Renal cell carcinoma in a semi-urban population of south-western Nigeria

Objective: To describe the demographic features, treatment challenges and  prognosis of renal cell carcinoma (RCC) in a semi-urban population of south-western NigeriaDesign: A retrospective review of RCC managed between January 2007 and  December 2014Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife,  southwestern NigeriaSubjects: Fifty-one patients with histologically confirmed RCC Interventions: Radical nephrectomy, ImmunotherapyMain outcome measures: Surgical outcomesResults: A total of 51 cases were reviewed, representing 46.8/100,000 of all new  patients. Age range was 21 to 83 years, with peak in third decade and male to female ratio of 1:1.5. Identified risk factors were systemic hypertension (15.7%), smoking  (11.8%) and obesity (3.9%). Triad of haematuria, loin pain and loin mass was found in 13.7% while 5.9% were discovered  incidentally. The right and left kidneys were involved in 41.2% and 58.8% respectively. Radical nephrectomy was the most  common procedure done (78.4%). Surgical complications included  excessive primary haemorrhage (8.5%), surgical site  infection (6.4%) and duodenal injury (2.1%) while mortality was (2.1%). Adjuvant immunotherapy with  sunitinib/sorafenib was given in 7.8% of patients. The histologic types were clear cell (60.8%), chromophobe (17.6%), papillary (13.7%), sarcomatoid (3.9%), mixed (1.9%) and multilocular cystic RCC (1.9%). Clear cell variant were low grade with good prognosis. Poor prognostic factors were sarcomatoid histology and late presentationConclusion: RCC is more common in females mainly of the younger age group in our environment. Radical nephrectomy remains the mainstay of management, including in advanced cases

Schistosomiasis presenting as acute appendicitis

Background: Schistosomiasis is a chronic granulomatous inflammation that affects many systems in the body including the gastrointestinal tract. This study was carried out by reviewing all cases of schistosomal appendicitis, and documents any association with acute appendicitis.Objective: To review all cases of schistosomal appendicitis and document any possible asspciation with acute appendicitis.Design: A retrospective study.Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, 1991 to 2004.Subjects: Eight hundred and three specimen of appendicectomy were reviewed. Thirty five of them were diagnosed as schistosomal appendicitis.Results: The involvement of the vermiform appendix by schistosomiasis found in 35/843 (4.2%) cases of all the appendicectomy specimen received in our histopathology laboratory between 1991 and 2004 shows that 23 of the cases (65.7%) had histologically proven acute appendicitis while the remaining 12 cases (34.3%) were schistosomiasis without active inflammation. The appendiceal wall oviposition is associated with submucosal fibrosis, narrowing of the lumen and subsequent acute suppurative inflammation in 17 cases while there were active granulomas with tissue eosinophilia in six cases.Conclusion: This finding has demonstrated that though the frequency of appendix involvement is low considering the endemicity of schistosomiasis in our environment, however acute appendicitismay be caused by schistosomiasis

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

Toxicological evaluation of the stem bark of Burkea africana hook. (Caesalpiniaceae) in wistar rats

Burkea africana Hook. (Caesalpiniaceae) is used traditionally to treat ulcers, headaches, skin disease and tumors. The study investigated the acute, sub-acute and chronic toxicity profiles of the ethanolic extract of Burkea africana stem bark. Rats of either sexes were used in this study (n=10). For  acute toxicity, a single dose of 5,000 mg/kg was administered while for the sub-acute and chronic toxicity study, three doses (40, 200 and 1000  mg/kg) of the extract were administered orally for 28 and 90 days respectively. At the end of each study, the biochemical, hematological and  histological parameters were evaluated. No mortality or behavioral changes were observed in the acute toxicity study. Extract caused significant  changes in the hematological parameters after the sub-acute toxicity study. In the chronic toxicity study, the extract caused significant increase in  the white blood cell count of the 200 mg/kg group. There was significant increase in the platelet count of treated groups compared to control in the sub-acute and chronic toxicity studies, with an observed total mortality of all the animals in the 1000 mg/kg group on the 44th day. No adverse pathology was observed in the organs examined. The extract elicited a hematological response and short term consumption of the extract at low doses might be relatively safe. However, long term consumption at high doses should be discouraged

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.  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  no significant correlation between VIA and HPV (p = 0.874) while LBC and HPV showed statistically significant correlation (p < 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