Early-onset malignant solid tumours in young adult South Africans - an audit based on histopathological records of patients seen at the three academic hospitals in Johannesburg.

BACKGROUND: Malignant tumours in adolescents and young adults (AYA) are referred to as early-onset cancers. This study analysed the histopathological profile of malignant solid tumours in AYA. METHODS: Records of patients who had confirmed malignant solid tumours were retrieved. Data collected included the treating hospital, year of presentation, age and histological diagnosis. The commonly diagnosed malignant tumours in AYA were compared with tumours in older adults. A p-value below 0.05 was considered significant. RESULTS: A total of 61 828 records were retrieved and 29 974 were excluded. Additionally, 1 055 post-excision results from AYA were excluded. Of the remaining 30 799 records, 13.1% (4 032/30 799) were diagnosed in AYA, of which 18.2% (734/4 032) were in-situ lesions. Overall, 11% (3 298/30 065) of invasive tumours were from the AYA. The majority, 81.1% (3 269/4 032), of invasive and non-invasive malignant tumours in AYA were from females. Breast and cervical cancer constituted 29.2% (962/3 298) and 23.2% (766/3 298) of diagnosed cancers in AYA, respectively. Ten (0.3%) cases of prostate and 0.4% (12/3 298) of lung cancers were reported in AYA. CONCLUSION: Eleven per cent of invasive malignancies were diagnosed in AYA and 81% involved females. Cancers of the breast, cervix, skin, and colon were the top four most common tumours in AYA. The burden of breast and colorectal cancer was higher in AYA than in older adults. Prostate cancer is rare in AYA and lung cancer was not among the top 10 malignant tumours in our setting. Over 11% of primary malignant tumours of the anus, breast, cervix, colon, conjunctiva, liver and rectum were diagnosed in AYA.

Management of lower urinary retention in a limited resource setting.

BACKGROUND: There is a projected increase in lower urinary tract obstruction by 2018, especially in the developing economies of Asia and Africa. However in many of these countries, the problems encountered both by the patients and the clinicians are not well documented. Our aims are, to prospectively analyse the management of urinary retention, the associated difficulties, and complications in our setting, where access to investigative modalities such as Computerize Tomography and Magnetic Resonance Imaging are not available. PATIENTS AND METHODS: The study was approved by the University Of Calabar Teaching Hospital ethical committee. A validated Proforma was used to collect data from all patients who were clinically diagnosed with urinary retention based on history, and physical examination, from July 2009 to June 2010. Data collected from the 1st of July 2009 to the 30th of June 2010, include demographics, findings on physical examination, previous medical history and co-morbid conditions. The results of investigations done such as: urinalysis, full blood count, electrolytes, urea and creatinine, intravenous urography, trans- abdominal ultrasonography, chest X-ray and histology of trans-rectal biopsies of the prostate . The total number of new patients seen, including those with urinary retention during the study was documented. The retentions were also classified into acute and chronic. All the patients were followed up throughout the study. The data was analysed using Epi-Info statistical program version 3.4 of 2007 to analyse the data, estimating averages, mean, median and percentages. RESULTS: The total number of new patients seen, including those with urinary retention was Seventy thousand, one hundred and thirty nine (70,139).Of this number, hundred and fifty nine (0.23%), presented with urinary retention; 145 (91.2%) were acute, and14 (8.8%) were chronic. The male: female ratio was 39:1.The patients ages ranged from 4 to 94 years, with a mean of 53.7±11.2. Seventy seven [48.4%] of them were in the 6(th) and 7(th) decades of life. The common causes were; prostatic diseases [BPH and cancer of the prostate] 77.0%, infections 75.8%, trauma 12.1%, and congenital 12.1%. Urinary retention was relieved by: indwelling urethral catheterization [IUC] 120 patients (75.5%), supra- pubic cystostomy [SC] 34 (21.4%) and intermittent urethral catheterization [IC] 5 (3.1%). The most frequently encountered complications include pyuria (18.2%), pericatheter sepsis 17.5%, and haemorrhage during change of catheter 16.8% [figure 2]. Figure 2Complication after one week bladder drainage. CONCLUSION: Lower urinary retention is common in our environment. The management is appropriate and standard. The man power and facilities are inadequate, and requires urgent improvement.

Analysis of Gleason grade and scores in 90 Nigerian Africans with prostate cancer during the period 1994 to 2004.

OBJECTIVES: To determine the relative frequency of prostate cancer among surgical specimens, and among prostate specimens received at the pathology department ,University Hospital Calabar. METHODS: Histology records were reviewed for the following: total number of histology specimens received; total number of prostate specimens; total number of prostate cancer; and the total number of cancers in males during the study period. Histology sections 4-5microns thick were cut from paraffin blocks and stained by Haematoxylin and Eosin (H&E). Histopathologic specimens were classified using the grading system of tumour differentiation described by Gleason and associates. RESULTS: One hundred and twenty three cancers of the prostate were received, constituting 2% of the total surgical specimens and 31% of prostate specimens. Thirty three cases (27%) could not be analyzed; therefore the study is based on 90 prostate cancer specimens. Eighty nine (99%) cases were epithelial tumours (adenocarcinoma.) There was a single mesenchymal tumour (rhabdomyosarcoma) (1%). The commonest grade in this study was the high grade (Gleason grade IV). CONCLUSIONS: We observed that prostate cancer is a common among males (all sites) diagnosed at the University Hospital Calabar, with a peak incidence between the ages of 61 - 70 years (seventh decade).