Histopathological Review of Childhood and Adolescent Cancers in Northern Ghana.

BACKGROUND: Published data on childhood and adolescent cancers in northern Ghana is scanty. The aim of this retrospective histopathological study was to identify and describe the relative proportions of childhood and adolescent cancers and the associated clinico-pathological features at the Tamale Teaching Hospital. MATERIALS AND METHODS: The cancers were classified according to the International Classification for Cancer in Children. Data was collected on the demographics and the clinico-pathological characteristics of the various types of cancers, from 1st January 2012 to 31st December, 2021, a 10-year period. The data was analysed using SPSS software (Version 26, Chicago). RESULTS: A total of 196 childhood and adolescent cancers were reviewed, with a mean age of 9.5± 5.5 years. Approximately, 51.5% were female, with a younger mean age (years) of 8.4±5.3, compared to 10.6±5.6 for males. Majority (74.0%), were within the 0-14 years age group, (P<0.0001). All the patients presented with swellings and mostly after 6 months of disease onset. The common cancers for the study population were: soft tissue sarcoma (24.2%), primary bone cancer (21.1%), retinoblastoma (17.5%), lymphoma (13.3%), and germ cell tumours (6.7%). For females these were: soft tissue sarcoma (21.0%), retinoblastoma (20.0%), primary bone cancer (19.0%), nephroblastoma (13.0%), and ovarian tumours (12.0%). For males, these were: soft tissue sarcoma (27.7%), bone cancer (23.4%), lymphoma (19.1%), retinoblastoma (14.9%) and head and neck cancer (6.4%). The common soft tissue cancers were: rhabdomyosarcoma (46.8%), and spindle cell sarcoma (NOS) (17.0%). Osteosarcoma (70.7%), and Ewing's sarcoma 6 (14.6%) were the common primary bone cancers. Many (46.4%) of the retinoblastomas were of a high pathological TNM stage III. The optic nerve was involved in 70.6%, with 26.5% margin involvements. CONCLUSION: Childhood and adolescent cancers were common in pediatric age group with late stage at presentation. The common histological subtypes were: soft tissue sarcoma, primary bone cancer and retinoblastoma. There is the need for detection, diagnosis, and prompt oncology care.

CONTEXTE: Les données publiées sur les cancers de l'enfant et de l'adolescent dans le nord du Ghana sont rares. Le but de cette étude histopathologique rétrospective était d'identifier et de décrire les proportions relatives des cancers de l'enfant et de l'adolescent et les caractéristiques clinico-pathologiques associées à l'hôpital universitaire de Tamale. MATÉRIEL ET MÉTHODES: Les cancers ont été classés selon la Classification internationale du cancer chez l'enfant. Des données ont été recueillies sur les caractéristiques démographiques et clinicopathologiques des différents types de cancers. Les données ont été analysées à l'aide du logiciel SPSS (version 26, Chicago). RÉSULTATS: Un total de 196 cancers d'enfants et d'adolescents ont été examinés, avec un âge moyen de 9,5± 5,5 ans. Environ 51,5 % étaient des femmes, avec un âge moyen plus jeune (ans) de 8,4±5,3, contre 10,6±5,6 pour les hommes. La majorité des patients (74,0 %) étaient âgés de 0 à 14 ans (P<0,0001). Tous les patients présentaient des gonflements, le plus souvent après 6 mois d'apparition de la maladie. Les cancers les plus fréquents dans la population étudiée étaient les suivants : sarcome des tissus mous (24,2%), cancer osseux primaire (21,1%), rétinoblastome (17,5%), lymphome (13,3%) et tumeurs germinales (6,7%). Pour les femmes, il s'agissait de sarcomes des tissus mous (21,0 %), de rétinoblastomes (20,0 %), de cancers osseux primaires (19,0 %), de néphroblastomes (13,0 %) et de tumeurs ovariennes (12,0 %). Chez les hommes, il s'agissait de : sarcome des tissus mous (27,7%), cancer des os (23,4%), lymphome (19,1%), rétinoblastome (14,9%) et cancer de la tête et du cou (6,4%). Les cancers des tissus mous les plus fréquents étaient : le rhabdomyosarcome (46,8%) et le sarcome à cellules fusiformes (NOS) (17,0%). Les cancers osseux primaires les plus fréquents étaient l'ostéosarcome (70,7 %) et le sarcome d'Ewing (14,6 %). Un grand nombre (46,4 %) des rétinoblastomes étaient d'un stade pathologique élevé (TNM III). Le nerf optique était impliqué dans 70,6 % des cas, avec 26,5 % d'implication des marges. CONCLUSION: Les cancers de l'enfant et de l'adolescent étaient fréquents dans le groupe d'âge pédiatrique avec un stade tardif à la présentation. Les sous-types histologiques les plus fréquents étaient : le sarcome des tissus mous, le cancer primaire des os et le rétinoblastome. Il est nécessaire de détecter, de diagnostiquer et de fournir des soins oncologiques rapides. Mots clés: Enfance, Adolescence, Cancer, Ghana du Nord.

The Prognostic Significance of the Size of Primary Malignant Breast Tumour in Ghanaian Women: A Retrospective Histopathological Review (2001-2014) in the Department of Pathology, Korle-Bu Teaching Hospital (KBTH).

BACKGROUND: Previous studies on breast cancer (BC) in Ghanaian women found the disease to be common in young women who present late with large palpable tumours. The aim of this study was to determine how the size of a primary malignant breast tumour influences the prognosis of BC in Ghanaian women. MATERIAL AND METHODS: A retrospective review of BCs diagnosed in mastectomy and wide local excision biopsy specimens with axillary clearance were conducted. Primary malignant breast tumours were categorised based on the size (cm) into: tumour d" 2.0cm (T1), tumour >2.0 d" 5.0 cm (T2) and tumour > 5.0 cm (T3). Data were analysed using SPSS version 23 (Chicago). Associations between tumour variables were determined by Spearman's correlation coefficient and Fisher's exact test (GraphPad prism version 5). RESULTS: The mean size of primary malignant breast tumours was large (5.8±3.8cm). Approximately half were T3 tumours. The mean ages of women diagnosed with T1, T2 and T3 tumours were: 51.5 ±2.0, 52.8±12.4 and 51.2 ±12.7 years, respectively. High grade BCs (II and III combined), involvement of 4 or more positive lymph nodes by malignant cells, high TNM stage and increased prevalence of positive malignant tumour margins were all significantly high in T3 tumours (P<0.0001) compared to T1 and T2 tumours. There were significant associations between T2 tumours and the histological subtype (p- = 0.011) and nodal involvement (p = 0.044) by malignant cells. Similarly, T3 tumours showed significant positive association with the histological subtype (p = 0.019) and nodal involvement (p = 0.018). CONCLUSION: The study found large primary tumour size (T3) to show significant positive association with the histological subtype and lymph nodes involvement by tumour. T3 tumours also showed increased prevalence of positive tumour margins.

CONTEXTE: Les études antérieures sur le cancer du sein (CS) chez les femmes ghanéennes ghanéennes, la maladie est fréquente chez les jeunes femmes qui se présentent tardivement avec de grosses tumeurs palpables.. Le but de cette étude était de déterminer l'influence de la taille d'une tumeur maligne primaire du sein sur le pronostic du cancer du sein au Ghana. MATÉRIEL ET MÉTHODES: Une revue rétrospective de cancer du sein diagnostiqués dans des spécimens de mastectomie et de biopsie d'excision locale large avec dégagement axillaire. Les tumeurs malignes primaires du sein Les tumeurs malignes primaires du sein ont été classées en fonction de leur taille (cm) en : tumeur d'" 2,0 cm (T1), tumeur >2,0 d" 5,0 cm (T2) et tumeur > 5,0 cm (T3). Les données ont été analysées en utilisant la version 23 du SPPS (Chicago). Les associations entre variables tumorales ont été déterminées par le coefficient de corrélation de Spearman et le test exact de Fisher (GraphPad prism version 5). RÉSULTATS: La taille moyenne des tumeurs malignes primaires du sein était grande (5,8±3,8cm). Environ la moitié étaient des tumeurs T3. L'âge moyen L'âge moyen des femmes diagnostiquées avec des tumeurs T1, T2 et T3 était de : 51.5±2,0, 52,8±12,4 et 51,2±12,7 ans, respectivement. Les cancer du sein de haut grade (II et III combinés), l'implication de 4 ganglions lymphatiques positifs ou plus par des cellules malignes, un stade TNM élevé et une prévalence accrue de marges tumorales malignes positives. et la prévalence accrue de marges tumorales malignes positives étaient toutes significativement élevées dans les tumeurs T3 (P<0,0001) par rapport aux tumeurs T1 et T2. Il existait Il y avait des associations significatives entre les tumeurs T2 et le sous-type histologique (p- = 0,0001). histologique (p- = 0,011) et l'atteinte ganglionnaire (p = 0,044) par les cellules malignes. cellules malignes. De même, les tumeurs T3 ont montré une association positive significative avec le sous-type histologique (p = 0,019) et la présence de ganglions (p = 0,018). CONCLUSION: L'étude a montré que la taille importante de la tumeur primaire (T3) à montrer une association positive significative avec le sous-type histologique et l'implication des ganglions lymphatiques par la tumeur. Les tumeurs T3 ont également montré prévalence accrue de marges tumorales positives. Mots clés: Taille de la tumeur primaire, variables tumorales, pronostic, femmes ghanéennes.

Surgical Healthcare Workers Knowledge and Attitude on Infection Prevention and Control: A Case of Tamale Teaching Hospital, Ghana.

BACKGROUND: Most morbidities and mortalities related to clinical, diagnostic, and therapeutic procedures are related to infection and the solution to this is good infection prevention and control (IPC) compliance which is influenced by the right knowledge and positive attitude. AIM: This study aimed to assess infection prevention and control (IPC) knowledge and attitude among healthcare workers at the surgical department of Tamale Teaching Hospital (TTH). METHODS: This study was conducted using a descriptive cross-sectional survey. Data entry and analysis were done using Statistical Package for the Social Sciences (SPSS) version 20 and Graph Pad Prism version 6.05. Tables, frequencies, and percentages were used for descriptive analysis and chi-square analysis for the associations. RESULTS: Of the 156 participants who responded, 22 (14.1%) were doctors, with 107 (68.6%) nurses, 12 (7.7%) certified registered anesthetics (CRA), and 15 (9.6%) orderlies. Approximately, 50.6% of the respondents were knowledgeable with regard to IPC and 55.1% of the respondents had a good attitude towards IPC. Factors associated with knowledge level were educational level (p ≤ 0.001), occupation (p ≤ 0.001), marital status (p=0.030), and age (p=0.030). The occupation was the only factor associated with the attitude level (p=0.048). CONCLUSION: More than half of the healthcare providers reported good knowledge and attitude towards IPC. Proportionally, more nurses had good IPC knowledge and attitude as compared to other professional groups. Firming up and assimilating universal precaution with routine services by providing training, protocol, rules, and regulation are recommended.

Case Report of Three Immature Cystic Teratomas in Northern Ghana.

BACKGROUND: Preoperative diagnosis of immature cystic teratoma can be challenging for clinicians. In this report, we present three cases. METHODS: We describe three women aged 10, 20, and 23 years, respectively, who presented with abdominal masses which were diagnosed by abdominal ultrasound as mature cystic teratomas. All women had emergency laparotomy and oophorectomy. RESULTS: Histopathological examination reported these ovarian tumours to be immature cystic teratomas. This case report also provided a brief summary of the clinicopathological features of all ovarian teratomas diagnosed in two centres during the period of review. CONCLUSION: Immature ovarian teratoma affects primarily younger patients; it is important for clinicians to have a high sense of suspicion whenever the diagnosis of a germ cell tumour is entertained.

Triple-negative breast cancer among ghanaian women seen at Korle-Bu teaching hospital

Background. Women with African ancestry in the United States and in continental Africa have been found to have exceptionally increased frequencies of triple-negative breast cancer (TNBC); prompting speculation that this risk may have an inherited basis and may at least partially explain breast cancer outcome disparities related to racial/ethnic identity. Our goal was to evaluate the breast cancers diagnosed in one of the largest health care facilities in western Africa; and to compare the frequencies as well as risk factors for TNBC versus non-TNBC. Methods. We reviewed all breast cancer cases that had immunohistochemistry (Novolink Detection system); in 2010. Results. The overall study population of 223 breast cancer cases was relatively young (median age 52.4?y); and most had palpable tumors larger than five centimeters in diameter. More than half were TNBC (130 cases; 58.3%). We observed similar frequencies of young age at diagnosis; stage at diagnosis; and tumor grade among cases of TNBC compared to cases of non-TNBC. Conclusion. Ghanaian breast cancer patients tend to have an advanced stage distribution and relatively young age at diagnosis. The triple-negative molecular marker pattern is the most common seen among these women; regardless of age; tumor grade; and stage of diagnosis. Additional research is necessary regarding the causes of TNBC; so that we can elucidate the reasons for its increased prevalence among women with African ancestry

Positive tumor margins in wide local excision of breast cancer: a 10-year retrospective study

Background. The safety of wide local excision as a standard surgical option for early stage breast cancer management in Ghana has not been evaluated. The aim of this study was to use retrospective histopathological descriptive study to evaluate the prevalence of positive tumor margins in wide local excision specimens and offer recommendations. Study design. We reviewed 147 breast lumps; following wide local excision; which were received in the Department of Pathology; for positive tumor margins. The data was analyzed using SPSS software (version 16). Results. A total of 2;751 female breast cancers were diagnosed during the study period; of which 147 (5.3%) were from wide local excisions (lumpectomies). Thirty-one (21.0%) had positive tumor margins. The mean age of women with positive margins was 53.4 (SD = 17.1) years. The mean size of primary tumor was 4.0 (SD = 2.1) cm; the majority (53.0%) of which were greater than 2.0?cm; but less than or equal to 5.0?cm (T2). A total of 26 (83.4%) of these tumors were invasive ductal carcinomas (NOS); 24 (92.3%) of the cases had combined Bloom-Richardson grading; and many; 10 (41.7%); were grade 1. Conclusion. Our study shows that 21.0% of all wide local excision biopsies had positive tumor margins; a figure that is comparable to those of other studies. Tumors with positive margins in this study were large; 4.0?cm (T2); and common in relatively young women. Treatment failure is therefore likely to occur in these patients

Pregnancy related causes of deaths in Ghana: a 5-year retrospective study.

OBJECTIVE: Data on maternal mortality varies by region and data source. Accurate local-level data are essential to appreciate its burden. This study uses autopsy results to assess maternal mortality causes in southern Ghana. METHODS: Autopsy log books of the Department of Pathology, Korle-Bu Teaching Hospital Mortuary were reviewed from 2004 through 2008 for pregnancy related deaths. Data were entered into a database and analyzed using SPSS statistical software (Version 19). RESULTS: Of 5,247 deaths among women aged 15-49, 12.1% (634) were pregnancy-related. Eighty one percent of pregnancy-related deaths (517) occurred in the community or within 24 hours of admission to a health facility and 18.5% (117) occurred in a health facility. Out of 634 pregnancy-related deaths, 79.5% (504) resulted from direct obstetric causes, including: haemorrhage (21.8%), abortion (20.8%), hypertensive disorders (19.4%), ectopic gestation (8.7%), uterine rupture (4.3%) and genital tract sepsis (2.5%). The remaining 20.5% (130) resulted from indirect obstetric causes, including: infections outside the genital tract, (9.2%), anemia (2.8%), sickle cell disease (2.7%), pulmonary embolism (1.9%) and disseminated intravascular coagulation (1.3%). The top five causes of maternal death were: haemorrhage (21.8%), abortion (20.7%), hypertensive disorders (19.4%), infections (9.1%) and ectopic gestation (8.7%). CONCLUSION: Ghana continues to have persistently high levels of preventable causes of maternal deaths. Community based studies, on maternal mortality are urgently needed in Ghana, since our autopsy studies indicates that 81% of deaths recorded in this study occurred in the community or within 24 hours of admission to a health facility.