Isolated Hepatic Sarcoidosis: A Case Report and Literature Review.

BACKGROUND: Sarcoidosis is a multi-systemic disorder of unknown aetiology that primarily involves the pulmonary system with the histological hall mark of a non-caseating granuloma. Isolated hepatic involvement is a manifestation of sarcoidosis. OBJECTIVE: We report an incidental finding of hepatic sarcoidosis in a hypertensive and diabetic patient who presented with abdominal pain and fatigue. METHODS: A case report of sole diagnosis of hepatic sarcoidosis from a Gastroenterology service in Port Harcourt metropolis Nigeria. A literature search was made using the words 'sarcoidosis' and 'hepatic' in PubMed Central, Cochrane and Google search engines. From the search results, literature in English were extracted and reviewed. RESULTS: The index case was referred on account of hepatomegaly with associated abdominal pain and fatigue. A diagnosis of isolated hepatic sarcoidosis was made from elevated liver enzymes, elevated angiotensin converting enzyme, sero-negative autoimmune studies, hepatomegaly with liver nodule on abdominal computerized tomography scan and non-caseating granuloma from liver biopsy. There was no evidence of other systems involvement. CONCLUSION: Hepatic sarcoidosis is rare in African literature more so as no specific laboratory or radiological test is diagnostic. Delayed diagnosis and underreporting of hepatic sarcoidosis are likely in our environment due to the elaborate evaluation needed.

CONTEXTE: La sarcoïdose est un trouble multisystémique d'étiologie inconnue qui touche principalement le système pulmonaire avec la marque de hall histologique d'un granulome non caséiforme. L'atteinte hépatique isoleé est une manifestation de la sarcoïdose. OBJECTIF: Nous rapportons la découverte fortuite d'une sarcoïdose hépatique chez un patient hypertendu et diabétique qui présentait des douleurs abdominales et de la fatigue. MÉTHODES: Un rapport de cas de diagnostic unique de sarcoïdose hépatique dans un service de gastro-entérologie de Port Harcourt au Nigeria. Une recherche documentaire a été effectuée en utilisant les mots " sarcoïdose " et " hépatique " dans les moteurs de recherche PubMed Central, Cochrane et Google. PubMed Central, Cochrane et Google. A partir des résultats de la recherche, la littérature en anglais a été extraite et examinée. RÉSULTATS: Le cas index a été référé en raison d'une hépatomégalie associée à des douleurs abdominale et fatigue associées. Un diagnostic de sarcoïdose hépatique isolée a été posé à partir de l'élévation des enzymes hépatiques, de l'élévation de l'enzyme de conversion de l'angiotensine, des études auto-immunes séro-négatives, hépatomégalie avec nodule hépatique sur la tomographie abdominale informatisée et tomographie abdominale assistée par ordinateur et granulome non caséiforme à la biopsie du foie. Il n'y avait aucun signe d'atteinte d'autres systèmes. CONCLUSION: La sarcoïdose hépatique est rare dans la littérature africaine d'autant plus que aucun test de laboratoire ou radiologique spécifique n'est diagnostique. Un diagnostic tardif et la sousdéclaration de la sarcoïdose hépatique sont probables dans notre environnement en raison de l'évaluation élaborée nécessaire. MOTS-CLÉS: Sarcoïdose, Foie.

Helicobacter pylori and precancerous lesions of the stomach in a Nigerian Metropolis: A Cohort Study.

INTRODUCTION: Helicobacter pylori (H. pylori)-related atrophic gastritis transits through a sequential pathway of intestinal metaplasia, dysplasia to gastric cancer. Gastroscopy offers early detection, treatment and surveillance of gastric cancer. AIMS: This study aims to study the prevalence of H. pylori infection and evaluate precancerous lesions (PCLs) of the stomach. PATIENTS AND METHODS: This is a case controlled study of patients with dyspepsia undergoing gastroscopy at a referral endoscopy facility in Port Harcourt metropolis of Nigeria. The variables studied included demographics, clinical, endoscopic, and histopathologic findings. Statistical analysis of data was done using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY, USA). RESULTS: A total of 104 patients were included in the study. Age ranged from 20 to 80 years (mean 47.1 ± 14.4 years); 56 were males and 48 were females. H. pylori were detected in 40 (38.5%) mucosal biopsies. The prevalence of PCLs was: chronic atrophic gastritis 6.7% (7 cases); intestinal metaplasia 2.9% (3 cases); and dysplasia 5.8% (6 cases). There was no statistical significance in sex distribution of PCLs (P = 0.245). CONCLUSION: There is a low prevalence of H. pylori in this metropolitan population. Mandatory multiple topographically targeted biopsies, even with normal mucosal appearance, at gastroscopy in addition to surveillance of PCL are recommended for early detection of gastric cancer.

Experience with neonatal hydrometrocolpos in the Niger Delta area of Nigeria: Upsurge or increased recognition?

BACKGROUND: Hydrometrocolpos (HMC) is a clinical condition in which there is a cystic distension of the vagina (hydrocolpos), uterus and sometimes, fallopian tubes (hydrosalpinx) with fluid. This study described our experience with cases of HMC seen in our practice, and highlighted the flare in our practice. PATIENTS AND METHODS: A retrospective study of cases of HMC managed at the University of Port Harcourt Teaching Hospital between September 2010 and August 2012. RESULTS: There were seven cases; their ages ranged from 2 to 27 days (median 13 days). All the patients had abdominal distension but abdominal mass was obvious only in four. Other features varied depending on the presence of sepsis or other associated anomalies. The diagnosis of HMC was missed in all cases by the referring clinicians. One patient was referred with the diagnosis of tracheoesophageal fistula and esophageal atresia, 2 with bladder outlet obstruction, 1 with intestinal obstruction, 2 with anorectal malformation, and 1 with neonatal sepsis. Ultrasound identified bulky uterus in two cases and upper urinary tract dilatation in 3 patients. Six patients had laparotomy, 1 had hymenotomy only. Postoperative complications were basically wound sepsis and rectovaginal fistula resulted. CONCLUSION: Diagnosis of HMC should be considered as a differential in newborn girls presenting with lower abdominal mass. Attention to clinical detail is necessary to avoid a misdiagnosis.

Coroner autopsy study of homicides in Rivers State of Nigeria: 11-year review.

As most developing countries, including Nigeria, grapple with economic crisis, poor human capital development and high levels of income inequality, violent crimes - especially homicides - continue to be a cause for concern. We studied the pathology and demographic distribution of homicides in Rivers State of Nigeria expecting that the findings would be useful in formulating preventive strategies. Reports of homicide autopsies in the state for 11 years were retrospectively scrutinized for age, gender, type of weapon, site of injury, circumstances, mechanisms and causes of death. The data were analyzed using SPSS version 17. Homicides constituted 50.5% of the medicolegal autopsies. Although the overall male:female ratio was 12.4 : 1, there was variation with weapon. Deaths by firearm had the highest male:female ratio of 24.6 : 1. The mean and peak ages were 29.2 ± 11.4 and 21-30 years, respectively, while the range was 1 to 96 years. Firearms were the most common weapons, at 68.9%, hemorrhagic shock and head injuries at 61.5% and 28.2% respectively were the most common mechanisms and causes of death. Armed robbery incidents were the most common circumstances, while the head was the most common site of injury at 48.8%. The homicide rate is high in our environment and most homicides are committed during armed robberies using firearms. Improving medical care and providing emergency medical services will reduce cases of deaths from homicides, most of which occur due to manageable hemorrhagic shock. Increasing the drive towards controlling illegal arms acquisition and possession will reduce the present carnage in the state.

Review of population based coroners autopsy findings in Rivers state of Nigeria.

BACKGROUND: Sudden deaths are common findings in Rivers state of Nigeria. The victims of such deaths are subjects, of coroners' autopsies, and the records there from constitute important sources of epidemiological data. AIMS: To determine the pattern, causes and demographic features of all deaths reported to the coroner for medico legal autopsies in Rivers state of Nigeria. MATERIALS AND METHODS: Retrospective descriptive study on reports of coroner autopsies carried out between January 2000 and December 2010 in different mortuaries located across Rivers state was undertaken. The autopsies were unlimited and standardized. Information analyzed were: gender, age, circumstances of death and, autopsy-defined cause of death. RESULTS: Of the 1987 cases reviewed, 83.4% were males. The age range was 2 weeks to 98 years with a mean of, 31.7 years. The peak age range was 21-30 years with 46.5%. The manners of deaths in descending order include: homicides with 50.5%, accidents with 32%, sudden natural deaths with 14.1%, maternal deaths with 2.6% and suicides with 0.8%. Males were most affected in homicidal death with average male:female ratio of 12.4:1. Gunshots constituted the commonest means of homicidal deaths, with 67.9% while decapitation was the least with 0.1%. The commonest cause of accidental death was, road traffic accident with 63.6%. Cardiovascular system pathologies were the commonest causes of natural deaths with 46.1%. Illegal abortions with 41.1% were the commonest causes of maternal, deaths and all suicidal cases were committed by hanging. CONCLUSIONS: Homicides were by far the commonest findings of medico legal autopsies, followed by accidental and natural deaths respectively while suicides were the least in Rivers state of Nigeria. Firearms were the, most frequently used weapons for homicides and road traffic accidents remain the major causes of accidental deaths while cardiovascular system pathologies account for the highest proportion of sudden natural deaths and suicides are committed by hanging. Males within the productive age, brackets of 20-49 years are more affected by sudden deaths of all manners.

A histopathological study of carcinoma of the prostate in Port Harcourt, Nigeria.

OBJECTIVES: To determine the incidence of prostate cancer in Port Harcourt and the surrounding towns whose residents patronize the University of Port Harcourt Teaching Hospital for tertiary health care, histologically characterize the patterns of these cancers, and grade them according to the Gleason scheme. MATERIALS AND METHODS: Blocks and slides of prostate specimens received at the Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital between January 1997 and December 2006 were retrospectively selected for this study. The slides were studied using a binocular Olympus light microscope. Patients' age at presentation, presenting symptoms, and clinical diagnosis were sorted out from the request cards and the department's archival register. RESULTS: Carcinoma was diagnosed in 198 specimens (37.4%) of the 529 cases reviewed. Of these, 164 (82.8%) were clinical carcinoma (having been found in clinically suspected carcinoma cases for which trucut biopsies were undertaken), while 34 (17.2%) were incidental carcinoma cases (being found in prostatectomy biopsy cases of patients clinically diagnosed with nodular hyperplasia). All of the clinical carcinomas were adenocarcinomas predominantly moderately differentiated and of large acinar pattern. Also, all of the incidental carcinomas were adenocarcinomas predominantly well differentiated and of large acinar pattern. The Gleason scores (GSs) were varied but predominantly of high values, particularly with clinical carcinoma cases. The age range was 42 to 90 years and the mean was 70 years with a peak of 70 to 79 years. CONCLUSION: The incidence of prostate cancer in Port Harcourt is high relative to other Nigerian centers where similar studies have been carried out and compares well with the high incidence found among African American men. Histologically, all cases are acinar adenocarcinomas. Most patients present late with high GS carcinoma and therefore have poor prognosis. There is a need for enlightenment of the male populace on the high incidence of this deadly disease as well as for screening to reduce the number of patients presenting late and therefore improve prognosis.

Duplication cyst of the bowel causing ileal volvulus. A case report.

A 10 month old male infant presents to us with features of acute intestinal obstruction and a palpable abdominal mass of five days duration. A prior ultrasound report had made a diagnosis of intussusception. Subtle but important details in history and examination cast doubts on the ultrasound diagnosis. Exploratory laparotomy revealed ileal volvulus secondary to duplication cyst. This case is reported because of its rarity and to show the strength of sound clinical evaluation even in the face of technological advancements.

Histopathologic characterisation of prostate diseases in Port Harcourt.

OBJECTIVE: To carry out histopathologic analysis of diseases of the prostate gland reported at the department of Anatomical Pathology of the University of Port Harcourt Teaching Hospital between January 1996 and December 2005. PATIENTS AND METHODS: This is a retrospective histologic analysis of prostate samples seen at the University of Port Harcourt Teaching Hospital. Where necessary, new slides were prepared from blocks of the samples. The request cards of the patients were also retrieved and scrutinized for age, presenting symptoms and clinical diagnosis. RESULTS: Prostate biopsies constituted 8.8% of all surgical specimens and 30.9% of all male specimens received during this study period. Only 529 (7.6%) of all prostate specimens where included for the review because the slides or blocks of the rest could not be traced. Of the 529 specimens reviewed, 301 (56.9%) were needle biopsies while 228 (43.1%) were prostatectomies. Three hundred and thirty one (62.6%) of the cases were nodular hyperplasia and 198 (37.4%) were invasive adenocarcinomas, thirty-four (17.2%) of the invasive adenocarcinomas were incidental carcinomas. There was prostatic intraepithelial neoplasia (PIN) in 79 (14.9%) cases. Prostatitis was found in 223 cases (42.2%) of the entire specimen studied. All cases of prostatitis occurred in association with nodular hyperplasia, invasive carcinoma or prostatic intraepithelial neoplasia (PIN). CONCLUSION: The burden of prostate diseases among adult males in Port Harcourt is high and malignant neoplastic diseases in the form of clinical and incidental carcinomas as well as premalignant diseases in the form of prostatic intraepithelial neoplasia (PIN) were quite common.