Diagnostic Utility of Fine Needle Aspiration Cytology in the Evaluation of Peripheral Lymphadenopathy.

BACKGROUND: Patients are often referred for fine needle aspiration cytology (FNAC) on account of peripheral lymphadenopathy. Relative to the rate of referrals, very few works have been done to establish the reliability of FNAC as a first-line investigation in the evaluation of peripheral lymphadenopathy in this environment. This study aims to determine the diagnostic utility of FNAC in evaluating common causes of peripheral lymphadenopathy in a teaching hospital in North western Nigeria. STUDY DESIGN: Eighty-six patients who had FNAC and histology or cell blocks preparation of the same lymph nodes were recruited over a 5-year period. Using histology and cell blocks as gold standards, the sensitivity, specificity, predictive values and test accuracy were deduced. RESULTS: The sensitivity, specificity, positive and negative predictive values were 71.4%, 91.5%, 87.5% and 81.1% respectively. The test accuracy of FNAC was 83.7%. CONCLUSION: FNAC is reliable for screening and diagnosing peripheral lymph node lesions. However, ancillary tests such as immunocytochemistry may be necessary for improved accuracy.

Histological pattern of thyroid gland neoplasms in Kano, Northern Nigeria.

BACKGROUND AND OBJECTIVE: Thyroid gland neoplasms occur globally with geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. There is, however, no published histological study from northwestern Nigeria; hence, the need for this retrospective study to document the pattern in Kano. MATERIALS AND METHOD: This was a retrospective study of all histologically diagnosed thyroid neoplasms in the Department of Pathology, Aminu Kano Teaching Hospital (AKTH), Kano Nigeria, over a ten year period from 1st January, 2002 to 31st December, 2011. RESULTS: A total of 522 thyroid specimens (1.5% of all biopsies) were received over the ten year period. Thyroid neoplasms accounted for 157 (30.1%) of all the thyroid specimens, comprising 130 females (82.8%) and 27 males (17.2%) with female to male ratio of 4.8:1. The ages range from 15 to 80 years with a mean age of 35.8 years and peak occurrence in the 4th decade. There were 82 cases (52.2%) of thyroid adenoma (mostly follicular) while thyroid carcinoma accounted for 66 cases (42%). Papillary carcinoma predominated (53%) followed by follicular carcinoma (33.3%) and medullary carcinoma (9.1%). One case each (1.5%) of anaplastic carcinoma, squamous cell carcinoma and metastatic squamous cell carcinoma were seen. All the malignant tumours were epithelial and all except one were primary thyroid malignancy. CONCLUSION: Thyroid neoplasmis a common thyroid gland lesion in Kano with a striking female preponderance. Thyroid adenoma was the most common benign neoplasm while papillary carcinoma seen a decade earlier in females was the most common malignant thyroid neoplasm. The predominance of papillary carcinoma over follicular carcinoma is a reverse of the finding of an earlier clinicopatholgical study on thyroid gland diseases in Kano.

Verrucous (hypertrophic) cutaneous lupus erythematosus: a case report.

Verrucous (Hypertrophic) lupus erythematosus (LE) represents a rare but distinct, variant of chronic discoid lupus erythematosus. We report a case of LE with verrucous lesions for its rarity and peculiar location posing a diagnostic dilemma.

Seasonal trends in epidemiological and entomological profiles of malaria transmission in North Central Nigeria.

The influence of seasonal changes on epidemiological and entomological indices of malaria transmission in North Central Nigeria was elucidated in a series of studies carried out between January 2004 and December 2009. The climate in the study area was divided into three seasonal periods namely, rainy (May-October), dry (December-March) and transitional (April and November), during which larval and adult anopheline mosquito collections were carried out and assessed for densities, sporozoite infection and parity rates and potentials for malaria transmission. The results indicated that the climate in the study area was clearly seasonal, with close similarities in the patterns of distribution of the climatic factors in the study sites. Mosquito densities, both at the adult and larval stages (i.e., 29.35 +/- 5.10 adult mosquitoes/man/night and 10.36 +/- 3.34 larvae/dip, respectively), were significantly (p<0.05) highest during the rainy season. However, while the former varied significantly in the three seasonal periods, the latter was not significantly different during the dry and transitional seasons. Malaria transmission risks, in terms of sporozoite rates and entomological inoculation rates, was significantly (p<0.05) least in the dry season (i.e., 2.89 +/- 1.25% and 0.37 +/- 0.21 infective bite/man/night, respectively) but the two variables were not significantly (p>0.05) different during the transitional and rainy seasons. Adult mosquito daily survival rate and adult longevity were least in the dry season (26.52 +/- 11.80% and 6.80 days, respectively) and significantly (p<0.05) highest during the rainy season (72.28 +/- 4.00% and 16.95 +/- 4.20 days, respectively). Parous rates of the mosquitoes and duration of sporogony had distinct distribution pattern from the other variables investigated. While, significantly highest parous rates were recorded in the transitional season (86.00 +/- 4.30%), duration of sporogony was not significantly (p>0.05) different during the three seasons. The epidemiology of urban malaria in North Central Nigeria was discussed from the view points of the these results and concluded that the findings should promote the development of informed temporally-targeted vector control programs for the area.

Health care providers' readiness to screen for intimate partner violence in Northern Nigeria.

Research on screening for intimate partner violence (IPV) within health care in a sub-Saharan African context is rare. This paper assessed factors associated with the readiness to screen for IPV among care providers (HCP, n = 274) at Kano hospital, Nigeria. Readiness was measured using the Domestic Violence Health Care Providers' survey instrument, which measures grade of perceived self-efficacy in screening for IPV, fear for victim/provider safety, access to system support to refer IPV victims, professional roles resistant/ fear of offending clients, and blaming the victim for being abused victim. Social workers perceived a higher self-efficacy and better access to system support networks to refer victims than peers in other occupation categories. Female care providers and doctors were less likely to blame the victim than males and social workers, respectively. Younger care providers of Yoruba ethnicity and social workers were less likely to perceive conflicting professional roles related to screening than older providers of Hausa ethnicity and doctors, respectively. Implications of our findings for interventions and further research are discussed.

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.

Immunohistochemical study of epithelial-myofibroblast interaction in Barrett metaplasia.

CONTEXT: Sub-epithelial myofibroblasts are known to influence the biology (proliferation, differentiation and apoptosis) of overlying epithelia. In the intestine, myofibroblasts have been demonstrated to be essential for epithelial differentiation. It is therefore hypothesized that myofibroblasts may also be involved in intestinal metaplasia that is characteristic of Barrett esophagus. OBJECTIVE: This study endeavors to immunohistologically evaluate epithelial-myofibroblast interaction in Barrett's metaplasia. MATERIALS AND METHODS: Nineteen archival esophageal endoscopic biopsies of Barrett's metaplasia were immune-phenotyped for the following epithelial and myofibroblast antigens - cytokeratins (CK) 8, 13, 18, CDX2 (Caudal type homeobox 2), a-smooth muscle actin (SMA). RESULTS: alpha-SMA immunostaining revealed close association between myofibroblasts and metaplastic Barrett's epithelium but not with normal esophageal squamous epithelium. Myofibroblasts were more prominent in dysplastic than in non-dysplastic Barrett metaplasia. CDX2 and CK 8/18, indicators of intestinal differentiation were expressed in Barrett metaplasia but not normal esophageal squamous epithelium, while the reverse was the case for CK 13, which only stained normal esophageal squamous epithelium. CONCLUSION: Although their precise role is yet to be clearly defined, sub-epithelial myofibroblasts are very likely involved in the pathogenesis of Barrett's metaplasia.

Idiopathic scrotal calcinosis; a rare scrotal tumour: a case report and review of literature.

Idiopathic scrotal calcinosis is a rare benign disease characterized by multiple, asymptomatic and painless nodules on the scrotum. We herein report this rare disease in a Nigerian adult male and briefly review the relevant literature.

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

Dyschromatosis universalis hereditaria in a young Nigerian female.

Dyschromatosis universalis hereditaria (DUH) is a clinically heterogeneous disorder that shows generalized mottled pigmentation. It occurs most commonly in Japanese persons, with sporadic reports from South Africa, India, and Iraq. Histopathology reveals a variable degree of pigmentary incontinence. Although the precise etiology of this disorder is not yet known, the clinicopathological findings implicate an inherent abnormality of melanosomes or melanin processing. We describe a case in a young Nigerian girl.

Type 2 segmental Darier's disease in a twelve-year-old Nigerian male--a case report.

Darier's disease is an autosomal dominant disorder characterized clinically by presence of keratotic papules in a seborrheic distribution, nail involvement and mucosal lesions. There are several clinical variants of Darier's disease, but few cases of segmental Darier's disease have been described in the literature. We describe a 12-year-old boy with type 2 mosaic phenotype. This unique clinical variant of Darier's disease has been described very rarely.

Krukenberg's tumour.

BACKGROUND: Krukenburg's tumour, a metastatic cancer to the ovary can pose difficulties in early diagnosis. The paucity of reports from our environment coupled with the difficulties we encountered makes it imperative that we report this case. METHODS: We present a 32-year-old lady who presented with mucoid and bloody diarrhoea associated with menstrual irregularity, weight loss and lower abdominal pains 2 years after surgical treatment for gastric cancer. Literature on Krukenburg's tumour was also reviewed. RESULTS: While serum level of CEA was found to be elevated and colonoscopy showed an ulcerated mass obliterating the lumen of the sigmoid colon, abdominal CT scan revealed bilateral adnexal masses. The histology of the colonic lesion showed signet ring carcinoma while the enlarged ovaries turned out to have evidence of metastatic adenocarcinoma. CONCLUSION: Early diagnosis of KT can be difficult. Periodic surveillance is, therefore, essential especially in those who have had a gastrointestinal malignancy.

Ichthyosis hystrix Curth-Macklin type in an African girl.

Ichthyosis hystrix Curth-Macklin type is a rare autosomal dominant skin disorder characterized by extensive hyperkeratosis and palmo-plantar keratoderma. It results from heterozygous frameshift mutation in keratin 1 gene (KRT1). Histological features, showing perinuclear vacuolization and binucleated cells, are similar to those of epidermolytic hyperkeratosis except for the absence of epidermolysis. The present report describes the condition in a 16-year-old African girl where available treatment was disappointing.

Implementing a hospital based injury surveillance system: a case study in Nigeria.

A pilot study of violent injury surveillance was implemented in two hospitals in Kano, Nigeria, in two phases: a formative evaluation including training and arranging the collection of hospital information, followed by a 6 month prospective data collection. Road traffic injuries constituted about 80 per cent of the cases, gunshot injuries were the commonest in victims of interpersonal violence (IPV). The causes and context of IPV, the relationship of victims and perpetrators, and the place, related activities and anatomical site of injuries from IPV are summarized.

Implementing a hospital based injury surveillance system in Africa: lessons learned.

A multinational injury surveillance pilot project was carried out in five African countries in the first half of 2007 (Democratic Republic of the Congo, Kenya, Nigeria, Uganda and Zambia). Hospitals were selected in each country and a uniform methodology was applied in all sites, including an injury surveillance questionnaire designed by a joint programme of the Pan American Health Organization and the United States Centres for Disease Control and Prevention. A total of 4207 injury cases were registered in all hospitals. More than half of all injury cases were due to road traffic accidents (58.3%) and 40% were due to interpersonal violence. Self-inflicted injuries were minimal (1.2% of all cases). This report provides an assessment of the implementation of the project and a preliminary comparison between the five African countries on the context in which inter-personal injury cases occurred. Strengths and weaknesses of the project as well as opportunities and threats identified by medical personnel are summarized and discussed. A call is made to transform this pilot project into a sustainable public health strategy.

Transurethral resection of the prostate in Northern Nigeria, problems and prospects.

BACKGROUND: Benign prostatic hyperplasia (BPH) is the commonest disease of the urinary tract afflicting the ageing male and is the commonest neoplastic disease in men aged 50 years and above. Transurethral prostatectomy (TURP) is the ultimate treatment of choice for benign prostatic hyperplasia (BPH) due mainly to the preference of minimally invasive surgery, long term relief of symptoms and cost effectiveness. It is however not available to the majority of Nigerians in need of prostatic surgery in Public Health Institutions. METHODS: The records of patients who underwent prostatectomy in Aminu Kano Teaching Hospital, over the period June 2001 to July 2007 were examined. The bio data of patients and laboratory investigations performed were retrieved. RESULTS: Five Hundred and forty two patients were operated upon, out of which 40 were excluded due to open prostatectomy (22 patients), bladder neck stenosis (16 patients) or bladder tumour around the trigon (2 patients). The age range of the patients was 47-110 years with a mean of 67.2 years. 289 patients (80.1%) had urethral catheter in situ at presentation and 11 (3%) patients had suprapubic cystostomy of which only 3 (0.85%) had combined urethral stricture and BPH. Only 131 (26%) had their PSA measured which ranged from 2-100 ng/ml out of which 39(29.8% n = 131) patients had more than 4 ng/ml and cancer of the prostate and 1(0.8%, n = 131) patient had a PSA level of 4 ng/ml and malignant prostate. Hospital stay was 1-32 days (mean 7.9) and the mean follow up period was 5.6 months (range 0-60) and there were 17.5% complications comprising of urinary tract infection (UTI) 7.2%, Orchitis 2.2%, urinary incontinence 0.6%, atonic bladder 1%, erectile dysfunction 0.6%, cerebrovascular accident 0.4%, myocardial infarction 0.4%, deep vein thrombosis 0.4% and disseminated intravascular coagulopathy (DIC) 0.6% and 1.2% mortality. The cost of treatment inclusive of pre-admission investigations was US$ 615.00 (range US$ 300-1,300) CONCLUSION: Despite advances in minimally invasive therapy for LUTH/BPH, TURP is the optimum treatment of choice for the ageing male of sub-Saharan Africa. It is however not available to the majority of patients in this region due to poor health allocation and inadequate facilities and training.

Cancer in Nigeria: a 10-year analysis of the Kano cancer registry.

BACKGROUND: Cancer is a major health problem in developed countries and epidemiological evidence shows the emergence of a similar tend in developing countries, particularly in sub-Saharan Africa where HIV/AIDS is predicted to augment the cancer burden. The present study analyses the profile of cancers recorded in the first decade (1995-2004) of establishment of the Kano cancer registry (KCR) a histology/cytology-based registry in Kano, Nigeria. METHODS: Records of cancer cases diagnosed based on histology or cytology and entered into the registry were retrieved and categorized by type/organ sites affected according to International Classification of Diseases for Oncology RESULTS: There was a steady rise in frequency of cancer over the period where a total of 1990 cancer cases were recorded comprising of 1001 (50.3%) males and 989 (49.7%) females. Cancers of the cervix (22.9%), Breast (18.9%), Ovary (8.2%), non-melanoma skin cancer (6.3%), and Uterus (6.2%) were the most frequent female cancers. In males, cancer of the prostate (16.5%), bladder (10.2%), non-melanoma skin (9.9%), colorectum (9.3%) and connective tissue (6.3%) were most common. Burkitt's lymphoma (31.4%), other lymphoreticular cancers (23.8%) and retinoblastoma (20%) predominated in children. CONCLUSION: The KCR supports existing predictions of an increase in incidence of cancers in developing countries. There is need for establishment of comprehensive cancer control programmes in developing countries for the common cancers of the cervix, breast, prostate, bladder, skin and colorectum which are amenable to prevention, early detection and cure.

Post kidney transplant tuberculosis in Nigeria: a case report.

BACKGROUND: Tuberculosis has been reported to be one of the most serious bacterial infections after transplant and occur up to 20 times more frequently in transplant recipients than in the general population. Renal transplant is available in few centers in the country and the post transplant population is increasing, but to our knowledge no case of post transplant tuberculosis has been reported in this environment. METHOD: The case report of a 35 year old Nigerian who had live related kidney transplant and later developed post transplant disseminated Tuberculosis is presented and the relevant literature is reviewed. RESULTS: A 35 year old university graduate had a live related kidney transplant in our center. He had stable allograft function on immunosuppressive regimen consisting of Cyclosporin, Azathioprine and Prednisolone, and presented with features of disseminated tuberculosis involving the cervical lymph nodes and chest with associated deterioration of allograft function. He was successfully treated with 2 months initial phase of quadruple anti tuberculosis drugs including Isoniazid, Rifampicin, Pyrazinamide and Ethambutol and four months continuation phase with Isoniazid and Rifampicin. He showed remarkable clinical improvement and reversal of the allograft dysfunction. CONCLUSION: This case illustrates one of the post transplant infectious complications seen in our environment and its successful treatment, and highlighted the need for Tuberculosis prophylaxis in transplant recipients in countries with high incidence of tuberculosis.

Giant and complicated subcutaneous lipoma of the neck.

BACKGROUND: Although lipomas around the head and neck region are not uncommon, giant lipomas around the neck are rare. OBJECTIVE: To report the case of a long standing giant lipoma of the neck which was managed easily by simple surgical excision. CASE REPORT: A case of giant subcutaneous lipoma of the neck is reported in a 70 year old woman who presented with dragging sensation and bleeding from the site of pressure ulceration as the major complaint. The patient was evaluated and definitive diagnosis was arrived at using Fine Needle Aspiration Cytology (FNAC). She had a successful Surgical excision and was subsequently discharged but never came back for follow up. CONCLUSION: Lipoma should always be considered in the differential diagnosis of pedunculated lesions around the neck.

Cancer in Nigeria: a 10-year analysis of the Kano Cancer registry

Background: Cancer is a major health problem in developed countries and epidemiological evidence shows the emergence of a similar tend in developing countries; particularly in sub-Saharan Africa where HIV/AIDS is predicted to augment the cancer burden. The present study analyses the profile of cancers recorded in the first decade (1995-2004) of establishment of the Kano cancer registry (KCR) a histology/ cytology-based registry in Kano; Nigeria. Methods: Records of cancer cases diagnosed based on histology or cytology and entered into the registry were retrieved and categorized by type/ organ sites affected according to International Classification of Diseases for Oncology.Results: There was a steady rise in frequency of cancer over the period where a total of 1990 cancer cases were recorded comprising of 1001 (50.3) males and 989 (49.7) females. Cancers of the cervix (22.9); Breast (18.9); Ovary (8.2); non-melanoma skin cancer (6.3); and Uterus (6.2) were the most frequent female cancers. In males; cancer of the prostate (16.5); bladder (10.2); non-melanoma skin (9.9); colorectum (9.3) and connective tissue (6.3) were most common.Burkits lymphoma (31.4); other lymphoreticular cancers (23.8) and retinoblastoma (20) predominated in children. Conclusion: The KCR supports existing predictions of an increase in incidence of cancers in developing countries. There is need for establishment of comprehensive cancer control programmes in developing countries for the common cancers of the cervix; breast; prostate; bladder; skin and colorectum which are amenable to prevention; early detection and cure