A Modified Rectal Mucosal Biopsy for the Diagnosis of Hirschsprung's Disease: Zaria Experience.

Background: Full-thickness rectal biopsy is often used for the diagnosis of Hirschsprung's disease (where a suction biopsy kit is not available). This is associated with some challenges such as limited theatre space and the need for general anaesthesia. We aim to highlight the usefulness and sensitivity of a modification of the rectal mucosal biopsy without general anaesthesia in the diagnosis of Hirschsprung's disease. Materials and Methods: This is a retrospective analysis of children with Hirschsprung's disease who had rectal mucosal biopsy over a 16-year period (January 2004-December 2019). Research was approved with institutional number ABUTHZ/HREC/H22/2022. The patients had the biopsy with small, curved artery forceps, surgical blade, and dissecting scissors. Histological analyses of tissue were done. Clinical data and results were recorded on a structured pro forma, and the data were analysed. Results: There were 263 boys and 97 girls with a median age of 10.5 months. Only 37 (10.3%) of the rectal biopsies were done by consultants. Hirschsprung's disease was confirmed in 279 (75.5%) of the partial-thickness biopsies, whereas 52 (14.4%) biopsies were inadequate specimens. Resident doctors were responsible for 92.2% (47) of inadequate biopsies (P = 0.63), although they did 89.7% of all biopsies. In one (0.3%) patient, the procedure ended as a full-thickness biopsy leading to a significant haemorrhage that required blood transfusion. Conclusions: The modified rectal mucosal biopsy is a simple, safe, and effective method for making the diagnosis of Hirschsprung's disease. This is performed without general anaesthesia and is useful where a suction biopsy kit is unavailable.

Appendiceal Schistosomiasis Presenting as an Appendiceal Mass.

Background: Schistosomiasis has been noted to be one of the most widespread parasitic diseases in the world. It is commonest in developing countries and 85% of the infections have been reported in Sub-Saharan Africa. Presentation with an appendiceal mass has been a rarity among the cases reported thus far. Case Presentation: We report the case of a 23-year-old man who presented with an appendiceal mass that responded to conservative treatment and had interval appendicectomy with histological confirmation of schistosomal appendicitis. He received post-operative medical therapy for schistosomiasis and had no sequelae thereafter. Conclusion: Appendiceal mass from schistosomal appendicitis responds to initial conservative management, followed by interval appendicectomy and post-operative anti-schistosomal medications serving as adequate treatment subsequently.

Paediatric neck masses in Zaria: A review of clinical profile and treatment outcome.

BACKGROUND: A neck mass is any abnormal lesion in the neck that can be seen, palpated, or identified on imaging. It is one of the most common reasons for presentation to the surgical clinics. AIM: the aim is to analyse the clinical presentation and treatment outcome in children who were diagnosed and managed for neck masses in a tertiary centre in Northwestern Nigeria. MATERIALS AND METHODS: The records of patients managed for neck masses over 7 years between January 2013 and December 2019 were reviewed. Demographic and clinical data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA). RESULTS: A total of 99 cases were reviewed and there were 52 (52.5%) males and 47 (47.5%) females with male-to-female ratio of 1.1:1, and mean age ± standard deviation of 4.4 ± 3.9 years, the primary complaints of all the patients were neck swellings. The anterior triangle was the most common region involved in 86 (86.9%) patients. The majority of the neck masses were congenital, accounting for 71 (71.8%) patients. Ultrasound scanning was the most commonly requested radiological investigation done in 87 (87.8%) patients. .: Thyroglossal duct cyst was the most common paediatric neck mass seen in 41 (41.4%) patients. The majority of the patients 68 (68.7%) had an excisional biopsy of the lesion. Surgical site infection was the most common complication noted in 7.1% of the study population. CONCLUSION: Most of the neck masses were congenital and were managed surgically. Prompt diagnosis with appropriate treatment may result in a good outcome.

Giant Ovarian Endometrioma: A Case Report.

Ovarian endometrioma is quite common among women of reproductive age but rarely exceed 6 cm in diameter. Ovarian endometrioma exceeding 10 cm in dimension, often referred to as giant endometrioma, is rare and can pose a diagnostic dilemma to clinicians. We present a 33-year-old single nullipara referred to our facility with a 3-year history of recurrent abdominal pain, abdominal swelling, and difficulty in breathing. The challenges in making diagnosis of a huge ovarian endometrioma are highlighted and the literature on huge ovarian endometrioma reviewed.

Concurrent giant tumoral pseudoangiomatous stromal hyperplasia necessitating bilateral mastectomy.

Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign mesenchymal tumor of the breast. Majority occur as diffuse lesions, and diagnosis is often incidental or in a background of other breast pathologies. Bilaterality with multiple tumoral masses in giant breasts is a rarity. We report a 34-year-old nonlactating female with 2-year history of rapid progressive painless bilateral enlargement of the breasts following surgical excision of ill-defined breast lumps which were not subjected to histopathological evaluation a year earlier. Examination revealed bilateral nontender giant breasts extending to the umbilical area with masses which were not attached to overlying skin, Grade 2 pressure ulcers on the lateral posterior breast aspects bilaterally and peau d'orange. There were no other palpable masses or lymph nodes. A clinical assessment of bilateral gigantomastia was made. Bilateral mastectomy revealed giant PASH which was confirmed with positive immunohistochemical reactivity for CD34 and vimentin. No other breast pathologies were seen with extensive sectioning. Diffuse multiple breast lesions with incomplete excision are associated with rapid growth in PASH as seen in this case. The presence of concurrent bilateral giant tumoral masses without any underlying breast pathology is a novelty. The mainstay of treatment in this case is mastectomy despite its benign nature.

L'hyperplasie stromale pseudoangiomateuse (PASH) est une tumeur mésenchymateuse bénigne rare du sein. La majorité se produisent comme des lésions diffuses, et le diagnostic est souvent fortuit ou dans un contexte d'autres pathologies mammaires. La bilatéralité avec de multiples masses tumorales dans les seins géants est une rareté. Nous rapportons une femme âgée de 34 ans, non lactante, ayant des antécédents de gonflement bilatéral rapide, progressif et indolore des seins, après une excision chirurgicale de morceaux de sein mal définis qui n'ont pas été soumis à une évaluation histopathologique un an plus tôt. L'examen a révélé des poitrines géantes non contendantes bilatérales s'étendant à la zone ombilicale avec des masses qui n'étaient pas attachées à la peau sus-jacente, des ulcères de pression de grade 2 sur les côtés latéraux de la poitrine et de la peau d'orange. Il n'y avait pas d'autres masses ou ganglions lymphatiques palpables. Une évaluation clinique de la gigantomastie bilatérale a été faite. La mastectomie bilatérale a révélé un PASH géant qui a été confirmé avec une réactivité immunohistochimique positive pour le CD34 et la vimentine. Aucune autre pathologie mammaire n'a été observée avec une section étendue. Les lésions mammaires diffuses multiples avec une excision incomplète sont associées à une croissance rapide du PASH comme on le voit dans ce cas. La présence simultanée de masses tumorales géantes bilatérales sans pathologie mammaire sous-jacente est une nouveauté. Le pilier du traitement dans ce cas est la mastectomie malgré sa nature bénigne. Mots-clés: hyperplasie bilatérale, mammaire, géante, pseudo-angiomateuse, tumoral.