Prostate Lesions in a Tertiary Institution in North Central Nigeria: A Histopathology Review.

BACKGROUND: Prostatic lesions are a significant cause of morbidity and mortality among middle aged and elderly men of African ancestry. Reviews on cancer distribution displayed prostate cancer as the most prevalent site specific cancer among adult Nigerian men. OBJECTIVE: This study provided baseline data of the frequency, histologic spectrum, and pathological characteristics of prostate lesions in a Tertiary institution in North Central Nigeria. MATERIALS AND METHOD: This was a descriptive review of all histologically diagnosed prostate lesions at the pathology department of the University of Abuja Teaching Hospital over a 5-year period from January 1, 2015 to December 31, 2019. RESULTS: Prostatic lesions represented 4.1% of all surgical specimens in the period under review. The age range of the patients' was 32 to 95 years with a mean age of 66.5 years at diagnosis and peak age incidence seen in the 7th decade. There were 259 (52.9%) cases of nodular hyperplasia and 231 (47.1%) cases of cancer of the prostate, giving a nodular hyperplasia to prostate cancer ratio of 1.12:1. Fifty two (52, 20.1%) cases of the nodular hyperplasia were associated with chronic inflammation while 7 (2.7%) were associated with prostatic intraepithelial neoplasm. Prostate adenocarcinoma was the predominant subtype, accounting for 99.1% of cases while ductal carcinoma constituted the remaining 0.9% cases. Gleason scores were adapted to the Grade Group system of the International Society of Urological Pathology and showed that high grade cancers; Grade Groups 4 and 5 were the predominant grades (n=130, 60.5%) followed by Grade Group 1 (n=64, 29.8%) cancers. CONCLUSION: Prostate lesions are common lesions encountered in our setting in keeping with reports from other regions in Nigeria. A significant proportion of these lesions are prostate cancers that are poorly differentiated with higher risk of mortality.

CONTEXTE: Les lésions prostatiques sont une cause importante de morbidité et de mortalité chez les hommes d'âge moyen et âgés d'ascendance africaine. Les revues sur la distribution du cancer ont montré que le cancer de la prostate est le cancer spécifique le plus répandu chez les hommes adultes du Nigeria. OBJECTIF: Cette étude a fourni des données de base sur la fréquence, le spectre histologique et les caractéristiques pathologiques des lésions de la prostate dans une institution tertiaire du centre-nord du Nigeria. MATÉRIEL ET MÉTHODE: Il s'agissait d'une revue descriptive de toutes les lésions prostatiques diagnostiquées histologiquement au département de pathologie de l'hôpital universitaire d'Abuja sur une période de 5 ans, du 1er janvier 2015 au 31 décembre 2019. RÉSULTATS: Les lésions prostatiques représentaient 4,1 % de toutes les pièces chirurgicales au cours de la période étudiée. La tranche d'âge des patients' était de 32 à 95 ans avec un âge moyen de 66,5 ans au moment du diagnostic et un pic d'incidence d'âge observé dans la 7e décennie. Il y a eu 259 (52,9 %) cas d'hyperplasie nodulaire et 231 (47,1 %) cas de cancer de la prostate, soit un rapport hyperplasie nodulaire/cancer de la prostate de 1,12:1. Cinquante-deux (52, 20,1 %) cas d'hyperplasie nodulaire étaient associés à une inflammation chronique, tandis que 7 (2,7 %) étaient associés à un néoplasme intraépithélial prostatique. L'adénocarcinome prostatique était le sous-type prédominant, représentant 99,1 % des cas, tandis que le carcinome canalaire constituait les 0,9 % de cas restants. Les scores de Gleason ont été adaptés au système de groupes de grades de la Société internationale de pathologie urologique et ont montré que les cancers de haut grade ; les groupes de grades 4 et 5 étaient les grades prédominants (n=130, 60,5%) suivis par les cancers de grade 1 (n=64, 29,8%). CONCLUSION: Les lésions de la prostate sont des lésions courantes rencontrées dans notre contexte, conformément aux rapports d'autres régions du Nigeria. Une proportion significative de ces lésions sont des cancers de la prostate qui sont peu différenciés avec un risque de mortalité plus élevé. MOTS CLÉS: Prostate, Hyperplasie nodulaire, Adénocarcinome.

Primary Fibrosarcoma of the Breast: Case Report of a Rare Breast Neoplasm.

Breast fibrosarcoma is an uncommon primary breast neoplasm. We report a case of a 57-year old woman who presented at our facility with a right breast mass having histomorphological and immunohistochemical features consistent with fibrosarcoma. She had simple mastectomy and an uneventful hospital stay. The mass recurred 4-weeks later for which she had supportive care and started on cyclical chemotherapy (Adriamycin, Cyclophosphamide and Dacarbazine). She was referred for haemostatic radiotherapy and her clinic follow-up scheduled.

Le fibrosarcome du sein est une tumeur primitive du sein rare. Nous rapportons le cas d'une femme de 57 ans qui s'est présentée dans notre établissement avec une masse mammaire droite présentant des caractéristiques histomorphologiques et immunohistochimiques compatibles avec un fibrosarcome. Elle a eu une mastectomie simple et un séjour à l'hôpital sans incident. La masse est réapparue 4 semaines plus tard pour laquelle elle a reçu des soins de soutien et a commencé une chimiothérapie cyclique (Adriamycine, Cyclophosphamide et Dacarbazine). Elle a été référée pour une radiothérapie hémostatique et son suivi clinique a été programmé.

Epidemiological characteristics of carcinoma of the cervix in the Federal capital Territory of Nigeria.

OBJECTIVES: To study the epidemiological characteristics of cancer of the cervix in the Nigerian Federal Capital Territory (FCT), and also to serve as baseline information for future monitoring of on-going screening for pre-malignant cervical lesions. METHODOLOGY: Retrospective study of all confirmed cases of cancer of cervix managed at the National Hospital, Abuja (NHA) from its inception in 1999 to 2003. The case records of the patients were retrieved from diagnosis, treatment and follow up. RESULTS: Over the 5 year study period, 117 cases of cancer in women were managed in the hospital. Thirty-six (30.8%) were Cancer of the cervix. The mean age of the patients was 52.4 years, STD 1.18. Twenty-five (69.4 %) were grandmultiparous. The age at first confinement ranged from 12 to 19 (mean 15) years. Six (15%) admitted to multiple sexual partners. A common presenting complain was bleeding through the vagina 28(51.9%), 27(50%) were anaemic and 21 (38.9%) were cachetic. Late stage cancers were 31(86%), and 34 (88.9%) were squamous cell carcinoma. Radiotherapy was offered to 21(58.3%). Five (13.9%) were confirmed dead but 16 (44.4%) were lost to follow up. CONCLUSION: Cancer of the cervix present late in the FCT and the burden is heavy. The mortality is such that ongoing screening for pre-malignant lesions of the service in the FCT should be encouraged and widened.

Morphology and function of the rat oviduct: effects of thyroidectomy and thyroxine administration.

The effect of thyroidectomy and thyroxine administration on the morphology and function of the oviduct was studied in 40 albino rats. Chronic administration of 10 microg/100g for 60 days resulted in atrophy of the smooth muscle and mucosal folds. The thyroidectomized rats had reduced smooth muscle wall thickness, the epithelium reduced from columnar to cuboidal; and also flattening of mucosal folding. The contractile responses to oxytocin, acetylcholine and indeed the spontaneous contraction in the four thyroid states suggest a dependence of oviductal contraction on adequate plasma level of thyroid hormone in the vicinity of the contracting smooth muscle of the oviduct. The results suggest that thyroid hormone affects the morphology and function of the oviduct.

Changing patterns of Kaposi's sarcoma in Nigerians.

This is a five-year retrospective study of 32 histologically diagnosed cases of Kaposi's sarcoma (KS) who had undergone HIV antibody testing at the Jos University Teaching Hospital: 13 cases (40%) were HIV-negative. Multiple lesions were more common in HIV-positive cases and affected unusual sites such as the face, oropharynx, conjuctiva, vulva and rectum in addition to the limbs and trunk, which were more frequently involved in HIV-negative cases. This pattern of KS seen in Nigerian patients shows similarities with other African countries which have been affected by the HIV epidemic.

Histopathologic diagnoses of lymphadenopathy in children in Jos, Nigeria.

Histopatholgical findings in 242 lymph node biopsies received in Jos University Teaching Hospital over a 10-year period (1988-1997) were reviewed. Tuberculosis is the most predominant lesion (33.05%), followed closely by the non-Hodgkin's lymphoma (31.4%). Burkitt's lymphoma accounting for one-quarter of all the cases of non-Hodgkin's lymphoma had a peak age range of 8-10 years. Hodgkin's lymphoma, chronic non-specific lymphadenitis, sinus histiocytosis, reactive hyperplasia, metastatic carcinoma, dermatopathic lymphadenitis, Kaposis sarcoma and sarcoidosis accounted for 2.9%, 14.46%, 9.9%, 4.96%, 1.7%, 0.4%, 0.8% and 0.4% respectively. The cervical region was the commonest site affected (54.1%), followed by mesenteric (22.3%), axillary (13.2%) and inguinal (10.3%). BCG immunization was carried out only on 121(50%) of cases, out of which 60 had tuberculosis and 54(22.3%) received no BCG immunization, while 67(27.7%) had no records of BCG immunization. Only 5(2%) had HIV screening done, out of which one was positive.

Aetiological significance of alcohol in liver cirrhosis on the Jos Plateau.

Fifty-one patients with histologically diagnosed cirrhosis were studied prospectively over one year period. There were forty-one males and ten females. The majority of patients (75.59%) took alcohol in significant quantity and it was thought to be the most likely cause of the cirrhosis in them. Eighty percent of them had micronodular cirrhosis and 51.3% of them drank only "burukutu" a local alcoholic brew brewed mostly in iron pots and contains two other hepatotoxic agents--aflatoxin and iron. Eight (5.7%) of the patients and five (9.8%) of controls were positive for hepatitis B surface antigen (HBs.Ag). It is likely that alcohol is very important cause of cirrhosis of the liver seen in Jos.

Tru-cut biopsy of palpable breast lesions: a practical option for pre-operative diagnosis in developing countries.

OBJECTIVES: To establish the role of Tru-cut needle biopsy in the pre-operative diagnosis of breast lesions in a developing country. DESIGN: Prospective cross sectional study. SUBJECTS: 112 consecutive patients with palpable breast lesions who had both Tru-cut and excision biopsy as a pre-operative diagnostic procedure. RESULTS: Four (3.6%) patients had specimens that were inadequate for histological diagnosis. Tru-cut biopsy diagnosed 42 of the remaining 108 as malignant and 66 as benign, but only 40 and 61 respectively were confirmed to be correctly so by excision biopsy. Tru-cut biopsy, therefore, achieved a sensitivity of 88.9% (95% CI 79.7 to 98.1) specificity of 96.8% (95% CI 92.5 to 100) and an over all diagnostic accuracy of 93.5% (95% CI 88.9 to 98.2). There was a false positive rate of 4.8%, a false negative rate of 7.6% and a positive predictive value of 95.2%. The pathologist was able to make a correct specific histological diagnosis in 76.2% of all the adequate Tru-cut samples. CONCLUSION: If Tru-cut biopsy is done instead of excision biopsy, it will sufficiently reduce waiting time and reduce cost (four fold). It is well tolerated by patients. We regard the procedure as a useful adjunct and indeed a practical option for accurate pre-operative diagnosis of palpable breast lesions.

Cancer of the larynx in black Africans in Jos Nigeria.

OBJECTIVE: A clinico-pathological study of cancer of the larynx in Jos from 1983 to 1995. SETTING: Jos University Teaching University. SUBJECTS: 38 patients. RESULTS: 38 (100%) patients were seen. Thirty four (89.5%) were Black African males. Mean age was 47.7 years. Twenty nine (76.3%) smoked cigarettes and drank alcohol. Hoarseness (100%) was the commonest symptom. Mean duration of symptoms was 13.5% months. Transglottic (42.1%) was the commonest site and squamous cell carcinoma (97.4%) was the predominant histologic type. CONCLUSION: There was a male preponderance. The mean age was lower than in other series. Patients often presented late. Squamous cell carcinoma was the commonest cell type.

Effect of thyroxine on the contractile responses of the vas deferens to prostaglandin E2.

The effects of prostaglandin E2 (PGE2) on the contractile activity of thyroidectomized and thyroxine-treated albino rats were studied in vitro. Thyroidectomy totally inhibited the contractile response of the vas deferens to PGE2. Thyroxine treatment, on the other hand, significantly (P < .001) potentiated the response of vasa deferentia to PGE2, when compared to controls. It is suggested that thyroid hormones play a role in the contractile response of the vas deferens to PGE2.

Comparative study of conservative resection and radical operation for thyroid carcinomas.

OBJECTIVE: To compare mortality and morbidity in management of thyroid cancers by total lobectomy (C-R) and near-total thyroidectomy (R-O) and to relate pathological subtype to prognosis. DESIGN: A retrospective study of patients with thyroid cancers that were managed during an eleven-year period. SETTING: Jos University Teaching Hospital, Nigeria. SUBJECTS: A total of 44 patients who underwent C-R (n = 26) and R-O (n = 18) were studied. INTERVENTION: A total of 509 goitrous specimens including the excised thyroid cancers were histopathologically studied. MAIN OUTCOME MEASURES: Cases were analysed for mortality and morbidity data in the two groups during a partial follow-up period of two years. RESULTS: Mortality figures for C-R was 4% versus 11 for R-O. Postoperative haemorrhage occurred in 14% for C-R versus six for R-O. Similarly, bilateral vocal cord paralysis occurred in 11% versus 22; voice changes in 11% versus 33, transitory hypoparathyroidism 8% versus 50, local recurrence in 18% versus eleven. Hypothyroidism occurred in all patients undergoing R-O and stitch granuloma in 11% of patients in C-R group versus six for R-O. Follicular carcinoma constituted 59% of the total number thyroid cancers with papillary cancer constituting 35%. CONCLUSION: C-R is recommended as the operation of choice for thyroid cancers.

Rhinosporidiosis in the nasal cavity.

A case of nasal rhinosporidiosis in a 17-year-old patient from the Middle Belt area of Nigeria is described, the first such case seen in 16 years since this centre was established. The clinical features and the results of gross and microscopic examination of biopsy material are presented.

Mastomys natalensis and Tatera gambiana as probable reservoirs of human cutaneous leishmaniasis in Nigeria.

Leishmania sp. was isolated from the livers and spleens of 4 of 56 Mastomys natalensis and one of 21 Tatera gambiana in Keana District, Nigeria; none of the rodents had cutaneous lesions. Parasites were not found in 42 Rattus rattus. Experimentally infected mice developed cutaneous lesions characteristic of L. major infection. The organisms could not be cultivated in vitro.

Laparoscopy in developing countries in the management of patients with an acute abdomen.

Surgeons in developing countries see a need to improve diagnosis and decision making in patients with an acute abdomen. Without the benefit of diagnostic aids such as computers and high-resolution ultrasonography, the rate of unnecessary laparotomy is often unacceptably high. The laparoscope is usually available in a developing country and its use easily acquired. Using laparoscopy in doubtful situations the unnecessary laparotomy rate was significantly reduced from 14.0 to 6 per cent (P < 0.05). Laparoscopy achieved a diagnostic accuracy of 86 per cent and prevented unnecessary laparotomy in 57 per cent of those in whom it was used.

Sudden death due to disseminated porocephalosis--a case history.

An 18-year-old Nigerian girl died suddenly and unexpectedly from disseminated porocephalosis. The patient was hospitalised complaining of fever, dizziness, weakness and jaundice. Clinical examination revealed a restless, confused and hypotensive patient. She died within two hours of admission. Autopsy revealed disseminated Porocephalus armilatus infestation involving the thoracic and abdominal linings and their internal organs. The relationship between the disseminated parasitic involvement and the death of this girl is discussed.

Diethylene glycol poisoning in Nigerian children.

Between June and September 1990, 47 children died at Jos University Teaching Hospital, Nigeria from ingestion of paracetamol syrup adulterated with diethylene glycol. Most of the children presented with anuria, fever, vomiting, diarrhoea and convulsions. Signs on admission were tachycardia, acidotic breathing, pallor, oedema and hepatomegaly. Laboratory findings included hyperkalaemia, acidosis, elevated creatinine level and hypoglycaemia. Management consisted of correction of dehydration and acidosis plus administration of antibiotics when indicated. None of the children had dialysis. All died within 2 weeks of admission. Proper government supervision of pharmaceutical companies and their agencies is urgently needed in order to prevent any future occurrence of such tragic deaths.

Malignant Cystosarcoma phyllodes: report of two cases.

Two cases of malignant Cystosarcoma phyllodes seen in Jos University Teaching Hospital over a 9-year period are being reported. One occurred in a 16-year girl now dead and the other in a 52-year old woman probably dead. Both cases showed metastases, the axillary nodes being involved in the deceased, cervical nodes in the elderly patient, and both had pulmonary and presumably hepatic metastasis. These were the 2 cases seen out of a total of 696 surgical breast specimens reviewed thus constituting 0.3 percent. It is not certain if chemotherapy has been beneficial but one might need more cases well organised trials to arrive at definitive conclusions.