Thyroid cancers in nodular goiters in Kano, Nigeria.

BACKGROUND: Cancer is an occasional incidental finding in nodular goiter, but there has been no formal study on this disease in our locality. AIMS AND OBJECTIVES: To determine the occurrence of histologically diagnosed malignancy in patients who present with nodular goiters. METHODOLOGY: This is a 7-year (2000-2006) retrospective study of all histologically diagnosed malignancies within nodular goiters at Aminu Kano Teaching Hospital, Kano. RESULTS: There were 160 multinodular goiters during the study period, out of which 24 (15.0%) had histologically diagnosed cancer, and 1 out of the thirteen patients with solitary thyroid nodule (7.6%) had carcinoma. The ages of the patients with carcinoma ranged from 16 to 65 years, with a mean age of 38.8 years. Eighteen (72%) were females, and 7 (28%) were males. Six out of the 25 cases of carcinoma were detected preoperatively by fine needle aspiration cytology. Well differentiated follicular carcinoma was the predominant histological type in 13 (52%) cases, followed by papillary in 10 (40%), medullary carcinoma in 1 (4%) and anaplastic carcinoma in 1 (4%) patient. CONCLUSION: One-seventh of nodular goiters in our center harboured malignancy, and follicular carcinoma was the prevalent histological type. This is consistent with the findings elsewhere in endemic goitrous regions. Ultrasound guided fine needle aspiration would improve preoperative diagnosis and guide appropriate surgical management.

A histopathological study of ovarian neoplasms in children in a tertiary hospital of northern Nigeria.

BACKGROUND: Information concerning the frequency and pattern of ovarian tumours in children is scant, more so in northern Nigeria. In view of this, we reviewed ovarian biopsies obtained from children in Zaria over a 25-year period. MATERIALS AND METHODS: Ovarian tumours occurring in 48 patients of age 15 years and below were reviewed and classified using the current World Health Organization (WHO) histological classification of ovarian tumours. RESULTS: Ovarian tumours in children accounted for 8.6% of all cases of tumours seen in all age groups over the period. Among all the malignant tumours seen in this period, 32% occurred in children, and Burkitt's lymphoma accounted for 31.2% of these. Germ cell tumours accounted for 58.0% while epithelial tumours had a frequency of 2.1%. CONCLUSION: Burkitt's lymphoma is the most common childhood ovarian tumour in Zaria, northern Nigeria.

Thyroid Cancers in Nodular Goiters in Kano; Nigeria

Cancer is an occasional incidental finding in nodular goiter; but there has been no formal study on this disease in our locality. To determine the occurrence of histologically diagnosed malignancy in patients who presentwith nodular goiters. This is a 7- year (2000-2006) retrospective study of all histologically diagnosed malignancies within nodular goiters atAminuKanoTeachingHospital;Kano There were 160 multinodular goiters during the study period; out of which 24 (15.0) had histologically diagnosed cancer; and 1 out of the thirteen patients with solitary thyroid nodule (7.6) had carcinoma. The ages of the patients with carcinoma ranged from 16 to 65 years; with amean age of 38.8 years. Eighteen (72) were females; and 7(28) were males. Six out of the 25 cases of carcinoma were detected preoperatively by fine needle aspiration cytology. Well differentiated follicular carcinoma was the predominant histological type in 13(52) cases; followed by papillary in 10(40); medullary carcinoma in 1(4) and anaplastic carcinoma in 1(4) patient. One-seventh of nodular goiters in our center harbouredmalignancy; and follicular carcinomawas the prevalent histological type. This is consistent with the findings elsewhere in endemic goitrous regions. Ultrasound guided fine needle aspirationwould improve preoperative diagnosis and guide appropriate surgical management

Clinical and histological characteristics of nasopharyngeal cancer in Sokoto, north-western, Nigeria.

BACKGROUND: Cancer of the nasopharynx poses diagnostic and therapeutic difficulties because of the hidden nature of the nasopharyngeal space, which allows for significant spread of the disease before diagnosis and hence poor prognosis. OBJECTIVE: To describe the clinical and histological characteristics of nasopharyngeal cancer in a tertiarty health institution in Northern Nigeria. METHODS: Clinical features of patients with nasopharyngeal cancer presenting at the Ear, Nose and Throat clinic of a University Teaching Hospital in North western Nigeria seen over a five-year period were analysed. RESULT: A total number of 30 cases, [22 (73.3%) males and 8 (27.7%) females] with a male to female ratio of 2.8:1 were seen. The mean age was 39.1 years with the fourth decade of life recording the highest number of 16 cases (53.3%) and the least in the thirth decade. The commonest clinical features were neck swelling caused by cervical lymphadenopathy 28 (93.3%), epistaxis 25 (83.3%), nasal obstruction 20 (66.7%),and deafness 11 (36.7%). Others were otalgia 9 (30%), palatal swelling 8 (26.7%),cranial nerve involvement 7 (23.3%) and visual impairment 6 (20%). According to the UICC 1997 staging for nasopharyngeal carcinoma, 23 (76.7%) and 7 (23.3%) were T3 and T4 or stages III and IV respectively. The histological diagnoses were squamous cell carcinoma 23 (76.7%) cases, non-Hodgkins lymphoma 3 (10%) cases, plasmacytoma 2 (6.7%) cases, rhabdomyosarcoma one (3.3%) case, karposis sarcoma one (3.3%) cases. Seventeen (56.7%) patients though accepted in principle never went for radiotherapy. Only 2 (6.7%) were still alive three and six years respectively from the time of diagnosis after chemoradiation while all others (93.3%) had died within one year of diagnosis. CONCLUSION: Nasopharyngeal cancer in Northern Nigeria is characterised by presentation with advanced disease, high mortality and low 5-year survival rates. Free or highly subsidized medical programme for early detection and treatment will reduce the high mortality rate associated with nasopharyngeal cancer in this region.

Histo-Pathological Features of Primary Ovarian Tumours Managed in a Tertiary Hospital; Sokoto

Background: Ovarian tumours are the 2nd most common female genital tract tumour in Sokoto; northwestern; Nigeria. We determined the histo-pathological features of surgically removed ovarian tumours. Methods: A 12-year retrospective study of all surgically removed ovarian tumours at the Gynaecological department of Usmanu Danfodiyo University Teaching Hospital UDUTH) Sokoto; North- Western Nigeria. Results: The highest incidence of ovarian tumours was within the age range of 20-45 years. Of the 125 cases of surgically removed neoplastic ovarian tumours seen during the study period; 83(66.4) were benign; 40(22.4) were malignant and 2(1.6) were of borderline malignancy. Epithelial tumours were the commonest neoplasms 54(43.2); while germ cell tumours were present in 47(37.6) cases. Mucinous cystadenocarcinoma was the ommonest malignant ovarian tumour 14(35) and was closely followed by granulosa cell tumour 10(25); dysgerminoma 17.5); serous cystadenocarcinoma (12.5); malignant teratoma 2(5) and endodermal sinus tumour (5). There were 2 cases of metastatic tumours: one from Burkitts lymphoma; and the other from gestational choriocarcinoma. Conclusion: The high frequency of malignant ovarian tumours in the young age group type in this study underscores the need for histology of all surgically removed tumours irrespective of age

Urinary bladder cancer and schistosomiasis in North-Western Nigeria.

BACKGROUND: An unusually high prevalence of bladder cancer was noticed by clinicians and in the cancer registry of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Several areas of this region were also known to be endemic for urinary schistosomiasis. OBJECTIVE: To determine the epidemiological characteristics of bladder cancer in the region and to assess the impact of schistosomiasis on these cases. METHOD: Retrospective review of clinical and histopathogical records of bladder cancer cases seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto from January 1999 to December 2004. RESULT: One hundred and thirty three cases satisfied our criteria for inclusion. There was a 4.7 fold rise in the number of bladder cancer cases between 1999 and 2004. The male to female ratio was 11.1:1.0. The mean age was 46.0 years and ranged from 20 to 82 years. Majority, 107 (80.5%) were farmers and fishermen from regions of the distribution of surrounding river or their smaller tributaries. Squamous Cell Carcinoma comprised 65.1% of histologically verified cases and in 50% of Squamous Cell Carcinoma; there was histological evidence of chronic urinary schistosomiasis. CONCLUSION: Bladder cancer is a common malignancy in Sokoto, North-Western Nigeria. The association with chronic urinary schistosomiasis is very strong and the hospital incidence appears to be rising.

Knowledge and practice of cervical screening among female health workers in Sokoto, North Western Nigeria.

BACKGROUND: Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening. AIMS: To determine the knowledge and utilisation of cervical cancer screening services in a cohort of subjects where awareness is naturally expected to be high. METHODS: A cross sectional questionnaire survey of 159 female health care providers in Usmanu Danfodiyo University Teaching Hospital Sokoto. The sample included doctors, nurses, pharmacists, laboratory scientists and medical social workers. RESULTS: Knowledge of cervical cancer screening is high among the respondents. However, only 4.4 % had availed themselves of the opportunity for the test. CONCLUSION: Health care providers should improve on opportunistic screening. It is necessary for a national screening policy to be formulated and implemented in Nigeria.

Surgical lymph node biopsies in University of Ilorin Teaching Hospital, Ilorin, Nigeria.

BACKGROUND: To determine the diagnostic value of lymph-node biopsy, commonest causes of lymph node enlargement requiring biopsy and the usual nodes involved. METHODS: A retrospective study of 169 lymph node biopsies representing 97% of lymph node biopsies and 3.2% of total biopsies specimen received at Pathology Department of University of Ilorin Teaching Hospital Ilorin, Nigeria over a 5 year period was undertaken. RESULTS: Tuberculous lymphadenitis (38%) and metastatic nodal involvement (25%) were the commonest causes of lymph node enlargement. Generalised lymphadenopathy occurred in 105 (62%) patients while localised enlargement was seen in 64{38%) of cases. The commonest sites of localised lymphadenopathy were axillary (38%), cervical (32%), inguinal (8%), and submandibular (8%). While axillary lymph node enlargements were mostly associated with tumour metastasis, cervical node enlargements were mostly associated with tuberculosis. Supraclavicular lymphadenopathy has the highest risk of malignancy. CONCLUSION: The result shows that tuberculous lymphadenitis and metastatic nodal malignancies are the commonest causes of lymph node enlargement in our environment. Reasons for this include the often involvement of lymph nodes in tuberculous infections {as lymphadenitis constituted the most frequent form of extra pulmonary tuberculosis} and cancer's metastasis. With an effective and nationwide immunisation against tuberculosis, health education on HIV infection coupled with early screening and detection of malignancies in generals, we hope this trend will change in the future. Lymph node biopsy remains an important and valuable diagnostic tool in evaluation of lymph node enlargement as it allows for the architecture of the gland to be viewed thereby given an accurate and concise diagnosis with very minimal risk to the patient.

Malignant peripheral nerve sheath tumour associated with von Recklinghausen's disease: case report.

Only a few cases of malignant peripheral nerve sheath tumour (MPNST) associated with Von Recklinghausen's disease or type I neurofibromatosis (NF-1) have so far been reported worldwide, yet the primary disease (NF-I ) does not seem rare even in Africa. We present a case of a 40 year old woman with MPNST of the left thigh associated with NF-1. The diagnosis was based on clinical, radiological and histopathological evidence. She presented with a 25 year history of painless, multiple, generalized skin nodules and hyperpigmented spots. She also noticed a gradually progressive, painless, redundant mass on the left side of the forehead 16 years prior to presentation. Four months before presentation, she noticed another mass at the back of the left thigh, which increased rapidly in size. Examination revealed a middle aged woman with generalized subcutaneous nodules of various sizes (3mm - 2.5cm), multiple café-au-lait spots (2cm-4.5cm), a plexiform neurofibroma on the left side of the forehead measuring 6cm x 5cm x 5cm. There was a firm, non-pulsatile and non-tender mass (11.5cm x 9cm x 5cm) on the posterior aspect of the left upper thigh. The mass was more mobile longitudinally than transversely and was attached to the overlying skin at the summit, the regional Iymph nodes were not enlarged. Most investigations were essentially normal except a plain radiograph, which revealed a soft tissue mass on the left thigh without bony involvement. At surgery, a well localized soft tissue tumour, abutting on the sciatic nerve was widely resected without neural damage to the nerve. Histologic sections of a tru cut as well as the surgical specimens showed a tumour consisting of closely packed serpentine cells arranged in palisades; marked nuclear and cellular pleomorphism and hyperchromatism, many bizarre tumour giant cells, mitotic figures and foci of necroses. The patient received six courses of cytotoxic therapy and is well eleven months after surgery. It is presented to highlight the clinical and pathological features of NF-1 complicated with malignant transformation.

Increasing the clinical utility of the cervical smear cytology report--a cytopathologist's recommendations.

Cervical smear cytology is becoming increasingly available as an important screening tool for precancerous lesions of the cervix in Nigeria. The gynaecologist has an important role to pay in arriving at a clinically useful cytologic diagnosis. The essential inputs to an efficient and reliable cervical smear cytology service include adequate clinical data, proper smear collection, use of a familiar reporting system and prompt follow-up. Cervical cytology has many limitations and without an awareness of its possible pitfalls and problems, the method may be easily abused.