Fine-needle aspiration of palpable breast lesions with histopathologic correlation

Abstract: Fine-needle aspiration biopsy of the breast has been used as a diagnostic step in the investigation of palpable breast lumps in the Department of Pathology, Tikur Anbessa Hospital, for more than 10 years. The purpose of this study is to evaluate the accuracy of fine-needle aspiration with histopathologic confirmation. A retrospective study was performed using records of fineneedle aspiration and biopsy results and request forms over four and half years. All women and men who had had fine-needle aspiration breast biopsy with histopathologic confirmation of the diagnosis were included. Fine-needle aspirations were interpreted as malignant, suspicious, or benign. Histopathologic diagnosis included incisional, excisional, and mastectomy specimen. A total of 244 patients fulfilled the criteria. Only eight (3.3%) of the specimens were inadequate for study. There were 52 total malignant fine-needle aspiration diagnoses, with only two falsepositive specimens. One was flbroadenoma and the other benign phylloides. There were 20 suspicious readings; 14 of these were malignant and six were false-suspicious specimens. Fibroadenoma, fibrocystic change, and papilloma were two each for the the six false suspicious specimens. Of the 164 lesions interpreted as benign, there were 10 false negative specimens. The test had 86% sensitivity, 95% specificity, 89% positive predictive value, and 94% negative predicitive value. Fine-needle aspiration is a sensitive and highly specific test that can be useful as an adjunct in the diagnosis of breast cancer. “Malignant†and “benign†interpretations are highly predictive but must be used only in the context of other diagnostic modalities. “Suspicious†“atypical†or “papillary†lesions require further investigation. [Ethiop. J. Health Dev. 1999;13(3):181-186

Patterns of neoplastic diseases among HIV-infected and HIV-uninfected patients

Abstract: In order to investigate the association between the human immunodeficiency virus (HIV) type-1 and neoplasms, we analyzed the pattern and rates of neoplastic disorders among HIVpositive and HIV-negative patients. A total of 108 incident neoplastic diseases were diagnosed among 4272 subjects tested for HIV at Tikur Anbessa Teaching Hospital, Addis Ababa, from September 1994 to March 1997. Forty-eight (1.1%) incident tumors were diagnosed among 2701 patients seropositive for antibodies to HIV-1 and 60 (1.4%) among 1573 seronegatives. There was no statistical diferrence on the occurrence of tumor in the HIV-positive or HIV-negative subjects (Odds ratio=0.48; 95% confidence interval=0.32,0.72). Kaposi's sarcoma (KS) was the most frequent neoplastic disease among HIV-positive subjects (47.9%) and it was strongly associated with HIV seropositivity (Odds ratio=13.5; 95% confidence interval=1.95, 268.99). Non-Hodgkin's lymphoma (NHL) (22.9%) and Hodgkin's disease (HD) (18.8%) were the other frequent neoplasms. Most (73%) of the HIV-related NHL were of the high grade type;64% of these tumors were extranodal and 55.6% of all NHL occurring in HIV-negative subjects were of the high grade type;only 33.3% were extranodal. NHL of the low grade type was less frequent in HIV- positive subjects compared to HIV-negative subjects (9.1 vs. 25.9%; Odds ratio= 4.08;95% confidence interval 0.51,88.42). Significant cases of cervical carcinomas (37.5%), classified histologicaly as sqamous cell carcinomas, were associated with HIV infection, although it was not statisticaly significant (Odds ratio=0.44;95% confidence interval=0.08,2.29). In the HIV-uninfected subjects, NHL was the most common neoplasm (45%) followed by HD (15%), hematological malignancies (10.1%) and cervical carcinomas (8.3%). Data from the present study demonstrate that some neoplasms are frequently associated with the current trends of the HIV/AIDS epidemic in Ethiopia. Many new AIDS-related neoplasms will likely continue to be identified in the future. [Ethiop. J. Health Dev. 1998;12(2):117-123

Case Report: Frontal lobe tuberculoma: A clinical and imaging challenge

Background: Pediatric nervous system tuberculomas are usually infra-tentorial and multiple. A frontal lobe location is rare.Case Details: We report a 10 year-old boy who presented with a chronic headache and episodes of loss of consciousness. He had no signs of primary pulmonary tuberculosis and a diagnosis of frontal tuberculoma was made upon a post-operative biopsy. He improved following treatment with anti-tubercular drugs.Conclusion: Tuberculosis should be considered in children with a chronic headache or focal neurologic deficit and a supra-tentorial intracranial mass in endemic countries like Ethiopia.Keywords: Tuberculoma, Tuberculosis, Frontal lobe, Ethiopi

Histopathological Changes of Placenta Associated with Maternal Anaemia in Northeast Ethiopia: A Comparative Study

BACKGROUND: Anaemia during pregnancy affects about half of all pregnant mothers in developing countries; it is the major causes of indirect maternal mortality. Anaemia can directly cause poor growth of fetus in utero due to inadequate oxygen flow to the placental tissue or it is indirect indicator of maternal nutritional deficiency. Mal-development of placenta is the leading cause of maternal and perinatal mortality and an important factor of fetal growth retardation. The aim of this study was to compare histopathological changes of placenta associated with maternal anaemia.METHODS: A comparative cross-sectional study was conducted from May-June, 2018 in Dessie Referral Hospital. A total of 66 placentas (33 anaemic and 33 non-anaemic) were collected after delivery. EPI data version 4.2.0 was used to enter the data while the data were analyzed by using SPSS version 22. Chi-square and oneway ANOVA were used to analyze the data.RESULTS; In pregnancies with maternal anaemia, 75.7% of anaemic placentas terminal villi vessels were increased in number, compared to 15.1% in non-anaemic (p=0.001). Placental calcification was 72.7% in anaemic groups compared to 54% in non-anaemic groups. However, it was insignificant (p=0.12). Intervillous space was wider in anaemic compared to non-anaemic groups (p<0.001).CONCLUSIONS; Chorionic villi capillaries were increased in number, and it was dilated in anaemic placenta, compared to non-anaemic. Intervillous space was significantly wider in anaemic placenta.&nbsp

Effect of Chronic Administration of Aqueous Leaves Extract of Moringa Stenopetala on Blood Parameters and Histology of Liver and Kidney in Rats

BACKGROUND: Moringa stenopetala is used as nourishments, and treatment of various diseases. However, there is no much information on its safety. Hence, this study aimed to investigate the chronic administration of aqueous leaves extract of the plant.MATERIALS AND METHODS: Twenty-four rats were divided into: a control group administered with distilled water and three experimental groups, respectively, administered with the extract at doses of 500, 1000, and 2000 mg/kg orally for six months were investigated. Various hematological and biochemical parameters followed by histopathological analysis were evaluated.RESULTS: Treatment with the extract did not significantly affect most of the hematological parameters. However, there were a significant decrease of MCH at doses of 1000 mg/kg and 2000 mg/kg in male rats and increase of MCV at all doses in female rats. Levels of ALP at 2000 mg/kg and those of AST and ALT at 1000 and 2000 mg/kg were significantly increased in male rats. Furthermore, significant decrease in urea and increase in creatinine levels at the dose of 2000 mg/kg occurred in female rats. Mild histopathological changes were also observed in the liver of male rats and kidney of female rats treated with the extract, respectively at doses of 1000 and 2000 mg/kg, and 2000 mg/kg.CONCLUSION: Findings from the present study suggest that prolonged administration of extract of Moringa stenopetala at therapeutic doses is safe, but shows sign of mild toxicity as dose increases, with differential effect on male verses female rats

Evaluation of Acute and Sub-Acute Toxicity of Aqueous Extracts of Artemisia afra Leaves on Brain, Heart and Suprarenal Glands in Swiss Albino Mice

BACKGROUND፡ The majority of population rely on traditional medicine as a source of healthcare. Artemisia afra is a plant traditionally used for its medicinal values, including treatment of malaria in many parts of the world. Currently, it is also attracting attention because of a claim that a related species, Artemisia annua, is a remedy for the COVD-19 pandemic. The aim of the present study was to investigate toxic effects of A. afra on brain, heart and suprarenal glands in mice aged 8-12 weeks and weighing 25-30g.METHODS: Leaves of A.afra were collected from Bale National Park, dried under shade, crushed into powder and soaked in distilled water to yield aqueous extract for oral administration. For acute toxicity study, seven treated and one control groups, with 3 female mice each, were used. They were given a single dose of 200mg/kg, 700mg/kg, 1200mg/kg, 2200mg/kg, 3200mg/kg, 4200mg/kg or 5000mg/kg b/wt of the extract. For the sub-acute toxicity study, two treated and one control groups, with 5 female and 5 male mice each, were used. They were daily treated with 600mg/kg or 1800mg/kg b/wt of extract.RESULTS: LD50 was found to be greater than 5000mg/kg indicating that the plant is relatively safe. In the sub-acute study, no signs of toxicity were observed in all treatment groups. On microscopic examination of the brain, heart and suprarenal glands no sign of cellular injury was observed.CONCLUSION: The findings of this study suggest that the leaves extract of A. afra is relatively safe in mice

Clinico-pathological Diagnosis of Facioscapulohumeral Dystrophy in a 22-year-old Male

Background: Facioscapulohumeral dystrophy (FSHD) is a rare hereditary disease with a prevalence of 2.03–6.8 per 100,000 individuals. FSHD is the third most common type of muscular dystrophy after the Duchene muscular dystrophy and myotonic dystrophy. To the best of our knowledge, the current case report is the first to report probable FSHD case mainly diagnosed using clinico-pathological evidence from sub-Saharan Africa (SSA). Case Report: A 22-year-old right-handed male college student presented with progressive proximal muscular weakness associated with wasting. The weakness started from the bilateral facial muscles and progressively involved proximal upper and lower limbs muscles associated with scapular winging, waddling gait, and bilateral foot drops. His bulbar, sensory, autonomic, and cognitive systems were spared. Muscles EMG showed myopathic patterns and normal serum CK. Muscle biopsy from affected muscles showed variation in fiber size with groups of angular fibers, preserved fibers, and hypertrophic fibers with marked fibrosis and adipose tissue replacement with no apparent inflammation and necrosis which is consistent with pathological features of muscular dystrophy. Considering the clinical semiology, physical findings, EMG findings, and pathological findings diagnosis of FSHD of scapuloperoneal variant was made. The patient was managed with analgesics, nutritional advice, and ankle prosthesis for foot drops. Currently, the patient is in a similar condition with modest improvement in his musculoskeletal pain complaints. Conclusion: This case highlights the fact that a careful clinical evaluation with thorough utilization of diagnostic investigations available at our disposal may support the diagnosis of FSHD in resource-limited areas where the necessary genetic tests were not available. Keywords: facioscapulohumeral muscular dystrophy, dystrophy, clinico-pathology, sub-Saharan Afric

Effect of oral administration of Gnidia Stenophylla Gilg aqueous root extract on food intake and histology of gastrointestinal tract in mice

Background: Aqueous preparations of a medicinal plant, Gnidia stenophylla Gilg (Thymelaeaceae) are commonly used to cure malaria and other ailments in Ethiopia. This study evaluated the safety of the plant extract by determining its effects on food intake and histology of gastrointestinal tract (GIT) after oral administration for 13 weeks in albino mice.Methods: Thirty mice were equally assigned to three groups. Group I served as control and received a vehicle while groups II and III were given 400 and 800 mg/kg body weight/day plant extract respectively, orally, for 13 weeks. At the end of the study, the mice were scarified and postmortem gross and histopathological evaluations were performed on their stomachs and intestines.Results: Chronic oral treatment with the extract for 13 weeks did not induce any sign of illness and death and had no effect on food intake of the mice. Furthermore, extract treatment at both doses did not produce any detectable gross morphological change in GIT. Microscopic evaluation of sections of the stomach, duodenum and jejunum of the mice treated with 400 mg/kg body weight did not show any histopathological change. In the mice treated with 800 mg/kg body weight, however, the GIT sections revealed cytoplasmic vacuolation, hydropic degeneration and excessive erosion of the surface mucosal cells.Conclusion: The results of this study revealed that aqueous root extract of G. stenophylla at effective antimalarial dose is safe even when taken for a longer period in mice. At a higher dose, however, the extract may induce gastrointestinal irritation. Further studies on other vital organs and non-rodent species including humans are recommended.Keywords: Gnidia stenophylla Gilg, aqueous root extract, chronic toxicity, histology, histopathology, gastrointestinal tract, gastrointestinal irritation deficit, Ethiopi

Acid fast bacilli in aspiration smears from tuberculous patients

Fine-Needle aspiration (FNA) has been used in the diagnosis of tuberculous adenitis or extrapulmonary tuberculosis of extranodal sites for more than ten years in the Tikur Anbessa Teaching Hospital, Department of Pathology, Faculty of Medicine, Addis Ababa University. The purpose of this study was to see the correlation between the cytomorphologic diagnosis and the subsequent demonstration of acid fast bacilli in the smear and also to know the overall acid fast bacilli (AFB) positivity. A cross sectional study, involving a total of 205 consecutive patients diagnosed to have tuberculosis by cytomorphology (FNA) between mid 1996 and early 1997 were included in the study. The May-Grunwald Giemsa stained smears were classified into three categories: Epithelioid granuloma without caseous necrosis, Epithelioid granuloma with caseous necrosis, Abscess and/or Caseous necrosis. There were 131 (63.9%) cases with granuloma with caseous necrosis, 67(32.7%) cases with abscess and/or caseous necrosis , and only seven (3.4%) cases with granuloma without caseous necrosis. The AFB positivity as stained by Ziehl Neelsen stain was 99 (75.6%) in granuloma with caseous necrosis, 46(68.7%) in tuberculous abscess and/or caseous necrosis and 2(28.5%) in granuloma without necrosis. The overall acid fast positivity was 71.7%. This study confirmed that FNA alone is helpful enough in making a diagnosis of tuberculosis in most of the cases. We recommend that the evaluation of all fine needle aspiration samples from suspected cases of tuberculosis should include staining for AFB for confirmation and in particular for cases of abscess and necrosis as part a diagnostic step. However, culture of the aspirate is still required when the smears are AFB negative and cytologically equivocal whenever it is available. (Ethiopian Journal of Health Development: 2000, 14(1): 99-104

Histopathological findings of Post-Menopausal bleeding in Ethiopian women

Background: Postmenopausal bleeding is an alarming sign that may be associated with uterine malignancy. In recent years about 60% of women with post menopausal bleeding are said to have no organic cause in developed countries. There is no data concerning about this issue in Ethiopia. Objective: To determine histopathologic etiology of postmenopausal bleeding. Methods: Retrospective analysis of four years biopsy material from women with postmenopausal bleeding. Results: Four hundred seventy five patients with postmenopausal bleeding were included in the study. Malignant lesions of the genital tract were found in 289 (60.8%) cases. Cervical carcinoma was seen in 245 cases, which accounted for 84.8% of all malignant lesions. Cervical carcinoma was responsible for 51.6% cases of all postmenopausal bleeding patients. Endometrial carcinoma was seen only in 31(10.7%) cases among the malignant cases. In this study underlying cervical malignancy was found in approximately one of every two patients with postmenopausal bleeding. The result of this study doesn't show the dramatic decrease in the prevalence of malignancy as a cause of postmenopausal bleeding seen in Europe and USA. Conclusion: The famous dictum that "Post Menopausal bleeding must be considered as indicative of malignant disease until proven otherwise" still holds true in our circumstance. Priority should be given to introduce a screening method such as cervicography, gynoscopy and pap smear of the cervix to effectively manage gynaecological malignancies in elder women. (Ethiopian Journal of Health Development, 2001, 15(1): 39-44