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

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

High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology

Background: The prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection. Methods: Between May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA. Results: We conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+). Conclusion: HIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting

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

Pattern of gynaecological malignancies in Jos

Context: Female cancer is a public health problem the world over. The malignancies of the female genital organs are major causes of morbidity and mortality which necessitates data for policy formulation and health planning.Objective: To document the relative frequency, age distribution and histological patterns of gynaecological malignancies seen at the Jos University Teaching Hospital (JUTH).Methodology: A retrospective 5 year review of all gynaecological malignancies seen at the JUTH. Main outcome measures: frequency, age distribution and histological patterns of gynaecological malignanciesResult: Female genital tract cancers account for 5.4% of gynaecological disorders in JUTH. The complete records of 203 out of 250 patients with gynaecological malignancies were retrieved giving a retrieval rate of 81.2%. Of these 203 case records, 152(74.9%) cases were from the uterine cervix while 31(15.3%) and 13(6.5%) cases were from the ovary and uterine corpus respectively. The vagina and vulva accounted for 3(1.4%) and 4(1.9%) cases respectively. Squamous cell carcinoma accounted for 93.4% of cervical cancers and 100% of vaginal and vulval cancers. Epithelial tumours accounted for 61% of ovarian tumours while choriocarcinoma accounted for 53.8% of cancers of the corpus uteri.Conclusion: Squamous cell cervical cancer is still the most common gynaecological malignancy in Jos. The challenges of HIV/AIDS and cervical screening need to be addressed to reduce its incidence.Keywords: Gynaecological cancers, pattern, frequency, histology, JosTrop J Obstet Gynaecol, 30 (1), April 201

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