Benign Lipomatous Soft Tissue Tumors in Nigerians: An Analysis of the Clinical and Morphological Features of a Common but Important Entity.

Introduction Benign lipomatous tumors are soft tissue tumors that exhibit a predominant adipocytic phenotype. Lipomas are the archetype and are the most common benign soft tissue tumors in adults but relatively uncommon in children. Their sex incidence is equivocal. They sometimes occur in combination with other mesenchymal elements, giving rise to variants including fibrolipoma, angiolipoma, myolipoma, spindle cell lipoma, chondroid lipoma, osteolipoma, and chondrolipoma. Their clinical significance is mainly due to the cosmetic disfigurement of patients and the differential diagnosis of malignant soft tissue tumors. Occasionally, due to their large size or presence near vital organs, they may cause life-threatening and/or excruciating pressure symptoms. This study was purposed to address the dearth of local studies on the clinical and morphological characteristics of benign lipomatous tumors in Nigerians, to compare these with those of other populations, and to establish baseline data. Materials and methods This was a retrospective study of all benign lipomatous tumors seen in the anatomic pathology and forensic medicine department of Asokoro District Hospital, Abuja, Federal Capital Territory, Nigeria, over an eight-year period. Surgical pathology reports were retrieved for patients' biodata and clinical information. The appropriate slides were retrieved, and reviewed, and new sections were cut where necessary. The tumors were classified according to the 2020 World Health Organization (WHO) guidelines and categorized based on size as small, medium, or giant. The data obtained were analyzed, and the results were presented as tables, bar charts, ratios, and percentages. Results Four hundred and eighteen cases met the inclusion criteria. Of these, 58.4% (244/418), occurred in females, while 41.6% (174/418) occurred in males. The age range was six to 91 years, while the median age was 42 years. The least number of cases, 0.5% (2/418), were seen in patients aged less than 10 years, while the majority, 35.4% (148/418), occurred in the fifth decade, followed by 27.8% (116/418) in the fourth. Size-wise, the majority of tumors, 60% (253/418), were medium, followed by small, 22.8% (95/418). Giant-sized tumors significantly accounted for 16.7% (70/418) of the cases. The diagnostic spectrum comprised conventional lipoma and variants such as fibrolipoma, spindle cell lipoma, pleomorphic lipoma, angiolipoma, chondrolipoma, intramuscular lipoma, and osteolipoma. Lipoma and fibrolipoma dominated with 87.1% (364/418) and 10.0% (42/418), respectively, while the rest accounted for <3%. The majority, 31.8% (133/418), occurred in the back/shoulder region, followed by the lower limb with 18.2% (76/418). Only two cases occurred in the abdominal/pelvic region. More tumors occurred in females in all the regions except the head and neck, which had a male-to-female ratio of 1.5:1. Multiple site tumors were more common in males in a ratio of 2.5:1. Most, 41.1% (39/95), of the small-sized tumors, occurred in the head/neck region, largely involving the face, 48.7% (19/39). Conclusion Our study showed many similarities in the clinical and morphological features of benign lipomatous tumors between Nigerians and other regions of the world. A notable finding, however, was the significantly higher proportion of giant benign lipomatous tumors when compared to studies from other regions, a finding that warrants further studies.

Cysticercosis Mimicking Fibroadenoma of the Breast in a Young Female: A Case Report From North Central Nigeria.

The parasitic infestation, cysticercosis, arises when humans are infested with the larvae (cysticerci) of the pork tapeworm, Taenia solium (T. solium). Epidemiologically, cysticercosis presents a worldwide distribution due in part to endemicity in developing countries in Latin America, Asia, and sub-Saharan Africa, and increased migration from these countries to more developed countries in Europe and North America. Cysticercosis may be asymptomatic or may manifest clinical symptoms and signs depending on which part of the body cysticerci are found, including skeletal and heart muscle, skin, subcutaneous tissues, the lungs, liver, the central nervous system (CNS), and less commonly, the oral mucosa and breast. We report a case of a mass in the left breast in an 11-year-old Nigerian girl, which was diagnosed clinically and on ultrasonography as fibroadenoma but was confirmed on histology to be cysticercosis. Cysticercosis should be included in the differential diagnoses of breast lumps in persons of all ages and sex, especially in endemic areas and in places with significant immigration from endemic areas.

Demographic and Diagnostic Spectrum of Neurosurgical Biopsies: Initial Experience From a Re-established Neurosurgical Unit in a Tertiary Hospital in North Central Nigeria.

Introduction Neurosurgical biopsies are obtained from lesions of the central nervous system, comprising the skull, brain, spine, spinal cord, and nerves. Neurosurgery practice is a highly specialized field with wide disparities related to access to care, especially in developing countries where there are few specialists and poor support care for patients. After over 20 years of redundancy, the neurosurgical unit in Jos University Teaching Hospital (JUTH), Jos, Plateau State, Nigeria, was re-established to meet the needs of patients in the area of neurosurgery. The aim of the study is to document the demographic and diagnostic spectrum of neurosurgical biopsies obtained in JUTH in the first five years of the re-establishment of its neurosurgical unit, highlighting the need for inclusion of neurosurgical services in health planning and resource allocation; and to compare these findings to similar studies elsewhere. Materials and methods This was a retrospective, descriptive, hospital-based study of neurosurgical lesions diagnosed in the Department of Histopathology at JUTH between January 2011 and December 2015. One hundred and forty-five lesions met the inclusion criteria out of 151 in the records and were studied. Archival slides of these neurosurgical biopsies were retrieved, and fresh sections were re-cut and stained with hematoxylin and eosin (H&E) where necessary. The diagnoses of some of the neoplastic lesions were confirmed by immunohistochemistry. The data obtained was analyzed, and the results are presented as tables, bar charts, ratios, and percentages. Results Thirty-one different lesions were diagnosed. The lesions most commonly diagnosed were traumatic/degenerative intervertebral disc, 54/145 (37.2%); neoplastic, 48/145 (33.1%); and congenital, 31/145 (21.4%), while inflammatory/infectious, 9/145 (6.2%); and vascular, 3 (2.0%) lesions were the least. Bimodal peak frequencies involving the 0-14 years and 30-44 years age ranges were noted for the neoplastic lesions, occurring 37.5% (18/48) in the 0-14 years and 25% (12/48) in the 30-44 years, respectively. The 31 congenital anomalies diagnosed were all neural tube defects, and of these, occipital encephalocele, 10/31 (32.3%) and myelomeningocele, 9/31 (29.0%) were diagnosed most frequently. Of the neoplastic lesions, 66.7% (32/48) were benign and low-grade, and 33.3% (16) were malignant. Meningioma, 14/32 (43.8%), was the most common benign and low-grade neoplasm and accounted for 29.1% (14/48) of all neoplastic lesions. Astrocytoma (WHO grades I, II), 25% (8/32), was the next most common benign and low-grade neoplasm and accounted for 16.7% (8/48) overall. Astrocytoma (WHO grades III, IV), 8/16 (50%), was the most common malignant neoplasm and accounted for 16.7% (8/48) overall. Overall, neuroepithelial tumors, both benign and low-grade, and malignant, 43.8% (21/48), were the commonest neoplastic lesions. Most neoplastic lesions occurred in the brain, 75% (32/48), followed by the spine, 10.4% (5/48), and skull, 8.3% (4/48); while the least common was the spinal cord, 2.1% (1/48). The sex distribution of the neoplastic lesions showed almost equal frequency between males and females, 23/48 (47.9%) and 25/48 (52.1%). Conclusion The spectrum of neurological lesions highlighted in this study demonstrates that neurosurgical lesions abound in our environment with a similar prevalence to other regions of the world, and therefore speaks to the need for neurosurgical services.

Biopsy-Proven Melanosis Coli Initially Diagnosed As Candidiasis on Colonoscopy: A Report of Two Cases From North Central Nigeria.

Melanosis coli is a benign condition, often identified as an incidental finding during colonoscopy, characterized by brown or black pigmentation of the colonic mucosa due to lipofuscin deposition within the cytoplasm of cells. It has been linked to the excessive use of laxatives, particularly those that are anthraquinone-based but also stimulant laxatives and herbal remedies. White patches on colonoscopy in this condition are an extremely rare finding. We present two cases of 31- and 38-year-old, male Nigerians, with a history of chronic constipation and prolonged stimulant laxative use in whom colonoscopy findings of white patches on the colonic mucosa were confirmed on histology to be melanosis coli. Melanosis coli should be considered in the differential diagnosis of patients with chronic constipation and/or prolonged use of laxatives or herbal remedies who exhibit mucosal changes on colonoscopy even if these changes are not black or brown discolorations.

Transaxillary endoscopic thyroidectomy: an alternative to traditional open thyroidectomy.

BACKGROUND: The traditional thyroidectomy technique typically approaches the thyroid through a range of different sized transverse incisions in the neck. Such a scar can result in hypesthesias, paresthesias, and increased patient self-awareness. Furthermore, in some patients of darker-skin ethnicity, the traditional neck incision can result in hyperplastic and keloid scar formation in a highly visible area of the neck. In an effort to lessen this adverse cosmetic outcome, we recently began performing endoscopic thyroidectomy, as described by Ikeda et al, using an axillary approach to conceal the incisions. We recently reviewed our series and studied the feasibility and safety of this approach in patients undergoing thyroidectomy. We herein present our results in the use of this procedure in all patients requiring thyroid resection and highlight the potential advantage in patients having a tendency for hypertrophic cervical scarring. From August 2003 to January 2008 we performed a transaxillary endoscopic thyroidectomy on 53 patients. Forty-one patients were of African descent. All patients underwent successful completion of thyroidectomy using this approach. CONCLUSIONS: Excellent aesthetic results with no visible scarring in the neck region can be safely achieved with this innovative surgical technique. Although the procedure has been shown to be of benefit to all patients, an added advantage may be seen in those patients prone to hypertrophic scarring. Transaxillary endoscopic thyroidectomy is a safe alternative to the traditional open approach in select patients with benign thyroid disease.

Endoscopic transaxillary near total thyroidectomy.

BACKGROUND: Since first reported in 1996, endoscopic minimally invasive surgery of the cervical region has been shown to be safe and effective in the treatment of benign thyroid and parathyroid disease. The endoscopic transaxillary technique uses a remote lateral approach to the thyroid gland. Because of the perceived difficulty in accessing the contralateral anatomy of the thyroid gland, this technique has typically been reserved for patients with unilateral disease. OBJECTIVES: The present study examines the safety and feasibility of the transaxillary technique in dissecting and assessment of both thyroid lobes in performing near total thyroidectomy. METHODS: Prior to this study we successfully performed endoscopic transaxillary thyroid lobectomy in 32 patients between August 2003 and August 2005. Technical feasibility in performing total thyroidectomy using this approach was accomplished first utilizing a porcine model followed by three human cadaver models prior to proceeding to human surgery. After IRB approval three female patients with histories of enlarging multinodular goiter were selected to undergo endoscopic near total thyroidectomy. RESULTS: The average operative time for all models was 142 minutes (range 57-327 min). The three patients in this study had clinically enlarging multinodular goiters with an average size of 4 cm. The contralateral recurrent laryngeal nerve and parathyroid glands were identified in all cases. There was no post-operative bleeding, hoarseness or subcutaneous emphysema. CONCLUSION: Endoscopic transaxillary near total thyroidectomy is feasible and can be performed safely in human patients with bilateral thyroid disease.