Occupational risk factors associated with lymphoid malignancies in Benin City, Nigeria.

AIM: This study is designed to identify the associated occupations most at risk of developing lymphoid malignancies. PATIENTS AND METHODS: The medical records of all lymphoid malignancy cases seen in University of Benin Teaching Hospital between July 2001 and June 2010 were retrieved from medical record library. The patient's bio-data, occupational, social and past medical history and pathologic subtypes were extracted. RESULTS: A total of 252 patients records with diagnosis of lymphoid malignancies were reviewed in this study. Farmers (20.6%) and students (38.9%) form the majority of the cases seen and both showed statistically significant association with risk of LM (p<0.0001) CONCLUSION: This study revealed that agricultural workers and students in Benin City are at higher risk of developing lymphoid malignancies. Although previous studies have implicated agricultural exposure, the same cannot be said about students. It is therefore recommended that a follow up study should be conducted to ascertain the possible environmental, nutritional, social/lifestyle stressors that put students in Benin City at higher risk of lymphoid malignancies.

Effects of chemotherapy on plasma lipids and lipoproteins in Nigerian patients with haematological malignancy.

AIMS AND OBJECTIVES: This study is to determine effect of chemotherapy on plasma lipids and lipoproteins in haematological malignancies. PATIENTS AND METHODS: All consecutive patients with haematological malignancies attending University of Benin Teaching Hospital, Benin City, Nigeria between July 2007 and December 2008 were studied. Clinico-pathological types of haematological cancers, demographic features, serum lipid and lipoprotein levels of the patients were analysed, pre and post treatment with chemotherapy. RESULTS: A total of 28 haematological cancers were studied. Chronic leukemias 10 (35.7%) and lymphomas 7(25.0%),acute leukaemia 6(21.4%), multiple myeloma 4(14.3%), and aplastic anaemia 1(3.6%). The pre therapy median values for TC, TG, LDL-C and HDL-C were 103, 115, 40 and 36mg/dl respectively while the median values for post therapy for TC, TG, LDL-C and HDL-C were 110, 126, 60 and 43 mg/dl respectively. The pre therapy ratio of TC : HDL-C in the patients was 2.4 while the post therapy ratio of TC : HDL-C was 2.7. CONCLUSION: Hypocholesterolaemia and hypolipoproteinaemia were seen in our patients when compared with the population reference values and there were no significant changes in lipid and lipoprotein levels between pre and post therapy values.

Hodgkin lymphoma: clinicopathologic features in Benin City, Nigeria and update on its biology and classification.

OBJECTIVE: To review the age incidence, common pathohistologic subtypes, and anatomical nodal sites of lymph nodes involvement for histology. MATERIALS AND METHODS: A 25 (May 1985-June 2010) years retrospective study of all patients who had lymph node biopsy. SETTING: Department of Pathology and Haematology, University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: Of 821 lymph node biopsies encountered, 56 (6.8%) cases biopsied were for Hodgkin lymphoma (HL). There was a bimodal peak incidence of age interval of 11-15 years and 21-25 years and the relationship between the age and sex distribution was statistically significant (P = 0.03). The overall median age was 23 years with a mean age of 25.6 ± 2.0 (SEM). Pathological re-appraisal of these 56 cases in the study indicates that mixed cellularity HL constituting 36 cases (64.3%) was the predominant subtype. This was followed by lymphocyte depleted HL with a total of 11 cases (19.6%). The major site of lymph node involvement where biopsy was taken for histological diagnosis was the cervical group of lymph nodes constituting 78.6%. Staging classification of the disease indicates low frequency of early stage disease (I-II) with 19 cases (33.9%) and high frequency of late stage (III-IV) with 37 cases (66.1%). CONCLUSION: Patients are predominantly males, children and young adults presenting with cervical lymphadenopathy at late stage of the disease, and a dominance of mixed cellularity and lymphocyte depleted histological subtypes were observed.

Prevalence of HIV seropositivity in patients with lymphoid malignancies in a tertiary centre in southern Nigeria.

OBJECTIVE: The human immunodeficiency virus (HIV) epidemic has a significant impact worldwide and infected subjects are at increased risk of developing cancer. We aim to determine the HIV seropositivity of lymphoid malignant patients in a tertiary centre in Southern Nigeria. METHOD: The course of disease in 275 patients with lymphoid malignant disorders at the University of Benin Teaching Hospital, Benin City, Nigeria, was analysed from 1996 to 2006. Blood specimens screened for antibody to HIV infection were confirmed by Western blot and the CD4+ lymphocyte count was measured by flow cytometry technique. RESULTS: A total of 275 patients aged 18-72 years were studied. Of the 275 lymphoid malignancies 11 cases were found to be HIV seropositive giving a seroprevalence of 4%. The most frequent lymphoid malignancy in association with HIV seropositivity was non-hodgkin's lymphoma (NHL) with a prevalence of 4.12% over the less frequent lymphoid neoplasms. The overall median CD4+ lymphocyte count was 185 microl with 9 cases seropositive for HIV below 200 microl (P<0.0001). CONCLUSION: We conclude that the seroprevalence of HIV infection in patients with lymphoid malignancies was 4% with NHL being the most common neoplasm associated with HIV infection in concordance with studies in the Diaspora.

Ophthalmic disorders in Adult Lymphoma Patients in Africa

Context: Ocular manifestations of lymphoma are rare events. Most reports of ocular involvement in lymphoma are case reports or reports of a few patients. Aims: To determine the ophthalmic disorders in adult; African; lymphoma patients. Settings and Design: A prospective study of ocular disorders in adult patients with lymphoma was conducted at the University of Benin Teaching Hospital; Benin City; Nigeria; between July 2004 and June 2007. Materials and Methods: The patients were interviewed and examined by the authors and the ocular findings recorded. Statistical Analysis: Data was analyzed on computer with the aid of the Instat GraghPadT v2.05a statistical package software. The mean; standard deviation; Mann-Whitney U-statistic and P value were calculated. Results: A total of 111 patients with hematological malignancies were seen over a period of three years of which 62 (55.85) had lymphomas. Of these; 51(82.3) were non-Hodgkin's lymphoma and 11(17.7) were Hodgkin's lymphoma. Ocular disorders occurred in 16 patients (31.4) with non-Hodgkin's lymphoma and none of the patients with Hodgkin's lymphoma (Mann-Whitney U-statistic is equal to 7.500; U' is equal to161.50; P ; 0.0001). The ocular disorders due to non-Hodgkin's lymphoma were seen as - proptosis in six patients (11.8); retinopathies in three (5.9); conjunctival infiltration in three (5.9); optic atrophy in two (3.9); keratoconjunctivitis in one (two per cent); desquamating nodular lid lesions in one (two per cent); papilloedema in one (two per cent); and upper lid mass in one (two per cent). Four patients (6.5) had monocular blindness. Conclusions: Ophthalmic disorders are relatively common in non-Hodgkin's lymphoma. Ophthalmic evaluation is needed in these patients for early identification and treatment of potentially blinding conditions

Maxillary herpes zoster with corneal involvement in a HIV positive pregnant woman.

Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features.

Chronic lymphoid leukaemia: clinico-haematological correlation and outcome in a single institution in Niger Delta region of Nigeria.

Sixty patients were prospectively studied with the aim of analyzing the clinical and laboratory features and outcome of patients diagnosed with chronic lymphocytic leukaemia (CLL) in a major referral center in Niger Delta region of Nigeria for 10 years (1995-2005). The peripheral blood, bone marrow cytology, clinical features and stage at diagnosis were studied. Treatment modalities, response to treatment and survival outcome of the patients were analysed. Sixty patients (15 men and 45 women) were seen, with female preponderance (M : F ratio,1 : 3). The CLL incidence was 36.4% of total leukaemias. The median age was 56 years with peak age group at 51-60 years while 15% were below 40 years. Major clinical findings include lymphadenopathy (91.7%), anaemia (58.3%), abdominal swelling (58.3%), and splenomegaly (50%) with 53 patients (88.3%) presenting as International (Binet) stage B and C while only seven patients (11.7%) were seen in stage A. The least clinical presentation includes Richter's syndrome in 3.3% of cases and herpes Zoster skin manifestations in two patients (3.3%). There was a strong association between the blood counts at diagnosis and outcome of therapy. The 2-year survival for young (<55 years) and older (>55 years) CLL patients was 27.2% and 28.9%, respectively, which is still very poor because of a number of strong limiting factors. CLL is not rare in Southern Nigeria and its presentations are similar to cases seen worldwide. Contrary to existing literature a female predominance was observed in this study with majority of patients seeking medical intervention late. It is therefore recommended that future research into the genetic make up/HLA typing of patients of African descent is needed to clarify some of the differences observed.

Adult malignant lymphomas in University of Benin Teaching Hospital, Benin City, Nigeria--incidence and survival.

BACKGROUND: The occurrence of malignant lymphomas is worldwide and its incidence has being increasing, ranked 12th among all, cancers worldwide. We aim to determine the incidence and survival of the lymphoma patients in the Niger Delta region of Nigeria. STUDY DESIGN: A study of 205 cases of lymphoma patients from 1993 to 2003. One-year survival was calculated using simple percentage of those alive and those that died before 1 year of diagnosis. RESULTS: A total of 205 patients aged 18-72 years were studied. Non-Hodgkin's Lymphoma (NHL) was the most frequent (83%) while Hodgkin's Lymphoma (HL) had an incidence of 17%. The 1 year survival for patients with NHL and HL was 35.3% and 42.9% respectively. We found a strong association between haemoglobin (Hb) and white blood cell count (WBC) at presentation and lyear survival in NHL patients (P=0.0003; P=0.0001) and HL patients (P=0.0001; P=0.0104) respectively. Also, the mean Erythrocyte sedimentation rate (ESR) for lymphoma patients alive at lyear was significantly lower than those that died within 1 year (P=0.0001). Duration of illness before presentation was found to influence 1 year survival. CONCLUSION: We conclude that NHL was the most common of the lymphoma seen in young adulthood in the Niger Delta region of Nigeria. A positive correlation between survival and duration of illness at presentation and haematological counts was found. The 1 year survival is still very poor and this may not be unconnected with late presentation and other strong limiting factors.

Ophthalmic manifestations of lymphoma.

BACKGROUND: Ophthalmic involvement in lymphoma is a relatively rare condition that can result from a primary intraocular lymphoma or an intraocular manifestation of systemic lymphoma. This report reviews the ophthalmic manifestations of lymphoma. METHODS: Review of relevant information from journal articles and Internet search. RESULTS: Almost all the structures in the orbit, adnexiae and eye can be involved in lymphoma. Lymphoma of the eye and adnexiae are most frequently of B lineage. Most of the ocular manifestations frequently masquerade as other more benign intraocular conditions including allergic or infectious conjunctivitis, uveitis, multiple evanescent white dot syndrome, acute retinal necrosis or herpetic retinitis. Correct diagnosis thus depends on a high index of suspicion and frequently requires radiologic imaging, histologic analysis, particularly vitreous biopsy or flow cytometry, subretinal aspiration and retinal biopsy. Diagnosis is often delayed and may lead to a fatal outcome. Recognition of its modes of presentation facilitates early diagnosis and treatment that may improve prognosis. CONCLUSIONS: It is important to review the ocular manifestations of lymphoma to assist the ophthalmologist to play a pivotal role in the prompt diagnosis and treatment of ocular lymphoma, and the haematologist/oncologist to recognize the need for a complete ophthalmic evaluation in the diagnosis, follow-up and management of lymphoma patients.

Ophthalmic manifestations of multiple myeloma.

BACKGROUND: The ophthalmic manifestations of multiple myeloma can be seen in practically every ocular structure. Ocular findings may be the first manifestations of the disease. It may also occur as one of the extramedullary manifestations of the disease or as the first sign of insufficient chemotherapy. Multiple myeloma may cause ocular pathology by direct infiltration or as extramedullary plasmacytomas resulting in displacement or compression of tissues, by causing hyperviscosity syndrome, and by immunoglobulin light chain deposition in ocular tissues. OBJECTIVE: To outline the ophthalmic manifestations of multiple myeloma. METHODS: Information about multiple myeloma and ophthalmic manifestations was obtained from original journal articles, review articles, case reports and standard postgraduate textbooks. RESULTS: Ophthalmic manifestations include proptosis, diplopia, lid ecchymosis, xanthomatosis, conjunctival and corneal crystalline and non-crystalline deposits, scleritis, episcleritis, secondary glaucoma, ciliary body cysts, ciliochoroidal effusion, uveal plasmacytoma, hyperviscosity retinopathy, retinal vasculitis, detachment of sensory retina and retinal pigment epithelium, and neuro-ophthalmic manifestations. CONCLUSIONS: In multiple myeloma, it is necessary to take a closer look at the ophthalmic manifestations, both because of their local morbidity and because they might act as a reservoir for proliferation of myeloma cells and eventual systemic relapse. Early detection may permit safer and effective treatment. All patients with multiple myeloma should thus undergo thorough ophthalmic examination at the time of initial diagnosis and during follow-up.

Haematological aspects of antiretroviral naive HIV patients in a Nigerian tertiary hospital: laboratory and clinical considerations

To determine the baseline haematological parameters including CD4+ cell count in naive HIV patients; which has not been documented in this part of the country; the study group comprised of 191 consecutive antiretroviral (ARV) naive adults living with HIV and AIDS recruited into the ARV pilot project in University of Benin Teaching Hospital; Nigeria between July and September 2004. They were classified with respect to severity of their disease state in accordance with Center for Diseases Control Clinical Categorization of HIV/AIDS. The patients had CD4+ cell count and haematological indices done to assess disease status and need for ARV therapy. This comprised of 69(36.1) males and 122 (63.9) females with a M:F ratio of 1:1.8. The median age at enrollment was 38 years (range; 21 to 75 years). At presentation; there were cytopenias and the males tended to have a slightly higher (195 cells/?l) CD4+ cell count than the females (180 cells/?l) with an overall median CD4+ cell count of 146 cells/?l. The difference was not statistically significant (p = 0.5407). There was a no significant correlation between the lymphocyte count and the CD4+ cell count. This study establishes local standard values for haematological indices including CD4+ cell count in naive HIV infected Nigerians

A smoldering/indolent myeloma with extensive abdominal presentation--case report.

A case of indolent/smoldering myeloma in a 70-year-old man is reported. He presented with an unusual multiple symptomatic myeloma with extramedulary impairment and absence of bone pain. He was treated with pulses of high-dose dexamethasone with commendable clinical improvement.

Socio-demographic factors of adult malignant lymphomas in Benin City, Nigeria.

AIM: The aim of this study is to determine the incidence and sociodemographic factors associated with adult malignant lymphoma in Benin City, Niger Delta region of Nigeria. METHOD: A retrospective study of 205 patients with a diagnosis of lymphoma seen over a 13-year period (1990-2003) at the University of Benin Teaching Hospital, Nigeria. They were analyzed in the context of gender, marital status, geographical abode, educational and occupational status. The patients had sufficient data recorded at diagnosis to allow retrospective assignment into the various subtypes. RESULTS: There were 70 males and 135 females with a male-to-female ratio of 1:1:9. Non-Hodgkin's lymphoma (NHL) was more frequent (83%) while Hodgkin's lymphoma had incidence of 17%. Marital status (P = 0.0002), geographical abode (p = 0.0046), educational (P = 0.0045) and occupational status (p = 0.0001) were significantly associated with the malignant lymphoma at presentation. All the lymphoma subtypes were most common in patients who resided in Delta state, a major oil producer. The majority of the lymphoma patients (46.3%) had tertiary form of education. The highest and lowest social classes were most likely to have lymphoma, which may have been related to age and industrial exposure. CONCLUSION: Poverty and illiteracy are additional problems with patients with malignant lymphomas. Living in Delta State where the petrochemical industries and gas flare sites are located may be a risk factor for the development of lymphoma.

Adult lymphomas in Edo state, Niger Delta region of Nigeria--clinicopathological profile of 205 cases.

The clinicopathologic features of malignant lymphomas had not been documented in the Niger Delta region of Nigeria, which is known for its petrochemical industries and gas flare sites. Cases of lymphomas that presented to the University of Benin Teaching Hospital (UBTH), a major referral centre in the region, from January 1990 to December 2003 were reviewed. Demographic and clinical information were obtained from the case files. Diagnosis was established based on the histological examination of an accessible biopsy lymph node and classified according to the Working Formulation (WF). Haematological parameters were done using an automated Coulter counter. Non-Hodgkin's lymphoma (NHL) occurred predominantly in young adults (20-39 years). A majority of the patients presented in the advanced stage of the disease (Stages III-IV) according to the Ann Arbor system and a performance status (PS) scale of 2-4. The intermediate grade NHL (41.2%) formed the largest group of which diffuse large cell lymphoma (DLCL) was the most commonly observed histopathologic type followed by the large cell immunoblastic type.

The value of foetal haemoglobin level in the management of nigerian sickle cell anaemia patients.

OBJECTIVE: This study was designed to determine the influence of foetal haemoglobin (HbF) concentration on the frequency of painful crisis, blood transfusion and other complications. METHOD: A prospective study of SCA patients in steady state and vaso-occlusive crisis (VOC) seen between August 2001 and July 2002 in 3 centers in Benin City, Nigeria. Two hundred patients (81.3% ) in steady state and forty-six patients (18.7%) in VOC were analysed in the context of gender, age, the frequency of VOC, number of blood transfusions and complications e.g. osteomyelitis, leg ulcer, cholelithiasis etc in the preceding one-year after informed consent. Eighty-four age and sex matched controls were also recruited. Their blood samples were analysed within two hours of collection for HbF using the Betke method and haemoglobin and haematocrit levels using the Automated Coulter Counter. RESULTS: The mean HbF in steady state, VOC and control were 2.17% +/- 1.81, 2.05%+/-1.19 and 1.28%+/-1.04 respectively. There was no significant difference (P>0.05) between HbF values in VOC and steady state periods but they were significantly higher than in control (P<0.01). The mean %HbF was significantly higher in patients who had no painful crisis (2.14% vs 1.55%, P=0.0023), those who had no complications (2.45% vs 1.12%, P<0.0001) and those who did not have blood transfusion (2.41% vs 0.68%, P<0.0001) in the preceding year than those who did. Conclusion-There is no significant difference in foetal haemoglobin values in steady state and vasoocclusive crisis. A higher level of foetal haemoglobin was associated with fewer painful crises, less complications and reduced need for blood transfusion. Key words: foetal haemoglobin, crisis, complications, transfusions.