Giant parotid pleomorphic adenoma in a Nigerian male.

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor, accounting for up to 60% of all tumors of the salivary gland and 75-80% of all parotid tumors. It has a slow but progressive growth pattern and if untreated can become greatly enlarged in size. However, giant PA is uncommon. We report a case of giant parotid PA of more than 10 years duration in a 60-year-old male Nigerian. A 60-year-old male patient with 10-year history of painless, massive, and pedunculated swelling in the left side of lower face measuring 25 cm × 23 cm × 17 cm in dimension. Computerized tomographic scan and percutaneous fine needle aspiration cytology returned a preliminary diagnosis of PA. Superficial parotidectomy with facial nerve preservation via the transcervical approach was performed. The excised mass weighed 5.5 kg while the postoperative healing was satisfactory. Benign PAs may attain a giant size if left untreated. Socioeconomic problems are some of the reasons for late presentation. Adequate excision of the tumor sparing the facial nerve is possible but intraoperative and reactionary hemorrhage are likely complications.

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.

Pattern of histopathological diagnosis of breast lesions in Gombe, Nigeria.

BACKGROUND: Diseases of the breast are common and include problems, related to pregnancy and lactation, abscesses and other inflammatory conditions, nonneoplastic proliferative disorders and neoplasms. No known previous histopathological analysis has been done in our setting to classify breast lesions. The purpose of this study is to review all cases of breast diseases seen in the department over a six-year period and to determine the pattern of histological diagnosis of breast diseases in our setting. METHODS: This was a hospital based retrospective study where our bench record books were used to identify all the breast lesions after which the Haematoxylin and Eosin stained slides and the request cards were retrieved. The slides were reviewed based on the diagnostic criteria by Juan Rosai. RESULTS: A total of 291 breast lesions were seen in the department. One hundred and seventy three (59.5%) of these were inflammatory non-neoplastic proliferative and benign neoplastic disorders, while 118 (40.5%) were malignant neoplasms. Fibroadenoma was the commonest benign breast lesion with 69 (23.7%) cases. Of all the malignancies, invasive ductal carcinoma was the most frequent (68.6%). Breast cancer was found most frequently in the 4th decade (32.2%), followed by the 5th decade (24.6%) of life. CONCLUSION: Female breast cancer was quite common in this study and most of our patients presented with advanced 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.

Pattern of Histopathological Diagnosis of Breast Lesions in Gombe; Nigeria

Background:Diseases of the breast are common and include problems; related to pregnancy and lactation; abscesses and other inflammatory conditions; nonneoplastic proliferative disorders and neoplasms. No known previous histopathological analysis has been done in our setting to classify breast lesions.The purpose of this study is to review all cases of breast diseases seen in the department over a six-year period and to determine the pattern of histological diagnosis of breast diseases in our setting.Methods: This was a hospital based retrospective study where our bench record books were used to identify all the breast lesions after which the Haematoxylin and Eosin stained slides and the request cards were retrieved. The slides were reviewed based on the diagnostic criteria by Juan Rosai. Results: A total of 291 breast lesions were seen in the department. One hundred and seventy three (59.5) of these were inflammatory; non-neoplastic proliferative and benign neoplastic disorders; while 118 (40.5) were malignant neoplasms. Fibroadenoma was the commonest benign breast lesion with 69 (23.7) cases. Of all the malignancies; invasive ductal carcinoma was the most frequent (68.6). Breast cancer was found most frequently in the 4th decade (32.2); followed by the 5th decade (24.6) of life. Conclusion: Female breast cancer was quite common in this study and most of our patients presented with advanced disease

Pattern of Histopathological Diagnosis of Breast Lesions in Gombe; Nigeria

Background:Diseases of the breast are common and include problems; related to pregnancy and lactation; abscesses and other inflammatory conditions; nonneoplastic proliferative disorders and neoplasms. No known previous histopathological analysis has been done in our setting to classify breast lesions.The purpose of this study is to review all cases of breast diseases seen in the department over a six-year period and to determine the pattern of histological diagnosis of breast diseases in our setting.Methods: This was a hospital based retrospective study where our bench record books were used to identify all the breast lesions after which the Haematoxylin and Eosin stained slides and the request cards were retrieved. The slides were reviewed based on the diagnostic criteria by Juan Rosai. Results: A total of 291 breast lesions were seen in the department. One hundred and seventy three (59.5) of these were inflammatory; non-neoplastic proliferative and benign neoplastic disorders; while 118 (40.5) were malignant neoplasms. Fibroadenoma was the commonest benign breast lesion with 69 (23.7) cases. Of all the malignancies; invasive ductal carcinoma was the most frequent (68.6). Breast cancer was found most frequently in the 4th decade (32.2); followed by the 5th decade (24.6) of life. Conclusion: Female breast cancer was quite common in this study and most of our patients presented with advanced disease

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.

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.

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.

Fine needle aspiration cytology diagnosis of liver diseases in the University of Maiduguri Teaching Hospital, Maiduguri.

The study is aimed at classifying liver diseases diagnosed by fine needle aspiration cytology (FNAC) in our environment and to emphasize the importance of the procedure for management of our patients. Forty-two patients were referred by the physicians for fine needle aspiration cytology diagnosis in Histopathology Department, University of Maiduguri Teaching Hospital between January 2001 and December 2003. There were 30 males and 12 females (2.5:1) with mean age of 44.7 years. The peak age is in the 5th decade of life. The commonest hepatic disease is primary hepatic malignancy, which accounted for 78.6% (33 patients); 3 suspicious of malignancy, one case each of metastatic carcinoma, amoebic liver abscess; liver storage disease and large cell dysplasia. The technique has gained popularity in our center because it is cheap, convenient, minimally invasive, quick and has high precision in obtaining samples. We therefore recommend this procedure in centers where liver diseases are common as a means of initial investigation.

Giant congenital pigmented naevus with unusual presentation and early malignant transformation in a Nigerian infant: case report and review of the literature.

A six month-old female infant with a giant congenital pigmented naevus is reported because of the rarity and unusual presentation and early malignant transformation. It was the first case to be documented in our centre. There was an extensive giant, darkly pigmented naevus of the "bathing trunk" distribution noted at birth, associated with multiple darkly pigmented smaller naevi scattered over the trunk and limbs. Bv the third month of life large pigmented lesion began to demonstrate small papillomatous projections studding the entire surface and at age six months nodular and warty excrescences appeared including a large pedunculated spherical mass attached to the anal verge. The labia majora became anatomically disfigured by these nodular, warty lesions of various sizes associated with the large pigmented hairy naevus. Histological examination of the excised large perianal and vulvar nodules showed the typical picture of an intradermal naevus consistent with giant congenital pigmented (melanocytic) naevus. The deeper portions of the lesion showed features of malignant transformation. The rapidity of evolution of the lesions including histologic features of early malignant transformation and the gross disfiguring of the genitalia and perineum are uncommon presentation of this melanocytic naevus. In view of the early malignant transformation immediate surgical treatment was indicated. Unfortunately the patient was lost to follow-up. The case report is complimented with a review of the literature.

African oral histoplasmosis mimicking lip carcinoma: case report.

A case of localised African histoplasmosis with an unusual presentation in a 56 year old Nigerian farmer is reported. The lesion presented as an ulcer clinically mimicking squamous cell carcinoma of the lower lip. An incisional biopsy and culture studies confirmed African histoplasmosis and the ulcer healed spontaneously without treatment. This case is reported to highlight the unusual location and clinical course of African histoplasmosis.

Suppurative granulomatous eosinophilic panniculitis: case report.

A case of 12 year-old Nigerian male is presented. He had an unusual variant of Weber-Christian disease and manifested massive subcutaneous indurations and nodules limited to the cheeks, lips, left pectoral, infraclavicular and supraclavicular areas. A wedge biopsy revealed suppurative granulomatous eosinophilic panniculitis. Despite exhaustive investigations, no obvious trigger of the panniculitis could be identified. Response to corticosteroids and to empirical trials with other drugs was poor, and the outcome was fatal. We believe this is the first report from Nigeria of this rare variant of Weber-Christian panniculitis in the paediatric age, and draw attention to the life-threatening nature of this disorder.