Placental Site Trophoblastic Tumour Mimicking Placenta Previa.

ABSTRACT: We present a 42-year-old Nigerian woman who had three previous caesarean sections and is being managed conservatively for placenta previa. She underwent a caesarean hysterectomy on account of uncontrollable bleeding, and histopathology revealed a placental site trophoblastic tumour.

Testicular and paratesticular non- neoplastic lesions in university of maiduguri teaching hospital: a 10-year retrospective review

Objectives: The present study is undertaken to describe the spectrum of histopathological features and age distribution of non-neoplastic testicular and paratesticular lesions in the University of Maiduguri Teaching Hospital (UMTH). Materials and methods: A retrospective descriptive study of 70 testicular and paratesticular nonneoplastic lesions was conducted over a period of 10 years; between January-2005 and December2014 in the Department of Histopathology, UMTH. Histopathological examination was done after routine processing and staining with Haematoxylin and Eosin. Special stain (Ziehl-Neelsen stain) was done to confirm the presence of acid fast bacilli in cases of tuberculous epididymoorchitis. Results: There were of which (24.3%) followed by testicular torsion and infarction (14.3%). The youngest patient was 2 years old and the oldest was 80 years of age. The highest incidence occurred in the age range of 30 ­ 59 years with a total of 25 cases representing 35.7%. The lowest incidence was observed in the elderly (= 60 years) with a total of 21 cases (30%). Conclusion: This study shows that inflammatory disorders are the predominant causes of the testicular and paratesticular non-neoplastic lesions capable of interfering with fertility and mimicking malignancy. There is also the need to emphasise the necessity of proper evaluation and treatment of acute orchitis and microabscess to avoid unnecessary orchidectomy.70 cases of non-neoplastic testicular and paratesticular lesions the majority were inflammatory disorders accounting for 53 cases (75.7%). They included acute orchitis (4.3%), tuberculosis (12.9%), schistosomiasis (8.6%), hydrocoele (24.3%), chronic orchitis (10.0%), epididymal cyst (11.4%) and tumoral calcinosis (4.3%). Other categories of the lesions included congenital abnormalities (10.0%) and traumatic disorder (14.3%). Long-standing hydrocoele was the commonest lesion

Pistol-grip Syringe holder (Cameco syringe pistol) in fine needle aspiration Biopsy: any advantages over the use of direct finger grip?

AIMS AND OBJECTIVES: The study seeks to determine the advantages of using the pistol-grip syringe holder in the performance of FNAB over the use of direct finger grip method. PATIENTS AND METHODS: The skin is cleaned with gauze soaked in methylated spirit and the lump is located and firmly held between the thumb and fore finger of the free hand. The syringe is held by the out side of the barrel or by pistol-grip, and the needle tip pushed into the lesion. The plunger is partially retracted, creating a negative pressure. The cutting edge of the needle tip frees the cells inside the lesion which are sucked into the fine bore of the needle. The contents of the needle are then emptied on a microscopic slide and thinly smeared. The slides are then fixed in alcohol and later stained. These were examined under the microscope and a comparison between the aspirations using pistol-grip and direct finger grip was made. RESULTS: A total of 266 cases of FNABs were carried out from 1st January to 31st December, 2008. There were 89 breast cases out of which 42 (47%) had pistol-grip method and 47 (53%) had direct finger grip method; 74 thyroid cases out of which 28 (38%) were pistol-grip and 46 (62%) were direct finger grip cases; 56 cases of lymph node FNABs of which 18(32%) and 38 (68%) had pistol-grip and direct finger grip methods respectively. There were 23 cases of salivary gland FNABs having 8 (35%) and 15 (65%) as pistol-grip and direct finger grip methods respectively. Marked cellularity was observed in the majority of cases using both methods of FNABs. CONCLUSION: This study has shown that the use of pistol-grip syringe holder in the performance of FNABs has no significant advantage compared to the direct finger grip method.

Helicobacter pylori indyspeptic Nigerians.

BACKGROUND: Dyspepsia is a common gastrointestinal disorder, and is the most common indication for upper gastrointestinal endoscopy. Helicobacter pylori is a significant aetiological factor in acid peptic diseases and gastric cancer. Detection of this organism during upper gastrointestinal endoscopy has become standard clinical practice. Data is scanty from North-Eastern Nigeria on the subject. OBJECTIVES: To determine the prevalence of Helicobacter pylori among dyspeptic patients, and alsoto find out the association of H. pylori and degree of activity in chronic gastritis. METHODS: This is a hospital-based cross sectional study which was carried out at the Endoscopy unit of Federal Medical Centre, Yola and Histopathology unit, University of Maiduguri Teaching Hospital, Maiduguri from November, 2006 to May, 2010. Patients with dyspepsia who underwent upper gastrointestinal endoscopy as part of their work-up, also had endoscopic biopsies taken from the antral portions of their stomach. The biopsy specimens were fixed in 10% formalin and transported from Yola to Maiduguri by courier for processing. RESULTS: Three hundred and forty-nine patients comprising 152(43.6%) males and 197(56.4%) females with dyspepsia had upper gastrointestinal endoscopy. Their age ranged between 14 and 103 years with a median of 44.1 years. A prevalence rate of 56.7% for Helicobacter pylori was found.Helicobacter pylori associated with severe activity accounted for 80.3%; moderate activity- 57.5%; mild activity - 20% and normal gastric mucosa- 9.1%. CONCLUSION: There is a high prevalence of Helicobacter pylori among patients with dyspepsia, and a strong association between H. pylori and chronic gastritis with severe activity.

Congenital aganglionic megacolon in Nigerian adults: two case reports and review of the literature.

Congenital aganglionic mega colon (Hirschsprung's disease) is a motor disorder in the gut, due to a defect in the craniocaudal migration of the neuroblast originating from the neural crest that occurs during the first twelve weeks of gestation, causing a functional intestinal obstruction, with its attendant complications, in infants. Despite modern pediatric practice, with emphasis on early diagnosis, Hirschsprung's disease is seen in adults in regions where perinatal care is limited. We report two cases of Nigerian adults with longstanding, recurrent constipation, getting relieved by laxatives and herbal enemata, and then presented to our Emergency Department with a history of progressive abdominal distention, colicky pain, occasional vomiting, and weight loss. Per rectal examination revealed a gripping sensation in the rectum, 10 cm from the anal verge, with rectal fecal load. Barium enema showed a grossly distended proximal large colon, with high fecal retention, with the transition zone at the middle one-third of the rectum. Due to difficulty in bowel preparation of these patients, emergency laparotomy was done. The first case had a diverting sigmoid colostomy and later had a low anterior resection. The second case had a one-stage procedure. Histology of both the cases showed aganglionosis of the stenotic segment and a normal distal rectum. Both patients had complete resolution of the symptoms, without complications, in a three-year follow-up. The related literatures were reviewed. Hirschsprung's disease should be considered in adults patient presenting with chronic constipation. Low anterior resection of the rectum would be a surgical option for the treatment of short and zonal segment of adult Hirschsprung's disease.

Nasopharyngeal cancer in North--Eastern Nigeria: clinical trends.

BACKGROUND: Nasopharyngeal cancer is the malignancy of the posterior aspect of the nose called Nasopharynx. It is one of the most difficult diseases to diagnose at an early stage. AIM: To determine prevalence, clinical trends and histopathological types of Nasopharyngeal cancer in Maiduguri, North Eastern Nigeria. PATIENTS AND METHOD: Fifteen year retrospective evaluation of patient's case notes and cancer registry records of 40 patients with histologically confirmed nasopharyngeal cancer between 1991-2005. RESULTS: Nasopharyngeal cancers constituted 35.1% of all malignancies of ear, nose, throat during the study period. The M:F was 2.1-1, the mean age was 39(+/- 16.5) years and a peak age group and its occurrence of 40-49 years. The commonest symptom at presentation were cervical lymphadenopathy (72.5%), rhinorrhoea (55%), epistaxis(45%). The commonest histological type was squamous cell carcinoma(92.5%). Patients who received chemotherapy in addition to radiotherapy and higher symptom free period. CONCLUSION: Cancer is a difficult disease to diagnose at an stage. A meticulous ear, nose and throat examination and thorough evaluation of nasal symptoms with associated cervical lymphadenopathy may lead to an early diagnosis of nasopharyngeal cancer's.

A histopathological analysis of thyroid diseases in Ile-ife, Nigeria. a review of 274 cases.

OBJECTIVE: To describe the spectrum of histopathological features of thyroid diseases; analyse the occurrence of each of the types and to compare the findings with those from previous studies done in Nigeria and elsewhere. MATERIALS AND METHODS: A retrospective study of thyroid lesions seen at the OAUTHC Histopathology Department during a 10-year period between 1988 and 1997. RESULTS: The 274 surgical thyroid specimens received during the study period came from 235 (85.8%) females and 39 (14.2%) males giving a female: male ratio of 6:1. Colloid goiter accounted for about 75% of cases with an average age of occurrence of 40.7 years. Only 1.8% showed features of toxic goiter and thyroiditis each. The adenomas constituted about 6% while carcinomas constituted about 11% of cases respectively. Adenomas occurred almost a decade earlier than carcinomas. Follicular carcinoma was the commonest thyroid cancer seen in this study. CONCLUSION: This study shows that the commonest thyroid disease in Ile-Ife is colloid goiter, which is a preventable disease. Thus, public health measures such as iodination of salt and health education are called for to reduce the occurrence of this disease.

Histopathological analysis of non-squamous cell malignancies of the uterine cervix in Maiduguri, Nigeria.

Carcinoma of the uterine cervix is the most common gynaecological malignancy in the developing world despite being largely preventable. The non-squamous cancers of the cervix have not been properly documented in our setting. This study is aimed at reviewing the histological types ofnon-squamous cell cancers of the uterine cervix in relation to the age of presentation, and to analyze some of the histopathological features of adenocarcinomas. Cases of cancer of the cervix histologically diagnosed between January 1989 and December 2004 were extracted from the cancer register of the University of Maiduguri Teaching Hospital. The request forms, slides, and some tissue blocks were retrieved from the archives of the Histopathology Department. The cases were histologically reviewed and the data analyzed using simple statistical methods. A total of 491 cases of cervical cancers were diagnosed. Of these, 432(88.0%) cases were squamous cell carcinomas while 59(12.0%) were non-squamous cell malignancies. Out of the 59 non-squamous cervical cancers, 42(71.2%) were endocervical-type adenocarcinomas, while serous papillary, clear cell, and adenosquamous carcinomas comprised 2(3.4%) cases each. Seven (11.9%) cases were metastatic choriocarcinomas. Over 60% of these cases occurred within the third and fourth decades of life. Adenocarcinomas are the most common non-squamous malignancies of the cervix and their age of presentation was similar to that of their squamous cell counterpart. Haemorrhage and lymphocytic infiltrates were significantly associated with tumour grade while necrosis was independent of tumour grade.

Correlation between histopathologic and fine needle aspiration cytology diagnosis of palpable breast lesions: a five-year review.

Fine needle aspiration cytology (FNAC) of the breast has been used as an initial investigative procedure of palpable breast lesions. The purpose of this study is to evaluate our experience with Fine Needle Aspiration Cytology (FNAC) and to correlate between histopathologic and FNAC diagnoses of palpable breast lesions. A 5-year retrospective study was performed using records of all patients who had had both FNAC and histopathologic results of breast lumps. This is a retrospective study of 220 diagnosed cases of breast lesion at the University of Maiduguri Teaching Hospital (UMTH), Nigeria between the periods of January 2001 and December 2005. The results of the FNAC were interpreted as inflammatory, benign, suspicious or malignant. A total of 220 patients had both cytopathologic and histopathologic diagnoses and therefore fulfilled the criteria for this study. There were 11 (5%) cases of inflammatory, 140 (63.6%) cases of benign and 69 (31.4%) cases of malignancy. There were two cases that were suspicious of malignancy and for the purpose of this study were considered as malignant. There were five (5) cases of cytologically interpreted errors which were three cases of false negative and two cases of false positive. The diagnostic accuracy was 97.7%, sensitivity was 95.7%: and specificity was 98.7%. The false negative and false positive rates were 2.9% and 1.9% respectively. FNAC of breast lesions is sensitive, specific, and highly accurate as the initial investigation of palpable breast lesions in our tertiary hospital. We therefore implore clinicians to embrace this procedure in the management of patients.

AIDS-associated Kaposi's sarcoma in Northeastern Nigeria.

INTRODUCTION: Kaposi's sarcoma is an acquired immunodeficiency syndrome (AIDS)-defining illness, and with the size of the human immunodeficiency virus (HIV)/AIDS pandemic in sub-Saharan Africa, AIDS-related Kaposi's sarcoma (KS) are now being diagnosed more frequently, although the true incidence of HIV-associated KS is not known. The clinical presentations of AIDS-related KS varied markedly across the African continent. This article reports a series of unusual clinical presentations of the tumour in Northeastern Nigeria. METHODS: This is a prospective study carried out from September 2003 to August 2005, at the University of Maiduguri Teaching Hospital, Borno State, Northeastern Nigeria. RESULTS: 20 cases of histologically-confirmed KS were prospectively studied. There were 17 (85 percent) men and three (15 percent) women, giving a male to female ratio of 5.7:1. Their ages ranged from 21-45 (median 37) years. 18 (90 percent) of the patients were anaemic. Mean haematocrit value, CD4+ cell count and duration of symptoms for all the patients were 29.5 +/- 7.5 percent, 119.0 +/- 91.4 cells per microlitre and 3.5 +/-1.7 months, respectively. Multiple lesions were a common presentation affecting sites such as lower limbs, trunk, conjunctiva, upper limbs and rectum as well as penis, lymph node, scrotum and oropharynx. CONCLUSION: Contrary to other reports that KS is not associated with HIV infection, our study has demonstrated otherwise. This study also showed that both sexes are affected but with a male preponderance. KS is also a late presentation of the HIV/AIDS disease spectrum in our environment and has varied clinical manifestations. There is an urgent need to develop health education programmes to enhance the understanding of this disease and how it spreads, particularly among the young generation.

Recurrent tumoral calcinosis.

Tumoral calcinosis is a rare, benign disease that commonly affects the African blacks. We report on a 20-year-old Nigerian presenting with recurrent multiple subcutaneous masses around the scapular, elbow, hip and gluteal regions. The X-rays, fine needle aspiration cytology and tissue biopsy confirmed the diagnosis and the patient had a successful excision with good healing.

Schistosomiasis of the appendix in Maiduguri.

We retrospectively studied 27 histologically diagnosed cases of schistosomiasis of the appendix at the University of Maiduguri Teaching Hospital between January 1994 and December 2003. Of 1183 cases of appendices histologically examined, schistosomiasis was seen in 27 (2.3%).

Appendicovesical fistula associated with Hirschsprung's disease.

Appendicovesical fistulae are rare. Only 112 cases in all ages have been reported previously in the world literature. Our case is that of a 1-year-old boy who presented during the neonatal period with missed appendiceal perforation associated with a long segment Hirschsprung's disease. The case is discussed.

Cutaneous metastasis from hepatocellular carcinoma: a rare presentation and review of the literature.

A 53-year-old male Nigerian with a rare cutaneous metastasis and a late manifestation of hepatocellular carcinoma is presented. The skin nodules were umbilicated, painless. firm and spread on the chest, abdomen and back. Ultrasonography showed a huge mass in the right lobe of the liver. Fine needle aspiration cytology of the liver revealed hepatocellular carcinoma and the skin nodule, metastatic carcinoma of hepatic origin. The immunological marker HBsAg was positive while Anti-HCV Ab and alpha-feto-protein were negative. Patient died and consent for post-mortem examination was refused.

Prostate cancer in Maiduguri.

BACKGROUND: Prostate cancer is the sixth most important cancer in the world, and its incidence in blacks has been on the increase. It is a very important cause of morbidity and mortality. In North-eastern Nigeria, reports on prostate cancer have been scarce. The aim of this paper is to highlight the clinico-pathological features and management of prostate cancer in north-eastern Nigeria. STUDY DESIGN: The clinical records and histopathological slides of all prostate cancer patients seen at the UMTH from January 1987 to December 2004 were retrospectively reviewed. The total number of cancers diagnosed during this period was also obtained from the cancer registry. RESULTS: Prostate cancer was seen in 165 patients and accounted for 6.15% of cancers diagnosed in this hospital. Majority of patients (56%) were aged 65 years and below and most presenting symptoms were similar to those of benign prostatic hypertrophy (BPH). The diagnosis was made in most cases on the basis of DRE, USS, PSA, and confirmed by trucut prostatic biopsy. Since most cases were advanced, the most frequent palliative treatment was subcapsular orchidectomy, which was psychologically satisfying to patients. Follow-up was very poor, only 26% at 3 years. CONCLUSION: Since most patients present late we conclude that prostate cancer should be suspected in men of 50 years and above who present with symptoms of prostatism and should be investigated promptly. Furthermore, aggressive screening of men in this age group would facilitate early diagnosis.

Histopathological findings in nephrectomy specimens--A review of 42 cases.

OBJECTIVE: This study aims at determining the histopathological findings in nephrectomy specimens in the University of Maiduguri Teaching Hospital. METHODS: A retrospective study of all cases of nephrectomies in UMTH between January 1993 and December 2003. RESULTS: There were 42 cases of unilateral nephrectomies, 26 (61.9%) males and 16 (38.1.9%) females giving a ratio of 1.6:1. Of these, 23 (54.8%) were benign and 19(45.2%) malignant. Chromic interstitial/pyelonephritis was the commonest indication for nephrectomy and this accounted for 28.6% of all cases. Nephroblastoma, the second commonest, accounted for 23.8% of all cases and is the major malignant indication for nephrectomies. Renal cell carcinoma and hydronephrosis accounted for 7(16.7%) cases each; polycystic kidney, transitional cell carcinoma and non-Hodgkin's lymphoma. CONCLUSION: There is need to emphasise the importance of early diagnosis and proper treatment of urinary tract infections, since chronic interstitial/pyelonephritis is the commonest indication for nephrectomy in our environment. This will go long way in reducing the rate nephrectomies on our patients.

Male breast cancer in north eastern Nigeria.

BACKGROUND: Carcinoma of the male breast is generally rare and constitutes 1% of all breast cancers. They often present late in developing countries and therefore has poor prognosis. The aim of this paper is to highlight the pattern of presentation and problems associated with management of this disease in Maiduguri, North Eastern Nigeria. PATIENTS AND METHOD: Case records of eleven (11) histologically diagnosed male breast cancers out of a total of two hundred and ninety-five (295) cases of breast cancer managed at the University of Maiduguri Teaching Hospital between 1989-2003 were retrospectively studied and analysed. RESULTS: Male breast cancer constitutes 3.7% of all cases of breast cancers seen in this hospital during the study period under review. The male to female ratio was 1:26. The peak age range at presentation was 40-49 years and all were advanced at presentation. The time interval between onset of symptoms and presentation were all over 12 months. All the patients either had toilet mastectomy or modified radical mastectomy. In addition, two patients had sub capsular orchidectomy while nine had Tamoxifen. Four patients had additional cytotoxic chemotherapy. Two patients died in the course of follow-up while the rest were lost to follow-up shortly after discharge. Only one patient was followed-up for more than two years. CONCLUSION: Male breast cancer though rare, is a serious clinical problem associated with late presentation. It is hoped that increased public awareness will improve the outcome of management.

Sacrococcygeal teratoma in Northeastern Nigeria: 18-years experience.

Although sacrococcygeal teratomas are rare, there have been several reports from various parts of Nigeria, outside the Northeast region. This report reviews the experience with this tumour from the northeastern part of Nigeria. A retrospective study of 21 children with histologically confirmed sacrococcygeal teratoma managed in 18 years. Over the 18-year-period, 21 histologically confirmed cases of sacrococcygeal teratoma were seen-80% were girls. Thirteen (60.9%) presented during the neonatal period. Eighteen patients presented with benign sacrococcygeal teratoma while three patients and a recurrence from an initial benign tumour had malignant sacrococcygeal teratoma. All malignant tumours had a significant presacral component. There were associated congenital malformations in 3 (14.3%) of the patients. All the benign tumours were resectable. Using the American Academy of Pediatrics (Altman's) classification, 13 patients were type I, 5 patients type II, 3 patients type Ill and none was for type IV. The commonest post-operative complication was wound infection in six patients. Others were wound dehiscence in three and post-operative diarrhoea in two patients. Three deaths were recorded in this series. The size of mass greater than 5 cm did not correlate with the incidence of post-operative complications (P=0.367). The post-operative follow-up was very poor; but there was a recurrence in a girl, two-years after the initial surgery. Our study revealed that most of our patients with sacrococcygeal teratoma present early to hospital with benign lesions and the immediate post-operative results were excellent. However, the follow-up was poor as such long-term post-operative results are difficult to study. It is to be recommended that sacrococcygeal teratoma presenting early to hospital should have prompt surgical intervention.

Post-thyroidectomy metastatic thyroid cancer.

BACKGROUND: The objective of this paper is to highlight the importance of tissue biopsy for histopathological diagnosis. METHOD: A report of a 46-year-old farmer with post-thyroidectomy metastatic thyroid cancer. RESULT: A post-thyroidectomy patient presenting with extensive skull and lumbar spine metastasis, paraparesis, huge occipital swelling and good healed scar without tumour residue. The thyroidectomy specimen was not subjected to histopathological diagnosis. Fine needle aspiration cytology of the occipital swelling revealed metastatic follicular carcinoma. Patient was placed on thyroxine 0.5mg daily with great improvement of lower limb muscle power. CONCLUSION: These bony metastases could have been reduced if proper investigation was done. There is need for continuous medical education for all clinical medical personnel.