Knowledge of Secondary School Children in Edo State on Lassa Fever and its Implications for Prevention and Control.

INTRODUCTION: Removal of testicular tissue is often performed for the evaluation or treatment of testicular lesions. Orchiectomy is a proven treatment modality for prostatic cancer. Testicular biopsy is also of vital importance in the management of infertility especially relating to artificial reproductive technology. Histopathologic assessment of such specimens is therefore useful in the review of current urological practice. AIM AND OBJECTIVES: This study aims to characterize the histologic spectrum of testicular lesions relating them to the various surgical procedures by which they were taken with a view to reviewing the current clinical practice in our environment. METHODOLOGY: Records of all testicular specimen received in the Department of Anatomic and Molecular Pathology from 2005 to 2014 were retrieved. Data such as age, indication for biopsy, nature of surgical specimen and histologic diagnosis for all such cases were retrieved from these records. They were classified, analyzed and represented in tables and charts using Microsoft Excel 2007. RESULTS: A total of 173 testicular and paratesticular specimens were submitted during the study period constituting 0.7% of surgical specimens received during the study period. One hundred and sixty two (93.6%) were testicular while remaining 11 samples (6.4%) were paratesticular.The most common indication for the submission of testicular specimen was for the treatment of prostate cancer (42.2%) followed by presence of a mass (20.2%) and pain (19.7%). Orchiectomy specimens were the commonest samples received (79.8%). A significant proportion of orchiectomy cases (57.1%) wereperformed for benign lesions. Hypospermatogenesis with maturation arrest (57.8%), hypospermatogenesis (15.8%) and tubular hyalinization (15.8%) were the commonest histologic diagnoses of male infertility. Germ cell tumours were the commonest testicular neoplasms (62.5%). Seminoma was the commonest testicular malignancy (50%) while embryonal rhabdomyosarcoma was the only paratesticular malignancy seen. CONCLUSION: Treatment of prostate cancer was the commonest indication for testicular biopsies in our environment. Testicular tumours are not common. Twelve (57.1%) out of a total of 21 cases of testicular masses that had orchiectomy were benign lesions. With core needle biopsies and frozen section analysis, unnecessary orchiectomies can be avoided.

Clinico-pathological study of female genital malignancies in Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.

OBJECTIVE: To ascertain the pattern and frequency of female genital malignancies among the different age groups, the common presenting complaints of cervical cancer patients and stages of presentation as seen in Sagamu, Ogun State. METHODOLOGY: A retrospective analysis of reports of formalin fixed paraffin embedded tissue blocks and slides of all female genital samples received at Morbid Anatomy & Histopathology Department of Olabisi Onabanjo University Teaching Hospital, Sagamu from January 1st, 2003 to June 30th, 2012. The personal data and clinical history were retrieved from laboratory forms and the patients' case files. RESULTS: The age range of patients whose specimens were reviewed was between 21-85 years. Cancers of the cervix accounted for majority (65.1%) of the cases followed by ovarian cancer (23.2%) and cancer involving the uterus (10.5%). Sixty-six percent of the cervical cancer patients are 50 years and above. Majority of the cervical cancer cases (82.2%) were squamous cell carcinoma. The common clinical features were post-menopausal bleeding (53.3%), vaginal discharge (43.3%), and intermenstrual bleeding (16.7%). The interval between onset of symptoms and seeking of healthcare was 6.7 ± 3.66 months. Stage IIIB cervical cancer was seen in 40% of the cervical cancer patients analyzed while no case of Stage IA was seen. Ninety-three percent of these patients were referred for radiotherapy. CONCLUSION: Cancer of the cervix is the commonest gynaecological malignancy and most patients presented late. Free or government subsidized cervical cancer screening programmes and awareness campaign is highly recommended.

Congenital mesoblastic nephroma in a premature neonate: a case report and review of literature.

Congenital mesoblastic nephroma (CMN) is a renal stromal neoplasm of infancy. It comprises 3-10% of all pediatric renal tumors. We report a case of CMN in a 30 week old premature female neonate seen at autopsy who was born to a 26-year-old woman by emergency cesarean section on account of polyhydramnios.

Clinicopathological and molecular significance of Sumolyation marker (ubiquitin conjugating enzyme 9 (UBC9)) expression in breast cancer of black women.

The majority of breast cancers (BC) in Nigerian women are triple negative and show breast cancer-associated gene 1 (BRCA1) deficiency as well as the basal like phenotype, with a high mortality rate. In contrast to the well-defined predictive factors for the hormonal therapy, there is a paucity of information on the BRCA1 deficiency breast tumor biology, particularly among African women. BRCA1 Sumoylation (UBC9) has been speculated to be involved in the ER transcription activity, BRCA1 deficiency and triple negative BC. We therefore hypothesized that UBC9, a SUMOylation marker, may have contributed to the aggressive nature of BRCA1 tumor phenotype observed in Nigerian women. This study investigated the immunoprofiles of UBC9 in tissue microarray (TMA) of 199 Nigerian women and correlated their protein expression with clinical outcome, pathological responses and the expression of other biomarkers to demonstrate the functional significance in Nigerian women. The protein expression of UBC9, as compared with other biomarkers, showed an inverse correlation with steroid hormones (ER, progesterone (PgR)), BRCA1, p27, p21 and MDM4, and a positive correlation with triple negative, basal cytokeratins (CK14 and CK5/6), epidermal growth factor receptor (EGFR), basal-like breast cancer phenotype, p53, phosphoinositide-3-kinases (PI3KCA), placental cadherin, (P-cadherin) and BRCA1 regulators (metastasis tumor antigen-1 (MTA1). Survival analysis showed that those tumors positive for UBC9 expression had a significantly poorer breast cancer-specific survival (BCSS) as compared with those showing negative expression. UBC9 remained an independent predictor of outcome for BCSS. This study demonstrates that UBC9 appears to play an important role in the tumor biology of Nigerian women. Therefore, a novel UBC9 targeted therapy in black women with BC could enhance a better patient outcome.

Vulva fibroadenoma associated with lactating adenoma in a 26-year-old nigerian female.

Background. Vulva lactating adenoma is rare and may be misdiagnosed as adenocarcinoma in frozen section and aspiration cytology if breast tissue is not anticipated. Objective. To raise the awareness of lactating vulva ectopic breast lesion among clinicians and pathologists. Case Report. We present a case of vulva fibroadenoma associated with lactating adenoma in a 26-year-old Nigerian female. Conclusion. The rarity of vulva ectopic breast tissue can present a diagnostic challenge for both the clinician and the anatomical pathologist. Once excisional biopsy is done and the lesion confirmed histologically, the anxious patient can be reassured.

An evaluation of usefulness of prostate specific antigen and digital rectal examination in the diagnosis of prostate cancer in an unscreened population:experience in a Nigerian teaching hospital.

OBJECTIVE: To evaluate the usefulness of prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of cancer of the prostate (CaP) amongst unscreened patients. PATIENTS, MATERIALS AND METHODS: A prospective study 168 unscreened men who were referred for evaluation for CaP. They all had a 10-core extended transrectal prostatic needle biopsy using size 16 Tru Cut needle for either an elevated serum total PSA of > 4 ng/ml or abnormal DRE findings or both. Overall cancer detection rate was determined and detection rates were determined separately for patients with elevated PSA with normal DRE, abnormal DRE with normal PSA and those with both indications. The performances of each indication were determined separately and in combination in terms of their sensitivity, specificity, predictive values and accuracy. The results were compared amongst patients with different indications for biopsy. RESULTS: The overall cancer detection rate was 44.0%. Detection rates in patients with elevated PSA with normal DRE and abnormal DRE with normal PSA were 30.0% and 17.4% respectively. There was statistically significant increased detection of 61.2% amongst patients with both indications. The overall sensitivities of PSA, DRE and combination of both were 94.6%, 75.7% and 70.3% respectively while the specificities were 20.2%, 44.7% and 64.9% respectively. The accuracies of PSA, DRE and combination of both indications were 53%, 58% and 67.3% respectively while the PPVs were 48.3%, 51.9% and 61.2% respectively. Mean Gleason score was 6.82 while the overall complication rate was 23.2% CONCLUSION: Neither PSA nor DRE is sensitive, specific, predictive or accurate enough on its own to be an ideal screening or diagnostic test for CaP. Therefore, optimal evaluation of patients with suspected CaP is best achieved with both even in unscreened populations.

Autopsy study of prostatic weight and lesions in LUTH: a 12 month prospective study.

BACKGROUND: Diseases of the prostate are common among adult Nigerians with some, clinically asymptomatic during life. OBJECTIVE: The study is to determine the prostatic weight and document the histopathologic patterns, frequency, and age distribution of clinically asymptomatic prostatic lesions seen at autopsy in LUTH, Lagos, Nigeria over a 12 month period (January to December 2009). METHODS: Consisted of hospital case files and prostate glands harvested en bloc from all autopsies in men aged 20 years and above who died of other causes other than clinically diagnosed prostate disease in LUTH within the study period. After en block removal, the prostate glands were fixed in formalin, weighed, sectioned at 3-5mm intervals, processed and embedded in paraffin. Whole mount serial sections were stained with H& E and examined. RESULTS: Only 145 prostate glands were suitable for histological evaluation. There was an increasing prostatic weight with age. The distribution of identified prostatic lesions showed 75 (51.7%) having no histological diagnosis. Acute and chronic prostatitis accounted for 2 (2.9%) each, benign prostatic hyperplasia alone, 52 (74.2%) while benign prostatic hyperplasia (BPH) associated with chronic prostatitis accounted for 7 (10%). Latent prostate cancerwas found in 7 (10%) of the cases. CONCLUSION: Prostate weight increased with age. Acute prostatitis was found to be commoner in the younger age groups, particularly below 50 years while chronic prostatitis was seen more in the older men and was largely associated with BPH. BPH was found to be the commonest lesion. Latent carcinoma showed a prevalence of 10%, which is significant and in keeping with similar studies done elsewhere.

Detection of prostate cancer: comparison of cancer detection rates of sextant and extended ten-core biopsy protocols.

AIMS AND OBJECTIVES: To compare the cancer detection rates of sextant and ten- core biopsy protocol amongst patients being evaluated for prostate cancer. PATIENTS AND METHODS: This is a prospective study involving 125 men with suspicion of prostate cancer. They all had an extended 10-core transrectal digitally-guided prostatic biopsy using Tru-Cut needle. Indications for biopsy were presence of one or more of the following: elevated Prostate Specific Antigen (PSA), abnormal Digital Rectal Examination (DRE) findings and abnormal prostate scan. Sextant biopsies were collected first, followed by four lateral biopsies in all patients. Both groups of specimen were kept and analyzsed separately by the same pathologist. The cancer detection rates of sextant and extended (combination of sextant and lateral) 10-core biopsy protocols were determined and compared. Pearson's Chi square and McNemar tests at two degrees of freedom with level of significance set at 0.05 ( P <0.005) were used to determine the statistical significance. RESULTS: The overall cancer detection rate of 10-core prostate biopsy was 48.8%. Of all positive biopsies, the sextant biopsy protocol detected 52 cancers (85.2%) while the lateral biopsy protocol detected 58 cases (95.1%). Three (3) cancers were detected by the sextant protocol only while the lateral protocol detected nine (9) cancers where sextant technique was negative for malignancy. Ten-core extended protocol showed a statistically significant increase of 14.8% over the traditional sextant. (P=0.046). The overall complication rate of ten-core biopsy was 26.4% and the procedure was well tolerated in most patients. CONCLUSION: We conclude that a ten-core prostate biopsy protocol significantly improves cancer detection and should be considered as the optimum biopsy protocol.

Is extended biopsy protocol justified in all patients with suspected prostate cancer?

OBJECTIVE: To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance. MATERIALS AND METHODS: We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson's Chi square test with level of significance set at <0.05. RESULTS: The overall cancer detection by the extended technique was 61 (48.8%) cases while the sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04) CONCLUSION: Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE.

Pattern of lymph node pathology in Lagos.

BACKGROUND: Enlarge lymph node is a common finding in clinical practice, which can be caused by several factors, such as infections, drugs etc. OBJECTIVE: To review the pathology of lymph node diseases in children and adults with both deep seated and peripheral lymphadenopathy in Lagos. METHODS: A 12- year retrospective study of lymph node biopsies at Histopathology Department of LUTH, and two main histopathology private laboratories in Lagos; The specialist Laboratory (TSL) and Histolab was carried out. RESULTS: 733 samples of lymph nodes were seen. Of these, 229 (31.37%) were reactive, 109 (14.93%) were chronic granulomatuos lesions while lymphoma was seen in 123 cases (16.85%) and metastatic lesions in 269 cases (36.50%). The male to female ratio was 1:1.5. (286:436). In 670 cases, the lymph nodes were peripheral in location with the distribution of 249, 140 and 42 from the axilla, cervical and inguinal regions respectively. Only 60 of the samples were deeply seated lymph nodes; 55 from the intra-abdominal cavity and 5 from the mediastenium. About 239 samples did not have their sites indicated and majority of these (106) were diagnosed to be reactive lymphadenitis. CONCLUSION: The categories of lymphoid disease are similar to that of other third world countries but there is slight disparity in the frequency distribution of these diseases compared with findings in literatures within the countries.

Carcinoma of the penis: experience from the Lagos University Teaching Hospital Lagos, Nigeria.

BACKGROUND: Carcinoma of penis is rare in countries where neonatal mate circumcision is the tradition and in Nigeria it is a common practice amongst almost all the tribes. OBJECTIVE: This is to document the prevalence, age distribution, site and histologic types of penile carcinoma at the Lagos University Teaching Hospital Idi-Araba over a 20 year period. METHODS: Cases of the penile carcinoma recorded in the surgical pathology register of the Department of Morbid Anatomy, the Cancer Registry and the Medical Records Department of the Lagos University Teaching Hospital over a twenty year period were reviewed. Information extracted included the age, site of lesion, and histopathologic type. The histopathology slides were reexamined to confirm the diagnosis and to grade the lesion. The data was analyzed using simple statistical methods. RESULTS: There were 7 cases of carcinoma of the penis accounting for 1.9% of malignant lesions of the male genital tracts in LUTH, 3 (42.85%) of which were on the shaft of the penis. The ages of the patients ranged from 42-79 years with a mean of 52.2 years, majority (42.92) of the cases were inthe 5th decade. All the cases were well differentiated squamous cell carcinomas. CONCLUSION: Carcinoma of the penis is rare in Lagos, Nigeria. This may be attributed to the common practice of neonatal male circumcision in Nigeria.

Accuracy of fine needle aspiration in the diagnosis of peripheral lymph node enlargements. Lagos University Teaching Hospital, Nigeria.

BACKGROUND: The usefulness of fine needle aspiration technique for cytology diagnosis of lymph node lesions has been a subject of controversy over years. OBJECTIVE: This study aims to determine the accuracy of this technique in the diagnosis of peripheral lymph node lesions, in our center, using histology diagnosis as a gold standard. METHODS: The cytopathological diagnosis of 49 cases of peripheral lymph node lesions seen in the Morbid Anatomy Department of the Lagos University Teaching Hospital, Lagos from Jan. 2000 to December 2009 were compared with their corresponding histological diagnosis. Lymph node lesions were categorized into inflammatory, Hodgkin's lymphoma, Non Hodgkin's lymphoma and metastatic. The sensitivity, specificity and positive as well as the negative predictive values of the technique were determined. RESULTS: The overall sensitivity, specificity and positive and negative predictive values were 79.6%, 95.9.0%, 79.6% and 95.9% respectively. For non neoplastic lesions, FNAC has a high false negative report. For primary lymphoid neoplasm, the sensitivity, specificity and both predictive values were above 80% while the procedure produced sensitivity and specificity values of 100 and 97.1 percent respectively in the diagnosis of metastatic lesions. CONCLUSION: Despite the pitfalls and limitations of the procedure, the study demonstrated that fine-needle aspiration is a valuable tool for the evaluation of peripheral adenopathy. But FNAC technique for cytological diagnosis of lymphoid lesions using H and E and Giemsa stains alone cannot be used as the sole diagnosis of lymphoid enlargements. Its accuracy can be improved with the availability immunocytochemistry and flow cytometry.

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.

Bromelain in the early phase of healing in acute crush Achilles tendon injury.

UNLABELLED: Bromelain, an enzyme extracted from the stem of the pineapple plant has been proposed as a treatment for reducing pain and swelling following acute muscle injuries but studies are yet to be done on its effect on tendon healing. This study therefore investigated the effects of bromelain on tenocyte proliferation and the tendon malondialdehyde (MDA) level in the early stage of healing in a crush injury to the Achilles tendon of Sprague-Dawley rats. Twenty four male rats were divided randomly into three groups; groups 2 and 3 had induced crush injury to the left Achilles tendon. Group 1; nil injury and nil treatment, Group 2; nil treatment, Group 3; oral bromelain treatment. Bromelain was given at a dosage of 7 mg/kg body weight daily over the first 14 days post-injury. On day 15 post injury, the animals were killed and the tendons excised and processed for histological study and MDA assay. The results showed a significant increase in the tenocyte population in the bromelain group; p < 0.05. There was, however, no significant difference in the MDA level. CONCLUSION: Based on this study, 600 GDU bromelain given once daily in acute tendon injury at a dosage of 7 mg/kg promoted healing by stimulating tenocyte proliferation.

Glomus Tumours of the Hand in Lagos; Nigeria

"Background: Glomus tumours of the hand are uncommon intriguing tumours which cause significant morbidity. Few reports have documented the epidemiology and presentation in the West African subregion. The aim of this review is to identify the common baseline demographics; the presentation; evaluation; diagnosis and treatment outcome of glomus tumours of the hand in Lagos; Nigeria Methods: A 10 year retrospective review of the records of all patients seen with histopathologically diagnosed glomus tumor of the hand at the Lagos University teaching hospital was carried out noting the biodata; demographics; method of presentation and treatment of this condition.Results: 11 patients were seen over the study period .There were nine females and 2 males seen.The mean age of the patients was 41 years. The symptoms had been on for between 3 and 40 months .All patients seen had a positive Love test.Only one patient had associated bony erosion.All had complete excision with no recurrence at 6 months.Conclusion: Glomus tumor of the hand is an uncommon tumour often occurring in adult women. Clinical test (Love ""test"") will correctly identify the diagnosis.Surgical treatment was curative in all our cases. High index of suspicion is needed to make earlier diagnosis"

The sensitivity, specificity and accuracy of fine needle aspirational cytology in the diagnosis of oro-facial neoplasms at Lagos University Teaching Hospital, Nigeria.

OBJECTIVE: The aim of the study is to compare the efficacy of fine needle aspirational cytology (FNAC) with open surgical biopsy in the diagnosis of orofacial tumours in patients seen at the Dental Centre of Lagos University Teaching Hospital from May 2005-May 2006. PATIENTS AND METHODS: Fine needle aspiration was performed on all patients scheduled for open surgical biopsy at the Oral and Maxillofacial clinic of the hospital before the open surgical biopsy was done. Forty six patients whose final histological diagnoses were oro-facial neoplasms were involved in this study. Sensitivity, specificity and accuracy for fine needle aspirational cytology were calculated. RESULTS: The sensitivity, specificity and accuracy of fine needle aspirational cytology in the diagnosis of oro-facial tumours were 95%, 95.8% and 95.5%, respectively. The false positive and false negative rates were 5% and 4.2%, respectively. CONCLUSION: The high sensitivity, specificity and accuracy of fine needle aspirational cytology reported in this preliminary study suggest that the test may have a place in the management of oro-facial tumours. However, when the result of fine needle aspirational cytology is not in agreement with the clinical diagnosis, especially in suspected malignancy, open surgical biopsy should be performed.

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.

Medical audit of diagnostic mammographic examination at the lagos university teaching hospital (luth), Nigeria.

PURPOSE: We studied the performance of diagnostic mammography in predicting malignancy among patients presenting with signs and symptoms of malignancy. MATERIALS AND METHODS: 310 patients who presented to the surgical out-patients of the Lagos University Teaching Hospital with signs and symptoms of breast cancer, between January 2002 and December 2003 had mammographic evaluation with a dedicated mammography unit. The mammographic appearances were prospectively classified using the BI-RADS assessment categorisation, and histological confirmation following surgical excision was correlated with mammography. RESULTS: The overall sensitivity of mammography in the study was 82.8% (CI 78.6 - 87%) while specificity, Positive predictive value (PPV) and accuracy were 90.7% (CI 87.5-93.9%), 69.97% (CI 46.6 - 74.8%), and 89% (CI 85.5-92.5%) respectively. Multivariate analysis showed that sensitivity and specificity generally declined as breast density increased. CONCLUSION: Diagnostic mammography is useful in characterising breast lesions. This study analyses the performance of mammography and shows that the resultant specificity is high, however it may have to be used in conjunction with needle biopsy to achieve improve sensitivity and avoid unnecessary benign surgical biopsies.

Tumours of the submandibular salivary gland: a clinicopathologic review of cases over a 17-year period.

OBJECTIVE: This study presents a clinicopathologic review of cases of submandibular salivary gland tumours at the Lagos University Teaching Hospital, Nigeria, over a period of 17 years. METHODS: The records of all patients with histological diagnosis of submandibular salivary gland tumours at the Lagos University Teaching Hospital over a period of 17 years (January 1990 to December 2006) were retrospectively reviewed. Parameters studied were; age and gender of patients, symptoms and duration of symptoms, and histological diagnosis. RESULTS: A total of 36 patients with submandibular gland tumours were seen during the period. Male-to-female ratio was 1.8:1 (male=23, female=13). Mean age (+/- SD) at presentation was 43 (+/- 19) years (age range, 17-84 years). There were 19 malignant tumours and 17 benign ones. Pleomorphic adenoma (36.1%) was the most frequent tumours, followed by adenoid cystic carcinoma (11.1%), anaplastic carcinoma (11.1%) and malignant lymphoma (11.1%). Patients with histological diagnosis of malignant tumours were significantly older than those with benign tumours (p = 0.01). Most patients (80.6%) presented with painless swelling. CONCLUSION: Malignant submandibular salivary gland tumours were slightly more than the benign ones in the studied population. Painful swelling or ulceration is indicative of a malignant submandibular gland tumour