer and the age of onset of the cancer (p-value = 0.03). The dominant clinical information was prostatic hypertrophy (40.37%), followed by acute urine retention (20.69%) and micturition disorders (17.27%). The median Prostate Specific Antigen (PSA) was 188 ng/ml with extremes of 20 ng/ml and 2100 ng/ml. A large proportion of patients had a PSA between 100 and 500 ng/ml. Histologically, they were all prostatic acinar adenocarcinomas. These adenocarcinomas were well differentiated (48%) and moderately differentiated (38%). The predominant histoprognostic grade was ISUP (International Society of Urological Pathology) grade 1 which was noted in 65.52%, followed by grade 2 in 20.69%. CONCLUSION: Prostate cancer in men under 50 years of age is relatively rare in Togo, sometimes occurring in the context of a family history of prostate cancer. Hence the importance of raising awareness among the male population, especially with a family history of prostate cancer, to start screening early, around the age of 40.

Breast Primary Angiosarcoma: A Clinicopathologic and Imaging Study of a Series Cases.

The aim of our study is to provide clinicopathologic and imaging features of breast primary angiosarcoma. We retrospectively analyzed cases of primary angiosarcoma diagnosed at the Pathological Laboratory of Lomé over a period of 20 years (2000-2019). Eight cases of primary angiosarcoma of the breast were collected, including 6 from women and 2 from men. The median age was 41.63 years (range from 17 to 66 years). Depending on the location, there were 4 of 8 cases in the left breast. Ultrasound classifications were BI-RADS 4 and 5. Histology revealed a malignant vascular proliferation composed of small lumens lined by atypical endothelial cells, evident mitoses, and foci of necrosis. On immunohistochemistry, the lesional cells expressed CD31, CD34, and Factor VIII. Based on Federation Nationale des Centers de Lutte Contre Le Cancer (FNCLCC) grading, the cases were grade II and III. Overall survival at 6 months was estimated to be 25% in a woman.

Prostate cancer screening: A survey of medical students' knowledge in Lome, Togo, and associated determinants in a resource-limited African context.

OBJECTIVES: The aims of this study were to assess the knowledge of medical students in Lomé about these means of screening for prostate cancer in a context of limited resources and controversy about prostate cancer screening, and to identify the determinants associated with these results. METHODS: This was a prospective descriptive and cross-sectional study conducted in the form of a survey of medical students regularly enrolled at the Faculty of Health Sciences of the University of Lomé for the 2019-2020 academic years. RESULTS: Of the 1635 eligible students, 1017 correctly completed the form, corresponding to a rate of 62.20%. The average age was 22 ± 3.35 years. The sex ratio (M/F) was 2.5. Undergraduate students were the most represented (53.69%). Students who had not received any training on prostate cancer were the most represented (57.13%). Only 12.88% of the students had completed a training course in urology. Concerning the prostate-specific antigen blood test, there was a statistically significant relationship between the students' knowledge and some of their socio-demographic characteristics, namely age (p value = 0.0037; 95% confidence interval (0.50-1.77)); gender (p value = 0.0034; 95% confidence interval (1.43-2.38)); study cycle (p value ˂ 0.0001; 95% confidence interval (0.56-5.13)) and whether or not they had completed a placement in a urology department (p value ˂ 0.0001; 95% confidence interval (0.49-1.55)). On the contrary, there was no statistically significant relationship between students' knowledge of the digital rectal examination and their study cycle (p value = 0.082; 95% confidence interval (0.18-3.44)). CONCLUSION: Medical students in Lomé have a good theoretical knowledge and a fair practical level of the digital rectal examination clinical examination and an average theoretical knowledge and a below average practical level of prostate-specific antigen, increasing however along the curriculum in the context of prostate cancer screening.

African particularities of sudden adult death in Togo on autopsy cases.

BACKGROUND: The purpose of the study was to determine the circumstances of occurrence of these sudden deaths, risk factors, to identify the causes of sudden death in adults at autopsy, with a view to improving prevention. METHODS: This is a retrospective study of the cases of sudden death that were the subject of an autopsy in the pathology anatomy department of the University Hospital Sylvanus Olympio in Lomé from 2009 to 2018. RESULTS: A total of 318 sudden death cases were recorded. The sex ratio (M/F) was 1.8, and the mean age was 43 ± 0.36 years. Sudden deaths were the second most common reason for autopsies after traffic accidents. The place of death was home in 76.7% of cases and in hospitals in 23.3%. Obesity was noted in 59.4%, with an umbilical adipose panicle varying between 7 and 12 cm thick. Cardiovascular causes excluding cerebral involvement (n = 173 cases, 54.40%) followed by pulmonary causes (n = 100 cases, 31.44%) were the most common cause of sudden death. The predominant cardiac pathology was infarction accounting for 32.07% of all causes of sudden death, and pulmonary embolism with 19.49% was the leading cause at the pulmonary level. CONCLUSION: The victims of sudden death in Togo are relatively young, predominantly male and predominantly obese. The main causes of sudden death were myocardial infarction followed by pulmonary embolism. The prevention of sudden death remains paramount, especially in the African context, where pre-hospital care is often inadequate.

Breast Cancer in Togolese Women: Imaging and Clinicopathological Findings.

BACKGROUND: Breast cancer is the most common cancer in women, and its incidence and mortality rates are expected to increase significantly over the next few years, particularly in developing countries. The aim of this study was to describe the epidemiological, clinical, radiological, histopathological, and prognostic aspects of breast cancer in Togo. MATERIALS AND METHODS: We retrospectively analyzed at our Department of Pathology of Lomé all cases of breast cancer in women confirmed by histology over a period of 20 years (2000-2019). RESULTS: We collected 804 cases of breast cancer in women. The median age was 46.7 years (range, 12-86 years). Patients aged <40 years represented 48.38% of cases, and the left breast was more affected (51.24%). Most women were sexually active (71.52%) and resided in urban areas (66.29%). Carcinomas represented the predominant histological group (796 cases, 99.00%) with a predominance of invasive nonspecific type carcinoma (92.34%). These cancers were diagnosed at late stage III using Nottingham grading (55.10%). The TNM classification showed a predominance of grades T2NxMx (72.45%) and T4N1Mx (17.76%). The luminal B profile (40.85%) was found mostly, and the mutation of BRCA2 and BRCA1 genes was found in 2.61% of cases. Mastectomy was performed in 7.59%, radiotherapy in 3.61%, and chemotherapy in 18.66%. CONCLUSION: Breast cancer is a frequent pathology in Togolese women, predominant in young adults, often diagnosed at a late stage with limited possibilities of treatment. The establishment of early care programs is essential.

Cervical lymphadenopathy of Togolese children in a tropical context: clinicopathological study.

Our study describes the epidemiology and aetiology of cervical lymphadenopathy in children diagnosed between 2003 and 2017 at the pathology laboratory of Lomé, Togo. A total of 221 cases were collected. The average age of diagnosis of the study population was 9.8 ± 0.3 years and consisted of 118 (53.4%) boys. HIV was confirmed by indirect ELISA test in 69 (31.2%) cases. The cohort consisted of infections (n = 128, 57.9%), tumours (n = 85, 38.5%) and others (n = 8, 1.6%). The main infectious aetiology was tuberculosis (n = 84). Tumour aetiology consisted of 79 primary malignancies and three metastatic cases. Primary tumours consisted predominantly of lymphoma (n = 74), with Burkitt's lymphoma (n = 44) being the most common. Tuberculosis on a background of HIV infection remains the dominant cause of cervical lymphadenopathy in the tropical region of Togo.

Male Breast Cancer in Togo: Imaging and Clinicopathological Findings.

BACKGROUND: Breast cancer in men is a rare condition, often diagnosed late. The purpose of this study was to describe its epidemiological, histopathological, and radiographic aspects in Togo. MATERIALS AND METHODS: This was a descriptive retrospective study on cases of breast cancer in humans diagnosed histologically at the Laboratory of Anatomy Pathological and Imagery of the University Hospital in Lomé, over a period of 25 years (1995 to 2019). The parameters studied were epidemiological, anatomopathological, and imaging. RESULTS: Eighty-two (82) cases were diagnosed, an annual frequency of 3.28 cases. The mean age was 45 ± 2.5 years; the range was 27-63 years. The family history of 47 patients (57.32%) was known. Carcinomas represented the predominant histological group with predominantly nonspecific invasive carcinoma (87.5%). These cancers were diagnosed at late stages (75.71% grade II). They were mainly of luminal B profile (38.75%) and associated with mutations of the BRCA2 and BRCA1 genes in 14.63% of the cases. The lesions were classified ACR 5 in 61.5% (11/18). Two cases of breast angiosarcoma were diagnosed by the identification of CD31 markers and factor VIII in immunohistochemistry. Hormone therapy such as tamoxifen was prescribed in all luminal patients (43 patients). Radiotherapy was administered to 15 patients (18.3%), with acute toxicity in 20% of the cases. After a median follow-up of 36 months, the evolution was complete remission in 27 patients (32.93%). CONCLUSION: Breast cancer in men is rare, often diagnosed late with a poor prognosis.

African histoplasmosis of the penis.

African Histoplasmosis is deep mycosis caused by Histoplasma duboisii and genitourinary involvement is extremely rare. We report a case of African histoplasmosis in a 27-year-old subject with painful penis ulcer. Ulcer edge biopsy had revealed inflammatory granulomas made of epithelioid cells, lymphoplasmocytes, polynuclear eosinophils and giant multinucleated cells, with ovoid yeasts surrounded by a clear halo. PAS and Grocott stains revealed numerous fungal structures with a morphology measuring 7 to 15 nm. The diagnosis Histoplasma capsulatum var. duboisii was placed and the patient put on itraconazole (400 mg/day) for six months with a good course. African histoplasmosis of the subject penis is an extremely rare entity. The diagnosis of certainty often makes use of histology and mycological examination, and makes it possible to eliminate differential diagnoses such as cryptoccocosis, tuberculosis or cancer.

Giant primary angiosarcoma of an adolescent girl's breast diagnosed postmortem: a case report.

BACKGROUND: Angiosarcoma is an endothelial malignant tumor; angiosarcoma located in the breast is extremely rare, less than 0.01%. We report a case of a giant angiosarcoma diagnosed postmortem in a 16-year-old girl in a resource-constrained country. CASE PRESENTATION: A 16-year-old black African girl was admitted for altered consciousness and a left breast tumor. She was admitted in a state of apparent death. Her death was confirmed on clinical examination. A postmortem biopsy of the mammary tumor showed standard histology of a proliferation of fusiform or rounded tumor cells in places, which were not very cohesive with marked anisokaryosis and numerous foci of tumor necrosis. Immunohistochemistry showed a positivity of CD31 and factor VIII markers with a proliferation index (Ki-67) estimated at 30%. CONCLUSION: Primary angiosarcoma of the breast is exceptional in adolescents and has a poor prognosis, especially in countries with limited resources.

Difficult Causality Relationship between Colorectal Cancer and Schistosomiasis.

The purpose of the study was to determine the nature of the association between colorectal cancer and schistosomiasis infection. This was a retrospective and descriptive study of colorectal cancers and to identify cases associated with schistosomiasis. A total of 814 cases of rectal colorectal cancer were collected and 3 cases were associated with schistosomiasis. These are 2 cases of Liberkunian adenocarcinoma and one case of malt lymphoma. The patients were all farmers and from rural areas. A co-infection with HIV was found in his 3 patients. Our data show an extreme rarity of the association colorectal cancer and schistosomiasis; it seems difficult to conceive of a causal relationship.

Primary squamous cell carcinoma of the endometrium associated with human papilloma virus in a young woman: a case report.

BACKGROUND: Primary squamous cell carcinoma of the endometrium is an extremely rare tumor with poorly understood pathogenesis. CASE PRESENTATION: We report a case of a 28-year-old Togolese woman who had consulted for vaginal bleeding and pelvic pain. Ultrasound showed thickening of the lining of the endometrium, and biopsy curettage was done. Anatomopathological examination was noteworthy for a proliferation of squamous cells often connected by union bridges arranged in tumor lobules with dyskeratotic maturation. Immunohistochemistry showed epithelial membrane antigen positivity, anti-pancytokeratin 1 markers of tumor cells positivity, chromogranin A negativity, actin negativity, S100 negativity, estrogen receptor negativity, and progesterone receptor negativity. In situ hybridization had objectified human papillomavirus genotypes 16/18. The diagnosis of primary squamous cell carcinoma of the endometrium associated with human papilloma virus was retained. A hysterectomy was performed, and the tumor was classified pT1N0M0. CONCLUSION: The pathogenesis of this endometrial cancer is complex, and its association with human papillomavirus does not explain its genesis.

Suicidal ideation and suicide attempts in subjects aged 15-19 in Lomé (Togo).

OBJECTIVES: The purpose of this study was to study the epidemiological and clinical profile of adolescents with suicidal thoughts, with or without suicide attempts, and to identify associated factors. RESULTS: A total of 155 (16.5%) of the 941 adolescents interviewed had suicidal thoughts. The average age of the respondents was 18 ± 2.1 years. The sex ratio (m/f) was 1.4. With regard to marital status, 70.2% were single and 29.8% were in a relationship with a cohabiting partner. Family history of suicide was reported in 40%. In their personal history, eight were infected with HIV, three were chronic ethylic and two were diabetics. Forty-six (29.7%) of the 155 adolescents who had suicidal ideation had ever had a suicide attempt. Teens affected by suicide lived in a boarding school in 25.8%, with one parent in 23.9% and 50.3% with both parents. Factors associated with suicide attempts were female sex (p = 0.0107), age over 18 years (p = 0.0177), living in a couple (p = 0.0316), underlying immunodepression (HIV infection, p = 0.0059, sickle cell disease, p = 0.0043) and having a family history of suicides (p = 0.0461).

A rare testicular tumor: primary carcinoid tumor.

BACKGROUND: Primary carcinoid tumors are rare and constitute 0.23% of all testicular tumors. We report a case of primary carcinoid tumor of testicular localization, with a review of the literature. CASE PRESENTATION: A 29-year-old man, without specific ascendants, consulted the urology department for progressive scrotal swelling of 6 months, associated with pain. After surgery, histology showed diffuse tumor proliferation composed of small round monotone cells with hyperchromatic nuclei evoking undifferentiated carcinoma. Immunohistochemistry showed that tumor cells were positive for chromogranin A and negative for placental alkaline phosphatase and α-fetoprotein. CONCLUSION: Primary neuroendocrine carcinoma of the testis is a very rare malignant tumor. Immunohistochemistry contributes to its diagnosis in relation to other metastatic neuroendocrine carcinomas, carcinoid tumor teratomas, seminoma, and Sertoli cells.

Association of Schistosomiasis with Cervical Cancer in Togo: the Consequence of this Association.

Objective of the study was to determine the association of cervical cancer association and schistosomiasis infection. We conducted a retrospective and descriptive study of cases of cervical cancer and identified cases associated with schistosomiasis. A total of 1027 cases of cervical cancer were collected, and 19 cases revealed an association with schistosomiasis. This association was mainly related to squamous carcinoma with 18/19 cases. All patients were from rural areas. Of the 19 cases of association, 17 cases showed signs of HPV infection. Our data show a high degree of HPV infection that causes cervical cancer and not schistosomiasis.

Basidiobolomycosis in Togo: clinico-pathological study of a series of 12 presumed cases.

OBJECTIVE: The purpose of our study was to describe the histological diagnosed of the Basidiobolomycosis cases from 1990 to 2017 (28 years) in the only Pathology Anatomy Laboratory in Togo. RESULTS: A total of 12 cases of suspected Basidiobolomycosis have been identified. The sex ratio (M/F) was 2. The average age of the patients was 24.8 ± 1.6 years. Six patients (6/12) had a pathological history: HIV infection (n = 4 cases) and tuberculosis (n = 2 cases). The clinical manifestations were localized to pure skin (n = 9 cases), skin and mucous digestive (n = 2 cases) and disseminated (n = 1 cases). Direct mycological examination and culture in 4 patients was positive in 3 patients. The samples examined consisted of 11 cutaneous biopsies measuring 1-3 cm and a biopsy of the intestinal mucosa. Histology showed granulomatous inflammation of the dermohypodermal site with numerous giant cells associated with eosinophilic polynuclear cells, in which there are 5-7 mm non-septate, irregular mycelial filaments. Patients were treated with ketoconazole at a dose of 10 mg/kg daily. The progression of the patients' condition was favorable after 4 weeks of treatment with a regression of the closets size. Patients were completely healed after 8 weeks of treatment, without recurrence after 6 months. No deaths have been recorded.