The case series of functional adrenal tumors: Experience of two tertiary hospitals in Yaoundé, Cameroon.

INTRODUCTION: Adrenal tumors are often found incidentally during abdominal imaging. Functioning adrenal tumors are less frequent than these incidentalomas discovered unexpectedly. We report treatment outcomes (major complications) of 7 cases of symptomatic adrenal masses from 2009 to 2019. PRESENTATION OF THE CASES: Seven cases of functioning adrenal tumors: four adenomas presenting with Cushing's syndrome, two adrenal carcinomas, and one pheochromocytoma are described. The preoperative diagnoses were made through clinical manifestations, an increase in urinary free cortisol with normal ACTH, elevated metanephrine and enlarged masses on CT. The diagnoses were established on histopathology of adrenalectomy specimens. Adrenal insufficiency in two patients following surgery was corrected with corticoid replacement therapy. One patient died of hypovolemia the day of surgery and another from anaphylactic shock (allergy) late in the post-operative period. DISCUSSION: Pre, intra and post-operative complications from vascular instability often complicate surgery in functioning adrenal tumors. Adrenal adenomas manifest as Cushing's syndrome in 10-15 % of patients. They are the most common adrenal tumor although the diagnosis is most often coincidental to abdominal imaging. The incidence of adrenal adenoma increases with age, up to 7 % in the seventh decade. Laparoscopic adrenalectomy, which was not available in our hospitals then, is standard treatment for most tumors. It is alleged to have better outcomes in trained and tested hands. CONCLUSION: Surgery of functioning adrenal tumors demands close collaboration of multiple clinical disciplines to manage vascular instability and adrenal insufficiency, especially in resource strapped communities.

First steps of laparoscopic surgery in a sub-Saharan African setting: a nine-month review at the Douala Gynaeco-Obstetric and Pediatric Hospital (Cameroon).

OBJECTIVES: To describe the first laparoscopic surgeries in a tertiary hospital in Cameroon. METHODS: We carried out a descriptive study at the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH). We examined the files of the 45 patients who underwent laparoscopic surgery from November 1, 2015 to July 31, 2016. Descriptive statistics were computed for patients' characteristics and surgical parameters. RESULTS: Mean (SD) age was 36.8(11.9) years. Women made up 86.7% of the sample. Twelve patients (26.7%) had a previous laparotomy. Cash deposit (86.7%) was the main mode of payment. Thirty-two (71.1%) laparoscopies were gynaeco-obstetrical (GO) and 13 (28.9%) were digestive. Main indications were infertility (59.4%) and chronic cholecystitis (30.8%) for GO and digestive laparoscopies respectively. Mean (SD) durations were 89.1(57.5) and 55.5(41.0) minutes for digestive and GO laparoscopies respectively. Mean (SD) costs were 1065.4 (406.1) and 934.2 (657.0) USD for digestive and GO laparoscopies respectively. Mean (SD) lengths of hospital stays were 5.5 (2.5) and 5.5 (2.5) days for digestive and GO laparoscopies respectively. Local staff carried out all GO laparoscopies while foreign (Belgian) experts did digestive cases. Only one (2.2%) complication (colic perforation) was registered. CONCLUSION: The beginnings of laparoscopy at the DGOPH were successful thanks to strong local leadership and Belgian technical assistance.

Risk factors and placental histopathological findings of term born low birth weight neonates.

INTRODUCTION: Low birth weight (LBW) is associated with increased neonatal morbidity and mortality. Hence, this condition should be well studied. The aims of this study were to identify the risk factors for term born LBW, as well as the placental histopathological lesions observed. METHODS: This case control study was carried out in the University Teaching Hospital and the Central Maternity, both of Yaoundé, Cameroon, from November 1st, 2013 to April 30th, 2014. Maternal medical records and placentas of term born (≥37 completed weeks) LBW (<2500 g at birth) or normal weight (3000-3500 g) were compared. The main variables recorded included maternal age and parity, maternal height, complications that occurred during pregnancy, maternal pre-gestational body mass index, the number of antenatal visits, the sex and birth weight of the newborn, the umbilical cord length, the placental weight and placental histology. Data were analyzed using Epi info 3.5.4. Fisher exact test, t-test and logistic regression were used for comparison. P < 0.05 was considered statistically significant. RESULTS: and DISCUSSION: A total of 30 cases of LBW and the same number of controls were examined. Significant risk factors for LBW were primiparity (aOR 14.0, 95%CI 2.1-92.7), hypertensive diseases of pregnancy (aOR 18.1, 95%CI 1.02-322.5) and <4 antenatal visits (aOR 9.5, 95%CI 1.3-67.5). Significant placental lesions were placental infarction (aOR 19.5, 95%CI 2.9-130.1) and chronic villitis (aOR 35.9, 95%CI 1.2-1034.3). Our study showed that primiparous women, those with pregnancy-induced hypertensive diseases and those with <4 antenatal visits were more at risk for LBW. Significant placental lesions observed among LBW were placental infarcts and chronic villitis. Since LBW has the tendency to recur, and given that some causes such as placental infarcts are preventable, we recommend that a histological examination of the placenta should always be carried out in cases of LBW.

[Sacrococcygeal teratoma of delayed diagnosis: clinical and radiological features of two cases and therapeutic considerations]. / Teratome sacro-coccygien vu tard: aspects cliniques, radiologiques et therapeutique a propos de deux cas.

The sacrococcygeal teratoma is a rare congenital embryonal tumor with high potential for malignant transformation and therefore considered as a neonate surgical emergency. The authors report two cases of sacrococcygeal teratomas with late diagnosis and treatment. The first case was a degenerated sacrococcygeal teratoma revealed by paraplegia in a 17-month-old infant with multiple metastasis and fatal outcome. The second case was a 14-month-old infant with a benign infected form of sacrococcygeal teratoma, successfully treated surgically. The authors highlight the diagnostic difficulties still existing in the tropical environment, and recall the need for a prenatal diagnosis and early treatment.

Le tératome sacro-coccygien est une tumeur embryonnaire congénitale rare à fort potentiel de transformation maligne et donc considéré comme une urgence chirurgicale néonatale. Les auteurs rapportent deux cas de tératomes sacro coccygiens, de diagnostic et de prise en charge tardifs. Dans le premier cas, il s'agissait d'un tératome sacro-coccygien dégénéré révélé par une paraplégie chez un nourrisson de 17 mois avec de multiples localisations secondaires et une évolution fatale. Le deuxième cas concernait un nourrisson de 14 mois avec une forme bénigne surinfectée traitée chirurgicalement avec succès. Les auteurs mettent en relief les difficultés diagnostiques encore existant en milieu tropical, et rappellent la nécessité d'un diagnostic anténatal et d'une prise en charge précoce.

Phénotypes de résistance des souches d'escherichia coli responsables des infections urinaires communautaires dans la ville de Yaoundé (Cameroun)

Introduction. L'objectif etait de rechercher les phenotypes de resistance des souches d'Escherichia coli (E. coli) dans les infections urinaires a Yaounde. Methodologie. Il s'agissait d'une etude prospective realisee de juin a decembre 2012. Les souches collectees dans quelques laboratoires ont ete identifiees par la galerie API 20E ; l'antibiogramme a ete realise par la methode des disques selon le CA-SFM 2012. La cytologie urinaire a ete effectuee par coloration de Papanicolaou. Resultats. Au total 103 souches d'E. coli ont ete isolees sur une cytologie urinaire avec des cellules transitionnelles reactives. L'antibiogramme a revele un haut niveau de resistance aux penicillines 76%-93;2% et inhibiteurs; cefalotine 60% et cefotaxime 69;9%. L'imipeneme a ete active sur toutes les souches. Les phenotypes de haut niveau de resistance etaient frequents chez les sujets de plus de 60 ans. Conclusion. Les phenotypes de resistance des souches d'E. coli ont ete frequemment retrouves dans la communaute

[Performance of users in tropical areas with the BI-RADS classification of breast lesions for predicting malignancy]. / Fiabilité des utilisateurs de la classification BI-RADS en milieu tropical pour la prédiction de la malignité des lésions mammaires.

OBJECTIVES: To evaluate the diagnostic performance of radiologists in Cameroon using the BI-RADS classification to interpret mammograms and ultrasound scans together for the prediction of malignant breast lesions. METHODS: This cross-sectional study took place at the Women's and Children's Hospital in Yaounde from July 2009 to April 2010 and included 211 women with breast lesions identified on mammograms during a breast screening campaign and subsequently assessed with ultrasonography and histology. The BI-RADS classifications of these lesions were compared to the corresponding histology results to evaluate the accuracy of predictions of malignancy from the mammograms and ultrasound scans interpreted with the BI-RADS system. The rate of malignancy in each ACR-classified category was also compared to the standard ACR categories as stipulated in the ACR classification. RESULTS: In all, 339 women aged from 16 to 78 years were screened, and lesions requiring biopsies were identified for 211. The age group included most often was the 41-50 year-old group (n = 98, 46.4%). Overall, 135 (64%) women had benign lesions and 76 (36%) malignant. Invasive carcinoma was found in 49 (65%) of the malignant lesions, in situ intraductal carcinoma in 23 (30%), and sarcoma in 4 (5%). Based on the BI-RADS classification, 124 (58.7%) breast lesions were classified as ACR2, 15 (7.1%) as ACR3, 44 (20.8%) as ACR4, and 28 (13.3%) as ACR5. Comparison of the BI-RADS classification and the histological findings showed that 19% of ACR2-classified lesions were malignant, 13% of those classified ACR3, 66% ACR4, and 75% ACR5. The global accuracy in the prediction of malignancy the BI-RADS classification was 77.3%. CONCLUSION: The accuracy of the radiologists using the BI-RADS classification in our hospital was good at 77.3%, although shortcomings in the evaluation and interpretation of some lesions resulted in a relatively high prevalence of malignant lesions in categories ACR2 and ACR3.

Les lymphangiomes : etude retrospective de 12 cas a Yaounde (Cameroun)

Objectif : Rechercher les donnees preliminaires sur les lymphangiomes au Cameroun; leurs topographies ainsi que leurs formes histologiques dans le but d'ameliorer le diagnostic et les modalitestherapeutiques de ces lesions. Materiel et methode : Il s'agit d'une etude retrospective; observationnelle et descriptive.Les patients ayant presente des lymphangiomes documentes par un rapport anatomopathologique ont ete recrutes consecutivement dans tous les laboratoires d'anatomie pathologique du Cameroun sur une periode de 06 ans; de 2004 a 2009. Les coupes histologiques colorees a l' hematoxyline-eosine ont ete revues pour confirmation diagnostique de differents types. Resultats : Douze cas ont ete recrutes. La moitie de ces cas provenait des malades originaires de la region de l'ouest du Cameroun. Le lymphangiome touchait le plus souvent l'enfant age de 1 a 5 ans avec predominance du type hygrome kystique. Les localisations les plus courantes etaient axillaires; cervicales et viscerales. Conclusion : Le lymphangiome constitueun desdiagnostics differentiels important de toute masse survenant chez les patients; en particulier chez les enfants ages de 1 a 5 ans.L'anatomie pathologique est d'une aide dans le diagnostic et la typisation

Tumeur a cellules granuleuses (tumeur d'Abrikossof) du clitoris

Les auteurs rapportent un cas rare de tumeur a cellules granuleuses du clitoris chez une patiente agee de 38 ans et font une breve revue de la litterature

The attitude and knowledge of cervical cancer by Cameroonian women; a clinical survey conducted in Maroua, the capital of Far North Province of Cameroon.

This study was conducted to assess the knowledge, attitudes, and assumption of cervical cancer by women living in Maroua, the capital of the Far North Province of Cameroon. In a 1-month period, 171 women were surveyed as to their socioeconomic status, sexual habits, prior knowledge of cervical cancer, its prevention, and their attitudes toward cervical cancer. Of 171 women, 48 (28%) had prior knowledge of cervical cancer; they were classified as the "aware group" compared with 123 of 171 (72%) women who were uninformed about cervical cancer and they were classified as the "unaware group" (UG). The UG of women tended to be single mothers, illiterate, housewives, and had their first child before the age of 20 (P < 0.005). Despite the awareness of cervical cancer by 28% of women, only a minority of them, 4 of 48 (8.3%), underwent a preventative screening test. Only 71 of 171 (41.5%) women stated that they would be having a screening test in the future. The awareness of cervical cancer by women in Cameroon is still inadequate. Thus, to avoid deaths from cervical cancer, a curable and preventable disease, the need of an aggressive campaign to make Cameroonian women aware of cervical cancer and its prevention is needed.

Bone tumours in Cameroon: incidence, demography and histopathology.

A multicentre analysis was carried out on bone tumours in Cameroon during a 10-year period. Registers and patient records of five pathology laboratories were consulted, and all patients with a histological report of a bone tumour were included in the study. A total of 268 bone tumours were studied and the average incidence was 27 tumours a year, or two per one million inhabitants. Of these tumours 48% were benign, 45% were primary bone cancers and only 6% were metastatic disease. Among the primary malignant bone tumours, osteosarcoma was the most frequent (39%), followed by non-Hodgkin's primary bone lymphoma, fibrosarcoma, chondrosarcoma, and Ewing's sarcoma. Primary site of the metastatic bone tumours was prostatic adenocarcinoma, breast cancer, hepatocarcinoma and thyroid cancer. In Cameroon many bone tumours are not diagnosed due to lack of medical facilities and little awareness among our medical staff. It is likely that the real incidence is at least ten times higher than that shown in our report.

[Risks of diagnostic errors in pathology research of post-abortion herpetic endometritis: limitations of immunohistochemistry in situ hybridization]. / Risques d'erreurs diagnostiques dans la recherche anatomo-pathologique de l'endométrite herpétique post-abortum : limites de l'immunohistochimie et de l'hybridation in situ.

Endometrial Herpes-simplex infection is rare. Less than 10 cases have been reported. The impact of herpetic endometritis and abortion is not known, because of the scarcity of clinical and histological data. We present and discuss two cases of abortion with microscopic intranuclear inclusion of biotin, suggestive of herpetic endometritis. These inclusions were positively marked on immunohistochemistry, using anti-herpes antibodies. Similar results were obtained with in situ hybridization using biotin labeled probes (commonly used in some laboratories). But the normal accumulation of biotin in the endometrial cells of pregnant women diminishes the value of such results in gestational material. In fact the interaction between intranuclear endogenous biotin and the avidin-biotin-peroxidase complex may explain the positive controls, performed without anti-herpes antibodies. The biotin labeled probes may also explain the positive results of in situ hybridization. We strongly support the opinion that in pregnant women, the diagnosis of herpetic endometritis needs methodological precautions to avoid pitfall caused by endogenous biotin.

Mandibular osteosarcoma with unusual expression of alpha-actin smooth muscle antibody.

Mandibular osteosarcoma is a rare neoplasm, appearing in young adults as a mass often accompanied by pain, occasionally with paraesthesias, gingival haemorrhages and mobility of teeth, and rarely with ulceration of the skin or mucosa. Roentgenological lytic and/or sclerotic findings are non-specific. Some patients have a previous history of Paget's disease, antecedent radiation treatment, or fibrous dysplasia. Malignant osteoid production can be minimal, resulting in diagnostic difficulties. We report a case of a 33 year-old woman, who, in the absence of a clinical soil associated with the condition, was presented with advanced disease. Immunohistochemical study using alpha-actin smooth muscle antibody disclosed bizarre tumor cells with "dendritic" appearance, to our knowledge, never described thus far. This report draws attention to this uncommon neoplasm and reviews the pertinent literature related to this entity.

Multiloculated epidermoid cyst of the liver.

Epidermoid cysts of the liver are extremely rare and have been described in both children and adults. Their etiology remains an enigma, and several theories have been suggested as to their origin. Due to their possible malignant potential, early detection and resection are mandatory whether the cysts are unilocular or multilocular.