Schistosomal stricture of the ureter-diagnostic dilemma

Chronic schistosomiasis of the urinary tract can present with symptoms unrelated to the disease. A 33-year-old man from Edo State Nigeria presented with recurrent left flank pain. Laboratory investigations did not reveal any cause. Radiological investigation revealed a stricture of the left ureter and hydronephrosis of the left kidney. Management included surgical excision and antischistosomiasis chemotherapy. Histopathological examination of specimen of the ureter obtained after surgical exploration revealed Schistosoma heamatobium ova in the wall of the ureter

Idiopathic Pulmonary Fibrosis with Complications at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria: A Case Report

No Abstract

Pattern of childhood and adolescent malignancies at a tertiary health institution in South-east Nigeria : A ten year study

Background: Cancer remains a major cause of death in children and adolescents, and differs in adults in nature, distribution and prognosis1. A culture of case documentation is lacking in our environment and many cases go unreported.Study objectives: To document the pattern of childhood and adolescent malignancies at a tertiary health institution in south-east Nigeria over a ten year period (January 2004 to December 2013)Methodology: Details of all children and adolescents aged 18 years and below treated for malignancy were extracted from the cancer registry and the records unit of the histopathology department for the period beginning at January 2004 to December 2013 at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Information retrieved was verified against the hospital admission register, as well as the medical and histopathology records for all cancer patients over the period of interest.Results: Eighty-five cases of childhood and adolescent malignancy were treated at NAUTH, Nnewi between January 2004 and December 2013. Median age of the study population was 9years, with a range of 0.1– 18years, more males (56.50%) than females (43.50%). Commonest tumours were the Lymphomas (11.76%) comprising Non- Hodgkin’s lymphoma (80%), Hodgkin’s lymphoma (10%) and Large-cell lymphoma (10%), the Leukaemias (11.76%) comprising Acute myeloblastic leukaemia (80%) and Acute lymphoblastic leukaemia (20%). Others were Rhabdomyosarcoma (11.76%), Nephroblastoma (11.76%), Retinoblastoma (5.88%), Ovarian tumours (4.71%), the Soft tissue sarcomas-excluding rhabdomyosarcoma (3.53%) and Osteogenic sarcoma (3.35%)’.Conclusion: Study findings suggest that lymphoma, leukaemia, rhabdomyosarcoma and nephroblastoma are the commonest childhood and adolescent malignancies in south-east Nigeria.Keywords: Childhood, Adolescent, Malignanc

Lymphoreticular diseases in Nigerians

Background: The lymphoreticular system plays a major role in both the innate and adaptive immune responses. This study reviews retrospectively cases of lymphoreticular diseases seen at a tertiary institution in Nigeria. Materials and Methods: This is a retrospective study in which biopsies from the bone marrow, spleen, lymph nodes and extranodal lymphoid tissues reported within a period of 16 years were reviewed with respect to age, sex and pathological diagnosis. Statistical analysis was performed for differences in proportion using Chi square by SPSS version 12. Results: Nine hundred and forty four cases comprising 559 biopsies from lymph nodes and extranodal lymphoid tissues, 272 bone marrow biopsies and 113 spleen biopsies were studied. Non Hodgkin\'s lymphoma (NHL) and tuberculosis were the most common lesions in lymph nodes and extranodal lymphoid tissues. The axillary and cervical nodes accounted for most cases of metastasis. Breast cancer accounted for the majority of metastasis to lymph nodes. The most common pathological changes in bone marrow were NHL and reactive hyperplasia. Patients with chronic lymphocytic leukaemia (CLL) had the highest mean age, which was significantly higher than in those with NHL (p=.001, 95% confidence interval -27.91 to -7.76). The most common finding in the spleen was splenic rupture and haemoperitoneum from road traffic accident. Conclusion: NHL and tuberculosis should be high on the list of differential diagnosis of lymphadenopathy in Nigerians. Whereas trauma from RTA was the major reason for splenectomy in Nigerians, in the elderly splenic biopsy would likely show CLL. African Health Science Vol. 8 (1) 2008: pp. 20-2

Pattern of Testicular Biopies as Seen in a Tertiary Institution in Nnewi, Southeast Nigeria

Background: Testicular biopsy is an acknowledged method of examination of the testes for diagnostic and therapeutic purposes. We describe the pattern of testicular histologies in our environment. Materials and Methods: We carried out a retrospective review of testicular histology results from the Pathology Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, over a 5‑year period, January 2008 to December 2012. Results: During the period, 285 testicular histologies were reported. Eighty‑one (28.4%) specimens were pathological specimens, while 204 (71.6%) were nonpathological specimens. Thirty‑seven (13.0%) of the histology reports were for diagnostic purpose while 248 (87.0%) were for therapeutic purpose. Based on the results, indications could also be categorized into three, benign testicular pathology, malignant testicular pathology, and testicular biopsy for male factor infertility. Thirty‑seven cases (13.0%) were due to male factor infertility with complete spermatogenic arrest as the most common histological finding in 21 (56.8%) of the cases. Malignant testicular diseases accounted for 16 (5.6%) of the indications for testicular biopsies. Benign testicular diseases accounted for 28 (9.8%) of the indications for testicular biopsies. Hemorrhagic infarction from testicular torsion represented the commonest histology in 12 (42.9%) cases, followed by inflammations of the testes. Conclusion: Indications for testicular biopsy can be diagnostic and therapeutic. They can also be categorized into benign testicular diseases, malignant testicular diseases, and male infertility. Investigation for male factor infertility was the only diagnostic indication for testicular biopsy. The high incidence of locally and metastatic prostate cancer in males explains why therapeutic removal of the testis is common.Keywords: Biopsy, histology, testis

Primary Ovarian Rhabdomyosarcoma: A Case Report

Background: Ovarian cancer is the second most common female genital tract cancer in Nigeria. The prognosis is usually poor due to late presentation. Objective: The objective of this case report is to present a case of rhabdomyosarcoma of the ovaries a very rare type of malignant ovarian tumour in children. Method: This is a case report of a thirteen year old girl who presented with abdominal swelling. Ultrasound examination revealed ascitis and bilateral enlargement of both ovaries. The findings were confirmed at laparotomy. Bilateral ovariectomy was done. Histology report showed rhabdomyosarcoma of the ovaries. Post operatively the patient presented with metastatic deposits to the spine. She could not afford chemotherapy or radiotherapy and died ninety three days after presentation. Conclusion: A rare ovarian malignancy has been reported. Treatment was inadequate largely because of poverty and delay in obtaining a histology report. A plea is made for increased training of, pathologists and oncologists and for free treatment of malignancies in the third world Key Words: Rhabdomyosarcoma, ovary, child

Diagnostic accuracy of clinical breast examination for breast cancer in patients with palpable breast lump in a middle income country

Background: Breast cancer assessment using breast self-examination (BSE), clinical breast examination (CBE) and mammography are secondary measures that aid in early detection of breast cancer and better management.Objective: The aim of this study is to evaluate the sensitivity, specificity, false positive and false negative rates of clinical breast examination for palpable breast masses at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.Methodology: This is a one-year prospective study from February 2009 to January 2010. All the consecutive patients with palpable breast lesions presenting at the general surgery out-patient clinics were recruited and evaluated clinically. Biopsy was performed on all the patients (open or core needle) and histology reports obtained. Data collected were recorded in a proforma and subsequently analyzed.Results: The age range of the patients was 16-73years (mean=36.9 SD 14.5). Out of the 110 patients, 109 were females and one was male, giving a male to female ratio of 1:109. Clinical breast examination achieved true positive value of 47(42.7%); true negative value 52(47.3%); false positive and false negative values 6(5.5%) and 5(4.5%), respectively. It also achieved the following diagnostic validities: sensitivity of 90.4%; specificity 89.7%; false positive rate 11.3%; false negative rate 8.8%; positive predictive value 88.7%; negative predictive value 91.2% and overall diagnostic accuracy of 90%.Conclusion: Clinical breast examination in trained hands is a useful tool for assessing breast cancer especially in resource poor countries where mammography is still largely unavailable. We recommend this examination to all women from the age of 20years especially in people with positive family history of breast cancer.Keywords: Biopsy, false-negatives, false-positives, family history,mammograph

Cost effectiveness of fine needle aspiration cytology for breast masses

Background: Fine Needle Aspiration Cytology (FNAC) is an excellent method for diagnosing palpable lesions. It is very cost effective and saves huge amounts of money for the patients when compared with open surgical biopsy.Objective: A prospective study carried out to evaluate the cost effectiveness of FNAC for palpable breast masses at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi.Methodology: A total of 180 patients were recruited into the study. All the patients had FNAC but only 110 patients had histopathological reports and the latter were used for test of validity. The total cost for FNAC and histopathology as well as cost saving between FNAC and histopathology for the 110 patients were calculated.Result: The total cost for FNAC procedure and cytological evaluation of each smear was one thousand, seven hundred naira (N1,700.00 = US$11). The total cost for open surgical biopsy and histopathological evaluation was thirteen thousand, six hundred naira (N13,600 = US$88) per patient. It took an average of 2 days +/- SD 1 day to obtain FNAC results while, on the other hand, it took an average of 28 days +/- SD 7 days to obtain histopathological diagnosis.Conclusion: Fine Needle Aspiration Cytology (FNAC) is very cost effective and saves huge amount of money and time for the patients when compared with open surgical biopsy.Keywords: Accuracy, biopsy, cost effective, histology, safet

Diagnostic dilemma; report of a bizarre case of advanced scalp and face angiosarcoma and literature review

Jude-Kennedy C Emejulu1, Igwebuike V Onyiaorah2, Cornelius O Ukah2, Titus OG Chukwuanukwu3, Nneka JF Osuigwe1, Effiong E Akang4, Adefolarin O Malomo51Neurosurgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, PMB 5025 Nnewi, Anambra State, Nigeria; 2Department of Pathology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025 Nnewi, Anambra State, Nigeria; 3Plastic Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, PMB 5025 Nnewi, Anambra State, Nigeria; 4Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria; 5Department of Neurological Surgery, Institute of Neurological Sciences, University College Hospital, Ibadan, Oyo State, NigeriaAbstract: A 36-year-old male painter presented to our service in 2007 with an ulcerated solitary scalp swelling of 8 months’ duration. The mass was a dormant, painless, pea-sized growth, which he had had since childhood and which he bruised in a passenger motorcycle road traffic accident 8 months prior to presentation. The accident caused it to flare up and progressively increase in size, with associated pain, contact bleeding, and ulceration. A work-up for excision biopsy was proposed, but the patient defaulted and presented 2 years later with an increased number of lesions all around the scalp and face and in an obviously deteriorating clinical status with regional lymph node involvement at this stage. An incisional biopsy was then carried out and the histological reports came out with three different diagnoses of glioblastoma multiforme, poorly differentiated angiosarcoma, and squamous cell carcinoma, constituting a major diagnostic dilemma for our service.Keywords: angiosarcoma, glioblastoma multiforme, head, neck, squamous cell carcinom