Autopsy Study of the Liver in Adult Nigerians at Lagos University Teaching Hospital.

BACKGROUND: Liver diseases are one of the major causes of morbidity and mortality in Nigeria. Detection of liver involvement in many disease conditions is often delayed till after death when autopsy is conducted, hence the importance of this study. STUDY DESIGN AND METHOD: This was a prospective study to assess the pathologic findings in the liver of one hundred (100) consecutive adults (without pre-mortem diagnosis of liver disease) at autopsy, at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. The organs were examined macroscopically, weighed and representative biopsies taken for histopathological assessment. Special histochemical stains to confirm diagnosis were carried out as appropriate. The biodata and other clinical information were obtained from the case notes. Analysis was carried using descriptive statistics. RESULTS: One hundred cases were studied, comprising of 46 males and 54 females, with overall mean age 47±15.6 years. The mean weight of the liver was 1737±586.02 grams (normal 1200-1400gm). In 19.0% of the cases, the liver showed normal histology. Of the others with pathological findings (81%), the three most common pathologies were chronic venous congestion, steatosis, and metastatic tumours. There was significant correlation of liver pathologies diagnosed with causes of death at autopsy (p=0.001). CONCLUSION: In view of the fact that major liver diseases may be asymptomatic and may not be diagnosed until death, there is need for a high index of suspicion by clinicians. It is therefore important that clinicians properly assess the functional state of the liver to prevent, detect and promptly treat these disorders.

KRAS and BRAF mutations in Nigerian colorectal cancers.

PURPOSE: Activation of the KRAS oncogene is implicated in colorectal carcinogenesis and mutations have been reported in 30-50% of cases. BRAF mutation, though less common, is also reported and importantly associated with shorter progression-free interval. This study aims to determine the KRAS and BRAF mutation statuses of Nigerian colorectal cancers (CRC). METHODS: Mutation analysis was carried out on archival paraffin-embedded blocks of CRC tissues. KRAS codons 12, 13 and 61 and BRAF V600E were assessed by pyrosequencing after DNA extraction from 200 cases at the Leeds Institute of Molecular Medicine, St. James's University Hospital, UK. Mutation rates and the spectra were determined. RESULTS: Pyrosequencing was successful in 112 of 200 cases. KRAS mutation in codons 12 and 13 was demonstrated in 23 of 112 cases (21%); none in codon 61. BRAF mutation in codon 600 was demonstrated in 4.5%. CONCLUSION: This study shows that 21% of Nigerian CRC patients carry a KRAS mutation; half the rate in Caucasians; and that BRAF mutation also occurs in Nigerian CRC cancers.

Prostate diseases in Lagos, Nigeria: a histologic study with tPSA correlation.

OBJECTIVE: To present a 10year retrospective histologic study of prostate diseases in Lagos, Nigeria. The aim is to document the prevalence, histologic pattern, age distribution and PSA values of prostatic diseases. MATERIALS AND METHODS: The materials consisted of slides, paraffin embedded tissue blocks, patients case files and histology request forms of all prostatic biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1999 to 2008. Each sample represents a different patient. RESULTS: Prostatic biopsies comprised 3.6 % of all biopsies in LUTH. BPH was the commonest prostatic lesion and accounted for 70.9% of all cases. The age range was 40 to 94 years with a mean of 67 years and a peak age group at 60-69 years. Stromoglandular pattern was the most common histological type of BPH accounting for 72.2 %( 393) of the cases. Malignant tumours constituted 28.9% of all prostatic biopsies. Most (93.7%) of these malignancies were seen in trucut biopsies. Adenocarcinoma accounted for 99.1% of the total 222 malignant tumours. It showed an age range of 40 to 98 years, a mean age of 66 years and peak prevalence in the 60-69 year age group. Gleason score nine was the most frequent (16.8%) in occurrence. Most adenocarcinomas were poorly differentiated (40%). Incidental carcinoma was seen in 4.2% of prostatectomy samples. High grade PIN was seen in 19.1% of adenocarcinoma cases. The most common inflammatory lesion was chronic non-specific prostatitis accounting for 76.4% of all inflammatory lesions. Malignant and benign lesions were accountable for PSA levels of 1 to 49.9ng/ml while values of 50ng/ml and above were seen exclusively in malignant lesions. CONCLUSION: Prostatic lesions constitute a significant source of morbidity among adult males in Lagos. Adenocarcinoma is the commonest histologic subtype of prostatic cancer and most are of poorly differentiated variety. Elevated levels of tPSA in Nigerian males may be as a result prostate cancer, BPH or BPH with prostatitis. PSA should in our opinion be used as a component of a strategy integrating multiple diagnostic approaches for prostate cancer screening and not to be used alone in our environment.

Bladder cancer in Lagos: a 15 year histopathologic review.

OBJECTIVE: To present a 15 year retrospective pathologic study of bladder cancers. The aim is to document histologic pattern, prevalence, sex and age distribution of urinary bladder cancer. MATERIALS AND METHODS: The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all urinary bladder biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1991 to 2005. Each sample represents a different patient. The study did not include information regarding the clinical or pathological stage of the tumours. RESULTS: Bladder malignancies comprised 39 (72.2 %) cases of all bladder biopsies and 0.86% of all diagnosed cancers in LUTH. The malignant lesions of the bladder showed a male preponderance with a M:F ratio of 4.6:1. The age range was 4-75 years with a mean age of 51.37 years and peak at 61-70 years age group. Transitional cell carcinoma was the commonest histological type accounting for 61.5% with a male to female ratio of 5:1 and mean age of 59 years. Squamous cell carcinoma accounted for 20.5% with a M:F ratio of 3:1 and showed a mean age of 47 years. Adenocarcinoma, anaplastic carcinoma and embryonal rhabdomyosarcoma accounted for 5.1%, 5.1% and 7.8% of cases respectively. CONCLUSION: Bladder cancer is not common in Lagos. The histopathologic pattern, prevalence, sex and age distribution of bladder cancer are similar to previous reports from schistosomiasis non endemic regions of Nigeria, Africa and the rest of the world.

Malignant gastrointestinal tumours in south western Nigeria: a histopathologic analysis of 713 cases.

BACKGROUND: Malignant tumours of the gastro-intestinal tract are not as rare as previous studies suggest. Recent studies have indicated increasing incidence. OBJECTIVE: To document the pattern, age and sex distribution as well as histopathology characteristics of malignant tumours of the gastro-intestinal system in Lagos and Sagamu in Southwestern Nigeria. METHODS: The paraffin embedded blocks and slides as well as pathology reports of malignant tumours of the gastrointestinal (GIT) organs collected from five laboratories (Morbid Anatomy Departments of the Lagos University Teaching Hospital and Olabisi Onabanjo University Teaching Hospital in Sagamu, Ogun State as well as the three private histolopathology laboratories in Lagos State) were reviewed. The clinical data such as the age, sex, and clinical summary were extracted from the records. RESULTS: About 80% (578 cases) of all the 713 malignant GIT tumours were epithelial; sarcomas, carcinoid and non-Hodgkin's lymphoma being less common. The ages ranged from 4-96 yrs (mean of 48.9 years) with the peak in patients 60-69-year age group and M:F ratio of 1.35:1. Colorectal tumours topped the list with 402 cases (56%), followed by liver 105 (14.7%), stomach 85 (12%) and omental metastases 67 (9.4%). The oesophagus, pancreas, small intestine and gall bladder represented 18 (2.5%), 16 (2.2%), 12 (1.7%), and eight (1.1%) respectively. Colorectal cancers peaked in the 60-69 year age group, liver and stomach cancer occurred mostly between the 50-59 years age group. Over half of the colorectal adenocarcinomata were located in the ano-rectum with 93 (23%) occurring in those below 40 years of age. CONCLUSION: Colorectal cancer remains the commonest GIT tumour in the region. Molecular studies are imperative to identify the common subtypes of GIT tumours in order to ascertain their specific pathogenetic and prognostic features.

Immunophenotyping of gastrointestinal mesenchymal tumours in Lagos, Nigeria.

BACKGROUND: Gastrointestinal stromal tumour (GIST) represents only 1% of all malignant tumours of the gastrointestinal tract (GIT) but it is the most common gastro-intestinal mesenchymal tumour (GMT) with majority arising from the stomach and small intestine. OBJECTIVE: To determine the prevalence of GIST using immunophenotypic characteristics. METHODS: Materials were formalin fixed paraffin embedded blocks of GMT diagnosed in Lagos Nigeria between January 1995 and February 2007. Sections were stained with CD117, CD34, SMA, S100 and Desmin antibodies at the research Laboratory of The Leeds General Infirmary, United Kingdom following standard procedure. RESULTS: Thirty-two cases of GMT (aged 10 to 78 years with a mean age of 46 and M: F=1.3:1) were analyzed. GIST accounted for 13 (40.6%), smooth muscle tumours 7(22%), vascular three(9.3%), de-differentiated liposarcoma two (6.2%), and unclassified (3%) of the GMT cases. Immuno-staining was not done for six cases of lipoma (18.7%). GIST patients had a mean age of 45.4 years with a M: F of 1.6:1; 54% was located in the stomach. Histologically, spindle cell type predominated accounting for 46% followed by mixed (31%) and epithelioid types (23%). Only 30.7% the GIST were suspected before immuno-staining. CONCLUSION: Gastrointestinal stromal tumour is the most common gastro-intestinal mesenchymal tumour in Lagos with a male preponderance. The most common site is the stomach. The immunophenotypic characteristics are comparable with gastrointestinal stromal tumours reported from other parts of the world.

Histopathological study of liver diseases at the Lagos University Teaching Hospital, Nigeria (1989-2000).

OBJECTIVE: We present a retrospective histopathological study of 345 liver biopsies over a 12-year period. The study sought to record the frequencies of the range of histopathological changes observed in liver biopsy specimens. MATERIALS AND METHODS: the materials consisted of slides and paraffin embedded blocks of all liver biopsy specimens received from within and outside the hospital. The clinical data such as the age, sex, and clinical summary were extracted from the request forms. RESULTS: there were 222 males and 123 females; M: F=1.8:1; peak age incidence of 41-50 years. The three common histopathological diagnoses were hepatocellular carcinoma-33%, chronic hepatitis-17.7%, and liver cirrhosis-17.7%. Thirty per cent of hepatocellular carcinoma was post-cirrhotic. The peak age incidence of chronic hepatitis precedes that of liver cirrhosis and hepatocellular carcinoma by one decade. CONCLUSION: the common forms of liver disease diagnosed histologically are hepatocellular carcinoma, chronic hepatitis and liver cirrhosis. The age and sex distribution are similar to those already established in the African literature.

Idiopathic interstitial pneumonias in LUTH--A morphologic study of three cases.

OBJECTIVE: Idiopathic interstitial pneumonias are rarely diagnosed in our environment. However in in the year 2000 a group of new cases were histologically diagnosed in the Department of Morbid Anatomy of the Lagos University Teaching Hospital (LUTH). This study aims to review the clinical and morphologic features of the three cases or Idiopathic Interstitial Pneumonias seen at surgicals and autopsy over a 10 year period (March 1995 to March 2005) in LUTH; as well as discuss some clinicopathologic features of interstitial pneumonias. MATERIALS AND METHODS: A review of the cases seen at surgicals and autopsy from March 1995 to March 2005 was done by retrieving the relevant reports. Cases described with interstitial pneumonitis were re-evaluated and their respective paraffin blocks re-cut for special staining to better demonstrate the changes in morphology. RESULTS: A total of 3 cases were retrieved from the ten year period reviewed. Incidentally, all occurred in the year 2000. Their mean age was 57 years and the male to female ratio was 2:1. The 'Usual Interstitial Pneumonitis' pattern was more common. CONCLUSION: Interstitial pneumonias are rare in our environment; the apparent emergence of three cases in the year 2000 alone is a curiosity as a search over a ten year period (March 1995 to March 2005) yielded no other histologically convincing case. An increased index of clinical suspicion on the part of our clinicians and pathologists as well as collaborative research involving several specialists and Medical Institutions will be required to determine the true frequency of this disease in our environment and its peculiar clinicopathological features.

Medical audit of maternal deaths in the Lagos University Teaching Hospital, Nigeria.

OBJECTIVES: To determine the rate of autopsy certification of maternal deaths; evaluate concordance and/discordance rates between autopsy and clinical diagnoses of maternal deaths, and to compare these with findings from other parts of the world. DESIGN: Retrospective study. SETTING: The Lagos University Teaching Hospital (LUTH), Nigeria between January 1989 and December 1998. SUBJECTS: Women who died from pregnancy-related complications having been on admission in or having presented as emergencies to LUTH. RESULTS: In the study period, 445 maternal deaths were registered in the LUTH mortuary. Autopsies were performed on 371 of these, giving an autopsy rate of 83.37%. Only 230 cases were found suitable for evaluation of concordance and discordance. Two hundred and six of these (89.57%) had related clinical and autopsy diagnoses (concordance) while 24 (10.43%) had completely unrelated diagnoses (discordance). CONCLUSION: Adequate investigation of cause of death using the autopsy will assist in accurately determining the sequence of events that result in death and hence provide required statistics for the planning of appropriate interventions.

Histological Review of Thyroid Lesions: A 13-year Retrospective Study (1989-2001).

OBJECTIVE: We present a 13-years retrospective histological study of 444 thyroidectomies received between 1989 and 2001 at the Morbid Anatomy department of the Lagos University Teaching Hospital, Nigeria. The aim of the study is to update the available literature on the frequencies of the common thyroid lesions as well as compare with previous studies. MATERIALS AND METHODS: The materials for this study consist of slides and paraffin embedded blocks of all thyroidectomies received from within and outside the teaching hospital. The clinical data such as the age, sex, and clinical summary were extracted from the request forms. RESULTS: The male: female ratio is 1: 7. The most common entity was goiter (74%); most of which occurred in the age group 30-39 yrs. Thyroid adenomas (majority; follicular), constituted 10%. There were 29 cases of thyroid carcinoma accounting for 7% of all lesions and occurring more in females than males (17:12). Histologically, follicular carcinoma predominated (48.3%), followed by papillary carcinoma (34.5%) and medullary carcinoma (13.8%). Thyroiditis was uncommon (only 2%). CONCLUSION: Goiter, adenoma and carcinoma remain the commonest pathologic entities of the thyroid gland in Lagos. The age and sex incidences as well as the histological characteristics concur with reports from other parts of Africa and Nigeria. However, unlike many of the Nigerian series except the latest from Ibadan, 4 cases of medullary carcinoma were encountered in this study. The frequencies of toxic hyperplasia and thyroiditis are also lower than those recorded in previous studies. KEYWORDS: thyroidectomy, histopathology, thyroid lesions.

Maternal deaths in the Lagos University Teaching Hospital: a ten-year review (1989 - 1998).

UNLABELLED: To determine the causes and frequencies of maternal deaths in the Lagos University Teaching Hospital (LUTH) as seen at autopsy; to find their age associated frequencies; and to compare these findings with previous studies done in this hospital as well as those from other parts of the world. MATERIALS AND METHODS: Those cases for which autopsies were requested and performed between January 1989 and December 1998 (inclusive) formed the material for this study. Excluded were patients who were dead on arrival, as well as badly autolysed cases. Records including autopsy protocols were retrieved from the Morbid Anatomy Department and relevant information was extracted and analysed from these records. RESULTS: About 81% of autopsy certified were due to direct causes. The three leading causes of maternal death were obstetric haemorrhage (25.61% ), genital sepsis (19.68% ) and pregnancy-induced hypertension (16.71% ). The most common indirect cause of death was anaemia (7.01% ) making it the fifth leading cause of death in this study. Majority of deaths (70% ) occurred in those between 11 and 30 years. Maternal mortality Ratio was 2,920/100,000 live births. CONCLUSION: Though maternal mortality figures from hospital-based studies are usually over-estimates of the true picture in the community they tend to provide a more thorough assessment of the underlying causes of death and their contributing factors, hence providing useful data for planning interventions.

Prognostic factors in the management outcome of carcinoma of the larynx in Lagos.

This is a retrospective analysis on the prognostic factors in the management outcome of clinically and histologically diagnosed carcinoma of larynx seen in Lagos University Teaching Hospital between 1996-1999. Various prognostic factors have been documented as determinants on the probable outcome of carcinoma of the larynx, such as duration of symptoms, smoking, medical status of the patient, degree of differentiation, size and site of tumour and presence of cervical lymph node. Thirty-six patients between 1996-1999 were reviewed, with a male to female ratio of 11:1, and peak age group of occurrence in 50-59 years, majority (86.12%) of which were non-smokers who presented in varied degrees of airway obstruction necessitating pre-treatment tracheostomy in 70% of the patients with more than 50% presenting within 3-6 months of onset of initial symptom. The tumours were staged clinically and histology revealed well differentiated T3 glottic tumour without any clinically palpable neck node in more than 50% of the patients which should predict a better outcome. But the interplay of many prognostic variables like pre-treatment tracheostomy and its attendant complications, supposed biological aggressive tumour in a non-smoker, coupled with treatment biased by patients, high costs of treatment, logistics and poor follow up compliance, resulted in poor outcome of our management.

Malignant haemangio endothelioma (angiosarcoma) concomitant presentation in the mandible and occiput--a case report.

A case of angiosarcoma presenting simultaneously in the mandible and occiput is presented. The mandibular swelling was preceded by toothache for which the patient had tooth extraction, after which the rate of growth increased tremendously. It was not possible to determine without doubt which lesion presented first. The need to evaluate and investigate all cases of jaw swelling that require tooth extraction is emphasised. Angiosarcoma being a haemorrhagic lesion could be complicated life threatening haemorrhage, if a tooth related to it is extracted, as was experienced on incisional biopsy of this lesion. The procedure was accompanied by torrential bleeding which was only controlled after external carotid artery ligation. This, to our knowledge, is the first reported case of angiosarcoma occurring simultaneously in the mandible and occipital bones.

Fatal head injuries: the Lagos University Teaching Hospital experience (1993-1997).

Head injuries are a universal problem and they constitute a major public health problem both in terms of morbidity and mortality. The aim of this study is to examine the causes and pattern of fatal head injuries in the Lagos University Teaching Hospital (LUTH). A retrospective autopsy study of fatal head injuries in LUTH between January 1993 and December 1997 was done by retrieving autopsy reports, extracting relevant information and analysing them. Two hundred and fourteen such cases were reviewed (7% of all autopsies during that period). Majority were consequences of road traffic accidents (52%) and assault (12%). Adults between the ages of 21 and 40 years were the most affected (44%), followed by children 10 years and below (17%). Seventy seven percent of all cases were males. Common lesions identified include skull fractures (73%), intracranial haemorrhages (69%), lacerations and contusions (31%).

Gastric antral juxtamucosal pH in helicobacter pylori positive and negative dyspeptic patients.

Maintenance of gastric juxtamucosal pH at a stable near neutral value may be the cumulative effect of the various components of the mucosal defense system. In order to assess the effect of helicobacter pylori (HP) infection on mucosal defense, we measured the gastric antral juxtamucosal pH in 40 dyspeptic patients by using a flexible glass pH microelectrode which can be passed down the instrument channel of standard gastroscopes. HP status was determined using serology, culture, histology and urease test. We also investigated the relationship between juxtamucosal pH and the severity of antral HP infection. The mean antral juxtamucosal pH in 26 (65%) HP positive patients was 6.49 +/- 0.20 compared to 6.19 +/- 0.21 in 14 (35%) HP negative patients (p < 0.00001). Other factors like age, sex, duodenogastric reflux or presence of chronic duodenal ulcer did not significantly affect juxtamucosal pH (p > 0.05). Subset analysis of data on HP positive patients (n = 26) revealed no significant correlations between antral chronic gastritis anti-HP IgG titre and antral juxtamucosal pH (p > 0.05). This study shows that HP increases gastric antral juxtamucosal pH. This finding supports the suggested role of HP in producing hypergastrinaemia and gastric acid hypersecretion.

Gastric acid secretion in Helicobacter pylori positive and negative dyspeptic Nigerians.

The pathological role of Helicobacter pylori is largely unproven in our region of high incidence of infection but very low incidence of serious gastroduodenal lesions. The aim of this study was to investigate the effect of H. pylori infection on gastric acid secretion. One week after gastroduodenoscopy, basal and pentagastrin (8 micrograms/kg) stimulated gastric acid secretion were measured in 39 dyspeptic Nigerians. H. pylori status was determined using urease test, culture, histology and serology, while gastritis was assessed using the Sydney system criteria. The median maximal acid output (MAO) and peak acid output (PAO) in mmol/h were significantly higher in H. pylori positive (29.3, range 7.4-81.6 and 34.4, range 7.6-144.0) than in H. pylori negative (16.6, range 4.2-44.1 and 22.4, range 5.6-48.6) patients, p = 0.019 and p = 0.029, respectively. Stimulated gastric acid secretion was significantly higher in patients with duodenal ulcer (n = 8) than in H. pylori negative (n = 11) patients, but was similar in non-ulcer dyspeptics (n = 20) and H. pylori negative patients. The median basal acid output was not significantly different between the groups of patients. Our patients (median age 32 years) had normal mucosa (12.1%), pangastritis with corpus predominance (12.1%), antrum-only gastritis (24.3%) and pangastritis with antral predominance (51.5%). In the subset of H. pylori positive patients (n = 28, 71.8%), there were no significant correlations between grade of antral chronic inflammation, gastritis index score, anti-H. pylori IgG titre and gastric acid secretion, p > 0.05. H. pylori infection increases MAO and PAO in our relatively young patients with antral predominant chronic gastritis.

Effects of anti-protozoal drugs and histopathological studies on trypanosome species.

The trypanosomostatic and trypanosomicidal effects of four anti-protozoal drugs, namely halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine, on species of trypanosomes, viz. Trypanosoma brucei brucei (MBOS/NG/94/NITR) Bassa strain, T. congolense (MBOS/NG/93/NVRI) Zaria strain and T. brucei gambiense (MHOM/NG/92/NITR) Abraka strain, were investigated. In vitro and in vivo studies on these drugs vis-a-vis the parasites were carried out. The histopathological changes in organs and tissues of experimentally infected rats were also studied. Results from the in vitro studies indicated that halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine appeared to be effective trypanosomicidal agents against T. brucei brucei (Bassa strain), T. congolense (Zaria strain) and T. brucei gambiense (Abraka strain). The in vivo studies showed that these drugs were sub-curative by prolonging the survival period of the trypanosome-infected rats, but not necessarily curing the infection. Histopathological findings indicated inflammatory reactions characterised by infiltration to variable degrees in the majority of tissues, mostly in the lungs and liver. The most consistent lesions were interstitial pneumonia, multifocal necrosis and oedema. Pathological findings showed the T. brucei brucei and T. brucei gambiense strains studied to be both intravascular and extravascular parasites. These results suggest that halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine could be used as supportive, suppressive and/or synergistic/additive drugs in the treatment of African trypanosomiasis. Their effects on species of trypanosomes have been studied and are reported for the first time.

Unilateral macronodular adrenal hyperplasia as an unusual cause of Cushing's syndrome--a case study.

To appraise clinicians of the problems that may be encountered in the diagnosis and management of Cushing's syndrome, we present a case report of a 20-year old female, who was admitted with a recently developed central obesity, ammenorrhea hirsuitism, proximal myopathy and depression. She was found to have multiple striae, thin skin, elevated blood pressure glycosuria and hyperglycaemia. Morning and mid-night plasma cortisol concentrations revealed elevated levels, with a loss of diurnal variation. There was a failure of the normal suppressibility of cortisol secretion by low doses of dexamethasone, while a significant suppression of plasma cortisol concentration was observed with high doses of dexamethasone. There were no significant abnormalities observed in the pituitary fossa on skull radiograph and on the cranial computerised tomographic scan. After a period of stabilisation, she had a bilateral adrenalectomy done, with a histopathological finding of a left adrenal macronodular hyperplasia, while the right adrenal gland was small and friable. There was an uneventful post-operative period, with a gradual return to normality of most of the presenting complaints. The hyperglycaemia and hypertension got controlled without medications, while her menstrual cycles resumed within three months of bilateral adrenalectomy. This case report illustrates that an adrenal-dependent Cushing's syndrome may mimic a pituitary-dependent one, especially as regards the suppressibility of plasma cortisol secretion by high doses of dexamethasone.

Colorectal neoplasms: a retrospective study.

A total of 254 cases of colorectal neoplasms were studied. A male predominance was noted with both benign and malignant neoplasms (M:F of 4.6:1 and 1.1:1 respectively). The peak incidence was in the fifth decade. The rectum was the commonest site for both benign and malignant neoplasms (75% and 63% respectively) followed by the sigmoid colon (11% and 16% respectively). Right-sided cancers presented commonly as fungating masses (74%) while left sided cancers were predominantly of the ulcerating/infiltrating pattern (81%). The commonest benign neoplasm was tubular adenoma (39%) while the commonest malignant neoplasm was adenocarcinoma (90%) followed by squamous cell carcinoma (4%). Advanced stage on presentation was noted with these cancers, especially the mucinous adenocarcinoma variant. This may be explained by the usual late presentation of patients to orthodox doctors in our environment.

Morphological patterns of paediatric solid cancer in Lagos, Nigeria.

With successful implementation of the Expanded Programme on Immunisation (E.P.I.), many Nigerian children are protected against the common infections of childhood which claim their lives within the first decade of existence. Recent observations tend to show that paediatric cancer may start to play a significant role in childhood morbidity and mortality. Therefore, this study analyses 372 cases of paediatric solid malignant tumours received at the Department of Morbid Anatomy, Lagos University Teaching Hospital (L.U.T.H) from 1974 to 1988. Considering all the age groups together, the commonest malignant tumour is lymphoma (32.8%), of which Burkitt's lymphoma accounts for 19.6%. Retinoblastoma and Wilms' tumour represent second and third commonest solid cancers respectively. There is, however, slight variation in the different age groups. For example, in the age group 1-4 years, malignant lymphoma is an uncommon disease representing only 11.0% of all cancers whilst retinoblastoma (34.5%) and nephroblastoma (24.0%) together account for 58.6%. Epithelial cancer although rare in children, represents 12.6% in the 10-14 year age group. There is a higher incidence of this tumour when compared to the other age groups (less than 1 year, 1-4 years and 5-9 years). Intracranial neoplasia are uncommon, representing only 2.0%. The overall incidence of solid malignant tumours in children aged 0-14 years in Lagos is estimated to be 22 per million person years.