Sub-classification of Breast Masses by Fine Needle Aspiration Cytology.

OBJECTIVE: The aim of this study is to evaluate the accuracy of sub-classification of breast diseases using Fine Needle Aspiration cytology (FNAC). MATERIALS AND METHODS: A one-year prospective study of 180 consecutive patients with palpable breast lesions who underwent FNAC and subsequently open surgical biopsy for histological confirmation. FNAC was used to sub-classify breast lesions and then correlated with histological diagnosis. RESULTS: A total of 180 patients were enrolled into the study but only 110 patients with histology report were used for test validity. Seventeen (15.5%) smears were C1; while 46 (41.8%), 5 (4.5%), 4 (3.6%) and 38 (34.6%) were C2, C3, C4 and C5, respectively. FNAC achieved sensitivity of 90.0%, specificity of 95.5%, false positive rate of 5.3%, false negative rate of 8.7%, positive predictive value of 94.7%, negative predictive value of 91.3% and overall diagnostic accuracy of 92.9%. Only 86 (78.2%) of the 110 smears could be sub-classified into different disease conditions of the breast on cytology. FNAC accurately sub-classified 25(78.1%) of fibroadenoma and 28(87.5%) of invasive ductal carcinoma. CONCLUSION: FNAC can reasonably sub-classify fibroadenoma, invasive ductal carcinoma and mastitis but there is still a challenge with lobular carcinomas, metaplastic carcinomas, papillary carcinomas and fibrocystic changes.

Vaginal myomectomy of a prolapsed gangrenous cervical leiomyoma.

We report a challenging case of a huge gangrenous prolapsed cervical leiomyoma in a multiparous HIV positive lady. A 37-year-old para 3 lady presented with a progressively increasing irreducible mass protruding out per vaginam, 3 months duration of heavy menses, and symptoms of a urinary tract infection. We performed a vaginal myomectomy and she did well postoperatively. A prolapsed gangrenous cervical leiomyoma is a rare condition with only a few cases reported in the literature. Vaginal myomectomy for this condition can be performed in experienced hands without difficulties.

Schistosomal stricture of the ureter-diagnostic dilemma.

Chronic schistosomiasis of the urinary tract can present with symptoms unrelated to the disease. A 33-year-old man from Edo State Nigeria presented with recurrent left flank pain. Laboratory investigations did not reveal any cause. Radiological investigation revealed a stricture of the left ureter and hydronephrosis of the left kidney. Management included surgical excision and antischistosomiasis chemotherapy. Histopathological examination of specimen of the ureter obtained after surgical exploration revealed Schistosoma heamatobium ova in the wall of the ureter.

Krukenberg tumour simulating uterine fibroids and pelvic inflammatory disease.

OBJECTIVE: To report a case of cancer of the colon which presented as secondaries to the ovaries. METHOD: Case report. SUMMARY: The case presented is that of a 39-year-old female who presented with lower abdominal pain and a multinodular pelvic mass which led to an initial diagnosis of multiple uterine fibroids and pelvic inflammatory disease. The presence of a colonic mass was first suggested by ultrasound. Laparotomy revealed carcinoma of the colon with bilateral krukenberg's tumour and an insignificant fibroleiomyoma. CONCLUSION: This case is reported to alert practitioners that all multinodular pelvic masses should not be assumed to be multiple fibroids.

Sarcoma botyroides of the cervix in a HIV positive 45-year-old woman: a case report.

UNLABELLED: Embryonal rhabdomyosarcomas (Sarcoma botyroides) are malignancies of connective tissue with abnormal cells which are thought to arise from skeletal muscle progenitors. It is a rare childhood malignant solid tumour and occurs in children mostly less than 10 years. It can occur at any age but two commonest peaks are 1-5 years (when approximately 66.6% occur) and 15-19 years accounting for the rest. Sarcoma botyroides which usually occurs in the vagina in childhood is rare in the female reproductive tract of adult women especially those over the age of 40. We report here a case of a 45-year-old HIV-positive woman who presented with profuse bleeding from the vagina with severe anaemia. Macroscopically, a cauliflower polypoid growth was seen protruding from the cervix into the vagina. Histopathological studies confirmed a diagnosis of sarcoma botyroides. CONCLUSION: The need for a high index of suspicion of sarcoma botyroides of the cervix must be borne in mind when making a diagnosis on all cervical polypoidal masses. Also the importance of looking out for lesions and malignancies on all HIV positive patients cannot be over-emphasized.

Clinicopathological analysis of cervical cancer seen in a tertiary health facility in Nnewi, south-east Nigeria.

Cervical cancer remains the commonest gynaecological cancer among women in the developing countries. The records of all the histologically confirmed cervical cancer patients managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, over a 5 year period were analysed for the clinical presentation and histological pattern of the malignancy. A total of 75 cases of cervical cancer were managed over the period giving an incidence of 65.2% of all gynaecological cancers and 13.4% of all gynaecological admissions. The majority of the patients were grandmultiparous women (81.3%) with a mean parity of 6.8. The modal age range was 60-69 years (38.7%) and the majority (94.7%) of the patients belonged to the low socioeconomic class. Squamous cell carcinoma of varying differentiation (89.3%) was the commonest histological type seen and adenocarcinoma accounted for only 8.0%. The common clinical features were post-menopausal bleeding (84.0%), vaginal discharge (72.0%), contact bleeding (63.9%) and abdominal pain (56.2%). Most (89.3%) of the patients presented late, in advanced stages of the disease, and almost all (97.3%) were referred for radiotherapy. The incidence of cervical cancer is high in our environment. Community sensitisation and provision of free cervical screening is recommended for early detection and treatment.

Primary papillary transitional cell carcinoma of the breast: a case report.

BACKGROUND: Primary papillary transitional cell carcinoma of the breast is a rare occurrence worldwide and few cases ever have been reported. It may be mistaken for the benign intraductal papillary lesions or papillary adnexal neoplasms. CASE REPORT: A 66 year old woman who presented with a recurrent right breast mass. Histopathologic studies confirmed a diagnosis of Primary Papillary Transitional cell carcinoma. CONCLUSION: The need for a high index of suspicion of primary papillary transitional cell carcinoma of the breast must be considered, especially in suspected benign intraductal papillary lesions to facilitate adequate and timely diagnosis and management of this lesion.

Axillary fibroadenoma mimicking lymphadenopathy.

Ectopic breast tissues are subject to the similar physiological and pathological alterations seen in breast tissues situated in their normal anatomical positions. We report a 34-year old multiparous woman who presented with a right axillary lump of about 1 year duration, for which clinical impression of axillary lymphadenopathy was made and lumpectomy carried out. Histology of excised lump revealed fibroadenoma. We discussed possible pathogeneses and consequences of this lesion.

Knowledge, attitude and practice of screening for cervical cancer among female students of a tertiary institution in South Eastern Nigeria.

BACKGROUND: Cervical cancer is the second commonest cancer of females worldwide and the commonest cancer of the female genital tract in our environment. It can be prevented through early detection by cervical screening (Pap smear). OBJECTIVE: The objective of this study is to determine the knowledge, attitude and practice of cervical cancer screening among female undergraduates. METHOD: A pre tested questionnaire was administered to third and fourth year female students of the Faculty of Natural Sciences, Nnamdi Azikiwe University Awka, Nigeria. RESULT: Out of the 220 students involved in the study, 134 (60.9) had knowledge of cervical cancer and 118 (53.6%) were sexually active with the average age at sexual debut being 21.2 years. The mean age of the students was 23.8 years and the age range was 17 to 39 years with 175 (80%) in the age range of 20-29 years. About 2/3 of the students did not know about Pap smear and worse still, none of them had undergone a Pap screening test before. This low participation in screening for cervical cancer was attributed to several reasons including ignorance of the existence of such a test, lack of awareness of centers where such services are obtainable, ignorance of the importance of screening and the risk factors to the development of cervical cancer. CONCLUSION: There is good level of awareness of cervical cancer among the female undergraduates but poor knowledge and participation in cervical cancer screening. The development of a comprehensive cervical cancer screening strategy is being recommended to improve participation with a view to prevent cervical cancer by early detection and treatment of the pre-malignant stages.