Audit of fibroepithelial tumors of the breast in a Nigerian tertiary institution

Background and Objectives: Fibroepithelial lesions are the most common lesions of the breast seen in our laboratory consisting of fibroadenomas (FAs) and phyllodes tumors (PT). The aim of the study was to audit all fibroepithelial lesions and to reclassify all confirmed cases of PTs seen in the study period according to standard criteria.Methodology: Records and slides of fibroepithelial lesions of the breast received at the department between January 2008 and December 2013 were retrieved and reviewed by the authors.Results: Out of the 1242 fibroepithelial lesions of the breast retrieved, all but 19 were FAs. The 19 were initially reported as PT: 11 benign, 2 borderlines, 2 malignant, and 4 not classified; however, only 16 of these 19, PTs (84%) met the WHO criteria on review. The remaining 3 (16%) turned out to be FAs based on the absence of stroma overgrowth and hypercellularity. The PTs were reclassified into benign PT, borderline PT, and malignant PT accounting for 75% (12/16), 18.7% (3/16), and 6.3% (1/16), respectively. All of the PTs previously not classified turned out benign on review. One of the borderline PTs was originally reported as malignant PT. All cases initially diagnosed as FAs did not change on review.Conclusion: These results show that FAs are rarely misdiagnosed. The three cases misdiagnosed as phyllodes may have been prevented if standard data sets were in use. Cases simply referred to as PT without further classification, limit the patients’ access to appropriate management as accurate classification helps in the overall management and prognostication.Keywords: Fibroadenoma, fibroepithelial tumor audit, phyllodes tumor grad

Clinico-pathological review of malignent gastric tumours in Lagos, Nigeria.

No Abstrac

Emerging Trends in the Epidemiological Pattern of Head and Neck Cancers in Lagos, Nigeria

Background: Unfortunately, despite an increase in medical knowledge, survival rates of head and neck cancers (HNCs) have not been observed to improve greatly. This is true, especially in tumors located in obscure primary sites or late presentation. Aim: The purpose of this study is to assess the epidemiologic pattern of HNCs and to evaluate its emerging trends and patterns in Lagos state. Subjects and Methods: A retrospective study was conducted from 2003 to 2013 that analyzed histologically diagnosed cases of HNC at the Pathology Departments of  he two tertiary teaching hospitals in Lagos. Data analysis was performed using the Statistical Package for the Social Sciences (version 20) statistical software. Results: One thousand and eighty‑three cases of head and neck malignancies were recorded. A female: male ratio of 1.01:1 was reported with mean age of 39.6 (standard deviation 21.1) years. The oral cavity was the most affected anatomic site (21.2%, 230/1083) in the period under review. Malignant epithelial tumors accounted for 72% (779/1083) of cases seen. Carcinomas were the most common histological variant seen (67%, 726/1083) and squamous cell carcinoma accounted for 58% (421/726) of carcinomas recorded. Oral cavity malignancies (21.8%, 118/540) were the most common in males while thyroid malignancies (28.5%, 155/543) were the most seen in females. In children (≤15 years), the most common histologic findings were carcinomas (42.3%; 77/182) and retinoblastomas (23.6%; 43/182). Conclusion: Epithelial malignancies were the most common malignancy in the study, and the oral cavity appears to be the increasingly predominant site for HNCs. A changing pattern in gender predominance, age distribution, and frequency with  histological variants and anatomical sites was also observed in this study.Keywords: Epidemiology, Head and neck cancer, Prevalenc

Chronic invasive fungal granulomatous rhino-sinusitis: a case report with review of literature

Fungal Rhino-Sinusitis (FRS) is a relatively uncommon entity. The chronic invasive granulomatous form of FRS (FGRS) is a slowly progressive form of fungal infection characterized by chronic granulomatous process with a time course of longer than 12 weeks. The aim of this report is to draw the attention of colleagues to the clinical presentation and histopathological diagnosis of FGRS of the paranasal sinuses, as differential diagnosis in lesions of the maxillofacial region. We present a 30-year-old Nigerian undergraduate who had a four-year history of right nasal blockage. He also presented with a two-year history of proptosis of the right eye. Clinical and radiological findings were reported to be consistent with nasopharyngeal tumour. A trans-nasal biopsy was, initially, histologically, diagnosed as chronic granulomatous inflammation However, after a second opinion, at our centre, the granulomatous lesion was confirmed. Periodic Acid Schiff (PAS) and Gomori Methenamine Silver (GMS) stains showed presence of numerous septate fungal hyphae, within the giant cells and extracellularly. An assessment of FGRS was made. The patient was commenced on voriconazole, and there was a dramatic regression. Fungal infection should be considered in patients with chronic sinusitis and, if they present late with, orbital apex syndrome. If diagnosed and treated early, there is a rapid response rate. Effective collaboration between the Surgeon, Radiologist, Microbiologist and Histopathologist will ensure early diagnosis.Keywords: Invasive Fungal Granulomatous Rhino-Sinusitis, PAS, GMS, Naso-Pharyngeal Tumo

Villoglandular papillary adenocarcinoma of the cervix – Report of 2 cases and a review of literature

Villoglandular papillary adenocarcinoma (VGA) of cervix is a rare subtype of cervical adenocarcinoma frequently associated with human papillomavirus and oral contraceptives usage. It is mostly seen in younger women and it has excellent prognosis. We reported two separate cases, the first is a woman in her third trimester of pregnancy who was successfully managed by surgery and the second in another young woman with recurrent vaginal bleeding complicated by severe anemia. The first patient has localized complete excisional biopsy which confirmed diagnosis of VPA while follow up type II hysterectomy showed no residual tumour. She was discharged from the follow up clinic and was disease free 16 months after surgery. The second case presented with an advanced disease and was therefore referred for radiotherapy after the management of bleeding and anaemia. She however defaulted due to financial constraint but she is still alive at 12 months post diagnosis as at last contact with the social worker. VPA is a rare disease with excellent prognosis, occurs in younger women and canbe confused with or be a component of other variants of adenocarcinoma with poorer prognosis. Conservative treatment is advocated and once confirmed histologically, radical surgery may not be indicated even though one of our cases had such. Poverty is unfortunately a confounding factor in our environment as reflected by the second case presented.Keywords: Villoglandular, Papillary adenocarcinoma, Human papilloma virus, Oral contraceptives, Pregnanc

The combined fixed-dose antituberculous drugs alter some reproductive functions with oxidative stress involvement in wistar rats

AbstractThe reproductive toxicity of combined fixed-dose first-line antituberculosis (CFDAT) regimen was assessed in rats. Thirty-two (32) Wistar rats weighing 168.1±8.0g were divided into four groups of eight rats per group. Two groups of male and female rats were administered oral distilled water (1.6ml) and CFDAT drugs containing rifampicin, isoniazid, pyrazinamide and ethambutol (RIPE, 92.5mg/m2 per body surface area) respectively for forty-five days. Serum follicle stimulating hormone, luteinizing and testosterone were reduced significantly (p<0.05) in the treated male rats. Similarly, sperm count levels were decreased by 27.3% when compared with control. RIPE elevated serum oestrogen (p<0.05), progesterone (p<0.05) as well as prolactin (p>0.05) levels in the treated females. In addition, RIPE reduced (p<0.05) total proteins levels and increased (p<0.05, 53%) catalase levels in male but not female animals. Superoxide dismutase, glutathione-S-transferase, glutathione peroxidase, reduced glutathione levels as well as lipid peroxidation were unaltered in all rats respectively. Histopathological studies revealed congested peritesticular vessels and no changes in the ovary when compared with control. Overall, our results demonstrate reproductive toxicity potentials of RIPE in the rat, thus, suggesting that these reproductive parameters be monitored during antituberculous chemotherapy

Screening for Preneoplastic Cervical Lesions: A Comparison of Visual Inspection with Acetic Acid, Liquid-based Cytology and HPV-DNA Testing

Background: Cervical cancer is the third most common malignancy and fourth leading cause of cancer death among women.&nbsp; Persistent infection with high-risk human papillomavirus (hrHPV) particularly HPV-16 and -18 is a necessary prerequite for the development of invasive carcinoma of the cervix.Objective: To screen for cervical preneoplastic lesions among female staff of our University using Visual Inspection with Acetic acid (VIA), Liquid-Based Cytology (LBC) and Human Papillomavirus DNA testing and to compare the detection rates of the screening methods.Methods: Following informed consent, VIA, LBC smear and HPV samples were collected. Individuals with abnormal result from any of the 3 screening modalities were recalled for colposcopy (± biopsy).Results: Out of the 208 screened, 9 (4.3%) were VIA positive and 13 (6.3%) had abnormal smear. The HPV DNA testing showed 15 (7.2%) were high-risk positive, and 3 (1.4%) were high- and low-risk positive. High-risk HPV type 18 was the commonest followed by types 52 and 58, and then type 31. All theVIApositive cases had normal LBC smear result and were negative for Hr-HPV DNA. Of the13 (6.3%) cases with LBC smear abnormality, 4 were Hr-HPV positive but all were VIA negative. Amongst the 4 cases with LBC and HPVabnormality, 2 of them (both HSIL and Hr-HPV positive) had colposcopically directed biopsy confirmed at histology as CIN 3. There was&nbsp; no significant correlation between VIA and HPV (p = 0.874) while LBC and HPV showed statistically significant correlation (p &lt; 0.001)Conclusion: VIA positivity rate was 4.3%, LBC 6.3% and HPV 8.6%. Confirmatory diagnostic test via colposcopically directed biopsy was possible in 2 out of the 34 women that were recalled for follow-up. Keywords: Cervical cancer, cytology, high-risk, precancerous, screening

The agreement of point-of-care and standard laboratory electrolyte and glucose analysis in critically ill patients in a sub-Saharan tertiary teaching hospital

Background: The critically ill patient undergoes rapid changes in the internal milieu requiring quick intervention. Point of care testing has been shown to be valuable in the early diagnosis and management of such patients.Objective: This study determined the agreement between I-STAT Abbot point of care testing with standard laboratory testing in the analysis of electrolytes and glucose concentrations in critically ill patients.Methods: The study was performed in a Sub-Saharan Tertiary Teaching Hospital in critically ill patients. Electrolyte and glucose analysis were measured with ISTAT Abbot Analyzer unit with parallel blood specimens (n=30) tested in the laboratory on an ion-selective electrode, SFRI analyzer ISE 6000.Results: There was no significant difference in mean sodium, potassium, chloride and glucose between I-STAT POCT and standard laboratory measurements. The agreement between POCT and laboratory glucose was good pc = 0.967, mean difference of 0.79 and 95% limit of agreement from -3.83 to +5.107 mmol/L, p = 0.733. Bicarbonate was moderate (pc) = 0.637, mean difference of 1.95 and 95% limit of agreement from -4.294 to +0.394 mmol/L, p = 0.101. There was moderate agreement for sodium (pc) = 0.32, mean difference of 5.8 and 95% limit of agreement from -0.378 to +11.98 mmol/L, p = 0.064. Agreement for potassium was moderate (pc) = 0.439, mean difference of 0.15 and limit of agreement from -0.401 to +0.701 mmol/L, p = 0.588. There was, however, a significant difference in mean chloride, and BUN values; chloride (pc) = 0.0796, mean difference of 13.8 and 95%  limit of agreement from -7.55 to + 20.015 mmol/L. Blood urea nitrogen (pc) = 0.064, mean difference of 18.55 and 95% limit of agreement from -30.126 to +6.974 mmol/L.Conclusion: The mean sodium, potassium, glucose and bicarbonate were comparable with moderate to good agreement between I-STAT POCT and ISE 6000 Analyzer. Though, the mean BUN and chloride levels between the analytical methods differ significantly.Keywords: Point of care testing, Bland and Altman, concordance, electrolytes, IC

Errata: Histopathological analysis of salivary gland tumors over A 10-year period, Lagos University Teaching Hospital

Errata:  Histopathological Analysis of Salivary Gland Tumors OverA 10-year Period, Lagos University Teaching Hospital *Akinde OR1, Awolola NA1, Odukoya LA,1 Bamigboye B,2 Adebayo LA,1 Olawuyi AB3 and AJAYI O

Vasoformative Neoplasms in a Teaching Hospital, Sagamu, Ogun State: A Histopathological Review.

Objective: To determine the pattern of occurrence and histopathologic characteristics of vasoformative tumours in Sagamu, South- West Nigeria, over a period of four years. Design: A cross-sectional retrospective study from January 2003 to December 2006. Setting: Department of Morbid Anatomy & Histopathology of Olabisi Onabanjo University Teaching Hospital, Sagamu with efficient laboratory services. Methods: All the pathological reports and slides of submitted vasoformative tumour biopsies were retrieved and reviewed. The relevant clinical information from the case notes, histopathology registers and reports included biodata of the patients, site of the lesions, and histological types were retrieved and analyzed. Results: Vasoformative tumours constituted 1.4% of all surgical biopsies and 37.7 % of all soft tissue tumours. Among the vasoformative tumours, 90.0% were benign and 20.0% malignant tumours. The male to female sex distribution was 0.8:1 for benign tumours with slight female preponderance whilst male preponderance existed in malignant vasoformative tumours. The age of patient ranged from 11days to 60years with peak age incidence in the age group 0-10 years. The mean ages for benign and malignant neoplasms were 18.0 years and 41.5 years respectively. Haemangiomas were the predominating benign vasoformative tumours (94.4%), of which the majority is capillary haemangioma. Angiofibroma was also seen in 5.5 % cases and located in the nasopharynx. Malignant vasoformative tumours accounted for 20.0% of vasoformative tumours, of which all were angiosarcomas. However, there was no case of Kaposi , sarcoma. Head and neck region are the most vulnerable anatomic sites for both benign and malignant vasoformative tumours in 70.0% and 50.0% cases respectively. No multicentric tumours were found in this series. Conclusion: Vasoformative tumours were common soft tissue tumours of childhood in Sagamu, South –West Nigeria. Haemangiomas were the most common vasoformative tumours and they share similar characteristics with those seen elsewhere. Also, there seems to be no relationship between malignant vascular tumours and AIDS infection but further future investigations will unravel this misery.KEY WORDS: Histopathological review, Haemangioma, Angiosarcoma