Facteurs pronostiques des carcinomes épidermoïdes non métastatiques du larynx / Prognostic factors in laryngeal non-metastatic squamous cell carcinomas

But: Etudier les facteurs influençant le pronostic des carcinomes épidermoïdes du larynx. Méthodes: Etude rétrospective analytique menée sur 100 patients présentant un carcinome épidermoïde primitif du larynx, durant une période de 24 ans (1992­2015). Résultats: La survie globale à 1 an, à 3 ans et à 5 ans a été respectivement de 99 %, de 77 % et de 63 %. La survie sans maladie à 1 an, à 3 ans et à 5 ans a été respectivement de 88 %, de 76 % et de 63 %. L'étude univariée de la survie globale et la survie sans maladie a montré un impact péjoratif de l'atteinte ganglionnaire histologique, de l'engainement péri-nerveux et des limites chirurgicales tumorales (facteurs histo-pronostiques). Dans l'étude multivariée, seuls le stade T, le stade N, l'atteinte sous-glottique, l'atteinte du cartilage thyroïde et le délai de la radiothérapie postopératoire ont présenté un impact significatif sur la survie sans maladie. Aucun facteur n'a présenté d'impact significatif sur la survie globale, en analyse multivariée. L'étude statistique de la récidive n'a montré aucun facteur prédictif. Conclusion: Le stade tumoral et les facteurs histo-pronostiques sont les 2 facteurs pronostiques majeurs. Dans la littérature, Les principaux facteurs prédictifs de récidive sont: le stade tumoral, les limites chirurgicales tumorales et l'extension extra-nodale. Dans notre étude, aucun facteur prédictif n'a été trouvé.

Multifocal epithelial hyperplasia: clinical diagnosis of an uncommon oral mucosal lesion. a case report

Objective: Multifocal epithelial hyperplasia (MEH) or Heck's disease is an uncommon oral mucosa disease caused by the Human Papilloma Virus (HPV) especially subtypes 13 or 32. It is contagious with a tendency to be transmitted to other family mem bers. There is geographic hic regional variation in the frequency of occurrence of this condition. A careful clinical examination is required to arrive at the diagnosis. Histopathological review however can help to confirm the diagnosis of MEH. Molecular biology techniques like PCR or ISH are useful in isolating the HPV subtypes involved. This report aims to highlight the clinical features of MEH for accurate clinical diagnosis by Dental and Medical Practitioners Case Report: A documentation of a case of a 6-year-old Efik, Nigerian male child with extensive multiple oral mucosa lesion of 2 years' duration. The diagnosis of this case was based on the clinical presentation. The presence of multiple painless pink to whitish oral mucosa papules and nodules on the lips, labial and buccal mucosa was seen and a diagnosis of Multifocal Epithelial Hyperplasia was made. Conclusion: We report a case of MEH, a rare benign oral mucosal lesion in a 6 -year-old male of the Efik ethnic group in the south-south zone of Nigeria who presented with a 2year history of multiple lesions in the oral mucosa. It is important for Dental and Medical practitioners to be aware of this rare condition

The Histological Significance of Atypical Glandular Cells on Cervical Cytology: Experience at Groote Schuur Hospital; Cape Town; South Africa

BACKGROUND:Atypical glandular cells (AGC) identified on Pap tests may be markers for potentially significant pathology. OBJECTIVES:Primarily; to correlate AGC findings at Groote Schuur Hospital (GSH; Cape Town; South Africa) with subsequent histological investigations and attempt to identify predictors of pathology relevant to the clinical management of women with a cytological diagnosis of AGC. Secondly; to compare the GSH data with data from similar international studies. METHODS:Records of AGC Pap tests were retrieved from the laboratory database in the anatomical pathology laboratory at GSH and clinically relevant information was summarised based on the available information. Standard descriptive statistics were used to summarise the study data; and Fisher's exact test was used to compare categorical outcomes; where possible. RESULTS:Of the 237 women with a cytological diagnosis of AGC and who had subsequent histological diagnoses; 120 (50.6%) had significant pathology (cervical intraepithelial neoplasia (CIN) 2 or worse). Significant cervical pathology was most common in women aged etlt;50 years; while significant endometrial pathology predominated in women aged =50 years. The results of the GSH study were largely consistent with international findings; but the risk of malignancy was six times higher in the GSH population than in a comparable international group.CONCLUSION: AGC identified on Pap tests may be markers for potentially significant pathology. Human papillomavirus DNA testing is recommended for younger women diagnosed with AGC to reduce invasive investigations and minimise expenses in a resource-poor setting

Review: Head and Neck Squamous Cell Carcinoma in Sub-Saharan Africa

Aim.Review the literature from 1990 to 2013 to determine known anatomic sites; risk factors; treatments; and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa.Methods.Using a systematic search strategy; literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics; anatomic sites; histology; stage; treatment; and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV); human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed. Results of the 342 papers identified; 46 were utilized for review; including 8611 patients. In sub-Saharan Africa; the oropharyngeal/oral cavity was found to be the most common site; with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity; making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx; nasal cavity; or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases); and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available; 43% used tobacco and 42% used alcohol; and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC; but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare.Conclusions The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies; but a majority of patients did not use tobacco and alcohol

Histopathological Pattern of Cervical Cancer in Benin City; Nigeria

Background: Cervical cancer is the second most frequent malignancy and a preventable cause of mortality and morbidity in females. Objective: The objective was to describe the relative frequency; pattern; and histological types of cervical cancer in a teaching hospital in South-South Nigeria. Materials and Methods: All histologically diagnosed cases of cervical cancer seen over a 10-year period in the Department of Pathology; University of Benin Teaching Hospital; Benin City; Nigeria were reviewed to determine their histopathological patterns. Results: Four hundred and six cases of cervical cancer accounting for 30.3% of cancers in females and 62.9% of female genital tract malignancies respectively were seen during the 10-year study period. The ages of patients with cervical cancer which ranged between 18 and 99 years with a mean of 51.5 years (standard deviation = 12.8); with most frequent occurrence in 50-59 years age group. Squamous cell carcinoma was the most predominant subtype comprising 84.2% of cases while adenocarcinoma constituted 11.8%. Adenoid cystic carcinoma; adenosquamous carcinoma and metastatic carcinoma accounted for 2.0%; 0.8%; and 1.2% of cases respectively. Conclusion: The relative frequency of cancer of the cervix is high in Benin City; and this should necessitate attention to effective cervical cancer screening to increase detection of preinvasive lesions which in turn will decrease the frequency of cervical cancer

Ocular Manifestations in HIV-AIDS Patients in a Nigerian Community

Background: The aim of this study was to determine the ocular manifestations of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) among the study population.Method: A cross-sectional descriptive study was conducted among HIV-AIDS patients at the Federal Medical Centre; Owo; Nigeria. Ethics clearance was obtained from the ethics review committee of the hospital. Informed consent was obtained from all the respondents. This study was conducted over a period of nine months; from October 2010-June 2011; at the medical outpatient centre and the eye clinic of the hospital. The obtained information included the socio-demographics of the respondents; World Health Organization clinical stage of AIDS; CD4 count; duration of HIV-positive status; history of ocular problems and the treatment sought.Results: A total of 112 consenting respondents participated in this study. Not many respondents (36; 32.1) were aware of eye complications that relate to HIV-AIDS. Most informed respondents had been enlightened by health workers (20; 55.6). Few respondents (16; 14.3) had HIV-AIDS ocular manifestations. Squamous cell carcinoma was the most common ocular manifestation.Conclusion: Efforts should be made to promote the ocular health of HIV-AIDS patients to prevent blinding ocular manifestation

Educational needs and causes of false diagnosis of atypical squamous cells of unknown significance at a university hospital

The entity of atypical squamous cells of undetermined significance (ASCUS) in The Bethesda System 2001 for reporting cervical cytology is characterized by equivocal diagnosis, poor reproducibility and debatable management. This retrospective study was done to analyse the causes of false ASCUS if any and identify the educational needs as part of quality assurance programme. Cervical smears of all ASCUS cases reported over the one-year period were reviewed by the Cytopathologist. Relevant clinical data was retrieved. ASCUS was the most common type of abnormality representing 43.0 % cases among 294 abnormal smears reported during study period. 16.0% cases were found to be non ASCUS on review. The main four causes of over use of ASCUS diagnosis were poor quality smears and cellular atypia associated with Candida infection, atrophy and squamous metaplasia. Educational measures are being undertaken to avoid over diagnosis and improve the patient management (Afr J Reprod Health 2011; 15[1]: 111-114)

The Pattern of Urological Cancers in Zambia

Objective: To examine the pattern of urological malignancies; particularly cancer of the bladder; seen at the University Teaching Hospital (UTH) in Lusaka and to compare the findings with previous studies on the same parameters done at UTH. Material and Methods: A retrospective study of urological cancers in Zambia was performed; based on histopathology reports of specimens reviewed at the UTH Pathology Laboratory in Lusaka; Zambia; between January 1990 and December 2005. The parameters studied were the histological type of the cancer; patient age and trends over a 15-year period. Results: In total; 8829 cancers were diagnosed during the study period; of which 749 (8.5) were urological malignancies affecting the kidney; bladder; prostate; testis or penis. The maleto- female ratio of the urological cancers was 10.7 to 1. Cancer of the prostate was the most common urological malignancy (54.6); followed by bladder cancer (21.1) and penile cancer (18.6). The histological type of bladder cancer was mainly squamous cell carcinoma (46.2); transitional cell carcinoma (23.4) and adenocarcinoma (22.2); other types (8.2) included rhabdomyosarcoma; small cell carcinoma and lymphoma. The majority of patients (79) with bladder cancer were between 56 and 65 years of age. Whereas 20 years ago prostate cancer comprised only 26of urological malignancies; it accounted for 55of urological cancers diagnosed in Zambia between 1990 and 2005. In contrast; cancer of the penis; kidney and testis have shown no change in frequency distribution compared to 20 years ago. Conclusion:Over the last 15 years there has been an increasing proportion of cancer of the prostate and squamous cell carcinoma of the bladder. This is associated with high levels of schistosomiasis; cystitis (some of which is HIV-related) and bladder stones. It may also be due to the extension of urological services and the diagnostic armamentarium (PSA; cystoscopy and histological diagnosis) to indigent rural populations; where the incidence of squamous cell carcinoma is likely to be higher than in affluent urban populations

A Clinicopathological Study of Urinary Bladder Neoplasms in Patients at Three Centers in Khartoum; Sudan

OBJECTIVES:To present the histopathological pattern of urinary bladder neoplasms using the WHO/ISUP classification system and relate it to the outcome.METHODS:This study was conducted in the period from January 2004 through December 2005 at three centres in Khartoum; Sudan. One hundred and six patients with urinary bladder neoplasms were included in the study.RESULTS:The commonest affected age group was 60-80 years with male to female ratio 4.6:1. Urothelial neoplasms were found in 72 (67.9); Squamous cell carcinoma (SCC) in 26 (24.5); urothelial neoplasms with Squamous differentiation in 3 (2.8); and other types in 5 (4.7) of the patients.There were 43.4of the urothelial neoplasms graded as papillary carcinoma of high grade; 52.6papillary carcinoma of low grade;1.3papillary neoplasm of low malignant potential;1.3papilloma; and 1.3was graded as flat neoplasm.Of the SCCs; twelve (42.9) were poorly differentiated SCCs;nine (32.1) moderately differentiated; and seven (25) cases were well differentiated SCCs. Follow-up information was available in 32 patients.At last followup; fifteen (46.9) patients were dead of the disease; twelve (35.5) were alive with no evidence of disease; four (12.5) were alive with disease; and one (3.1) was alive and terminally ill Conclusion:Histological grade (P: 0.006); and muscle invasion (P: 0.002) were significantly associated with survival.A subset of the cases could not be assessed for muscle invasion due to inadequate sampling; we thus recommend proper trans-urethral bladder biopsy (TUBP) sampling

Basal and Squamous Cell Carcinomata on the Same Patients: Report of Two Cases in Aibinos

Background: Skin cancer is the most common cancer among the lightly pigmented individuals in Europe; North America and Australia. It occurs infrequently in darkly pigmented individuals because they have more melanin. Melanin and albinism are a known risk factors for skin cancers in Africans. Those already treated for skin cancer run a risk of developing another skin cancer. Method: Two case reports of albinos who developed basal cell carcinoma (BCC) and squamous cell carcinomata (SCC) later are presented. The two female albinos aged 61 and 21 years had BCC and SCC involving the left arm and the dorsum of the left hand in case1 and involving the face and the medial side of the right elbow in case 2. Both patients had numerous actinic keratoses that indicated chronic exposure to sunlight. Results: The outcome was good for the BCC's as the wounds healed post excision. There was no evidence of recurrence when the patients represented with SCC at 12 and 18 months respectively. Conclusion: Albinos run a risk of developing both BCC and SCC with chronic exposure to sunlight. Health education strategies on the need for early institution of preventive measures and follow up are emphasised as they run a risk of developing another cancer

Pathologic Pattern of Invasive Bladder Carcinoma: Impact of Bilharziasis

Objective: To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Patients and Methods: Between April 2002 and October 2006; 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department; Cairo; Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type; stage; grade and gross features in addition to lymph node involvement were particularly noted. Results: Bilharzial bladder pathology (lesions or ova) was present in 105 (70.9) of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma (TCC) in 84 (56.7); squamous cell carcinoma (SCC) in 51 (34.5); adenocarcinoma in 9 (6.1) and anaplastic tumor in 4 (2.7) of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23; pT3 in 70.9and pT4a involving the prostate or seminal vesicles in 6.1. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 (48.6) and high grade in 76 (51.4) specimens. Regional lymph node involvement was detected in 31 (20.9) specimens irrespective of bilharzial infestation. Conclusion: Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3; low-grade SCC and commonly appears as an ulcerative; bulky; fungating or verrucous mass. On the other hand; bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation

Local Advanced Transitional Cell Cancer and Squamous Cell Cancer of the Urethra Treated with Neoadjuvant Chemotherapy Followed by Radical Surgery

Background: Primary urethral cancer is rare; accounting for less than 1of all malignancies. The management of the urethral cancer depends on several factors which includes the clinical stage and the location of the lesion. Local surgical excision is the treatment of choice for the distal and low stage tumor while proximal tumors need more radical surgery.Aim: To report a case of a young African man who presented with locally advanced squamous cell cancer of the periurethral tissues and underlying isolated transitional cell cancer of the urethra.Case report: A 51-year-old man presented with a locally advanced squamous cell cancer of the periurethral tissues as well as an underlying isolated transitional cell cancer of the urethra. Chemotherapy with Gemcitabin and Cisplatinum together with local radiation to the pelvis and the perineum was given. There was remarkable regression of the tumour was identified by clinical examination and computed tomography scan after the treatment. The patient subsequently underwent cystoprostatectomy; radical penectomy; excision of the scrotum and ileal conduit. He recovered well postoperatively.Conclusion: Multimodal therapy combining chemotherapy and surgical resection should be used in locally advanced cases to improve the patient's survival chance

Penectomy with Simultaneous Compared to deferred Bilateral Inguinal Lymph Node Dissection for Squamous Cell Carcinoma of the Penis - Evaluation of Surgical Complications

Objective: In men with advanced squamous cell carcinoma of the penis; inguinal lymph node dissection is usually deferred for 6 weeks after primary penectomy. The rationale is that the penile lesion is usually infected and immediate lymphadenectomy may lead to a higher surgical complication rate. However; some patients do not return for deferred node dissection and then present much later with incurable metastatic disease. The aim of this study was to compare the complication rates of simultaneous versus deferred bilateral inguinal lymph node dissection. Patients and Methodsn: From October 1999 to September 2006; 29 men with histologically confirmed squamous cell carcinoma of the penis were treated. Penectomy with simultaneous bilateral inguinal lymph node dissection was performed in 18 patients with locally advanced primary lesions (cT2 in 8; cT3 in 10) and palpable inguinal nodes. The complications were compared with a previous study of 34 men who underwent bilateral inguinal lymph node dissection at a mean of 72 days after penectomy at Tygerberg Hospital during the period November 1983 to April 1995. Results: Post-operative complications occurred in 11 of 18 patients (61.1): lymphocele formation in 8; lymph leak in 1; wound dehiscence and skin edge necrosis in 5; wound sepsis in 1; lymphedema of the legs in 2; scrotal edema in 1 and cellulitis in 2 patients (more than one complication occurred in some patients). In the previously reported comparison group who had undergone deferred inguinal lymph node dissection at a mean of 72 days after penectomy; complications occurred in 26 of 34 (76.5) patients: wound sepsis in 12; wound dehiscence in 7; lymphocele in 7; lymph leak in 4; wound abscess in 3; necrosis of wound edges in 2 and hematoma formation in 1. Conclusion: Penectomy with simultaneous bilateral inguinal lymph node dissection in men with squamous cell carcinoma of the penis does not lead to a higher complication rate compared with primary penectomy and deferred inguinal lymph node dissection performed at a mean of 10 weeks after the primary procedure

Blader tumors in Benin city : a 15 year histopathological study

A 15 year (1988 - 2002) retrospective study was undertaken to determine the frequency and histological pattern of bladder neoplasms seen in the University of Benin Teaching Hospital; Benin City; Nigeria. Forty-five cases were diagnosed. Males predominated constituting 35 (77.8) cases; giving a M:F ratio of 3.5:1 with ages ranging from 1.5 - 75 years. Malignant neoplasms (40 cases) accounted for 88.9of the bladder tumours and 1.85of all malignant neoplasms seen during the study period. Contrary to most reports; the malignant neoplasms were predominantly transitional cell carcinoma constituting 27(67.2) cases; with peak in the 7th and 8th decades; mean age of 61 years (SD + 13.3) and an age range of 33 - 75 years. Squamous cell carcinoma (SqCC) was relatively rare accounting for 15malignant tumours. SqCC patients had a lower mean age 42 years (SD + 27.5) with ages ranging from 11 - 64 years. None of the SqCC cases showed evidence of schistosoma ova. Rhabdomyosarcoma; fibrosarcoma; non Hodgkin's lymphoma and metastatic tumours constituted 7.5; 2.5; 2.5and 5of the malignant tumours respectively. The benign tumours were all squamous papillomas comprising 5(11.1) cases. Haematuria screening for individuals in high risk occupation; and provision of pipe borne water were recommended

Bladder Tumors in Benin City : a 15 Year Histopathological Study

A 15 year (1988 - 2002) retrospective study was undertaken to determine the frequency and histological pattern of bladder neoplasms seen in the University of Benin Teaching Hospital; Benin City; Nigeria. Forty-five cases were diagnosed. Males predominated constituting 35 (77.8) cases; giving a M:F ratio of 3.5:1 with ages ranging from 1.5 - 75 years. Malignant neoplasms (40 cases) accounted for 88.9 of the bladder tumours and 1.85 of all malignant neoplasms seen during the study period. Contrary to most reports; the malignant neoplasms were predominantly transitional cell carcinoma constituting 27(67.2) cases; with peak in the 7th and 8th decades; mean age of 61 years (SD + 13.3) and an age range of 33 - 75 years. Squamous cell carcinoma (SqCC) was relatively rare accounting for 15 malignant tumours. SqCC patients had a lower mean age 42 years (SD + 27.5) with ages ranging from 11 - 64 years. None of the SqCC cases showed evidence of schistosoma ova. Rhabdomyosarcoma; fibrosarcoma; non Hodgkin's lymphoma and metastatic tumours constituted 7.5; 2.5; 2.5 and 5 of the malignant tumours respectively. The benign tumours were all squamous papillomas comprising 5(11.1) cases. Haematuria screening for individuals in high risk occupation; and provision of pipe borne water were recommended

Classification and grading of squamous cell carcinoma of the cervix

Two hundred and twenty three cases of squamous cell carcinoma of the cervix were classified according to their resemblance to cells in any of the layers in the ectocervix and a grade of low and high malignancy was also given to each case. Forty cases were classified as basal; 59 as prickle; 115 as intermediate and one as superficial cell types. Ninety cases were high grade (seven basal; 14 prickle; 63 intermediate and six superficial) and 133 were low grades (33 basal; 45 prickle; 52 intermediate; three superficial). This study shows that the intermediate cell type is the commonest and are usually high grade tumours. The findings also support the idea that squamous cell carcinoma of the cervix may arise from any of the normal layers in ectocervix and suggests that squamous cell carcinoma of the cervix is not a single disease entity; but heterogenous group of tumours like the non-Hodgkin's B cell or T cell lymphomas. Further study is needed to correlate the cyokeratin subtypes and clinical features of each histological type

Human papillomavirus (HPV) DNA in penile carcinomas and in two cell lines from high-incidence areas for genital cancers in Africa

Biopsies of 13 penile cancers (PC); from patients living in regions of Uganda with a high incidence of genital cancers; were studied for the presence; molecular characteristics and physical state of DNA related to that of human papillomavirus (HPV) types 6; 11; 16; 18; 31 and 33. HPV DNA sequences were detected in all PC specimens by dot/Southern blot analyses and by gene amplification of DNA sequences highly conserved among several HPVs. HPV 16 DNA sequences were found in one PC; DNA sequences with low homology to HPV16 or HPV18 were present in all other samples. Viral DNA is primarily integrated in the cellular DNA. To isolate and characterize a possible highly oncogenic HPV; a genomic library of the DNA extracted from the PC-8 biopsy has been constructed in the EcoRI arms of the EMBL4 phage. A single phage containing 8.30-kb HPV16-related sequences has been identified and the 3 segments of 0.45; 0.65 and 7.2 kb; released by EcoRI digestion; have been independently subcloned in pUC18 for further analysis