Echejoh, GO

Mandong, BM

Menasseh, AN

Otoh, EC

Silas, OA

Bioline International

Page | 199Annals of African Medicine  Vol. 8, July-September, 2009likely to report serious injury (OR, 0.46; 95% CI, 0.35-0.60). Students who reported ever having had sexual intercourse and those who reported being involved in a physical fight on one or more occasions in the past 12 months were also more likely to have suffered serious injury in the past 12 months (OR, 1.43; 95% CI, 1.01-2.05 and OR, 3.0; 95% CI, 2.12-4.23, respectively); while no statistically significant association was found between ever having used illicit drugs like marijuana or having missed school/ classes without permission on one or more days in the past 30 days and having suffered serious injury in the past 12 months. Results of Hosmer-Lemeshow Wald goodness-of-fit test concluded that the model was a good fit for the data.The results of this unique nationally representative survey demonstrate that class 7 students in Kenya, regardless of their gender, were more likely to report having suffered serious injury in the past 12 months if they had ever engaged in sexual intercourse in their lifetime, or had been involved in a physical fight one or more times during the past 12 months. Results augur for the need on the part of parents, school nurses and health educators to prioritize their efforts towards those class 7 students who had been involved in physical fights and those who had sexual relations and intercede appropriately to positively impact the burden of serious injuries. For attaining the goal of improved general health, public health education efforts at identifying adolescents at high risk of serious injury would be particularly beneficial for this school-going group in the country, in addition to professional continuing education of primary care physicians and other cadres of health providers.Irshad Ali Shaikh, Masood Ali Shaikh, Zulfiqar Siddiqui1Independent Consultant, Al Rehab, Cairo, Egypt, 1Public Health Physician, Rawalpindi, PakistanAddress for correspondence: Dr. Masood Ali Shaikh, Apartment No. 32, Building No. 3, Group No. 71, Al Rehab, Cairo, Egypt. E-mail: masoodali1@yahoo.com DOI: 10.4103/1596-3519.57245 PMID: 19884701References1.  Nordberg E, Kimani V, Diwan V. Household survey of injuries in a Kenyan district. East Afr Med J  2000;77:240-4.2.  Odero W, Polsky S, Urbane D, Carel R, Tierney WM. Characteristics of injuries presenting to a rural health centre in western Kenya. East Afr Med J 2007;84:367-73.3.  Odero WO, Kibosia JC. Incidence and characteristics of injuries in Eldoret, Kenya. East Afr Med J 1995;72:706-10. 4.  Runyan CW, Gerken EA. Epidemiology and prevention of adolescent injury: a review and research agenda. JAMA 1989;262:2273-8.5.  Kenya. http://www.cdc.gov/gshs/countries/kenya/index.htm. [last accessed on 2007 Nov 14].Letters to EditorDescriptive pattern of salivary gland tumors in Jos University Teaching Hospital: A 10-year retrospective studyDear Sir,Salivary glands are mainly distributed in the head and neck region, with major ones comprising the paired parotid, submandibular and sublingual glands. The minor salivary glands are situated in the palate, lips, cheek and floor of the mouth. The major and minor glands are subject to the same tumor types. Etiology of salivary gland tumors is relatively unknown, and high-risk populations have not been identified.Salivary gland tumors account for about 2% of tumors in humans;[1] malignant tumors of the major salivary glands comprise about 10% of the cancers of intraoral and adjacent structures.[2] In general, tumors of the minor salivary glands are much less common than those of the major glands, accounting for some 15% to 20% of all salivary gland tumors.[3,4] About 65% to 85% of salivary gland tumors arise within the parotid gland; 10%, in the submandibular gland; and the remaining, in the minor salivary glands. As many as 15% to 30% of tumors in the parotid are malignant, in contrast to about 40% in the submandibular gland, 70% in the sublingual gland and 50% in the minor salivary glands.[5] The likelihood that a salivary gland tumor may be malignant is inversely proportional to the size of the gland.[5]In Africa, only few studies on salivary gland tumors have been reported, mainly in Kenya, Tanzania and Page | 200Vol. 8, July-September, 2009 Annals of African MedicineTable 1: Distribution of salivary gland tumors by ageTumor Type < 20 21-30 31-40 41-50 51-60 61-70BenignPA (%) 0 (0.0) 40 (34.9) 65 (56.5) 10 (8.7)AL (%) 0 (0.0) 0 (0.0) 6 (100) 0 (0.0)ON (%) 0 (0.0) 0 (0.0) 1 (25.0) 3 (75.0)BA (%) 0 (0.0) 0 (0.0) 1 (100) 0 (0.0)BNET (%) 2 (100) 0 (0.0) 0 (0.0) 0 (0.0)Total 2 40 73 13MalignantME (%) 5 (15.6) 12 (37.5) 15 (46.7)ADC (%) 3 (12.5) 18 (75.0) 3 (12.5)AC (%) 4 (22.2) 6 (33.3) 8 (44.4)Total 12 36 26Benign MalignantMean age = 31 Mean age = 58Peak age group = 31-40 Peak age group = 50-59 chi-square (x2) = 39.8PA- pleomorphic adenomaKEY Degree of freedom = 4AL- adenolymphoma P = 0.00 (statistically signifi cant)ON- oncocytomaBA- basal cell adenoma KEYBNET- benign non-epithelial ME- mucoepidermoid carcinomaTumor, e.g., lipoma, hemangioma ACC- adenoid cystic carcinomaAC- acinic cell carcinoma  Letters to EditorNigeria. The prevalence of salivary gland tumors in these countries ranges from 2.8%- to 10% of all head and neck tumors.[6,7] The parotid gland is the commonest site in 46.5%- to 60% of the cases.[7] The commonest benign tumor is the pleomorphic adenoma,[8] while the commonest malignant tumor is the adenoid cystic carcinoma.[8-10]This study is the first comprehensive study in Jos University Teaching Hospital (JUTH), and the findings will form the basis for health planning and further research. This is a retrospective study of all histologically confirmed salivary gland tumors over a period of 10 years. The study was conducted in Jos University Teaching Hospital (JUTH), Jos, which is located in Jos city of Plateau State in north central region of Nigeria. It has a 530-bed capacity and serves as a referral center for most private, missionary and government hospitals in this region. The histopathology laboratory of the hospital receives about 30- to 40 salivary gland specimens annually.Fresh sections of tissue blocks of all histologically confirmed salivary glands  over the period of study were made. The tissues were mainly excisional and incisional biopsies of salivary gland lesions. The tissue sections were cut and made into slides and stained with hematoxylin and eosin (H and E) and periodic acid Schiff (PAS) stains.The slides made were reported independently by 4 pathologists, and only those with common diagnosis were included in this study. Those undifferentiated carcinomas requiring immunohistochemistry were excluded from this study. Classification done was according to the World Health Organization (WHO) classification of salivary gland tumors. Information such as age, sex and site was retrieved from patient case files.The data was analyzed using statistical mean, chi-square and P-value. Deductions made were then discussed.A total of 202 salivary gland tumors were reported during the study period, 86 of which were in males and 116 in females with overall male-to-female ratio of 1:1.4; while 128 (63%) were benign and 74 (34%) were malignant. Of the patients presenting with benign tumors, 69 (54%) were males and 59 (46%) were females, with a male-to-female ratio of 1.2:1; while of those presenting with malignant tumors, 17 (23%) were males and 57 (77%) were females, with a male-to-female ratio of 1.3:4. The overall age range was 4 to 69 years with a mean of 32 years. The age range for patients with benign tumors was 4- to 49 years; and 73 (57%) tumors occurred in the 31-40 years age group, accounting for the highest frequency [Table 1].  The age range for patients with malignant tumors was 40- to 69 years with a mean age of 58 years; m ajority [36 (49%)] of these tumors were found to occur in the sixth decade of life [Table 1].The parotid gland was the commonest site for benign and malignant tumors, accounting for 101 (97%) and 43 (58%) tumors, respectively [Table Page | 201Annals of African Medicine  Vol. 8, July-September, 20092]. Pleomorphic adenoma [Figure 1] was the commonest salivary gland tumor; it accounted for 115 (90%) of all benign tumors. Only 1 case of basal cell adenoma was found. Of the 74 malignant salivary gland tumors, mucoepidermoid carcinoma was the commonest, accounting for 32 (43%) tumors; while acinic cell tumor (malignant) was the least common type, accounting for only 18 (24%) tumors. There were 6 (8%) malignant cases in the minor salivary glands [Table 2]. Of the 202 salivary gland tumors studied, benign tumors accounted for 128 (63%) tumors, while malignant tumors accounted for 74 (37%). This is similar to the report by Abiose et al.[6] from Ibadan, who reported 71% benign tumors and 32% malignant tumors; and by Stell et al.[11] from Britain, who documented 62% benign and 48% malignant lesions. Of the 128 benign salivary gland tumors studied, the distribution showed a slight male preponderance (1.2:1). This finding contrasts with the Ibadan and Lagos reports, which have documented a female preponderance.[10,12] The higher male preponderance in this study might be attributed to the sample size; and some cultural factors that do not allow females to attend clinics alone and without the permission of their husbands, which restricted female attendance and thus inclusion in the study . In this study, the highest percentage (57%) occurring in the age group 31-40 years confirms that benign tumors occur in patients of relatively younger age groups. Similar figures have been reported in other Nigerian studies.[13] The occurrence of malignant salivary gland tumors in the older age group in this study is also consistent with other studies in Nigeria.[14] In line with global reports, majority of the benign tumors were found in the parotid gland.[13-15]O. A. Silas, G. O. Echejoh, A. N. Menasseh, B. M. Mandong, E. C. Otoh1Department of Pathology, JUTH, Jos, 1Regional Centre for Oral Health Research and Training Initiatives for Africa, Jos Address for correspondence: Dr. Silas O. A, Department of Pathology, Jos University Teaching Hospital, PMB 2076, Jos, Plateau State, Nigeria. E-mail: drgbenga@yahoo.comDOI: 10.4103/1596-3519.57242 PMID: 19884702References1. Ezeonolue BE. Salivary gland neoplasms: a descriptive analysis of the pattern seen in Enugu: West Afr J Med 1999;18:179-83.2. Odukoya O. Pleomorphic adenoma of salivary glands in Lagos, Nigeria. Afr J Med Sci 1990;19:195-199.Figure 1: Histologic appearance of different types of salivary gland tumors (H and E, ×40)Letters to EditorTable 2: Distribution of salivary gland tumors by anatomic siteTumor type Parotid Submandibular SublingualBenignPA (%) 93 (80.9) 16 (13.9) 6 (5.2)AL (%) 4 (66.7) 2 (33.3) 0 (0.0)ON (%) 3 (75.0) 1 (25.0) 0 (0.0)BA (%) 0 (0.0) 0 (0.0) 1 (100.0)BNET (%) 1 (50.0) 1 (50.0) 0 (0.0)Total 101 20 7MalignantME (%) 25 (78.1) 4 (12.5) 2 (6.3)ACC (%) 6 (25.0) 8 (33.3) 5 (20.8)AC (%) 12 (66.7) 5 (27.8) 1 (5.6)Total 43 17 8KEY:Benign MalignantPA- pleomorphic adenoma Minor- glands of palate, cheeks, lipsAL- adenolymphoma ME- mucoepidermoid carcinomaON- oncocytoma ACC- adenoid cystic carcinomaBA- basal cell adenoma AC- acinic cell carcinomaBNET- benign non-epithelialTumor, e.g., lipoma, hemangiomaPage | 202Vol. 8, July-September, 2009 Annals of African Medicine3. Lucas RB. Pathology of Tumours of the Oral Tissues. Longman Group Limited, 3rd ed. Churchill Livingstone; 1976. p. 297-350.4. Layola AM, de Aranjo VC, de Aranjo NS. Minor salivary gland tumours. A retrospective study of 164 cases in Brazilian population. ORL J Otorhinolaryn gol Relat spec 1986;48:137-49.5. Ramzi S, Cotran MD, Collins T. Head and Neck, pathological basis of disease. 6th ed London: Saunders W. B. company; 1999. p. 769-76.6. Abiose BO, Oyejide O, Oguniyi J. Salivary gland tumours in Ibadan Nigeria. Rev Stomatol Chir Maxillofac 1990;91:83-5.7. Masanja MI, Kalyanyams BM, Simon EN. Salivary gland tumours in Tanzania. West India Med  J 2001;50:62-5.8. Hill AG. Major salivary gland tumours in a rural Kenyan hospital. Laryngoscope 1997;107:127-80.9. Arotiba GT. Salivary gland neoplasms in Lagos. East Afr med J 1996;72:560-3.10. Kolude B, Lawoyin JO, Akang EE. Mucoepidermoid Carcinoma of Oral Cavity: West Indian Med J 2001;50:62-5.11. Stella and Maran in Tumours of major salivary gland in Stella and Maran’s Head and Neck surgery, Butter Worth Heinemann Linacre House, Jordan Hill. 4th ed. Oxford: OX28DP; 2000p. 441-58.12. Arotiba JT, Obiechina AE, Fasola OI. Oral squamous cell carcinoma: A review of 246 Nigerian cases. J Natl med Assoc 2001;93:178-84.13. Otoh EC, Johnson NW, Olasoji H, Danfi llo IS, Adeleke OA. Salivary gland neoplasms in maiduguri, North-Eastern Nigeria. Oral Disease 2005;11:386-91.14. Neway M, Eshete S, Minasse M. Oro-facial tumours in Ethopian patients. Clinical analysis of 108 cases and review of literature. J Craniomaxillofac Surg 1994;22:76-80.15. Betsakis JG, Luna MA. Histologic grading of salivary gland neoplasms. Acinic cells carcinoma. Larygoscope 1988;98:784-8.Letters to Editor

Descriptive pattern of salivary gland tumors in Jos University Teaching Hospital: A 10-year retrospective study

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