Carcinoid tumours in a tertiary hospital in northern Nigeria: morphological pattern and review of the literature.

BACKGROUND: Carcinoid tumours are uncommon neuroendocrine neoplasms that may be found anywhere in the body but are most commonly seen in the gastro-intestinal and respiratory tracts and usually follow an indolent course. However, some tumours particularly the larger ones may metastasize to liver or regional lymph nodes. This study described the histological types of carcinoid tumors seen in a tertiary institution in Northern Nigeria. METHODS: This is a retrospective study in which surgical biopsy specimens seen over a 10-year period were reviewed with respect to age, sex, site and histological type. RESULTS: Five cases consisting of 1 endoscopic, 1 wedge, 3 hemicolectomy specimens were studied. There was a slight female preponderance with a female to male ratio of 1.5:1. The peak age of occurrence was the 6th decade of life (mean age was 36.4 years). Two cases were located in the large colon and a case each in the stomach, lymph node, and tongue. Three cases show trabecular pattern, while 2 cases were mixed pattern, in all the cases there are neither mitosis nor necrosis. These features are in keeping with typical carcinoids. Two out of the five cases were metastases to the lymph node and the tongue. CONCLUSION: Carcinoid tumours are rare, slow-growing NETs that display a relatively indolent disease course. Carcinoid tumours are uncommon in our environment and the cases seen are of good prognostic type.

Lymphadenopathic Kaposi's sarcoma in an immunocompetent adult.

Kaposi's sarcomas (KS) are vascular lesions which usually originate from multiple sites in the mid-dermis extending to the dermis. The aetiology is unknown, but infection from human herpes virus type 8 has been suggested. Several reports of KS had come from Africa initially and from worldwide later due to the close association with HIV/AIDS. Prior to this however, KS was very frequent in Eastern Europe, Italy and the United States where it existed in an indolent form in the elderly men of Jewish ancestry. KS may also be due to iatrogenic immune suppression from chronic use of steroids, elevated degree of expression of numerous cytokines and angiogenic growth factors including TNF alpha, IL-6, bFGF, HIVtat protein and oncostatin M. Lymphadenopathic KS involves the lymph-nodes, viscera and the gastrointestinal tract and may run a disseminated and aggressive course. We are reporting one such case in an immunocompetent male.

Choriocarcinoma in northwestern Nigeria: a histopathological review.

AIMS AND OBJECTIVES: Gestational choriocarcinoma is a malignant form of gestational trophoblastic disease with a highly aggressive biologic behavior and responds well to chemotherapy. The objective of this study is to analyse the various histological features of this neoplasm as seen in Ahmadu Bello University Teaching hospital, ( ABUTH ) Zaria, determine its incidence, and compare with other studies. MATERIALS AND METHODS: The bench registers were used to retrieve the request forms, slides, and tissue blocks. The slides were all stained with standard haematoxylin and Eosin. The histological criteria published by Gehrig and van Lee was used to diagnose the tumours and grading of the cases from grade I to III. RESULTS: Forty three cases were studied and these formed 4.9% of all products of conception and 37.7% of all gestational trophoblastic diseases. The peak age of incidence was in the third and fourth decades of life with vaginal bleeding as the leading mode of presentation. Extensive histopathological analysis and grading revealed haemorrhage, necrosis diamorphic appearance and pleomorphism as the most frequent features. CONCLUSION: Gestational choriocarcinoma is a common problem in Zaria, North- Western Nigeria with an incidence of 1 in 1039 deliveries. Haemorrhage, necrosis, diamorphic appearance and pleomorphism were the most frequent histological features. Health education and early detection are of paramount importance in reducing morbidity and mortality.

The cervical smear pattern in patients with chronic pelvic inflammatory disease.

BACKGROUND: Cancer of the cervix is the commonest malignancy of the genital tract in Nigeria. In an atmosphere of opportunistic screening due to lack of a national screening programme, studies are needed to determine patients at risk of premalignant lesions of the cervix. GOAL: To determine cervical smear pattern in patients with chronic pelvic inflammatory disease and investigate the potential of chronic pelvic inflammatory disease as a risk factor to cervical dysplasia. STUDY DESIGN: Case-control study. SETTING: Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria. SUBJECTS: Three hundred and sixty-nine premenopausal women attending the gynaecologic and family planning clinics of Ahmadu Bello University Teaching Hospital Zaria, Nigeria from January to December 2000. RESULTS: Of the 369 women that had cervical cytology by Pap smear, 163 (44%) had chronic pelvic inflammatory disease (cases) while 206 (56%) were non chronic PID patients (control). There was no statistical significance in the mean age between the two groups. The mean age at first coitus and marriage of all the women were 17.92.7 years and 18.5 3.4 years respectively. There were 52 dysplastic smears encountered, giving a prevalence rate of 140/1,000 or 14% for Cervical Intraepithelial Neoplasia. There were higher cases of dysplasia in the chronic PID group than in the control and this differences was statistically significant (p<0.05). Other risk factors to dysplasia identified include high parity (>4) and age of first coitus less than 20 years. Only 10% of all the women screened were aware of both cervical cancer and Pap smear. CONCLUSION: Women with chronic pelvic inflammatory disease are probably at higher risk of developing cervical dysplasia than women without chronic pelvic inflammatory disease. Cervical cancer screening programmes should be intensified in chronic pelvic inflammatory disease patients. However, further studies are needed in our setting to verify the association between pelvic inflammatory disease and cervical dysplasia.

Anti-Retroviral Therapy Induced Diabetes in a Nigerian

Background:Anti-retroviral therapy (ART) using Highly Active Anti-retroviral Therapy (HAART) has led to considerable reduction in morbidity and mortality associated with human Immune deficiency virus (HIV) infection.This has led to increased life expectancy in HIV infected individuals on one hand; and side effects of chronic administration of these drugs on the other. One of such untoward effects is the association of anti-retroviral drugs especially the protease inhibitors (PI's) with metabolic derangements such as dyslipi- daemia; lipodystrophy; insulin resistance and rarely Diabetes mellitus. Although there is extensive literature on this dysmetabolic syndrome in the Western World; there is to our knowledge no previous report from Nigeria. Objective: to report a case of diabetes mellitus following the initiation of anti-retroviral therapy. Methods: a case report of diabetes mellitus induced by anti-retroviral therapy in a 48 year old Nigerian male. Conclusion: Awareness and high index of suspicion is required to identify the metabolic complications of ART

Cervical Cancer Management in Zaria; Nigeria

The paper's objective was to identify factors influencing cervical cancer management in Zaria with a view to improving the outcome of management. Case notes of patients managed for cervical cancer in Ahmadu Bello University Teaching Hospital (ABUTH); Zaria between January 1 1999 and December 31 2003; were retrieved and relevant information extracted and analyzed using MINITAB statistical software. There were 70 women with cervical cancer managed during the study period and their mean age was 47.61 years. Risk factors included high parity (mean = 7.4); low age at first coitus (mean = 14.62 years); multiple sex partners (81.63in polygamous marriages; 42.55with multiple marriages); and smoking (15.09). Poor prognostic factors included delayed presentation - mean duration of symptoms was 12.59 months and only 4.35presented with stage I disease. Lack of funds for investigations and treatment was also a risk factor for poor prognosis (only 25of the 24 patients who needed blood transfusion were adequately transfused and only 21.74of all patients had complete treatment). The paper concludes that increased public awareness about cervical cancer is needed to minimise risk factors and encourage early presentation. Governments and other funding agencies need to devote more funds for cervical cancer prevention; screening and treatment