Hodgkin lymphoma: Clinicopathologic features in Benin City, Nigeria and update on its biology and classification

Objective: To review the age incidence, common pathohistologic subtypes, and anatomical nodal sites of lymph nodes involvement for histology.Materials and Methods: A 25 (May 1985-June 2010) years retrospective study of all patients who had lymph node biopsy.Setting: Department of Pathology and Haematology, University of Benin Teaching Hospital, Benin City, Nigeria.Results: Of 821 lymph node biopsies encountered, 56 (6.8%) cases biopsied were for Hodgkin lymphoma (HL). There was a bimodal peak incidence of age interval of 11-15 years and 21-25 years and the relationship between the age and sex distribution was statistically significant (P = 0.03). The overall median age was 23 years with a mean age of 25.6 ± 2.0 (SEM). Pathological re-appraisal of these 56 cases in the study indicates that mixed cellularity HL constituting 36 cases (64.3%) was the predominant subtype. This was followed by lymphocyte depleted HL with a total of 11 cases (19.6%). The major site of lymph node involvement where biopsy was taken for histological diagnosis was the cervical group of lymph nodes constituting 78.6%. Staging classification of the disease indicates low frequency of early stage disease (I-II) with 19 cases (33.9%) and high frequency of late stage (III-IV) with 37 cases (66.1%).Conclusion: Patients are predominantly males, children and young adults presenting with cervical lymphadenopathy at late stage of the disease, and a dominance of mixed cellularity and lymphocyte depleted histological subtypes were observed

Diagnostic evaluation of primary cervical adenopathies in a developing country

pectively. Hodgkin's lymphoma occurred most commonly in young male adults. Metastatic tumours constituted 80 (22.4%) cases and was the predominant cause of cervical lymphadenopathy above the age of 45 years. Non specific reactive lymphadenitis constituted 56 (15.7%) cases. CONCLUSION: Chronic lymphadenopathy in our environment has a high incidence of tuberculosis. We recommend urgent lymph node biopsy in significantly enlarged nodes not responding to treatment

Immunohistochemical detection of Her-2/neu overexpression in breast carcinoma in Nigerians: A 5-year retrospective study

Objective: To determine the pattern of Her-2/neu status among breast carcinoma in the University of Benin Teaching Hospital, Benin City, Nigeria.Materials and Methods: Immunohistochemical staining for Her-2/neu was performed on 10% formalin-fixed, paraffinembedded primary carcinoma of the breast from 83 patients, between 2003 and 2007 using anti-Her-2/neu rabbit polyclonal antibody (DakoCytomation, CA, USA) and reactivity detected by an avidin-biotin immunoperoxidase method. The clinicopathologic parameters analyzed were patients’ age, histological types, and tumor grade. The Her-2/neu Dako scoring system was used.Results: During the 5-year period, 83 histologically confirmed cases of invasive breast carcinoma were assessed for Her-2/neu status. These included 67 (80.7%) cases of invasive ductal carcinoma, nine cases of invasive lobular carcinoma (10.8%), three cases of medullary carcinoma (3.6%), two cases of papillary carcinoma (2.4%), and a case each of mucinous and clear cell carcinoma (1.2%). Mean age of patients was 48.9 ± 13.6 years with an age range of 25 to 83 years. Only nine (10.8%) cases showed immunopositivity for Her-2/neu. Seven of these were cases of invasive ductal carcinoma, while two were invasive lobular carcinoma. Tumors were predominantly high grade with grade III, II, and I accounting for 42, 28, and 13 cases, respectively. There was no significant correlation between patient age, the various histological types, tumor grade, and Her-2/neu positivity.Conclusions: This study indicates that Her-2/neu may not be useful in defining the prognosis of breast cancer in this environment. Nevertheless, it highlights the need for routine immunostaining for Her-2/neu before institution of trastuzumab (Herceptin) therapy

The Epidemiological features of lymphoid malignancies in Benin City, Nigeria: a 15 years study

Introduction: Lymphoid malignancies compose a wide spectrum of different morphologic and clinical syndromes known to vary widely throughout the world. The purpose of this study is to determine the prevalence and time trends of lymphoid malignancies. Methods: A 15 (May 1st 1996-April 30th 2010) years study of all patients who had lymph node biopsy at the Department of Haematology and Pathology, University of Benin Teaching Hospital, Benin City, Nigeria. Results: The 391 patients had a male preponderance (M:F; 1.6:1). An increase in the lymphoid malignant cases was noted from 95 cases in the first 5-year interval (1996-2000) to 179 cases in the last 5-year interval (2006-2010) giving an average increase of 84.0%. Non-Hodgkins lymphoma (61.1%) and chronic lymphocytic leukaemia (18.2%) were the most frequent followed by Hodgkin’s lymphoma and myeloma with equal proportions of 9.0% each. A positive correlation with a significant linear trends was obtained (r=0.1949, p<0.0001). Geographic areas at risk were found mainly in patients residing in Delta State (67.0%) which is a major oil producing state and Edo State (30.4%) where the hospital is located, both in the Niger Delta Region of Nigeria. Conclusion: Future research into environmental agents and genetic makeup/HLA typing of patients can be carried out

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

Head And Neck Rhabdomyosacroma In Childhood: An Immunohistochemical Study

Background: Rhabdomyosarcoma may be histologically indistinguishable from other undifferentiated childhood tumours occurring in the head and neck region on routine heamatoxylin and eosin staining. Aim: aimed at assessing the usefulness of employing immunohistochemistry, as an adjunct to routine H&E staining, in the histogenetic diagnosis of childhood rhabdomyosarcoma. Methodology: This was a 5-year retrospective study of twelve cases of childhood head and neck rhabdomyosarcoma at the Department of Pathology, University College Hospital, Ibadan, Nigeria. Antibodies used included antibodies to desmin, myoglobin, leukocyte-common-antigen (LCA), vimentin, cytokeratin, neuron-specific-enolase(NSE), neurofilament and retinal-S-antigen. Results: A change was made in the diagnosis of 4(33.3%) cases. Of these 4 cases, 3(25%) cases showed immunoreactivity for LCA and were designated lymphoma. The 4th case co-expressed NSE and retinal-S-antigen and was therefore diagnosed as retinoblastoma. The average survival of patients with final immunohistochemical diagnosis of rhabdomyosarcoma was 43.8 months while patients with changed diagnosis had an average survival of 7.5 months. Conclusion: Immunohistochemistry should be made available for the routine diagnosis of these undifferentiated tumours in reference laboratories in developing countries. Keywords: Childhood; Rhabdomyosarcoma; Immunohistochemistry Sahel Medical Journal Vol. 11 (3) 2008: pp. 88-9

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.Key words: Benign breast disease, benign breast lesion in Africans, fibroadenoma and fibrocystic change in an African populatio

Histopathological study of thyroid cancer in a Nigerian tertiary hospital

No Abstract

A ten year histopathological review of breast lumps in a tertiary health institution in Nigeria.

The aim of this work was to evaluate retrospectively the prevalence of various breast lesions in women living in Benin City and environs and to determine the common age of onset of different lesions. The pathology reports and charts of all patients who had breast masses excised in the University of Benin Teaching hospital between January 2001 and December 2010 were reviewed. One thousand four hundred and fifty-three (1453) breast lesions were analysed out of which 38 (2.6%) were from males while 1415 (97.4%) were from females giving a male to female ratio of 1:37. There were 1002 (69%) benign lesions and 451 (31%) malignant lesions (ratio 2:1). For the female breast, benign lesions were 971 (68.6%) while malignant lesions constituted 444 (31.4%), whereas in the males (n=31), 81.6% of breast lesions were benign leaving only (n=7) 18.4% as malignant. Of all the Benign lesions, fibroadenoma was the most frequent, constituting 359 (37%) followed by fibrocystic change disease which accounted for 238 (24.5%). Fibroadenoma had a mean age of 22.3 (SD = 5.5) years. This was followed closely by invasive ductal carcinoma with a mean age of 48.2 (SD = 4.1) years. Fibrocystic change disease occurred in women with a mean age of 30 (SD = 3.5) years, whereas sclerosing adenosis was found to occur most commonly in women with a mean age of 27.1 (SD =5.5). The most common age of occurrence of fibrous disease of the breast was 31.3 (SD = 5.4). Only 38 breast lesions were seen in the male with gynaecomastia constituting the majority, 30 (79.0%) and invasive ductal carcinoma making up 15.8%. The mean ages for gynaecomastia and invasive ductal carcinoma in the male breast were 42.0 (SD = 9.1) and 56.7 (SD = 7.3) years respectively. Fibroadenoma still remains the most common benign breast lesion in female while gynaecomastia is the commonest benign breast lesion in males. Breast Cancer tends to occur at significantly higher age in males than in females. The age ranges of both male and female breast cancer patients need to be considered in setting up breast cancer screening programme

Incidence of breast cancer in HIV-infected women seen at the University of Benin teaching hospital

Breast cancer and HIV/AIDS are two major issues in women&rsquo;s health at the beginning of the second decade of the 21ST century. Both conditions affect predominantly premenopausal women in Nigeria and sub-Saharan Africa. Literature on breast cancer in women with HIV are still few and most of them are case reports based on experience with 1-5 cases. No clear association has been established between breast cancer and HIV/AIDS. This study focused on the incidence of breast cancer among HIV infected patients. The incidence was 1 in 136 HIV patients. This portrays a deficit of breast cancer incidence/registration among HIV patients. Epidemiological and biological basis for this deficit have been proffered while further data collection and analysis are being undertaken