HISTOPATHOLOGIC PATTERN OF BLADDER CANCERS IN IBADAN SOUTHWEST NIGERIA: AN UPDATE.

BACKGROUND: A study from the University College Hospital, Ibadan, Southwest, Nigeria on bladder cancers had described an increase in the frequency of urothelial carcinoma compared to the earlier reported preponderance of squamous-cell carcinoma. AIM: To provide an update on the histopathologic pattern of bladder cancers in our community and to explore its implications for future health system policies. METHODS: The records of the Ibadan Cancer Registry from January 1997 to December 2014 were reviewed and the data analyzed for the histologic subtypes of bladder cancers diagnosed in the hospital. RESULTS: Two hundred and sixteen bladder tumours were recorded during this period with a male to female ratio of 3.2:1. Complete information was available in 195 cases of which 181 (96.8%) were bladder carcinomas whilst 14 were sarcomas. Of the bladder carcinomas, 68.5%, 19.9% and 11.6% were urothelial carcinomas, squamous cell carcinomas, and adenocarcinomas (AC) respectively. Urothelial carcinoma was more common in all age groups and its peak age of occurrence was in the 51-60 year age group. The peak age for squamous cell carcinoma was in the 41-50 year age group. Mean and median age of occurrence was significantly lower in females in the urothelial and squamous cell carcinomas, but lowest in squamous cell carcinoma [P = < 0.0001]. CONCLUSION: This population study has confirmed urothelial carcinoma as the predominant histotype of bladder cancer in Ibadan, Southwest Nigeria currently and that both urothelial and squamous cell carcinomas occur earlier in women.

Idiopathic pulmonary calcification and ossification in an elderly woman with a missed diagnosis of subarachnoid haemorrhage.

This is a case of idiopathic pulmonary calcification and ossification in a 70 year old with long-standing diabetes and hypertension. Thirteen years prior to her demise, she was first noticed to have multiple calcific deposits in her lungs on a chest X-ray film. She had no risk factors for soft tissue calcification and ossification. Histology of tissue from autopsy showed intraparenchymal pulmonary calcification and ossification with marrow elements. Idiopathic pulmonary calcification and ossification is rare. At autopsy, she was also found to have had bilateral subarachnoid haemorrhage (SAH), a diagnosis missed during clinical evaluation. We highlight the pertinent details in our patient's management that could have helped to prevent a missed diagnosis of SAH. Even though SAH occurs most commonly following head trauma, the more familiar medical use of SAH is for non-traumatic SAH occurring following a ruptured cerebral aneurysm. This patient had notable risk factors for cerebral aneurysm formation but an aneurysm was not identified at autopsy. The location of the blood high on the cerebral convexities further suggests a traumatic origin rather than a ruptured aneurysm. Heterotopic calcification and ossification (HO) is known to occur in the setting of severe neurologic disorders such as traumatic brain injury but the fact that the lung calcification in our patient predated the brain injury by over 10 years makes it unlikely for the HO to have been due to the brain trauma. Other organ pathologies found at autopsy include chromophobe renal cell carcinoma, renal papillary necrosis, lymphocytic thyroiditis, and seborrheic keratosis.

End-stage renal disease in Nigeria: an overview of the epidemiology and the pathogenetic mechanisms.

There is paucity of information on the magnitude of the burden of renal disease in our environment. Obtaining accurate data is hampered by the poor socioeconomic status of most patients with lack of access to specialized care in tertiary institutions, where most of the data is generated. The incidence of chronic renal failure (CRF) and end-stage renal disease (ESRD) in any specified area is known to be influenced by the prevalence of specific disease entities resulting in CRF. Hypertension, glomerulonephritis (GN), sickle cell disease, quartan malaria nephropathy, urinary tract schistosomiasis and other parasite-related forms of chronic GN are known to contribute significantly to the incidence of CRF in Nigeria. As is the situation in other parts of the world, diabetic nephropathy appears to be of increasing importance in the causation of ESRD in Nigeria. Even though the underlying cause of renal disease can often not be treated, extensive studies in experimental animals and preliminary studies in humans suggest that progression in chronic renal disease may largely be due to secondary factors, attention to which may be important in the prevention and/or control of renal disease.

The epidemiology of end-stage renal disease in Nigeria: the way forward.

The incidence of CKD (Chronic kidney disease) in Nigeria has been shown by various studies to range between 1.6 and 12.4%. We have shown that the burden of renal disease in Nigeria is probably significantly higher than any previous study on end-stage renal disease (ESRD) has documented, as most studies are hospital-based and fail to include the many patients who do not have access to hospital care. The increased prevalence of ESRD among blacks in the United States and South Africa compared with other races also suggests that ESRD may be more prevalent in Africa than in the United States and other developed nations. Common causes of CKD in Nigerian adults are glomerulonephritis and hypertension, while common causes in children are glomerulonephritis and posterior urethral valves. In the United States, diabetes and hypertension are the commonest causes of CKD and glomerulonephritis plays a less important role. Access to renal replacement therapy (RRT) in Nigeria is limited, and mortality rates are very high, ranging between 40 and 50%. Important steps towards improving the situation are the development of prevention programmes and increased funding to ensure increased availability of RRT. To achieve this, health policies concerning CKD must be formulated, and the lack of a renal registry makes it difficult for this to be done. There is need for the development of a functional organizational structure for the reporting of CKD in Nigeria, the Nigerian Renal Registry.

The microbiological diagnosis of tuberculosis in a resource - limited setting: is Acid-fast bacilli microscopy alone sufficient?

The objective of this study is to audit the processes for the microbiological diagnosis of tuberculosis (TB) in our resource-limited setting. A total of 694 specimens were received from 333 patients. 129 (38.7%) of these patients were positive for TB. 78 (60.5%) were positive on AFB microscopy alone, 13 (10.0%) on culture alone and 38 (29.5%) on both culture and AFB microscopy. Fifty-one (51) cases were positive on culture, 38 of these (74.5%) had growth on Lowensen-Jensen culture medium alone, 11 (19.6%) on Pyruvic Acid Enhanced Medium (PAEM) and 3 (5.9%) on both culture media. AFB microscopy showed a diagnostic specificity of 71.6% and a sensitivity of 74.5%. M. Bovis appears to be prevalent and we suggest the need for speciation. If AFB microscopy is to be routinely used alone, without confirmation by culture, then the overriding need is for quality to be fully assured in its use.

Histopathological pattern of renal cell carcinoma in Ibadan.

There has been a paucity of Nigerian studies on renal cell carcinomas (RCC). This retrospective review analyzes cases of RCC diagnosed in the University College Hospital, Ibadan from January 1960 to June 2007. Cases were typed using the 2004 World Health Organization classification of renal tumours. Papillary RCC were further grouped into Type 1 or 2 and Fuhrman's nuclear grade was determined for clear cell and papillary RCC. There were 159 cases, 108 being females, with a male to female ratio of 1:2.1. Peak age of occurrence was in the fourth decade. The right kidney was more commonly affected (58.6%). Papillary RCC was the most common variant accounting for 27 of the 62 cases that were available for review. Six (22.2%) of the 27 papillary RCC had the distinctive histological features that have been associated with Xp 11 translocation carcinoma. All 27 cases of papillary RCC were Type 2. Twenty-one (61.8%) RCC were Fuhrman's nuclear grade 1 and 2. Renal cell carcinoma in Ibadan occurs two decades earlier than in Caucasians. Papillary RCC is the most common histological sub type of RCC in Ibadan, and Xp translocation carcinomas may be more common in this environment than earlier described in America. This is in contrast to the observation that clear cell carcinomas is the most common histological sub type of RCC in Caucasians series.