Childhood teratomas in Ibadan, Nigeria.

Childhood teratomas are uncommon neoplasms worldwide. They are nonetheless important because their exact histogenesis has not yet been resolved. The weight of the evidence points to a germ cell origin for these neoplasms. Eighteen percent of 407 teratomas reviewed in the Department of Pathology, University College Hospital, Ibadan, Nigeria, between 1960 and 1985 occurred in children up to 15 years of age. There was a bimodal peak age incidence among these children, the first being due to sacrococcygeal and the second to ovarian teratomas. The female to male ratio was 5:1. The two most common sites of occurrence were the sacrococcygeal region and the ovaries. Eighty-one percent of all childhood teratomas were mature, 15% were immature, and 4% were malignant. Both malignant neoplasms arose in the sacrococcygeal region and occurred in patients relatively older than those with benign sacrococcygeal teratomas. These two malignant teratomas contained yolk sac elements.

Cryptococcal granuloma (toruloma) of the central nervous system in a patient with schistosomiasis.

A case of cryptococcal granuloma of the brain and lung is described in a Nigerian woman who also had Schistosoma haematobium infection.

Sarcoidosis in Africans: 12 cases with histological confirmation from Nigeria.

During a 2 year-period 12 Nigerians with sarcoidosis were diagnosed at the chest and dermatology clinics of the University College Hospital, Ibadan, Nigeria. Intrathoracic involvement was the commonest presentation followed by the skin, lymph nodes and liver. Histological diagnosis was obtained in all cases either from skin biopsy, transbronchial lung biopsy, lymph node or liver biopsy where applicable. This study suggests that sarcoidosis is not as rare as previous literature on the subject portrays.

Melanotic ameloblastoma (retinal anlage tumour) of the skull in a Nigerian child.

An unusually large melanotic neuroectodermal (retinal anlage) tumour of the frontal bone is described in a Nigerian child. It is the first instance of involvement of the skull by this disease seen in 20 years at the University College Hospital, Ibadan, Nigeria.

Clinicopathologic study of breast carcinoma occurring during pregnancy and lactation.

In a 16-year study of 703 cases of female breast carcinomas seen at the University College Hospital, Ibadan, Nigeria, seven cases were found in pregnant women and another seven cases in lactating women. Thus, pregnancy and lactation complicated breast carcinoma about two times per 100 female breast carcinomas. During the same period there were 51,058 deliveries, for a rate of three breast carcinomas per 10,000 deliveries. When women in the most active reproductive age group (20-40 years) were considered, there were 309 cases of female breast carcinomas. Therefore, 5% of women with breast carcinoma in this age group had concurrent pregnancy or lactation. The patients presented late, and the prognosis was generally poor. While the clinical features of inflammatory carcinoma are similar in most countries, the characteristics of some of the histologic types of breast neoplasia encountered in pregnancy and lactation in Nigerian women appear to differ from those reported in most European and American studies.

Simultaneous bilateral malignant breast neoplasms in Nigerian women.

This study reviews the clinicopathological features and survival of 18 Nigerian women with simultaneous bilateral breast cancer. Twelve (67%) of these patients had bilateral Burkitt's lymphoma of the breast. The average age of these patients was 22 years, and all of the women were pregnant or lactating at the time of initial clinical presentation. The remaining six patients (33%) had bilateral malignant epithelial neoplasms, with lobular carcinoma being present in four cases. The average age of patients with bilateral malignant epithelial tumors was 37 years. None of the 18 patients with simultaneous bilateral breast cancer survived for up to 2 years after diagnosis, indicating that bilateral synchronous breast cancer in Nigerian women is a rapidly progressive and aggressive disease.

Olfactory neuroblastoma. A case report in an African child.

The case is described of an eight-year-old Nigerian boy who died from olfactory neuroblastoma which presented with nasal obstruction and epistaxis. Autopsy showed intracranial extension of the tumour into the frontal lobe, and histology revealed undifferentiated neuroblasts, forming rosettes in some areas and producing tangled neurofibrils in others. The histogenesis of the tumour and its diagnosis are briefly discussed.

Seminoma arising in cryptorchid testes in Nigerian males.

Histological slides of seventy four patients with testicular malignancy found in the records of the cancer registry, University College Hospital, Ibadan over a thirty-five year period (1960-1994) were reviewed. Three (4%) cases occurred in undescended testes. Overall, eighteen (24.3%) patients were found to have seminomas. All the tumours seen in undescended testes (100%) were seminomas while about seventeen percent of seminomas were seen in undescended testes. There was a statistically significant difference between the mean ages of those with seminomas (37.6 years) and those with non-seminomatous testicular cancers (30.3 years); t = 1.69; p < 0.05. The numbers seen corroborate the fact that testicular cancers are not very common in this environment. The incidence of undescended testes is not established in this environment either. However, it seems that 100% of tumours arising in undescended testes are seminomas. It is recommended that abdominal testes seen after puberty should be removed and older patients presenting with abdominal masses should have a differential diagnosis of testicular cancer entertained.

Intracranial neoplasms in Ibadan, Nigeria.

OBJECTIVE: To determine the pattern of histopathological variants of intracranial neoplasms, relative distribution of the variants in the age groups and also to determine the gender differences that exist in these tumours. DESIGN: Case control study. SETTING: Department of Pathology, University College Hospital, Ibadan, Nigeria. PATIENTS: Two hundred and ten histologically confirmed cases of intracranial neoplasms seen during eleven-year period (1980 to 1990) were analysed. INTERVENTIONS: Slides of tumours stained with haematoxylin and eosin, reticulin and phosphotungstic acid haematoxylin. RESULTS: Two hundred and ten intracronial neoplasms comprising 172 primary and 48 secondary neoplasms were seen. One hundred and thirty five neoplasms occurred in adults and 75 in children. There was no gender difference, the ratio being 1:1. Gliomas accounted for the largest group of tumours followed by metastases to the brain. Of the gliomas, astrocytoma was the commonest. Craniopharyngiomas were found to be common in children. Germ cell tumours were found to be uncommon. CONCLUSION: Gliomas are the commonest group of intracranial neoplasms in both adults and children. This is followed by metastatic tumours. Tumours of the sella turcica are predominantly found in children. Involvement of the brain in disseminated Burkitt's lymphomas is predominantly found in Africans as the Burkitt's tumour is uncommon in non Africans.

Carcinoma of the oesophagus in Ibadan.

This was a retrospective analysis of 177 histologically confirmed cases of oesophageal carcinoma seen in the University College Hospital, Ibadan, Nigeria over a period of 30 years. Oesophageal carcinoma constituted 0.6 per cent of all malignant neoplasms and 1.4 cases per 1000 surgical biopsies during the study period. Dysphagia and weight loss were the most common clinical manifestations. Ninety three patients presented within one year of onset of clinical symptoms. The peak age incidence occurred in the seventh decade of life. Sex distribution was equal. The middle third of the oesophagus was the most common location of the neoplasm and the vast majority (94.5%) were squamous cell carcinomas. Achalasia of the cardia and Barrett's oesophagus were not associated with oesophageal carcinoma in this study. Regional lymph nodes and lungs were the most common sites of metastasis. Surgical complications included mediastinitis and bronchopneumonia, both occurring within seven days postoperatively. Late clinical presentation and high postoperative mortality are responsible for the persistently poor prognosis of oesophageal carcinoma despite significant advances in the diagnosis and management of these neoplasms.

Rhinosporodium: case report.

This is the first reported case of rhinosporidiosis in Ibadan, Nigeria. A review of literature shows that the patient came from northern Nigeria where the first case was reported in the country. The organism is difficult to culture and the diagnosis was based on microscopy and histological examination of the polyp. We present the case of recurrent rhinosporidiosis in a 16 year old girl a year after polypectomy in Zaria, northern Nigeria.

Pulmonary embolism in Ibadan, Nigeria: five years autopsy report.

The autopsy findings and clinical features in 60 patients with fatal pulmonary embolism (PE) in University College Hospital, Ibadan, between 1985 and 1989 are analysed in the current study. Pulmonary embolism occurred in 3,8 pc of all autopsied patients during this period. There was a male to female ratio 1,4 to one and average age was 47 years. Malignant neoplasms, infections and cardiac failure were the leading predisposing factors to PE identified. The ante-mortem clinical features consisted largely of non-specific respiratory symptoms of dyspnoea, cough, chest pain and haemoptysis. Of these patients, 15,6 pc were diagnosed ante-mortem as having PE. Pulmonary infarction occurred in 13,3 pc of the cases and was commoner in females and in patients with underlying cardiac diseases. This study emphasises the need for a high clinical index of suspicion to improve the antemortem diagnosis of this potentially fatal condition and to advocate a greater use of prophylactic anti-coagulant therapy in high risk patients.

Pulmonary metastatic malignant tumours in Ibadan, Nigeria: 10 years autopsy review.

This study reports the findings of a ten year review of autopsy records at the University College Hospital, Ibadan, Nigeria of patients who died of malignant tumour metastases to the lungs and pleurae. During the study period 1977 to 1986, a total of 3,549 autopsies were performed out of which 339 cases 10.5 pc died of malignant tumours. One hundred and thirteen of these tumours (33.3 pc) metastasised to the lungs and pleurae among other sites. Further analysis of these 113 patients showed that 49 were male and 64 females giving a male:female ratio of 1:1,3. In addition, the ages of the patients ranged between 9 months and 90 years with a mean of 38.3 years. The uterus was the commonest organ from which pulmonary metastases occurred (28.3 pc), with choriocarcinoma being the predominant historical type of uterine tumour. The liver was the next most common organ 26.5 pc with male to female ration of 3:3,1. Twenty other organs were also identified, the breast, kidney and oesophagus 7 pc each; pancreas ovary and thyroid 3 pc each being the most important. Other organs are adrenals, foot, neck, cervix and rectum--2 pc each.

A prospective study of coroner's autopsies in University College Hospital, Ibadan, Nigeria.

The present study reviews 876 consecutive coroner's autopsies performed in the Department of Pathology, University College Hospital, Ibadan over a two-year period (1 February 1991 to 31 January 1993). The hospital autopsy rate during the study period was 36.2%, and 62.5 per cent of these post-mortems were medico-legal cases. The most common indications for coroner's autopsies were sudden natural deaths (55.6%), followed by accidental deaths (35.3%). The proportions of maternal (4.3%), homicidal (3.1%) and suicidal (0.3%) deaths were much lower. The male to female ratio was 1.7 to 1. Ninety-one (10.4%) of the cases fell within the paediatric age group and the peak age incidence for these cases was in the 5-14 years age group. The remaining 785 (89.6%) cases were adults and the peak age incidence for these cases was in the fourth decade of life. The most common cause of sudden natural death was cardiovascular disease, of which hypertension constituted the majority of cases. Other major causes of sudden death included pneumonia, meningitis, typhoid fever and neoplastic diseases. Road traffic accidents accounted for 78 per cent of accidental deaths followed by falls (13.3%) and burns (4.6%). Abortions, post-partum haemorrhage and eclampsia were the major causes of maternal deaths in the present study. Homicidal deaths were eight times more frequent in male than female victims and the commonest mode of death was gunshot injuries. Suicidal deaths remain extremely uncommon in African patients, as confirmed by our study.

Gastrointestinal malignancies in a young tropical African population.

The records of 695 patients with confirmed gastroenterological malignancies over a 10 year period (January 1976-December 1985) were analysed. Of these, 264 patients (37.98%) were below the age of 40 years. Primary liver cell carcinoma was the commonest malignancy while gallbladder and oropharyngeal cancers were the least common. Most of the patients (66.3%) were in their fourth decade. The prognosis was poor as most of the patients presented late.

Retinoblastomas in Ibadan Nigeria: II--Clinicopathologic features.

Retinoblastomas are primary malignant intraocular neoplasms of childhood displaying photoreceptor differentiation. The present study reviews clinicopathological features of these neoplasms in Ibadan, Nigeria. Clinical, surgical pathology, and histological material of 44 histologically verified cases of retinoblastoma indexed in the Cancer Registry, University of Ibadan were analyzed. Retinoblastomas accounted for 1.1% of all malignant neoplasms and were equally frequent in male and female children. The mean age of our patients at the time of diagnosis was 32.3 months, which exceeds a corresponding age of 16-21.5 months recorded among Caucasian children. Leukocoria was the most common clinical manifestation. Eighteen percent of our patients had bilateral neoplasms. These patients were significantly younger than those with unilateral retinoblastomas. Flexner-Wintersteiner rosettes occurred in 61% and optic nerve involvement in 78% of the cases and the sites of predilection were regional lymph nodes, scalp, jaw, brain, skull, long bones, and gum.

Retinoblastomas in Ibadan: treatment and prognosis.

This study reviews the influence of different clinicopathological features of retinoblastoma on outcome and prognosis in 44 Nigerian patients. Twenty-five of the patients had a fatal outcome. These patients were younger and more frequently had bilateral retinoblastomas, orbital tumour recurrence and tumour metastases, compared to patients who had disease free survival. Postoperative tumour recurrence occurred in eleven patients and was commoner in patient who had tumour metastases. Tumour metastases occurred in eighteen of the patients. Though there has been an improvement in the prognosis of retinoblastoma at Ibadan with the advent of radiotherapy, the outlook for children with this neoplasm in this environment is still bleak in comparison with what obtains in developed countries.

Cancer of the male breast: analysis of forty-three cases in Ibadan, Nigeria.

Male breast cancer accounts for 0.4% of all male neoplasia in Ibadan, and about 3.4% of all breast cancers in both females and males. The clinical features often presented include mass in breast, skin involvement by fixation and ulceration, sanguinous and serous discharge from the nipple. Symptoms are often delayed, the longest duration in the current series being 36 months. Geographical comparison of the histological types of male breast cancer appears to show that, while papillary carcinoma is commoner in Nigerian than in American and Danish males, on the other hand, infiltrating duct carcinoma appears much more common in the latter than in the former male races. Invasive lobular carcinoma occurs more in Nigerian than in American and Danish males. Mucinous carcinoma, on the other hand, appears much more common in the Danish than in the Nigerian and American males. In all the compared races, prognosis in male breast cancer appears to depend on the age at onset of the disease, the histological type, and presence or absence of lymph node metastases. In Nigerian males mucinous carcinoma appears to offer an excellent prognosis compared with papillary carcinoma, which has better prognostic features in American male patients.

A review of teratomas in Ibadan.

Teratomas accounted for 3.4 cases per 1,000 surgical biopsies received in the Pathology Department of UCH Ibadan, between 1960 and 1985. The commonest site of teratomas was in the ovaries which accounted for 83.2% of the cases, followed by the sacrococcygeal region which accounted for a further 6.3%. Other sites of occurrence included the neck, testes, mediastinum, abdominal cavity and buccal cavity in descending order of frequency. Rare sites of occurrence were extracranial, intracranial, uterine cervix and intraocular regions. There was a female to male ratio of 18 to 1 and the average age of the patients was 25.8 years. Sixty per cent of ovarian and mediastinal teratomas contained hair and sebaceous material permitting their gross identification. Eighty-eight per cent of the teratomas reviewed histologically were classified as mature, a further 8% were immature, and 4% were malignant.

Cervicovaginitis emphysematosa mimicking carcinoma of the cervix: a case report.

Cervicovaginitis emphysematous is a rare self-limiting disease in which multiple gas-filled cysts are present in the submucosa of the upper vagina and ectocervix. We report a case in a 40 year-old trader who presented with clinical features suggestive of carcinoma of the cervix. It is hoped that this case report will heighten the awareness of clinicians and pathologists in the recognition of this unusual condition.