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.

Evaluation of Iodinated Contrast Media Use in Abdominal CT Scans in Cancer Assessments: A Cross-Sectional Study in Lomé (Togo).

Background: There is great variability between centers regarding contrast injection protocols. They should only be injected if they can provide useful information for diagnosis with the necessary and sufficient quantity of iodine. We wanted to know through this study if the use of iodinated contrast media is optimised in abdominal CT scans performed for cancer assessment in Lomé. Materials and Methods: It was a cross-sectional, descriptive, and analytical study with a prospective collection over a period of 6 months in three CT units in Lomé. It involved abdominal CT scans performed for oncological evaluation. Data were reported as the mean ± standard deviation. The Pearson correlation coefficient, ANOVA, chi-square, and the Fisher test were used. Results: A total of 218 examinations were recorded. The female sex represented 56.88% of the patients. The mean age was 50.92 ± 15.78 years. The mean weight was 70.46 ± 15.23 kg. The mean BMI was 24.91 ± 5.32 kg/m2. The examinations were performed with a voltage of 120 kV in 195 cases (89.45%). The mean dose of injected iodine was 0.42 ± 0.09 gI/kg with a dose of 0.40 gI/kg at 80 kV and 0.45 gI/kg at 130 kV. The mean injection rate was 2.90 ± 0.34 mL/s. The mean injected volume was 83.19 ± 7.29 mL. The mean duration of the injection was 30.60 ± 7.39 s. The mean iodine delivery rate was 0.98 ± 0.17 gI/s. There was no saline injection in 152 cases (69.72%). Liver contrast enhancement was satisfactory in 94.5% of cases. There was a strong negative linear correlation between the dose of injected iodine and weight. Conclusions: Optimization guidelines for the use of iodinated contrast media are not always applied. Therefore, monitoring and benchmarking programmes for iodinated contrast injection protocols that involve all radiology personnel should be implemented.

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.

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.

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.

Qualité des demandes d'examens radiologiques: à propos de 552 demandes évaluées par des radiologues

Objectifs : Evaluer la qualité des demandes d'examens radiologiques. Matériels et méthodes : Il s'est agi d'une étude transversale descriptive réalisée dans le service de radiologie du CHU Campus du 1er août au 15 août 2015. Résultats : Au cours de la période d'étude, nous avons colligé 144 demandes d'examens de tomodensitométrie (26,1%) et 408 demandes d'examens de radiographie (73,9%). Les demandeurs étaient des médecins spécialistes dans 25% des cas (102 examens) pour la radiographie et 19,4% des cas (28 examens) pour la tomodensitométrie. Les demandeurs d'examen de radiographie étaient des rhumatologues dans 8,8% des cas (36 examens) et aucun urologue n'avait demandé un examen de radiographie ; les demandeurs d'examen de tomodensitométrie étaient des neurologues dans 19,4% des cas (28 examens) et aucun gynécologue ni pédiatre n'avait demandé un examen de tomodensitométrie. Les demandes sans question et les demandes sans retour étaient les deux principaux types de demandes observés. L'âge et le sexe des patients n'avaient pas été précisés respectivement dans 4,4% (18 cas) et 2,9% (12 cas) des demandes d'examen de radiographie. Les résultats d'examens para-cliniques pouvant être utiles à l'interprétation et au compte-rendu radiologique manquaient sur 384 cas (94,1%) des demandes d'examens de radiographie et sur 140 cas (97,2 %) des demandes d'examens de tomodensitométrie. Sur les demandes d'examen de radiographie, le demandeur ne pouvait être identifié par son nom dans 78 cas (19,1%) et le motif de demande était précisé dans 402 cas (98,5 %) ; sur les demandes d'examen de tomodensitométrie, le demandeur ne pouvait être identifié par un numéro de téléphone dans 96 cas (66,7%). Conclusion : Les demandes d'examen radiologiques sont établies de manière incomplète. L'exercice radiologique suppose cependant une obligation de moyens, avec sérieux, prudence et réflexion

Profil radiographique de la tuberculose pulmonaire de l'adulte immunocompétent en milieu rural au Togo

Contexte et objectifs. La tuberculose pulmonaire (TP) présente un profil varié à la radiographie thoracique. Les signes présomptifs sont à déterminer, surtout en milieux peu nantis. L'objectif de la présente étude était de décrire le profil radiographique de la TP de l'adulte immunocompétent en milieu rural. Méthodes. Etude documentaire descriptive et analytique incluant des patients adultes immunocompétents, traités pour TP et référés au centre de prise en charge de la tuberculose de la région centrale, Centre Hospitalier Régional de Sokodé durant la période du 1er janvier 2016 au 30 juin 2018. Résultats. Cent-trois dossiers ont été colligés, comprenant 38 patients (36,9%) à bacilloscopie négative et 65 autres (63,1%) à bacilloscopie positive. Le sexe féminin était prédominant (59,2% avec un sexe ratio de F/H de 1,17/1). Soixante-deux patients ont été considérés dans l'analyse, 31 à bacilloscopie positive et 31 à bacilloscopie négative. La moyenne d'âge pour les patients à bacilloscopie positive était de 37,41±16,85 ans et de 41,74±15,59 ans pour ceux à bacilloscopie négative (p=0,29). On notait 9 patients âgés de plus de 60 ans (14,5%). Les syndromes alvéolaire (88,9%) et cavitaire (76,9%) étaient plus observés chez les patients à bacilloscopie positive et jeunes, alors que les opacités réticulo-nodulaires (85,7%) prédominaient dans le groupe des patients à bacilloscopie négative. Les lésions étaient bilatérales (n=34 ; 54,8%), localisées au poumon droit (n=17 ; 27,5%). Ces lésions étaient diffuses dans 53,2%; et intéressaient le tiers supérieur du poumon dans 29% des cas. Conclusion. Chez le sujet immunocompétent, le profil radiographique de la TP bacillifère est caractérisé par des lésions alvéolaires et/ou cavitaires, tandis que celui de la TP- par les opacités réticulo-nodulaires

Breast cancer cases of female patients under 35 years of age in Togo: A series of 158 cases.

Breast cancer in young female patients represents a public health problem in developing countries. The objectives of the study were to study the epidemiological and histological characteristics of breast cancer in female patients under 35 years of age. This was a retrospective analytical study of a series of 158 cases of breast cancer in female patients under 35 years of age, conducted at the University Teaching Hospital of Lomé between 2000 and 2015. A total of 158 cases were collected, representing 36.2% (436) of all breast cancer cases. The average age of the patients was 30.9 years (range, 16-35 years). A family history of breast cancer at the 1st or 2nd degree was identified in 13.9% of cases. Genetic mutation studies were carried out for 7 patients, 5 of which revealed mutations (4 BRCA1 and 1 BRCA2). According to the locus, the cancer was located preferentially in the left breast in 88 cases (55.7%). Malignant mammary lesions were epithelial tumors (n=144 cases, 91.1%), infiltrating (n=125 cases, 79.1%) and non-infiltrating (n=19 cases, 12.0%). The other histological groups consisted of 8 cases of sarcomas (5 cases of angiosarcoma, 2 cases of fibrosarcoma and 1 case of Kaposi's sarcoma), 5 cases of lymphomas and one case of melanoma. Not otherwise specified infiltrating ductal carcinomas were SBR II and III in 43.2 and 35.2% of cases, respectively. The tumors classified as T4 were the most frequent (30.4%). Regarding the lymph node status, lymph node metastasis was noted in 22.8% of cases. Studies of hormone receptors were carried out in 23 patients and were positive for 11 patients: Estrogen receptor (ER)+plus progesterone receptor (PR)+(7 patients), ER+PR-(4 patients). Of the aforementioned 8 cases of sarcoma, 5 were angiosarcoma. The lymphomas were predominantly Burkitt's type for 4 cases. Mammary ultrasonography was performed in 45.6% of the patients and 54.4% underwent the combined ultrasonography and mammography. Ultrasound identified one or more sign of malignancy in 67 patients (42.4%), and combined ultrasonography and mammography classified 51.9% of lesions in BIRADS 4 and 5. The incidence of breast cancer in young Togolese patients is high. It is a disease distinguished by a delay in diagnosis, which contributes to the high number of cases that initially diagnosed at an advanced stage, particularly the high histo-prognosis grades of infiltrating ductal carcinoma. These results indicate a genetic origin; therefore, a thorough investigation into genetic mutations should be carried. In addition, further collaborative studies are required to verify these results.

Breast Abscessed Cancer in Nonlactating Women in Tropical Environment: Radiological, Bacteriological, and Anatomopathological Features about 3 Cases.

The association of breast cancer and abscess is rare in daily practice. The authors report a short series of 3 cases of cancer of the breast in nonlactating women presented as breast abscess, reviewing aspects in radiology (ultrasound and mammography), correlating them with the histopathology findings and the bacteriological profile of the isolated germs.

[Torsion of wandering spleen: a case report in the Kara University Hospital (Togo)]. / Torsion d'une rate ectopique: a propos d'un cas au CHU Kara (Togo).

Wandering spleen is a rare pathology. Spleen infarction which results from the torsion of the pedicle is its main complication. We report a case of torsion of a wandering spleen diagnosed by computed tomography. The therapeutic sanction was a splenectomy because of the infarction. Nowadays, splenopexy is the best treatment if the diagnosis is done early.

La rate ectopique ou baladeuse est une entité pathologique rare. Sa complication majeure est la torsion de son pédicule pouvant conduire à un infarctus splénique. Nous rapportons un cas de torsion de rate ectopique dont le scanner avait permis de poser le diagnostic. La splénectomie a été la sanction thérapeutique à cause de son infarcissement. Actuellement, la splénopexie est proposée quand le diagnostic est fait précocement.

Tuberculous Abscess of the Chest Wall Simulate Pyogenic Abscess.

The chest wall tuberculosis abscesses is rare. We present a case of a 27-year-old immunocompetent male who presented chest wall abscesses. Imaging (chest radiographic, ultrasound, and computed tomography) and Ziehl-Neelsen staining demonstrated chest wall tuberculosis abscesses.

Intravenous Contrast Medium Administration for Computed Tomography Scan in Emergency: A Possible Cause of Contrast-Induced Nephropathy.

The goal of this study was to assess risk for CIN after CT Scan during an emergency and to identify risk factors for the patient. Prospective review of all patients admitted to the emergency room (ER) of the Teaching Hospital of Lomé (Togo) during a 2-year period. CIN was defined as an increase in serum creatinine by 0.5 mg/dL from admission after undergoing CT Scan with intravenous contrast. A total of 620 patients underwent a CT Scan in the emergency room using intravenous contrast and 672 patients took the CT Scan without intravenous contrast. Out of the patients who received intravenous contrast for CT Scan, three percent of them developed CIN during their admission. Moreover, upon discharge no patient had continued renal impairment. No patient required dialysis during their admission. The multivariate analysis of all patients who had serial creatinine levels (including those who did not receive any contrast load) shows no increased risk for acute kidney injury associated intravenous contrast (odds ratio = 0.619, p value = 0.886); only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26, p value = 0.031).

Aspects tomodensitometriques des demences au Togo

Introduction : La demence est une pathologie en rapport avec l'age dont la prevalence est en progression dans le monde; et en particulier dans les pays en developpement. L'objectif de cette etude etait de determiner les aspects tomodensitometriques des demences au Togo. Patients et Methodes : Il s'agit d'une etude prospective et analytique portant sur 144 patients durant la periode allant de janvier 2011 a decembre 2012. Etaient inclus a l'etude; tout patient presentant une deterioration des fonctions superieures et ayant beneficie d'une tomodensitometrie (TDM) cerebrale. L'examen tomodensitometrique avait ete realise sur un scanner de 16 barrettes de marque General Electric; avec des acquisitions volumiques sans et avec injection du produit de contraste (en cas de necessite) suivies de reconstructions coronales. Resultats : Au total 2320 TDM cerebrales avaient ete realisees pendant la periode d'etude dont 144 pour deterioration des fonctions superieures (6;2). La repartition des patients en fonction de l'age montre une predominance masculine (sex ratio = 1;5). La frequence de la pathologie augmentait avec l'age avec une moyenne de 60 ans. Les causes curables avaient ete retrouvees chez 41 patients (28;5); dominees par l'hydrocephalie chronique de l'adulte. Les causes non curables representaient 78 patients (54;2). La TDM etait normale chez 25 patients (17;3). Conclusion : La tomodensitometrie peut etre suffisante dans l'exploration des demences dans les pays en developpement ou l'acces a l'imagerie par resonnance magnetique est limite