[Atypical Localization of a Case of Leprosy in Lomé (Togo)]. / Localisation atypique d'un cas de lèpre à Lomé (Togo).

This was a 50-year-old woman with a selling activity living in Lomé who came for a consultation in March 2016 for a facial flushing that had been going on for 2 months without pain or pruritus. On examination, there was a single, erythemato-squamous closet of the right hemiface. There was no infiltration of the right ear. There was moderate cutaneous heat compared to the left hemiface which was without any lesion. Examination of nails, hair, palms and plants was normal. There was no hypertrophy of the peripheral nerves (superficial cervical plexus, ulnar, median). The face was not fixed. Complementary examinations noted a normal blood count and negative HIV status. Histology performed on a biopsy fragment concluded tuberculoid leprosy. The patient was first put on WHO multidrug therapy during 6 months. But one month after stopping this treatment, the lesions resumed. She was referred to a multibacillary leprosy protocol during one year. She had been seen 4 months after stopping treatment, without recurrence. It is important not to ignore leprosy in case of atypical erythema of the face even in the absence of other evocative signs and to perform a biopsy to the slightest doubt.

Il s'agit d'une femme de 50 ans, revendeuse, résidant à Lomé qui a consulté en mars 2016 pour une rougeur du visage évoluant depuis 2 mois sans douleur, ni prurit. À l'examen, on notait un placard unique érythémato-squameux de l'hémiface droit avec une bordure infiltrée. Il n'y avait pas d'infiltration du pavillon de l'oreille droite. Il y avait une chaleur cutanée modérée par rapport à l'hémiface gauche qui était sans aucune lésion. L'examen des ongles, des cheveux, des paumes et plantes était normal. On notait une absence d'hypertrophie des nerfs périphériques (plexus cervical superficiel, cubital, médiane). Le visage n'était pas figé. Les examens complémentaires notaient un hémogramme normal et une sérologie VIH négative. L'histologie réalisée sur un fragment biopsique a conclu à une lèpre tuberculoïde. La patiente a d'abord été mise sous le protocole de polychimiothérapie de l'OMS pendant 6 mois. Mais un mois après l'arrêt de ce traitement, les lésions ont repris. Elle a été remise sous un protocole de lèpre multibacillaire pour une durée d'un an. Elle a été revue 4 mois après l'arrêt du traitement, sans récidive. Il importe de ne pas méconnaître une lèpre devant un érythème atypique du visage même en l'absence d'autres signes évocateurs et de réaliser une biopsie au moindre doute.

Tuberculosis of the Breast in Togo: A Series of 28 Presumed Cases.

Our study aimed to describe the epidemiological, clinical and histological aspects of mammary tuberculosis in Togo. This is a descriptive cross-sectional study of breast tuberculosis for which the diagnosis was presumed on histological grounds in the pathology department (LAP) of the Lomé Tokoin university hospital from January 1995 to December 2016 (20 years). A total of 28 presumed cases of mammary tuberculosis were identified. There were 26 women and 2 men, with an average age of 34.2 ± 0.3 years. The clinical signs were nodule (84.1%), tumefaction (75%), abscess (63.6%) and tumefaction with cutaneous fistulization (59.1%). Breast involvement was isolated in 31.8% of cases and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was found in 63.9 % of cases. Histology showed inflammatory granulomas made of Langhans giant cells, epithelioid cells and lymphocytes around the foci of caseous necrosis. Thoracic radiography was abnormal in 16 patients (57.1%).Mammary tuberculosis is not rare in our country. Clinical presentation is often misleading and is a diagnostic challenge, more particularly with breast abscess or cancer.

Epidemiological data and forensic aspects of road traffic fatalities in Lomé, Togo.

We collected 190 forensic records from the only pathology laboratory in Lomé, over the period from January 2010 to December 2014. The sex ratio (M/F) was 4.4 and the decedents' average age 33.4 years. In 43.2% of cases, the accident resulted from a collision between a pedestrian and a motorcycle; excess speed noted in 56.8% of cases. Four principal groups of fatal injuries were observed: polytrauma (136 cases), isolated severe head injury (49 cases), isolated thoracic contusion (3 cases), and abdominal pelvic contusion with perinea trauma (2 cases).

[Analysis of a series of 44 cases of peritoneal tuberculosis diagnosed in the pathology laboratory of the Tokoin teaching hospital of Lomé (1993-2014)]. / Analyse d'une série de 44 cas de tuberculose péritonéale diagnostiqués au laboratoire d'anatomie pathologique du CHU Tokoin de Lomé (1993-2014).

It is a descriptive and cross-sectional study on all issues relating to peritoneal tuberculosis histological diagnosed in the pathology department (LAP) of the Lomé Tokoin CHU from January 1993 to December 2014 (20 years). A total of 44 cases of peritoneal tuberculosis were included. They were 18 women and 26 men, with a mean age of 37.6±0.2 years. The circumstances of discovery were dominated by ascites (84.1%), fever (75%), weight loss (63.6%) and abdominal pain (59.1%). The peritoneal involvement was isolated in 31.8% of cases, and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was present in 63.9% of cases. Twenty-five patients (69.4%) with information about their social conditions had low socioeconomic level: unemployed (10 cases; 40%), workers (10 cases; 40%) and retired (5 cases; 20%). An increase in cell count was observed in 94.6% of cases. Histology revealed the epithelial giant cell granuloma associated with caseous necrosis in 38 cases (86.4%) and cheesy isolated in 6 patients. Peritoneal tuberculosis is not exceptional in our country. The diagnosis should be considered in febrile ascites, and will be confirmed by laparoscopy with histological samples for a histological diagnosis.

[Histological aspect of urinary schistosomiasis in Togo: results of a cohort of 192 cases]. / Aspect histologique des séquelles de la bilharziose urinaire au Togo: résultats d'une série de 192 cas.

The high prevalence of urinary schistosomiasis in Togo and its late management often lead to sequels. This study takes stock of these cancerous and non-cancerous lesions observed on histological pieces in the pathology laboratory of the Teaching Hospital of Lome in 10 years. We find 28.1 % of malignant tumor lesions, dominated by urothelial carcinoma.

[Disseminated cysticercosis: report of three cases in Togo]. / Cysticercose disséminée: trois cas au Togo.

We report 3 cases of disseminated cysticercosis (DC) in adult male subjects in Togo. All had consulted in dermatology for asymptomatic subcutaneous nodules. The diagnosis was confirmed by histology of a resected nodule. Computed tomography allowed us to bring out the widespread dissemination of cysticerci. The skin, brain, muscle, eye, thyroid, and pleura were the affected organs. Treatment was based on albendazole and betamethasone, with adverse side effects in 2 of our 3 patients. Our 3 observations seem to be the first of their kind in Togo. The mechanism of contamination in these disseminated forms is not yet elucidated, however ingesting a gravid proglottis could be the basis of the widespread dissemination of cysticerci in the body. No consensus has yet been established in the treatment of DC and the management should follow the guideline for treatment of neurocysticercosis and ocular cysticercosis.

[Stomach cancer: Epidemiological, clinical and histological aspects at the Lome Campus teaching hospital (Togo)]. / Cancer de l'estomac: aspects épidémiologiques, cliniques et histologiques au CHU Campus de Lomé (Togo).

PURPOSE: To describe the epidemiological, clinical, and histological aspects of stomach cancer in the gastroenterology department of University Hospital Campus of Lome (Togo). METHODS: This retrospective descriptive and analytical study reviewed records of patients hospitalized for stomach cancer over an 8-year period. RESULTS: With 32 cases among the 250 gastrointestinal tract cancers over the study period, stomach cancer accounted for the largest proportion (12.8%) of these cases. The sex ratio was 2.5 and the mean age of patients was 58.82 years (range: 32 to 85 years). The clinical picture was dominated by epigastric pain (44%). Ulcerative budding lesions were most common, especially in the pyloric antrum (72%). Adenocarcinoma was the most common histological type (94%). Thirteen of our patients were transferred to the visceral surgery department for palliative care. Nine more were lost to follow-up after release against medical advice due to lack of financial support. Five patients died (16%) during hospitalization. CONCLUSION: Stomach cancer is common in Togo and ranks first among gastrointestinal cancers in our department. Training hepatogastroenterologists and providing adequate technical facilities, on the one hand, and early recognition of warning signs and a reduction in the cost of gastrointestinal endoscopies, on the other, could improve the survival of patients with gastric cancer in Togo.

[Ocular tumors in Togo: epidemiological, clinical, and histopathological features observed at the Lomé Teaching Hospital of Sylvanus Olympio]. / Tumeurs oculaires au Togo: aspects épidémiologiques, cliniques et histopathologiques à propos de quarante-cinq cas observés au CHU Sylvanus-Olympio de Lomé.

PURPOSE: To describe the epidemiological, clinical, and histopathological features of ocular tumors in Togo. METHODS: We have a retrospective and descriptive study of the ocular specimens registered in the pathology laboratory from January 1, 2006, to December 31, 2010. The frequency of ocular tumors, the patients' age and sex, the department from which the specimen came, the sampling procedure, and the histopathological patterns were analyzed. RESULTS: During the study period, 80 ocular specimens were recorded among a total of 6000, for a frequency of 1.33%. Histopathological results were available for 45 cases in our sample. The mean age was 30.9 ± 15.1 years, and the sex ratio 0.88 (21M/24F). The two teaching hospitals in Lomé furnished 73.4% of the ocular specimens. The most common site was the conjunctiva, accounting for 75.5% of the cases. Benign tumors represented 69.9% of the histological diagnoses. Papilloma was the histopathological diagnosis in 33.3% of cases. CONCLUSION: Ocular tumors are relatively common, occur at any age, and are located most often in the conjunctiva. Close collaboration between the pathologist and the ophthalmologist is essential for the best management of these tumors.

[Management of a case of unilateral exophthalmos due to an intraorbital lipofibroma at Kara teaching hospital in Togo]. / Prise en charge d'un cas d'exophtalmie unilatérale due à un lipofibrome intra-orbitaire au CHU de Kara au Togo.

In childhood, benign tumors are uncommon causes of exophtalmos. We report a case of intraorbital lipofibroma in an 11-year-old girl who presented with painless, progressive proptosis of the right eye over the preceding 6 months. Ultrasound had shown an extraconal intraorbital mass. Complete excision and pathologic examination were performed, revealing a lipofibroma with no signs of malignancy This case report is notable due to the rarity of the condition.

Preliminary evaluation of the wound healing effect of Vitex doniana sweet (Verbenaceae) in mice.

Vitex doniana is traditionally used in Togo to treat various diseases including wounds. The aim of this work was to evaluate the efficiency of Vitex doniana on cutaneous wound healing. Wounds were induced in ICR mice divided into four groups as following: Group I received carbopol 974P NF empty gel, Groups II and III were treated topically with carbopol gel containing 2.5% and 5% of Vitex doniana extract. Group IV received Betadine® 10% as standard drug. The efficacy of treatment was evaluated by planimetry and histological analysis. We secondary used the gel containing Vitex doniana at 2.5% and the pure extract at 10 mg/ml on the model of ear edema induced by xylene. Skin toxicity test was performed with the gel containing Vitex doniana at 5% and the pure extract at 30 mg/ml. Vitex doniana at 5% and 2.5% provided better wound contraction (91.14% and 86.38%) at day 12 post-excision when compared to control (51.15%). The results of histological evaluation supported the outcome of excision wound model. Moreover Vitex doniana inhibited significantly edema induced by xylene when compared to control (p< 0.05). In skin toxicity test, no abnormal symptoms were developed over 14 day-time period. Vitex doniana inhibits the topical inflammation and accelerate cutaneous wound repair.

[Early guttate leukoderma in Darier's disease in a patient with black skin]. / Leucodermie en gouttes précoce au cours de la maladie de Darier chez un sujet à peau noire.

BACKGROUND: The clinical manifestations of Darier's disease are polymorphic and diverse. Guttate leukoderma has been described in around twenty patients with genetically pigmented skin. We report a case of widespread guttate leukoderma several years before the classic signs of Darier's disease in a patient with black skin. CASE REPORT: A 19-year-old woman consulted for characteristic signs of Darier's disease evolving for the previous four years. Examination revealed perifollicular, non-confluent hypopigmented macules and papules in small drop size (1-5mm in diameter) scattered on the trunk, limbs and the jaw and chin. These hypopigmented lesions had been present since the age of six years. Histology of the keratotic papules confirmed the diagnosis of Darier's disease. Histological inspection of a hypopigmented lesion showed hyperkeratosis, acantholysis and a considerable reduction of epidermal melanin pigment. DISCUSSION: Our observation suggests that a guttate leukoderma could be an early sign, readily accessible to dermatologists, in the diagnosis of Darier's disease in black-skinned patients.

[Bilateral simultaneous central retinal artery occlusion revealing giant cell arteritis]. / Occlusion bilaterale et simultanee de l'artere centrale de la retine revelatrice d'une maladie de Horton.

AIM: To point out the importance of the early diagnosis of giant cell arteritis (GCA) (Horton's disease). MATERIALS AND METHODS: a case report of a sudden bilateral blindness that had revealed GCA. CASE REPORT: A 68-year old female patient with a history of elevated blood pressure and diabetes mellitus type 2, was examined in emergency for a right painful headache developed one week previously. In ophthalmological examination, her BCVA was 0.9 and P2 in both eyes. Diagnosis of Horton's disease was not initially done in spite of elevated erythrocytes sedimentation rate (ESR) at 30 mm, protein C reactive (CRP) at 19 mg/l. The patient consulted seven weeks later in emergency for a sudden bilateral blindness associated with severe headache, recent asthenia, and limping of the lower jaw. At that time, visual acuity was reduced to light perception in both eyes whereas ophthalmoscopy revealed a bilateral central retinal artery occlusion (CRAO). ESR was 74 mm and CRP 233 mg/I. Temporal artery biopsy confirmed the diagnosis of GCA. The patient was treated with systemic steroids without visual recovery. CONCLUSION: This case outlines the importance of the early diagnosis of GCA in order to make possible to start treatment before the occurrence of irreversible complications.

[Epidemiological and pathological aspects of the gynecological and mammary cancers in Togo]. / Aspects epidémiologiques et histopathologiques des cancers gynéco-mammaires au Togo.

OBJECTIVE: Gynecologic and mammary cancers occupy a prominent place in female tumor pathology. The purpose of this report is to describe aspects of these cancers in Togo. MATERIAL AND METHODS: This retrospective and descriptive study includes all gynecologic and mammary cancers diagnosed between 1987 and 2006 in the pathology laboratory of Tokoin University Hospital in Lomé, Togo. RESULTS: During the study period, 882 gynecologic and mammary cancers were diagnosed. Breast cancer accounted for 440 cases (49.88%). The most common gynecologic cancer locations were the cervix in 212 cases (24.03%) and uterine corpus in 108 cases (12.25%). Mean patient age was 48.3 years overall, 48,6 years for breast cancer and 49 years for cervical cancer. In almost all cases, cancer was diagnosed at an invasive stage. CONCLUSION: Gynecologic and mammary cancers are common in Togo and most cases are diagnosed at a late stage. An epidemiological monitoring program is needed.

[Probable basidiobolomycosis in a Togolese rural young successfully treated with ketoconazole]. / Basidiobolomycose probable chez un jeune rural togolais traitée avec succès par du kétoconazole.

Basidiobolomycosis is a deep mycosis which preferentially affects rural young people in tropical countries. We report a case of basidiobolomycosis successfully treated with ketoconazole. It was a 9-year-old boy of rural origin in whom the diagnosis of basidiobolomycosis was suspected due to a deep skin infiltration involving the chest and neck. Histology revealed hypodermic granulomatous inflammation with predominantly macrophage and eosinophils. The child was treated successfully with ketoconazole in eight weeks. Treatment of basidiobolomycosis is based on azole derivatives which are particularly effective. Histopathology is very important in the diagnosis of this affection, especially in tropical countries where it may simulate Mycobacterium ulcerans infection.

Epidemiologie et anatomo-pathologie des cancers colorectaux en Cote d'Ivoire

Consideres comme rares dans les pays en developpement; les cancers colorectaux sont de plus en plus frequents avec l'occidentalisation des habitudes alimentaires. Notre objectif a ete de decrire le profil epidemiologique et anatomopathologique de ces cancers dans deux CHU d'Abidjan en Cote d'Ivoire. Il s'agissait d'une etude retrospective realisee dans les laboratoires d'Anatomie pathologique de deux trois CHU d'Abidjan sur les cancers colorectaux histologiquement confirmes. La periode d'etude a ete de 24 ans (1984-2007). La frequence relative trouvee a ete de 3;34(394/11854) des cancers avec une predominance masculine (64). L'age moyen etait de 49 ans avec des extremes de 6 et 84 ans. Les polypes et les polyposes etaient les plus frequents des facteurs predisposants (41;66). L'ampoule rectale etait la zone la plus touchee (57; 82u). Les aspects vegetants; les adenocarcinomes et le stade pT2-T3 N1M0 ont constitues les aspects anatomopathologiques predominants. Ces cancers touchent ainsi des sujets jeunes avec pronostic souvent pejoratif

[Epidemiology and pathological profile of childhood ovary tumours in Togo: about 32 cases]. / Profil histo-épidémiologique des tumeurs ovariennes de l'enfant au Togo: à propos de 32 cas.

PURPOSE: Tumours of the ovary is rare in childhood. The aim of our work was to describe the epidemiology and histological aspects of these tumours in Togo. MATERIAL AND METHODS: Retrospective review of the epidemiologic and pathologic features of the ovary tumours in childhood (0 to 15 years), observed from 1988 to 2007 at the laboratory of pathology of the Tokoin teaching hospital in Lomé, Togo. RESULTS: During our study period, we observed 32 cases of childhood ovary tumours that represent 8.16% of all ovarian tumours. The average age of occurring was 10.7 years. Histologically it was germ cell tumours in 40.6% of cases (mature teratomas: 34.4% ; immature teratomas: 3.1% ; yolk sac tumours: 3.1%), sex cord-stromal tumours in 21.8% of cases (granulosa cell tumours: 18.7% ; fibroma: 3.1%) and Burkitt lymphoma in 37.6%. CONCLUSION: The childhood ovary tumours although rare, exist in Togo dominated by Burkitt lymphoma.

[Epidemiology and histopronostic of prostatic cancer in Togo: about 202 cases diagnosed at the laboratory of pathology of the Tokoin teaching hospital of Lome]. / Epidémiologie et histopronostic du cancer de la prostate au Togo : à propos de 202cas diagnostiqués au laboratoire d'anatomie pathologique du CHU Tokoin de Lomé.

OBJECTIVES: Describe the epidemiological and histological aspects of the prostate cancer in Togo. METHODS: It was a retrospective descriptive study relating to 202 cases diagnosed between 1984 and 2003 at the Laboratory of Pathology of the Tokoin teaching hospital of Lome. The parameters studied were: frequency, age, circumstances of discovery, PSA value and histological type. RESULTS: The frequency of prostate cancer was 10 cases on average. The average age of patients was 70 years (45 to 95 years). The circumstances of discovery were dominated by voiding disorders and the average PSA was 88.5 ng/ml (7.8 to 560.4). Histologically, it was adenocarcinoma in 97.5% of cases and squamous cell carcinoma in 1.9% of cases. CONCLUSION: The prostate cancer although uncommon in Togo remains a public health problem because of the weak accessibility of the population to the diagnosis. So, a national program of screening is needed.

Epidemiological and pathological aspects of gastrointestinal tumors in Togo.

PURPOSE: The incidence of gastrointestinal tumors is difficult to estimate in Togo, so the purpose of this report was to describe the tumors diagnosed by the national pathology laboratory. METHODS: This was a retrospective descriptive study of 742 gastrointestinal tumors diagnosed between 1986 and 2005 by the pathology laboratory of the Tokoin university hospital in Lomé, Togo. RESULTS: There was an annual incidence of 37 gastrointestinal tumors, including 27 cancers, with twice as many tumors diagnosed in men as in women. The average age of patients diagnosed with a benign tumor was 44 years compared with 52 years for those with a malignant tumor. Stomach tumors predominated (n=306; 41.2%). Papilloma was the most frequent benign tumor type (n=100; 47.8%), while malignant tumors were mostly gastric adenocarcinoma (n=224; 42% of all cancers), esophageal squamous cell carcinoma (n=100; 19%) and colorectal adenocarcinoma (n=89; 17%). CONCLUSION: Gastrointestinal tumors are frequently seen in Togo, and an epidemiological monitoring program is needed.

[Gastrointestinal lymphomas in Togo: epidemiological and prognosis aspects]. / Lymphomes gastro-intestinaux au Togo: aspects epidemiologiques et histopronostiques.

The digestive tract is the principal site of the extranodal non Hodgkin lymphomas. The purpose of our work was to describe the epidemiology and the prognosis of gastro-intestinal lymphomas in Togo. It was about a retrospective study relating to 32 cases diagnosed in Togo during 20 years. The gastro-intestinal lymphomas are not very frequent affection in Togo accounting for 5.6% of cancers of the digestive tract and occurring at 37 years an average age with a sex-ratio H/F to 1.5. Histologically, the lymphomas of intermediate rank were most observed according to the classification of Working Formulation (62.6%), where in fact the MALT lymphomas of high rank of malignity prevailed according to the classification of Isaacson. Their preferential topography was the stomach (59%). The narrowness of our technical plate poses enormous diagnostic problems of these lymphomas.

Lymphomes gastro-intestinaux au Togo : aspects epidemiologiques et histopronostiques

Le tube digestif est le site principal des lymphomes non hodgkinien extra ganglionnaires. Le but de notre travail etait de decrire l'epidemiologie et l'histopronostic des lymphomes gastro-intestinaux au Togo. Il s'est agi d'une etude retrospective portant sur 32 cas diagnostiques au Togo pendant 20 ans. Les lymphomes gastro-intestinaux constituent une affection peu frequente au Togo representant 5;6des cancers du tube digestif et survenant a un age moyen de 37 ans avec un sex-ratio H/F a 1;5. Au plan histologique; les lymphomes de grade intermediaire etaient les plus observes suivant la classification de la Working Formulation (62;6); alors que ce sont les lymphomes de MALT de haut grade de malignite qui predominaient suivant la classification d'Isaacson. Leur topographie preferentielle etait l'estomac (59des cas). L'etroitesse du plateau technique de notre Laboratoire d'Anatomie Pathologique pose d'enormes problemes diagnostiques de ces lymphomes