Histological Examination in Obtaining a Diagnosis in Patients with Lymphadenopathy in Lima, Peru.

The differential diagnosis for lymphadenopathy is wide and clinical presentations overlap, making obtaining an accurate diagnosis challenging. We sought to characterize the clinical and radiological characteristics, histological findings, and diagnoses for a cohort of patients with lymphadenopathy of unknown etiology. 121 Peruvian adults with lymphadenopathy underwent lymph node biopsy for microbiological and histopathological evaluation. Mean patient age was 41 years (Interquartile Range 26-52), 56% were males, and 39% were HIV positive. Patients reported fever (31%), weight loss (23%), and headache (22%); HIV infection was associated with fever (P < 0.05) and gastrointestinal symptoms (P < 0.05). Abnormalities were reported in 40% of chest X-rays (N = 101). Physicians suspected TB in 92 patients (76%), lymphoma in 19 patients (16%), and other malignancy in seven patients (5.8%). Histological diagnoses (N = 117) included tuberculosis (34%), hyperplasia (27%), lymphoma (13%), and nonlymphoma malignancy (14%). Hyperplasia was more common (P < 0.001) and lymphoma less common (P = 0.005) among HIV-positive than HIV-negative patients. There was a trend toward reduced frequency of caseous necrosis in samples from HIV-positive than HIV-negative TB patients (67 versus 93%, P = 0.055). The spectrum of diagnoses was broad, and clinical and radiological features correlated poorly with diagnosis. On the basis of clinical features, physicians over-diagnosed TB, and under-diagnosed malignancy. Although this may not be inappropriate in resource-limited settings where TB is the most frequent easily treatable cause of lymphadenopathy, diagnostic delays can be detrimental to patients with malignancy. It is important that patients with lymphadenopathy undergo a full diagnostic work-up including sampling for histological evaluation to obtain an accurate diagnosis

Benign breast lesions in an African population: A 25-year histopathological review of 1864 cases

Objective: The objective of this study was to delineate the prevalence and characterize the histologic pattern of benign breast diseases (BBDs) in the University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: A 25-year-old (1985-2009) retrospective study of all patients presenting with BBD. Results: During the 25-year-old study period, 1864 cases of BBD constituting 72.4% of all breast lesions were seen. The female to male ratio was 28.6:1. An increasing incidence of BBDs was observed. The overall mean age for BBD was 27.5 years, SD±11.3 with an age range of 9-84 years and a peak age occurrence in the third decade. The single most common lesion was fibroadenoma accounting for 43.1% of cases, followed by fibrocystic change (23.8%) with mean ages of 22.3 years and 30.2 years, respectively. Both lesions had a peak occurrence in the third decade. Other major lesions encountered were sclerosing adenosis (7.3%), atypical ductal hyperplasia (3.6%), and blunt duct adenosis (2.3%). Gynecomastia (2.1%) was the predominant lesion in males. Inflammatory lesions constituted 8.1% of cases while stromal and skin lesions accounted for 1.1% and 0.9% of cases respectively. Conclusion: BBDs constituted 70% of breast lumps and were mostly fibroadenoma and fibrocystic change. BBDs occurred predominantly in young females with a peak in the third decade. Though premalignant lesions of atypical hyperplasia were less common, biopsy of all BBDs should be done to exclude these lesions and routine mammographic screening of at risk individuals instituted to increase their detection

Pneumothorax in a 16-year-old Nigerian male with asthma

Background: Asthma is a commonly occurring disease but the combination of asthma with pneumothorax is not as common. Aim: To outline the diagnostic features and management of this disorder. Case Report: A 16-year-old male student presented with history of marked dyspnoea, tachycardia and chest findings of bilateral polyphonic rhonchi. Drugs which are used for acute severe asthma were administered. The response was not satisfactory . A chest radiograph showed left pneumothorax. A chest tube was inserted and connected to an under- water seal drainage. Conclusion: A detailed history and physical examination aided by a chest radiograph are important in patients who present with acute severe asthma to rule out possible complications, such as pneumothorax. Keywords: Acute severe asthma, Pneumothorax.Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 121-12