Pistol-grip Syringe holder (Cameco syringe pistol) in fine needle aspiration Biopsy: any advantages over the use of direct finger grip?

AIMS AND OBJECTIVES: The study seeks to determine the advantages of using the pistol-grip syringe holder in the performance of FNAB over the use of direct finger grip method. PATIENTS AND METHODS: The skin is cleaned with gauze soaked in methylated spirit and the lump is located and firmly held between the thumb and fore finger of the free hand. The syringe is held by the out side of the barrel or by pistol-grip, and the needle tip pushed into the lesion. The plunger is partially retracted, creating a negative pressure. The cutting edge of the needle tip frees the cells inside the lesion which are sucked into the fine bore of the needle. The contents of the needle are then emptied on a microscopic slide and thinly smeared. The slides are then fixed in alcohol and later stained. These were examined under the microscope and a comparison between the aspirations using pistol-grip and direct finger grip was made. RESULTS: A total of 266 cases of FNABs were carried out from 1st January to 31st December, 2008. There were 89 breast cases out of which 42 (47%) had pistol-grip method and 47 (53%) had direct finger grip method; 74 thyroid cases out of which 28 (38%) were pistol-grip and 46 (62%) were direct finger grip cases; 56 cases of lymph node FNABs of which 18(32%) and 38 (68%) had pistol-grip and direct finger grip methods respectively. There were 23 cases of salivary gland FNABs having 8 (35%) and 15 (65%) as pistol-grip and direct finger grip methods respectively. Marked cellularity was observed in the majority of cases using both methods of FNABs. CONCLUSION: This study has shown that the use of pistol-grip syringe holder in the performance of FNABs has no significant advantage compared to the direct finger grip method.

Spectrum of haematologic malignancies and survival outcomes of adult lymphomas in Maiduguri, north eastern Nigeria--a fourteen year review.

BACKGROUND: The incidence of Haematologic malignancies has been shown to vary according to gender, age, geographic region, and histologic subtypes, while cure rates can vary according to region and may be impacted by treatment availability and access to care. METHOD: This was an institution based review of data from the Medical Records Department, Department of Haematology and Cancer Registry of the Histopathology Department of the University of Maiduguri Teaching Hospital between January 1998 and December 2011. The aim was to study the spectrum of Haematologic malignancies and the survival pattern of adult lymphomas in this region and to compare our findings to studies reported elsewhere. RESULTS: The Haematologic malignancies represented 6.05% of all cancer cases seen and 0.31% of hospital admissions. Among the Haematologic malignancies, Non-Hodgkins Lymphoma (NHL) was the most frequent, constituting 51.3% while others include: Hodgkins Lymphoma (HL), 26.7% Chronic Myeloid Leukaemia (CML), 5.5%, Acute Myeloblastic leukaemia (AML), 4.2% Multiple Myeloma (MM), 4.2% Acute Lymphoblastic leukaemia (ALL), 3.8%, Chronic Lymphocytic Leukaemia (CLL), 3.4% Myelodysplastic Syndrome (MDS), 0.4% and Chronic Myelofibrosis 0.4%. Haematologic malignancies are more common in younger age group and also more common in males than females. Lymphomas are particularly common in young adults and the incidence tends to fall after 70 years. Similarly, the characteristic bimodal age incidence for HL found in western world has not been seen in this study. The histological subtypes for both NHL and HL are similar to the pattern reported elsewhere. Default rate was high and we found a strong association between cycles of chemotherapy given and survival in lymphoma patients. CONCLUSION: This study has shown that Haematologic malignancies are not uncommon in our environment. There is need to provide basic facilities and training for immunophenotyping and immunohistochemistry in all cancer treatment centers across the country. Cytotoxic drugs must be subsidized and also be made readily available to all patients with Haematologic malignancies.

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.

Breast malignancies in a tertiary health setting in north-eastern Nigeria: a histopathological review.

Breast cancer is one of the most common malignancies that occurs in women. Most of the studies done on breast cancer in our setting are epidemiological. This study aims at determining the histopathological subtypes and various features of breast malignancies seen in our setting. The bench record books of the Department of Pathology, Federal Medical Centre Gombe were used to identify all the breast cancer cases seen from May 2000 to May 2007, after which the Haematoxylin and Eosin-stained slides and request forms were retrieved. The slides were reviewed based on the 2003 WHO classification of breast tumours. One hundred and thirty four breast cancer cases were reviewed histologically. Invasive ductal carcinoma (NOS) made up 66.6% (89/134), followed by invasive lobular carcinoma which comprised 9.7% (13/134). Medullary carcinoma was seen in 6.0% (8/134). Invasive papillary and sarcomatoid carcinomas comprised 3.0% (4/134) each. Invasive ductal carcinomas were graded as follows: grade I - 12%, grade II - 22.5%, and grade III - 65%. The majority of breast cancer cases occurred in the fourth and fifth decades of life. Invasive ductal carcinoma remains the most frequent histopathological subtype and most of the patients in this environment have grade III disease.

Hydatidiform mole in gombe: a five year Histopathological review.

OBJECTIVE: The purpose of this study is to do a histopathological review of all cases ofhydatidiform moles seen in pathology department of Federal Medical Centre, Gombe between June 2000 and May 2005. METHODS: All the relevant request forms, slides and paraffin embedded tissue blocks were retrieved. The slides stained with routine Haematoxylin and Eosin were then reviewed. RESULTS: Thirty four cases of hydatidiform moles were studied and these formed 7.5% of all products of conception seen during the review period. There were 18 cases of complete hydatidiform mole and 16 cases of partial hydatidiform mole. No invasive or tubal mole was seen during this period. The frequency of hydatidiform moles was 1 in 166 delivaries. The age range for all the molar pregnancies was 15-44 years with vaginal bleeding as their leading mode of presentation between 11-18 weeks ofgestatation. CONCLUSION: Molar gestation was found to be a common gynaecological problem in Gombe affecting women mainly in their third decade of life.

Pattern of histopathological diagnosis of breast lesions in Gombe, Nigeria.

BACKGROUND: Diseases of the breast are common and include problems, related to pregnancy and lactation, abscesses and other inflammatory conditions, nonneoplastic proliferative disorders and neoplasms. No known previous histopathological analysis has been done in our setting to classify breast lesions. The purpose of this study is to review all cases of breast diseases seen in the department over a six-year period and to determine the pattern of histological diagnosis of breast diseases in our setting. METHODS: This was a hospital based retrospective study where our bench record books were used to identify all the breast lesions after which the Haematoxylin and Eosin stained slides and the request cards were retrieved. The slides were reviewed based on the diagnostic criteria by Juan Rosai. RESULTS: A total of 291 breast lesions were seen in the department. One hundred and seventy three (59.5%) of these were inflammatory non-neoplastic proliferative and benign neoplastic disorders, while 118 (40.5%) were malignant neoplasms. Fibroadenoma was the commonest benign breast lesion with 69 (23.7%) cases. Of all the malignancies, invasive ductal carcinoma was the most frequent (68.6%). Breast cancer was found most frequently in the 4th decade (32.2%), followed by the 5th decade (24.6%) of life. CONCLUSION: Female breast cancer was quite common in this study and most of our patients presented with advanced disease.

Histopathological analysis of non-squamous cell malignancies of the uterine cervix in Maiduguri, Nigeria.

Carcinoma of the uterine cervix is the most common gynaecological malignancy in the developing world despite being largely preventable. The non-squamous cancers of the cervix have not been properly documented in our setting. This study is aimed at reviewing the histological types ofnon-squamous cell cancers of the uterine cervix in relation to the age of presentation, and to analyze some of the histopathological features of adenocarcinomas. Cases of cancer of the cervix histologically diagnosed between January 1989 and December 2004 were extracted from the cancer register of the University of Maiduguri Teaching Hospital. The request forms, slides, and some tissue blocks were retrieved from the archives of the Histopathology Department. The cases were histologically reviewed and the data analyzed using simple statistical methods. A total of 491 cases of cervical cancers were diagnosed. Of these, 432(88.0%) cases were squamous cell carcinomas while 59(12.0%) were non-squamous cell malignancies. Out of the 59 non-squamous cervical cancers, 42(71.2%) were endocervical-type adenocarcinomas, while serous papillary, clear cell, and adenosquamous carcinomas comprised 2(3.4%) cases each. Seven (11.9%) cases were metastatic choriocarcinomas. Over 60% of these cases occurred within the third and fourth decades of life. Adenocarcinomas are the most common non-squamous malignancies of the cervix and their age of presentation was similar to that of their squamous cell counterpart. Haemorrhage and lymphocytic infiltrates were significantly associated with tumour grade while necrosis was independent of tumour grade.

Pattern of Histopathological Diagnosis of Breast Lesions in Gombe; Nigeria

Background:Diseases of the breast are common and include problems; related to pregnancy and lactation; abscesses and other inflammatory conditions; nonneoplastic proliferative disorders and neoplasms. No known previous histopathological analysis has been done in our setting to classify breast lesions.The purpose of this study is to review all cases of breast diseases seen in the department over a six-year period and to determine the pattern of histological diagnosis of breast diseases in our setting.Methods: This was a hospital based retrospective study where our bench record books were used to identify all the breast lesions after which the Haematoxylin and Eosin stained slides and the request cards were retrieved. The slides were reviewed based on the diagnostic criteria by Juan Rosai. Results: A total of 291 breast lesions were seen in the department. One hundred and seventy three (59.5) of these were inflammatory; non-neoplastic proliferative and benign neoplastic disorders; while 118 (40.5) were malignant neoplasms. Fibroadenoma was the commonest benign breast lesion with 69 (23.7) cases. Of all the malignancies; invasive ductal carcinoma was the most frequent (68.6). Breast cancer was found most frequently in the 4th decade (32.2); followed by the 5th decade (24.6) of life. Conclusion: Female breast cancer was quite common in this study and most of our patients presented with advanced disease

Pattern of Histopathological Diagnosis of Breast Lesions in Gombe; Nigeria

Background:Diseases of the breast are common and include problems; related to pregnancy and lactation; abscesses and other inflammatory conditions; nonneoplastic proliferative disorders and neoplasms. No known previous histopathological analysis has been done in our setting to classify breast lesions.The purpose of this study is to review all cases of breast diseases seen in the department over a six-year period and to determine the pattern of histological diagnosis of breast diseases in our setting.Methods: This was a hospital based retrospective study where our bench record books were used to identify all the breast lesions after which the Haematoxylin and Eosin stained slides and the request cards were retrieved. The slides were reviewed based on the diagnostic criteria by Juan Rosai. Results: A total of 291 breast lesions were seen in the department. One hundred and seventy three (59.5) of these were inflammatory; non-neoplastic proliferative and benign neoplastic disorders; while 118 (40.5) were malignant neoplasms. Fibroadenoma was the commonest benign breast lesion with 69 (23.7) cases. Of all the malignancies; invasive ductal carcinoma was the most frequent (68.6). Breast cancer was found most frequently in the 4th decade (32.2); followed by the 5th decade (24.6) of life. Conclusion: Female breast cancer was quite common in this study and most of our patients presented with advanced disease

Correlation between histopathologic and fine needle aspiration cytology diagnosis of palpable breast lesions: a five-year review.

Fine needle aspiration cytology (FNAC) of the breast has been used as an initial investigative procedure of palpable breast lesions. The purpose of this study is to evaluate our experience with Fine Needle Aspiration Cytology (FNAC) and to correlate between histopathologic and FNAC diagnoses of palpable breast lesions. A 5-year retrospective study was performed using records of all patients who had had both FNAC and histopathologic results of breast lumps. This is a retrospective study of 220 diagnosed cases of breast lesion at the University of Maiduguri Teaching Hospital (UMTH), Nigeria between the periods of January 2001 and December 2005. The results of the FNAC were interpreted as inflammatory, benign, suspicious or malignant. A total of 220 patients had both cytopathologic and histopathologic diagnoses and therefore fulfilled the criteria for this study. There were 11 (5%) cases of inflammatory, 140 (63.6%) cases of benign and 69 (31.4%) cases of malignancy. There were two cases that were suspicious of malignancy and for the purpose of this study were considered as malignant. There were five (5) cases of cytologically interpreted errors which were three cases of false negative and two cases of false positive. The diagnostic accuracy was 97.7%, sensitivity was 95.7%: and specificity was 98.7%. The false negative and false positive rates were 2.9% and 1.9% respectively. FNAC of breast lesions is sensitive, specific, and highly accurate as the initial investigation of palpable breast lesions in our tertiary hospital. We therefore implore clinicians to embrace this procedure in the management of patients.

Increasing the clinical utility of the cervical smear cytology report--a cytopathologist's recommendations.

Cervical smear cytology is becoming increasingly available as an important screening tool for precancerous lesions of the cervix in Nigeria. The gynaecologist has an important role to pay in arriving at a clinically useful cytologic diagnosis. The essential inputs to an efficient and reliable cervical smear cytology service include adequate clinical data, proper smear collection, use of a familiar reporting system and prompt follow-up. Cervical cytology has many limitations and without an awareness of its possible pitfalls and problems, the method may be easily abused.