Hand Tumours in Lagos, Nigeria: A Clinicopathologic Study

Background: Hand tumours occur infrequently and are commonly benign, however when malignant they could be life threatening. This study was aimed at determining the prevalence, demographics, the clinical presentations and treatment outcome of hand tumours among patients attending the hand service of the Lagos University Teaching Hospital.Methods: We studied the clinical and pathological records of a 124  consecutive hand tumours that presented at hand clinic of the Lagos University Teaching Hospital(LUTH) between June 2003 and June 2013 .Results: A total of 124 patients were seen of which 98 had excision biopsies . The male to female sex ratio was 1: 1.3. The mean age at presentation was 32.7 years sd ± 8.44 years. An overwhelming majority (94.9%) had their procedures done under local/regional anaesthesia. Two patients died and three of the tumours recurred during the follow up period. The commonest histopathological diagnoses included ganglion cyst, giant cell tumor of the tendon sheath and pyogenic granuloma constituting 23.8%. 15.7% and 6.7% of the cases seen respectively.Conclusion: Hand tumours in Lagos tend to affect young adults with a slight female preponderance. Majority of the tumours were benign. Primary hand malignancy was uncommon and mortality was low. Nearly all (97%) of the surgically treated patients returned to their premorbid occupation.Key words: Hand tumours, biopsy, soft tissue

Congenital Toxoplasmosis: A Review of its Pathology, Immune Response and Current Treatment Options.

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is one of the most common parasites of man and other warm-blooded animals. Humans are infected through contaminated food, water, and blood transfusion, organ transplantation or from mother to foetus through the placenta. Severe congenital infections occur as a result of primary T. gondii infection in early pregnancy. Transmission of T.gondii to the foetus can result in serious health problems, including mental retardation, seizures, blindness and death. Frequency of foetal infection is higher when maternal infection occurs later in pregnancy and sequelae are more severe when maternal infections occur early in the first trimester of pregnancy. The ability of the parasite to survive intracellularly largely depends on the blocking of different proapoptotic signaling cascades of the host cells. During pregnancy, however, alterations in the incidence of apoptosis are associated with abnormal placental morphology and function. Both cellular and humoral immune responses control T.gondii infection. Toxoplasma is asymptomatic, infected women can only be detected by serological testing. In many instances, congenital toxoplasmosis can be prevented by educating pregnant women and women of childbearing age about the route of transmission. The need for screening suspected cases of T. gondii will help reduce transmission to the foetus. Keywords: Toxoplasmosis, Congenital toxoplasmosis, Toxoplasmosis and immunosuppression. Toxoplasma gondii

Is extended biopsy protocol justified in all patients with suspected prostate cancer?

Objective: To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance.Materials and Methods: We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson’s Chi square test with level of significance set at <0.05.Results: The overall cancer detection by the extended technique was 61 (48.8%) cases while the sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04).Conclusion: Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE

Evaluation of Xpert® MTB/RIF and ustar easyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania : a prospective descriptive study

Fine needle aspiration biopsy has become a standard approach for diagnosis of peripheral tuberculous lymphadenitis. The aim of this study was to compare the performance of Xpert MTB/RIF and Ustar EasyNAT TB IAD nucleic acid amplification assays, against acid-fast bacilli microscopy, cytology and mycobacterial culture for the diagnosis of TB lymphadenitis in children from a TB-endemic setting in Tanzania.; Children of 8 weeks to 16 years of age, suspected of having TB lymphadenitis, were recruited at a district hospital in Tanzania. Fine needle aspirates of lymph nodes were analysed using acid-fast bacilli microscopy, liquid TB culture, cytology, Xpert MTB/RIF and EasyNAT. Latent class analysis and comparison against a composite reference standard comprising "culture and/or cytology" was done, to assess the performance of Xpert MTB/RIF and EasyNAT for the diagnosis of TB lymphadenitis.; Seventy-nine children were recruited; 4 were excluded from analysis. Against a composite reference standard of culture and/or cytology, Xpert MTB/RIF and EasyNAT had a sensitivity and specificity of 58 % and 93 %; and 19 % and 100 % respectively. Relative to latent class definitions, cytology had a sensitivity of 100 % and specificity of 94.7 %.; Combining clinical assessment, cytology and Xpert MTB/RIF may allow for a rapid and accurate diagnosis of childhood TB lymphadenitis. Larger diagnostic evaluation studies are recommended to validate these findings and on Xpert MTB/RIF to assess its use as a solitary initial test for TB lymphadenitis in children

Meningeal Neoplasms at the Lagos University Teaching Hospital, Nigeria

Meningeal neoplasms are one of the commonest primary central nervous system (CNS) tumours worldwide. Though most are benign their location and tendency for recurrence contributes significantly for mortality and morbidity associated with these tumours. Meningiomas in Nigeria have been poorly studied and little has been published about their histopathologic characteristics. The aim of this study therefore is to present our institution's experience of patients with meningeal neoplasms seen between January 2009 and December 2013 and to compare our findings with those from published literature. Fifty one meningeal tumours were seen during the study period accounting for 34.9% of primary CNS tumours. Peak age of occurrence was in the 4th decade with a male to female ratio of 1:2.4. The cerebral convexities (44.7%) and parasagittal regions (14.9%) were the commonest sites seen. The transitional variant (45.2%) was the commonest histologic type seen and the vast majority (96.1%) were WHO grade I tumours. Meningiomas in Lagos follow the epidemiological patterns discussed in literature, but occur at a younger age group. Further studies correlating the clinical behaviour and pathologic findings as well as molecular studies need to be carried out in our environment to help refine and individualize treatment of this heterogenous entity.Keywords: Meningioma, atypical, anaplastic, Lago

Risk Factors for Breast Cancer in Nigeria

Various reports have shown that there is an increase in the incidence of breast cancer in Nigeria which can not be accounted for by increased awareness. To asses the risk factors for breast cancer in Lagos, Nigeria and to compare these with the rest of the world. This was a descriptive prospective study involving the use of an interview-administered semi-structured questionnaire. Patients who presented at the breast clinic of the Lagos University Teaching Hospital, Railway Hospital Lagos and Motayo Hospital Lagos with histological diagnosis of breast cancer between January 2002 and June 2004 were included in the study. Eighty patients (females= 79; male= 1) were studied. The age range was 25-86 years with a modal age bracket of 30-50 years. Majority (47.9%) of the patients were traders and 85% were married. Seventy five percent were overweight while 52 (83.9%) accepted increased intake of high carbohydrate and protein diet. Majority (65.4%) had tertiary education, 86.3% earn 200,000 naira (USD 1,500) and below yearly, 81.3% do not drink alcohol and only one patient smokes. Most (80%) were para 3 and above, 67.5% had menarche at 14 years while 37.2% of the menopausal patients attained menopause at the age of 46-50 years. Sixty four percent carried first full term pregnancy at 25 years and above, all patients breastfed their children while 50% use oral contraceptives. Female gender, high intake of carbohydrate and fat, age at first pregnancy, early menarche, overweight and poorphysical activity may be cardinal factors in the aetiology of breast cancer in our environment

Haemosuccus pancreaticus as a rare initial manifestation of pancreatic carcinoma

No Abstract

Carcinoma of the Penis: Experience from the Lagos University Teaching Hospital Lagos, Nigeria

Background: Carcinoma of penis is rare in countries where neonatal male circumcision is the tradition and in Nigeria it is a common practice amongst almost all the tribes.Objective: This is to document the prevalence, age distribution, site and histologic types of penile carcinoma at the Lagos University Teaching Hospital Idi-Araba over a 20year period.Methods: Cases of the penile carcinoma recorded in the surgical pathology register of the Department of Morbid Anatomy, the Cancer Registry and the Medical Records Department of the Lagos University Teaching Hospital overa twenty year period were reviewed. Information extracted included the age, site of lesion, and histopathologic type. The histopathology slides were reexamined to confirm the diagnosis and to grade the lesion. The data was analyzed using simple statistical methods.Results: There were 7 cases of carcinoma of the penis accounting for 1.9% of malignant lesions of the male genital tracts in LUTH, 3 (42.85%) of which were on the shaft of the penis. The ages of the patients ranged from 42-79 years with a mean of 52.2 years. majority (42.92) of the cases wereinthe 5th decade. All the cases were well differentiated squamous cell carcinomasConclusion: Carcinoma of the penis is rare in Lagos, Nigeria. This may be attributed to the common practice of neonatal male circumcision in NigeriaKeywords: squamous cell carcinoma, peni

An audit of Autopsy practice - Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu Experience

No Abstracts.Nigerian Medical Practitioner Vol.49(4)2006: pp.88-9