A Fifteen-year Review of Lymphomas in a Nigerian Tertiary Healthcare Centre

In Africa, epidemiological data on the effect of the HIV epidemic on the occurrence of lymphomas are scanty. The 1990s witnessed the alarming rates of HIV/AIDS in Nigeria. The prevalence of HIV/AIDS in Nigeria increased from 1.8% in 1991 to 4.4% in 2005. The aim of this study was to determine whether there have been any changes in the frequency and pattern of lymphomas in view of the HIV/AIDS epidemic in the country. This is a retrospective study of all lymphoma cases diagnosed during 1991-2005. The prevalence of lymphomas declined from 1.4% to 0.7% of surgical biopsies during 1991-2005. There was a decline in the proportion of high-grade non-Hodgkin lymphoma and Burkitt's lymphoma from 79.1% and 45.8% respectively to 21.1% and 13.6% respectively. There is a suggestion that the HIV/AIDS epidemic in the country may not have influenced the pattern of occurrence of both major histomorphological types of lymphoma in Ibadan

Adult granulosa cell tumor associated with endometrial carcinoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>If strict criteria for the diagnosis of carcinoma are used and all patients with granulosa cell tumors are considered, the best estimate of the incidence of associated endometrial carcinomas is under 5%. In patients with granulosa cell tumors, estrogen-dependent endometrial cancers are rarely found, and most of these endometrial cancers are well-differentiated endometrioid adenocarcinomas that carry a good prognosis when detected early.</p> <p>Case presentation</p> <p>We report the case of a 65-year-old post-menopausal Nigerian woman of the Igbo tribe with an adult granulosa cell tumor that was initially treated as endometrial carcinoma. She underwent a total abdominal hysterectomy and a bilateral salpingo-oophorectomy after histopathologic confirmation of a well-differentiated granulosa cell tumor of the ovary and a nuclear grade 1 adenocarcinoma of the endometrium (International Federation of Obstetricians and Gynecologists stage 1B). She had a good post-operative recovery and was discharged 10 days after treatment.</p> <p>Conclusion</p> <p>The association between adult granulosa cell tumors of the ovary and endometrial carcinomas is rare. A high index of suspicion as well as good imaging and histopathologic analyses are important in making this diagnosis.</p

Issuing and appropriate completion of medical certification of cause-of-death forms by physicians at a tertiary teaching hospital in Nigeria

Background: Medical certificates of cause-of-death are essential public health documents needed in proof of death, crime prevention, health planning, setting of priorities, monitoring of the health of the population, outcome review studies and others. When cause-of-death forms are filled out erroneously, they provide misleading and inaccurate information; and thus not useful in cause-of-death statistics.Objective: This retrospective study was to answer the following questions: how frequent is death certificates issued for deaths occurring at a tertiary hospital in Nigeria, and are death certificate forms completed correctly by physicians?Methods: All deaths occurring at the hospital over a 5-year-period were stratified by ward and sex. Errors in death certificate’s completion were grouped into 4 categories according to the classification system adopted by Tsung-Hsueh Lu et al. We also extracted other information such as decedents’ ages and qualifications of the certifiers from the reviewed forms.Results: A total of 5,392 deaths were recorded, 53.3% of whom were males; only 350 (6.5%) death certificates were issued - 299 (85.4%) in males and 51 (14.6%) in females - out of which only 125 (35.7%) were completed correctly as regards the section on cause of death. Less than 1% of these certificates were issued in decedents less than 20 years of age. The most common type of error was Minor Error, 2 (41.3%). A total of 321 (91.7%) of the certifiers included their qualifications in the forms. Consultants in charge of the cases directly completed the cause-of-death forms in only 3.1% of the cases. Also, very insignificant proportion (0.6%) of the certificates was issued following autopsies.Conclusion: Death certification forms are not routinely issued by physicians; more than half of the issued certificates completed by both the lowest and highest echelons of medical professionals contained no useful information for epidemiological studies. Thus, there is a strong reason for a continuous medical education on the need for a vigorous and systematic documentation of causes of deaths in Nigeria.Keywords: Death, Certificate, Request, Accuracy, Clinicians, Hospital-base

Cancer incidence in south-east Nigeria: a report from Nnewi Cancer Registry

Background: This study is the first population based cancer incidence report from a cancer registry in south-east Nigeria.Objective: To evaluate the incidence of some invasive cancers in southeast Nigeria.Methodology: We collected all new cases of invasive cancers between 1st January and 31st December, 2013. We computed the age standardized incidence rate (ASRs) for all invasive cancers in men and women: prostate, breast, and cervical cancers; the mean age at diagnosis and the standard deviations of the means. The denominator population data used was that of the 2006 census conducted by the National Population Commission. We reported our results by gender and in 5 year age classes. We calculated the age-specific incidence rates per 100 000 per annum and age-standardized incidence rates per 100 000 per annum using the world standard population.Results: We recorded a total of 722 new cases of invasive cancers, 43.8% in males and 56.2% in females. The mean age for the males was 58.9 ± 19.2 years while that of females was 53.1 ±14.7years. The five most common new cases of cancers in both males and females were cancers of breast (23.4%), prostate (15.1%), cervix (10.1%), colorectum (8.2%), and liver (6.7%).Conclusion: We observed that the typical profile of incidence of the invasive cancers in southeast Nigeria is similar to those observed in the other zones in Nigeria earlier studied as well as those in the other parts of the world.Keywords: Breast Cancer, Prostate Cancer, Cervical Cancer, Nigeri

The clinical effectiveness of fine needle aspiration biopsy in patients with palpable breast lesions seen at the University College Hospital, Ibadan, Nigeria: A 10-year retrospective study

Background: Although open surgical biopsy is the ′gold standard′ for diagnosis of palpable breast lesions, in recent years two types of minimally invasive breast biopsy techniques, core needle biopsy and fine needle aspiration biopsy (FNAB), have become established for the diagnostic evaluation of palpable breast lesions. Aims: This study was undertaken to evaluate the clinical effectiveness of FNAB as a first line diagnostic procedure in the management of patients with breast lumps in University College Hospital (UCH), Ibadan, using the suggested thresholds for cytology performance as recommended by the United Kingdom National Health Services Breast Screening Programme (NHSBSP). Settings and Design: A 10-year retrospective cohort study carried out in the Pathology Department of UCH. Materials and Methods: All FNAB and histologically diagnosed cases of breast lesions in the pathology department between January 1996 and December 2005 were reviewed. The cytological diagnoses were then categorized into one of five diagnostic categories in accordance with the recommendations of the NHSBSP. Results: The positive predictive value for malignancy was 99.3% with a complete sensitivity of 97.7% and specificity (full) of 94.2%. Conclusions: The high quality assurance measures obtained in this study affirms FNAB as a clinically effective diagnostic procedure for breast lesions

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&apos;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

Histologically diagnosed cases of nasopharyngeal carcinoma in two Nigerian children within one year period: case reports and review of literature

Background: Nasopharyngeal carcinoma is a rare tumour arising from epithelium of the nasopharynx. It constitutes only 1-5% of all cancers. In Nigeria, it represents 1.7-2% of all cancers with a prevalence rate of 4/100,000. The incidence of nasopharyngeal carcinoma in children is even rarer, accounting for less than 1% of all childhood malignancies. Ten to twenty percent of nasopharyngeal carcinoma in Nigeria occurs in children.Aim: To increase the index of suspicion of clinicians to this disease in children for prompt diagnosis and management.Case Reports: The patients were 8 and 16 year-old Nigerian males who presented with painless neck swelling at the paediatric clinic of a tertiary hospital in south eastern Nigeria. Both were misdiagnosed and managed for tuberculous lymphadenitis until a histological diagnosis suggested nasopharyngeal carcinoma. They were referred to a paediatric oncologist at a premier tertiary hospital for further management, following confirmation by otorhinolaryngologists.Conclusion: Though rare, nasopharyngeal carcinoma should be included as a differential in children presenting with cervical lymphadenopathy. As a result, a throat examination by an ENT surgeon should be made routine in all children presenting with cervical lymphadenopathy. This is desirable since early diagnosis and prompt treatment lead to a better prognosis.Keywords: Airway, cervical, children, lymphadenopathy, tuberculosi

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

A Correlation between the Cytology and Histology of Serous Effusions at a Teaching Hospital in South-East Nigeria

Background: Cytological evaluation of body fluids is an important diagnostic test for various malignant and benign conditions.Objectives: Our study aims to analyse the various body fluids received in our department over a ten-year period. It also seeks to determine the accuracy and significance of specimen volumes of fluid cytology specimens in diagnosing malignancy in a resource-poor setting.Methodology: This is a retrospective study carried out in the Department of Anatomic Pathology of a teaching hospital in South-East, Nigeria. Histopathologic tissue results, if available were also retrieved from the archives as gold standard.Results: Within the period under review, 358 pleural fluid specimens, 358 ascitic fluid specimens and 2 pericardial effusion specimens were retrieved. Of all effusion cytology specimens, 126 (17.5%) were cytologically malignant. More specifically, 48 (13.4%) of pleural effusion specimens, and 78 (21.8%) of ascitic fluid specimens were malignant. The most common histologically diagnosed cancer observed in patients with malignant pleural effusion was breast cancer, while for ascitic fluid, it was ovarian cancer. For all cytologic diagnoses, the sensitivity was 37.0%, specificity 87.2%, PPV 84.4%, NPV 42.5% and accuracy 54.5%. With respect to the specimen volume of the histologically confirmed malignant cases received for cytological examination, 114 (52.1%) of the specimen were &lt;10mls, only 36 (16.4%) were ≥20mls. Those cytologically positive for malignant cells had a median volume of 10.0ml, while those cytologically negative for malignant cells had a median volume of 8.8ml. In addition, there was an incremental increase in the percentage of cytologically malignant effusions with increased volume of specimen used for the analysis from 34.2% for specimens &lt;10mls to 50% for specimen volumes ≥20mls. However, a Chi-squared test showed there is no statistically significant difference between these (P = 0.213).Conclusion: The sensitivity of effusion cytology in this study is at the lower end of the spectrum. This may be related amongst other factors to the suboptimal specimen volume received for evaluation and lack of resources for cell block and immunocytochemistry