Pattern of childhood cancer in University College Hospital, Ibadan during 1991-2010 and comparison with the previous three decades.

BACKGROUND: Cancer is an important cause of morbidity and mortality worldwide in children under 15 years of age, with the incidence and mortality rate varying from 40 to 155 per million children. AIM: To describe the pattern of childhood cancer in Ibadan, Nigeria. OBJECTIVE: To compare the findings of this study with those of previous studies in Ibadan and internationally. METHODS: A retrospective review of histologically and cytologically confirmed cases of cancer in children aged <15 years diagnosed at University College Hospital (UCH), Ibadan between January 1991 and December 2010 was undertaken. The cases were categorised using the International Classification of Childhood Cancer, third edition (ICCC-3). RESULTS: There were 625 cases comprising 360 (57·6%) males with a modal age of 3 years. The most common neoplasms were lymphomas (140, 22·4%), of which 90% were non-Hodgkin lymphomas, with Burkitt lymphoma constituting the majority of cases (73). Other common neoplasms were retinoblastomas (21%), soft tissue sarcomas (14·9%), leukaemias (10·2%) and CNS tumours (6·9%). Lymphomas, bone tumours, malignant hepatic tumours and other malignant epithelial neoplasms had the highest mean and modal ages, while retinoblastomas, neuroblastomas, germ cell tumours and renal tumours had the lowest mean and modal ages. During 1960-72 there were 1326 cases and during 1973-90 there were 1881 cases and the proportion of lymphomas was 58·9% and 45·4%, respectively. The present study demonstrated a marked decline in the number of cases and proportion of lymphomas (22·4%), particularly Burkitt lymphomas. CONCLUSION: During the last 20 years, there has been a decline in the number of cases of childhood cancer seen at UCH, Ibadan. This may be due to the establishment of additional specialist centres in the sub-region. Owing to a persistent decline in the frequency of Burkitt lymphoma, retinoblastoma is now the most common individual childhood cancer seen at Ibadan.

Is the art of renal biopsy on the decline in Nigeria?

BACKGROUND: Renal biopsy remains the means by which definitive parenchymal kidney disease diagnoses are made. With the renal biopsy, the activity, progression and prognosis of renal parenchymal diseases can be studied with objectivity. We investigated the trend of renal histopathology request in a tertiary hospital in Nigeria over 31 years. OBJECTIVE: To determine the trend of renal biopsy requests in one of the biggest tertiary hospitals in Nigeria over a 31-year period (1981- 2011). METHODS: We retrospectively analysed all the renal biopsies submitted to the Department of Pathology, University College Hospital (UCH) Ibadan, South-West Nigeria over a 30 year period (1981-2011). Trend of requests of all the biopsies submitted from the Surgery, Paediatrics and Medicine departments was analysed using a test for linear trend. Gender and age groups trends were also studied. RESULTS: A significant reduction in the rates of renal biopsy request over the 31-year period (p=0.001) was noted which is attributed to diminution in requests from the Medicine and Paediatrics Departments (p<0.001), while the rates of requests from Surgery Department remain fairly uniform over this period (p=0.05). Decrease in biopsy requests significantly cuts across the ages in both genders. CONCLUSION: Lack of adequately trained manpower, poor health insurance scheme and lack of facilities may be contributory in renal biopsy requests decline. Adequate efforts should be made towards reviving this important investigative modality in Nigerian tertiary hospitals.

Pediatric brain tumors in Nigeria: clinical profile, management strategies, and outcome.

INTRODUCTION: Although modern neuroimaging has facilitated early care of brain tumors in children worldwide, there are, however, few published reports on clinical profile, treatment, and outcome of brain tumors in children from our subregion. PURPOSE: We aimed to retrospectively study the clinical profile and outcome of pediatric brain tumors in a tertiary referral center from a developing country. METHODS: Forty pediatric patients with histologically verified brain tumors managed by the authors over a 13-year period (May 1994-April 2006) were studied. Patients' data from clinical, radiological, and pathology records were analyzed using the statistical package for social sciences version 16. RESULTS: The mean age was 9.75 years (range 1-15 years). Twenty-two males, 18 females. Common presenting symptoms were headaches (23 patients, 57.5%) and seizures (15 patients, 37.5%). Hyperreflexia (72.5%) and focal motor deficits (62.5%) were the most common neurologic signs. The mean interval from onset of symptoms to neurosurgical diagnosis was 13.4 months (95% CI). All patients had tumor resection, while 11 (27.5%) patients received adjuvant radiotherapy. Hydrocephalus occurred in 19 (47.5%) patients and was associated with early presentation (X2 = 10.65, p < 0.01). Low-grade astrocytoma (25%) and medulloblastoma (25%) were the most common tumors. Survival at 1 and 5 years were 56 and 47%, respectively. CONCLUSION: Focal motor signs and elevated intracranial pressure are the salient presenting features of brain tumors in children seen in Nigeria. Those of them with hydrocephalus are likely to present early. The outcome for pediatric brain tumors remains poor.

Paediatric head and neck cancers in Nigeria: Implications for treatment planning in resource limited settings.

BACKGROUND: The head and neck (H/N) is a common site for childhood cancers. This study examined all cases of H/N childhood cancers diagnosed in a major teaching hospital in Nigeria over 18 years to determine patterns of broad lineage cancer groups. MATERIALS AND METHODS: Primary pediatric childhood malignancies diagnosed between 1990 and 2008 were analysed. Logistic regression models were fitted to determine significant clinical correlates of childhood cancer. RESULTS: Lymphomas were the commonest cancers (49.5%). After controlling for site and age, there was no significant difference in the incidence of Burkitt's lymphoma (BL) by sex (P=0.423). The jaw bones (mandible and maxilla) were the commonest sites in the H/N for involvement of BL, with over 20 times the odds of occurrence when compared to other non-jaw sites of the H/N region (Adjusted Odds Ratio [AOR]=21.41, P<0.001). Among the jaw bones, there was no significant difference in the occurrence of BL (P=0.860). CONCLUSION: Lymphomas are the commonest cancer group among children in Nigeria. In resource limited settings where diagnoses depend majorly on clinical intuition, an awareness of predictors of a disease can shorten the time spent on arriving at a working diagnosis and guide the immediate choice of investigations and treatment.

Paediatric head and neck cancers in Nigeria: implications for treatment planning in resource limited settings

Background: The head and neck (H/N) is a common site for childhood cancers. This study examined all cases of H/N childhood cancers diagnosed in a major teaching hospital in Nigeria over 18 years to determine patterns of broad lineage cancer groups. Materials and Methods: Primary pediatric childhood malignancies diagnosed between 1990 and 2008 were analysed. Logistic regression models were fitted to determine significant clinical correlates of childhood cancer. Results: Lymphomas were the commonest cancers (49.5). After controlling for site and age; there was no significant difference in the incidence of Burkitt's lymphoma (BL) by sex ( P=0.423). The jaw bones (mandible and maxilla) were the commonest sites in the H/N for involvement of BL; with over 20 times the odds of occurrence when compared to other non-jaw sites of the H/N region (Adjusted Odds Ratio [AOR]=21.41; P0.001). Among the jaw bones; there was no significant difference in the occurrence of BL ( P

A retrospective histopathological review of oral squamous cell carcinoma in a Nigerian teaching hospital.

This study was undertaken to describe the demographic pattern of oral squamous cell carcinoma (OSCC) in Ibadan, Nigeria and compare our findings with that of other countries. It involved a retrospective review of OSCC diagnosed at the University College Hospital Ibadan, Nigeria between 1990 and 2008. A review of studies from other countries was done with respect to the three most frequently affected sites by OSCC, as well as mean ages and gender ratios. OSCC comprised 181 (43.7%) of the 414 malignant neoplasms diagnosed in the oral cavity within the study period. The most frequently affected sites were the maxillary gingiva (24.9%) and mandibular gingiva (21.5%). There was a slight male preponderance; with a male to female ratio of 1.2:1. The peak age was in the eighth decade of life. About 17.7% of cases were diagnosed in patients below the age of 40 years and 1.1% of cases occurred in children. Worldwide, the tongue is the most frequently affected site by squamous cell carcinoma followed by the floor of the mouth. Males are also more frequently affected. In conclusion, OSCC remains an important cause of morbidity and mortality among middle aged individuals in our environment and worldwide, but sometimes affecting younger individuals.

Pattern of homicide coroner's autopsies at University College Hospital, Ibadan, Nigeria: 1997-2006.

There is relatively little information regarding the pattern of homicides in developing countries such as Nigeria. This study is aimed at determining the pattern and demographic factors associated with homicide cases seen in a Nigerian Teaching Hospital. It is a descriptive autopsy study of homicide cases seen at the University College Hospital (UCH), Ibadan over a 10-year period from January 1997 to December 2006. All the coroner's autopsies for the period, of homicides or suspected homicides, were reviewed with emphasis on the following: gender, age, occupation, circumstances surrounding event, likely motive, type of weapon used, site(s) of injury and mechanism of death. Homicides accounted for 153 (3.1%) of the 4928 coroner's cases at the UCH within the study period. One hundred and thirty-seven of the 152 cases were men, and the overall age range was 4-83 years. The mechanism of death was haemorrhagic shock in 91 cases (59.9%); severe raised intracranial pressure in 58 cases (38.2%); septicaemic shock in two cases (1.3%); and asphyxia in one case (0.7%). Gunshot injuries accounted for 64.5% of the fatalities, sharp objects 21.1% and blunt force 14.5%. Most were victims of armed robbery attacks. The head, abdomen, chest and lower limbs were single sites of injuries in descending order of frequency and most of the cases sustained multiple injuries involving two or more of these sites. Gunshot deaths were the commonest form of homicides in the period under review. Young males and victims of armed robbery attacks were most susceptible.

Review of fine needle aspiration cytology in the management of goitres in Ibadan, Nigeria.

OBJECTIVE: The use of Fine Needle Aspiration Cytology (FNAC) in the investigation of goitres was introduced into our practice more than a decade ago. This is a review of its diagnostic accuracy for thyroid carcinoma seven years after the first evaluation and following the establishment of the 'FNAC Clinic'. METHOD: This is a retrospective study of patients who had FNAC of goitres and the histopathology of their thyroidectomy specimens between 1995 and 2004. The accuracy of the cytology reports were evaluated against the histology reports. The turnaround time of the patients for surgery was also determined. RESULTS: There were 130 females and 21 males with an age range of 7-86 years. The diagnostic accuracy of the procedure for carcinoma was 89% with a sensitivity of 35%, specificity of 97%, positive predictive value of 64%, and a negative predictive value of 91%. The average turnaround time for surgery was 178.7 +/- 248.7 days with a range of five days to three and a half years. CONCLUSION: The diagnostic accuracy of FNAC of goitre for carcinoma improved in the period under review. However, the long surgery turnaround time may reduce the usefulness of the procedure. The accuracy may be improved further by a protocol of ultrasound guidance, capillary collection with no-aspiration technique, on-site review of slides with a repeat of FNA as necessary.

Histopathological pattern of renal cell carcinoma in Ibadan.

There has been a paucity of Nigerian studies on renal cell carcinomas (RCC). This retrospective review analyzes cases of RCC diagnosed in the University College Hospital, Ibadan from January 1960 to June 2007. Cases were typed using the 2004 World Health Organization classification of renal tumours. Papillary RCC were further grouped into Type 1 or 2 and Fuhrman's nuclear grade was determined for clear cell and papillary RCC. There were 159 cases, 108 being females, with a male to female ratio of 1:2.1. Peak age of occurrence was in the fourth decade. The right kidney was more commonly affected (58.6%). Papillary RCC was the most common variant accounting for 27 of the 62 cases that were available for review. Six (22.2%) of the 27 papillary RCC had the distinctive histological features that have been associated with Xp 11 translocation carcinoma. All 27 cases of papillary RCC were Type 2. Twenty-one (61.8%) RCC were Fuhrman's nuclear grade 1 and 2. Renal cell carcinoma in Ibadan occurs two decades earlier than in Caucasians. Papillary RCC is the most common histological sub type of RCC in Ibadan, and Xp translocation carcinomas may be more common in this environment than earlier described in America. This is in contrast to the observation that clear cell carcinomas is the most common histological sub type of RCC in Caucasians series.

Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria.

BACKGROUND: Tear instability is associated with symptoms of ocular discomfort and irritation. Many patients with dry eyes remain untreated due to improper diagnoses. OBJECTIVE: To identify symptoms and surface abnormalities associated with dry eyes. MATERIALS AND METHODS: One hundred and fifty-six eyes of 78 subjects attending the Eye Clinic of the University College Hospital Ibadan were screened for dry eyes/tear instability using rose Bengal stain (graded 0-9), tear break-up time (TBUT), Schirmer's 1 tests, tear meniscus height and a standardised symptoms questionnaire. Grades 4-9 rose Bengal staining were considered as positive dry eye and were compared with grades 0-3 staining eyes as negative controls. RESULTS: Mean tear meniscus height, Schirmer's test and TBUT were lower among cases than their corresponding control eyes. The difference between the mean Schirmer's test values of cases and their controls were statistically significant (P = 0.00 for right eyes and P = 0.002 for left eyes). Rose Bengal grades were inversely correlated with the mean Schirmer's values (Pearson correlation -0.429, P = 0.05 for right eyes and -0.335, P = 0.03 for left eyes) and TBUT (Pearson correlation -0.316, P = 0.05 for right eyes and -0.212, P = 0.06 for left eyes). About 95.8% of the cases were symptomatic, as opposed to 70.4% of the controls (P = 0.01, Fisher's exact test) and 95.8% of dry right eyes compared to 61.1% of their controls had ocular surface abnormalities (P = 0.001), while 89.5% of dry left eyes compared to 62.7% of controls had surface abnormalities (P = 0.07). CONCLUSION: A close relationship exists between ocular irritation symptoms, surface abnormalities and functional evidence of tear instability. Such patients should be treated empirically or screened for dry eyes.

Presentation of Colorectal Cancers in Benin-City; Nigeria

Background: Colorectal cancer is a major cause of cancer death worldwide; and the prevalence in Nigeria appears to be increasing due to a shift to western diets. We undertook a retrospective analysis of colorectal cancers seen at the University of Benin Teaching Hospital; Benin City from January 1983 to December 2002. Methods: One hundred and two cases involving the large bowel were encountered. These were analysed for age; sex; site; histological type and clinical features. Results: The mean age was 44.5 +/-4.5 years. Males accounted for 56 (54.9) cases; while 46(45.1) were females. Seventy two (70.2) of the tumours were located in the rectum. Adenocarcinoma was the predominant histological type; with 89 (87.2) cases. Fifty two (51) cases presented with intestinal obstruction. Conclusions: Conclusion; colorectal cancers are not rare in our environment as previously believed; though; the frequency in Benin City is relatively low

Surgical Anatomy of the Vertebrobasilar Territory and Posterior Circle of Willis

BACKGROUND: In the present era of microscopic and neuroendoscopic procedures; the surgical anatomy of the skull base vessels has gained increased significance. The pattern of the vertebrobasilar arterial complex and the posterior circle of Willis (COW) in Nigerians has not been previously reported despite various variants of these complexes existing in different populations. OBJECTIVE: To review and document the size; distribution and anomalies of the vertebrobasilar territory and posterior COW pattern in a Nigerian set of brains. Methods: The target population for this study was a group of Nigerian adults 18 years and above. Specimens from patients with an ante-mortem or post-mortem evidence of meningitis or atherosclerosis were excluded. The size; distribution and anomalies of the vertebrobasilar artery; its branches; and the posterior COW were defined in 50 brains. RESULTS: The male: female ratio was 1.9:1 and a mean age of 44 years. Statistical analysis showed significant differences between the sizes of posterior inferior cerebellar arteries and anterior inferior cerebellar arteries (Student's t = -30.189; p-value = 0.000). Fifty-six percent of the brains had no anomalies. Thirty anomalies were noted in posterior COW compared with six in the vertebrobasilar territory. There were no aneurysms in all the specimens studied. CONCLUSION: Anomalies in the region of the posterior COW are commoner than the vertebrobasilar territory and the region of the posterior communicating artery is the most common site of anomalies in the posterior COW territory. These variations should be taken into account during skull base and carotid surgeries; and cerebral angiography

Paediatric head and neck malignancies in Ibadan, Nigeria.

Studies on paediatric head and neck cancer are limited in the medical literature. Most studies have been restricted to specific histological types such as rhabdomyosarcoma, osteogenic sarcoma or Burkitt's lymphoma. This study describes the relative frequency of cancers seen in the head and neck region of children below 16 years of age at the University College Hospital, Ibadan, Nigeria. A total of 281 cases of paediatric head and neck tumours were diagnosed within the study period, out of which 84 cases were malignant. Fifty-four of these cases were males while 30 were females, giving a male to female ratio of 1.8:1. The age range for these cases was 3 days to 15 years with a mean age of 9.03 +/- 4.63 years. The most frequently diagnosed tumours were haematopoietic malignancies, accounting for 47.6% of cases, followed by sarcomas (27.4%) and carcinomas (21.4%). Burkitt's lymphoma constituted 28.6%, followed by rhabdomyosarcoma accounting for 17.9% of cases. Malignant neoplasms of the head and neck region are rare in the paediatric age group. The pattern of these neoplasms also differs from that in the adult population. However, malignant head and neck neoplasms in the paediatric age group also showed the male preponderance characteristic of head and neck malignancies in the adult population.

Pattern of coroners' autopsies at Ring Road State Hospital, Ibadan, Nigeria: a retrospective study (1994-2000).

This study reviews 1,993 coroners' autopsies performed at the Adeoyo and Ring Road State Hospitals, Ibadan, over a seven-year period (January 1994 to December 2000). The most common indication for a coroner's autopsy was accidental death (59.6%), followed by homicidal death (20.7%), sudden natural death (11.6%), maternal death (1.4%) and suicidal death (0.4%). The overall male to female ratio was 2.8:1 and the majority of victims were in the fourth decade of life. Road traffic accidents were the leading cause of accidental death. Homicidal deaths were 9.3 times more common in male than female victims and the most common mode of death was firearm injuries. In contrast to an earlier study from University College Hospital, Ibadan, the present study has revealed a predominance of accidental and homicidal deaths, with a relatively lower rate of maternal deaths.

Benign childhood tumours in Benin City, Nigeria.

A retrospective analysis of benign tumours seen in children aged 0-14 years over a 10-year period (1993-2002) was carried out in Benin City Nigeria, in order to determine the various histological types of such tumours. A total of 76 cases were seen during the study period, out of which 32 occurred in males and 44 in females. The commonest histological categories were tumours of connective tissues, peripheral nerve and teratoma. Haemangioma and neurofibroma occurred with equal frequency and were the single most common histological types of benign childhood tumours. Head and neck was the most common anatomic region to be involved with childhood benign tumours.

Malignant childhood solid tumours in Benin City, Nigeria.

BACKGROUND: Tumours are uncommon in childhood; malignancies are even more uncommon. Yet malignancies are among the leading causes of childhood death in many parts of the world. The pattern of these tumours in Benin City Nigeria, however, is not known. OBJECTIVE: To describe the pattern and histological types of childhood tumours in a Nigerian teaching hospital. METHODS: All histologically diagnosed cases of malignant solid tumours in children less than 15 years of age seen over a 10 year at the University of Benin Teaching Hospital (UBTH) Benin City of southern Nigeria were analysed in order to determine their histological patterns. RESULTS: Eighty-four cases of malignant tumours were seen during the 10-year period (1993 to 2002) in children less than 15 years of age at the UBTH Benin City. Forty-nine (50.3%) cases occurred in males and 35 (41.7%) in females. There was a decline in the frequency of childhood cancer with increasing age. The histological types, in descending order of frequency, were lymphoma 28(33.3%), nephroblastoma 18 (21.4%), retinoblastoma, rhabdomyosarcoma 12 (14.3%) each, and carcinoma 9 (10.7%). The head and neck region was the commonest location for all the various histological types (except tumours arising from tissues specific to other regions e.g. nephroblastoma). About 40% of all tumours occurred in the head and neck compared to 32% that occurred in the abdomen. CONCLUSION: Malignant childhood solid tumour pattern in Benin City Nigeria is similar to that observed in other third world countries.

Anomalies, aneurysm and histology of the middle cerebral artery in Nigerian Africans

The histology of the middle cerebral artery (MCA) in Nigerian Africans has not been previously studied. One hundred MCAs obtained at autopsy from fifty adult Nigerians were studied. The vessels were processed and stained with Ehrlich's haematoxylin and eosin, elastic Van Gieson and Masson's trichrome stains. Early branches were given off before the perforators in two middle cerebral arteries, and there was one accessory MCA, making an incidence of anomalies of 3 percent. No aneurysm was observed in any of the cases. The internal elastic laminas were well developed but the external elastic laminas of the vessels were poorly developed. Close to the bifurcations the tunica media tapered gradually and at the bifurcations, the tunica media was completely deficient being replaced by the tunica adventitia (Forbus raphé). The tunica adventitia was thicker at the bifurcations (0.21mm) compared to other sites of the vessel. The average thickness of the MCA tunica media at its origin was 0.12mm while that of the tunica adventitia was O.lOmm. These results are similar to what has been described in the literature for Caucasians. It buttresses the assertion that anatomical anomalies of the MCA are rare. The seemingly low frequency of MCA aneurysms in Nigerian Africans is not due to its anomalies or histology.

La histología de la arteria cerebral media (ACM) de los africanos de Nigeria no ha sido previamente estudiada. Fueron examinadas 100 ACM, obtenidas en autopsias de 50 individuos nigerianos adultos. Las arterias fueron procesadas y teñidas con hematoxilina y eosina de Ehrlich, Van Gieson para fibras elásticas y tricrómico de Masson. Ramas proximales se originan antes de la división en dos arterias cerebrales medias, y había una ACM accesoria, constituyendo una incidencia de anomalías del 3 por ciento. No se observó aneurisma en ninguno de los casos. La lámina elástica interna estaba bien desarrollada, pero la lámina elástica externa de los vasos estaba pobremente desarrollada. Cerca de la bifurcación la túnica media es gradualmente cónica, la túnica media es totalmente deficiente siendo sustituida por la túnica adventicia (Forbus raphé). La túnica adventicia es más gruesa en las bifurcaciones (0.21mm) en comparación con otros lugares del buque. El grosor medio de la túnica media de ACM en su origen fue 0.12mm mientras que el de la túnica adventicia de O.lOmm. Estos resultados son similares a los que han sido descritos en la literatura para Caucásicos. Es importante la afirmación que las anomalías anatómicas de la ACM son raras. La aparentemente baja frecuencia de los aneurismas de ACM en nigerianos africanos no es debido a sus anomalías o a la histología.

Malignant schwannoma of the nasal cavity and paranasal sinuses in a Nigerian.

An unusual case of malignant schwannoma with involvement of the forehead, external nose, right nasal cavity, paranasal sinus system (bilateral frontal sinus, right ethmoidal sinus), right orbit and anterior cranial fossa is reported in a Nigerian. Malignant schwannomas of the paranasal sinus are extremely rare, as only 20 well-documented cases have been previously published in English literature. No report in black Africans has been found in extant literature. The clinical features of this tumour are presented with detailed management. The patient had a wide surgical resection of the lesion with reconstruction of the resultant fronto-nasal defect using forehead musculofascial flap plus full thickness skin graft and adjuvant radiotherapy with satisfactory outcome. The good result of combined surgery and radiation regimens in this case demonstrates the usefulness of adjuvant radiation therapy in this condition.