Signet ring lymphoma: The import of immunohistochemistry in resolving diagnostic dilemnas

Signet ring cell lymphomas are a rare subtype of non Hodgkin lymphoma characterised by malignant lymphoid cells with cytoplasmic inclusions that displace the nucleus and imparts a “signet ring” appearance.This poses a diagnostic challenge as it can be mistaken for an adenocarcinoma or any other epithelial malignancy.A 54yr old male presented with a 6month history of generalised lymphadenopathy. Examination of excision biopsy of the lymph nodes show effacement of architecture by sheets neoplastic cells with abundant cytoplasm distended by eosinophilic amorphous substances. Immunohistochemistry with a panel of three monoclonal antibodies [LCA, CD20, and CD3] confirmed these cells to be of lymphoid origin.Keywords: Non Hodgkin Lymphoma;Signet Ring,Immunohistochemistr

The Role of Necropsy in Diagnostic Dilemmas as Seen in a Tertiary Hospital in North Central Nigeria

Background. Necropsy (autopsy) has helped medical science and law. It has given rise to numerous diagnostic surprises as it explains cause of death, pathogenesis of diseases, and circumstances of death. It also explains reasons for most therapeutic failures. In spite of its usefulness, the rate has dropped worldwide and Africa is worse hit. This work aims to highlight the role autopsy (Necropsy) plays in demystifying diagnostic dilemmas and to encourage its patronage by medical practitioners, law enforcement agents and society. Methods. This is a retrospective review of autopsy and clinical reports of cases seen by pathologists and physicians in the Jos University Teaching Hospital (JUTH), Jos, North central Nigeria. Results. A total 166 cases were studied out of which 52 had same diagnosis for both attending physician and pathologist, 106 had different diagnoses and in eight cases diagnoses remained unknown even after autopsy was performed. Conclusions. Autopsy remains an important tool for obtaining definitive diagnosis, determining cause of death to explain pathogenesis of diseases, medical auditing and a vital source of data for health statistics and planning

Persistent alveolar soft-part sarcoma with liver metastasis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Alveolar soft-part sarcomas are rare, slow-growing tumors that metastasize commonly via vascular routes to the lungs, bones, lymph nodes and brain, causing morbidity and mortality. To the best of our knowledge, this is the first case describing metastasis to the liver reported from Nigeria.</p> <p>Case presentation</p> <p>A 57-year-old man of the Urhobo ethnic group of Nigeria presented with a persistent mass in his left calf. It was initially diagnosed as soft-tissue sarcoma, and its associated systemic effects lead to his death before a histological diagnosis could be obtained.</p> <p>Conclusions</p> <p>Alveolar soft-part sarcoma with metastasis to the liver can occur in our region (northeast Africa), and a high index of suspicion is required to make an early diagnosis, followed by prompt surgical excision with clear margins in order to prevent mortality.</p

Sacrococcygeal teratoma: Clinical characteristics and long-term outcome in Nigerian children

Background/Purpose : The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Methods : Between January 1990 and May 2008 inclusive, 38 consecutive children with the diagnosis of SCT were identified from the operation register and the Cancer Registry of the Jos University Teaching Hospital. Their clinical presentation, investigation, operative findings, histology report, and outcome were recorded and analyzed. The long-term follow-up of some of the patients were also recorded and analyzed. Results : There were 31 females and 7 males. Twenty-three patients presented during the neonatal period with a median age at presentation of 7 days (range 1-18 days) and a median weight at presentation of 2.8 kg (range 2.0-3.6kg), 10 presented between 1 month and 12 months, while 5 were older than 1 year at presentation. Most of the patients had significantly external tumors. Excision of the tumor was mainly by the sacral route, four had abdominal-sacral excision. Histology was mainly benign; four were malignant at presentation. Four children with malignant disease had chemotherapy in addition to excision of the tumor. Eight had immediate post-operative wound-related complications while three children died, two of the deaths were related to anesthesia, while one died of colostomy complications. Twenty-one (60%) were followed up for a median duration of 6 years (range 1 month-8 years). Two (9.5%) had recurrent disease after primary excision; five (23.8%) had some degree of functional impairment at the follow-up. Conclusion : While SCT is usually benign, recurrence, malignant transformations in patients who present late and long-term functional sequelae are problems that must be tackled by the care givers. A multi-center study may be necessary to characterize this disease in developing countries and assess the long-term functional sequelae in survivors

Mortality In A Nigerian Teaching Hospital: Experience At Jos University Teaching Hospital (JUTH) 1995-1999

Objectives: A five year retrospective analysis of hospital death was undertaken to ascertain the pattern of mortality and trends of hospital admission. Methods: All record of death in hospital admission were record between 1995-1999. Demographic information were obtained from the patient files. The data were broken into diagnosis, age range, mean age for each group at intervals of 5years, percentage of death for each ward were determined. Result: A total of seventy thousand two hundred and twenty eight {70,228} admission was recorded under the period of study. A total of 3;980 deaths were recorded which accounted for5.7 percent of total admission .The analysis showed that medical ward recorded highest death rate {71.5%} in the hospital .in the medical ward HIV related disease account for the highest death {23.3%} following by chronic liver disease , neoplasia and cardiovascular disease which accounted for, 20.0%,19.6% and 18.2% respectively Deaths; malnutrition in paediatric ward accounted for 14.2% of hospital deaths; Malnutrition and infection accounted for highest causes of death in paediatric ward. Death in surgery and obstetric and Gynaecology accounted for 9.3 and 5 percent respectively. Conclusion: The study clearly shows that infectious disease still account for the highest mortality in our teaching hospital. The authors are of the option that the government of attention to preventive medical health care and improvement in the living condition of its citizens. Key words:-Mortality, Teaching Hospitals, jos. Highland Medical Research Journal Vol.1(2) 2002: 16-1

Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor‑2 status of breast cancers in women visiting the Jos University Teaching Hospital

Introduction: Breast cancer remains the most common malignancy in women and the leading cause of morbidity and mortality in this gender. The disease in the indigenous African woman is associated with an inherent aggressive biology and worst clinical outcome. As the malignancy is a heterogeneous entity, each case must be individually categorized for efficient therapy. Current clinical practice employs the use of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), as biomarkers to appropriately select patients that would benefit from targeted therapy against these major molecular pathways of the disease. This study aims at establishing the ER, PR, and HER2 status of breast cancer in women visiting the Jos University Teaching Hospital.Materials and Methods: All histologically confirmed cases of breast cancer at the Jos University Teaching Hospital, between January 1, 2010, and December 31, 2012, with sufficient clinical records, were subjected to immunohistochemistry for the ER, PR, and HER2 status.Results: A total of 96 cases of female breast cancers were histologically diagnosed during the period of the study. Sixty‑three (65.6%) cases met the inclusion criteria. The predominant histological type was invasive carcinoma (no special type) accounting for 54 (85.7%) cases. Scarf Bloom Richardson Grade 1, 2, and 3 for the cancer cases were: 18 (28.6%), 29 (46.0%), and 16 (25.4%), respectively. The rate of ER, PR, and HER2 positivity were 36.5%, 28.6%, and 33.3%, respectively. There were 26 (41.3%) triple‑negative cases.Conclusion: The study shows a relatively low rate of hormone‑receptor positivity, and higher HER2 positivity of breast cancers in our locality, which may be responsible for poor prognosis in our patients.Keywords: Breast, cancer, estrogen, human epidermal growth factor receptor 2, Jos, progesterone, recepto

Estimation of weight in adults from height: a novel option for a quick bedside technique

Abstract Purpose In critical care situations, there are often neither the means nor the time to weigh each patient before administering strict weight-based drugs/procedures. A convenient, quick and accurate method is a priority in such circumstances for safety and effectiveness in emergent interventions as none exists in adults while those available are complex and yet to be validated. We aimed to study the correlation and accuracy of a quick bedside method of weight estimation in adults using height. Method The technique is estimated body weight—eBW(kg) = (N − 1)100, where ‘N’ is the measured height in metres. Adult undergraduates were enrolled 10/09/2015. Their heights and weights were measured while the formula was used to obtain the estimated weight. The SPSS version 21.0, Chicago, IL, USA was utilised for data analysis. Results We analysed 122 participants aged 21–38 years with height = 1.55 m–1.95 m. The actual body weight range = 48.0 kg–91.0 kg, mean = 65.3 kg ± 9.7 kg and S.E. = 2.0 while eBW = 55 kg–95 kg, mean = 69.1 kg ± 8.4 kg and S.E. = 1.5. On BMI classes, a positive predictive value of 94.7% for the ‘normal’ category and 95.5% for ‘overweight’. Correlation coefficient at 99% confidence interval yielded (r) = + 1, (P = 0.000) while the linear regression coefficient (r 2) = + 1 at 95% confidence interval (P = 0.000). The strength of agreement/precision was established by the Bland-Altman plot at 95% ± 2 s (P = 0.000) and kappa statistic with value = 0. 618. Conclusion This unprecedented statistical characterisation of the two weight estimate measures to have a good agreement scientifically proposes the utility of our method with the formula eBW(kg) = 100(N−1) in critical care and ATLS protocol

Testicular embryonal rhabdomyosarcoma: A case report

Rhabdomyosarcoma is one of the most frequent soft tissue sarcomas in children. It is found mostly in children, primarily infants, toddlers, and pre-school pupils. However, pure testicular rhabdomyosarcoma is a very rare tumor and few cases have been reported in literature. The tumor usually presents as a painless testicular enlargement with early dissemination via the blood stream and lymphatics. The origin of this tumor is presumed to be from overgrowth of a sarcomatous area of the teratoma. Here, we present a case of testicular rhabdomyosarcoma in a 15-year-old student with a fatal outcome during chemotherapy. This is actually the first case of pure testicular rhabdomyosarcoma diagnosed in this centre after over 10 years

Sacrococcygeal teratoma: Clinical characteristics and long-term outcome in Nigerian children

Background/Purpose : The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Methods : Between January 1990 and May 2008 inclusive, 38 consecutive children with the diagnosis of SCT were identified from the operation register and the Cancer Registry of the Jos University Teaching Hospital. Their clinical presentation, investigation, operative findings, histology report, and outcome were recorded and analyzed. The long-term follow-up of some of the patients were also recorded and analyzed. Results : There were 31 females and 7 males. Twenty-three patients presented during the neonatal period with a median age at presentation of 7 days (range 1-18 days) and a median weight at presentation of 2.8 kg (range 2.0-3.6kg), 10 presented between 1 month and 12 months, while 5 were older than 1 year at presentation. Most of the patients had significantly external tumors. Excision of the tumor was mainly by the sacral route, four had abdominal-sacral excision. Histology was mainly benign; four were malignant at presentation. Four children with malignant disease had chemotherapy in addition to excision of the tumor. Eight had immediate post-operative wound-related complications while three children died, two of the deaths were related to anesthesia, while one died of colostomy complications. Twenty-one (60%) were followed up for a median duration of 6 years (range 1 month-8 years). Two (9.5%) had recurrent disease after primary excision; five (23.8%) had some degree of functional impairment at the follow-up. Conclusion : While SCT is usually benign, recurrence, malignant transformations in patients who present late and long-term functional sequelae are problems that must be tackled by the care givers. A multi-center study may be necessary to characterize this disease in developing countries and assess the long-term functional sequelae in survivors