Biopsy-proven renal disease in Ile-Ife, Nigeria: A histopathologic review.

Although various patterns of renal diseases have been reported from different renal biopsy registries worldwide, data from Nigeria remain scanty. A 10-year retrospective review of renal biopsies was conducted in our tertiary health care facility. All cases were reclassified based on their light microscopic features after the application of standard histochemical stains. A total of 165 cases were reviewed with a male:female ratio of 1.8:1 and a mean age of 15.4 ± 12.0 years. About 69.7% of the cases were below the age of 16 years, while only 2.4% were older than 50 years. The most common indications for biopsy were nephrotic syndrome (72.1%) and acute renal failure of unknown etiology (11.5%). Overall, glomerulonephritis (80%) was the most common histologic category and occurred only in individuals younger than 50 years old. Minimal change disease (22.9%) and membranoproliferative glomerulonephritis (21.9%) were the most common varieties in children, while membranous glomerulonephritis (30.6%) and focal segmental glomerulosclerosis (27.8%) were the commonest among the adult population. The initial histologic diagnosis was revised in 18 cases while a diagnosis was arrived at in seven cases initially adjudged as inadequate for assessment. This study showed that renal biopsy was predominantly performed in children and adolescents. Although glomerulonephritis was the predominant disease, the predominant histologic patterns varied with the patient age. Despite the scarcity of advanced diagnostic tools in resource-poor environments, routine use of histochemical stains is helpful in the evaluation of renal biopsies.

Histopathology practice and training in Nigeria ­ a model.

Objectives: Contemporary histopathology practice and training in Nigeria have been plagued by the fundamental issue of inadequate exposure to surgical pathology material by both trainees and trainers. This paper critically examines the factors that affect the discipline and profers practical solutions to aid its advancement. Materials and Method: This review is based on the authors experience and observations of histopathology practice in Nigeria. Results: The Nigerian health sector is plagued by many ills including poor funding, weak policies, dilapidated structures, disgruntled and frustrated practitioners, amongst others - and pathologists are not immune to all these. In recent times, there has been a proliferation of accredited training centres as well as medical graduates interested in the specialty of histopathology. The busiest histopathology laboratories in the country ascession between 2200 and 5500 surgical samples yearly. Thus there is inadequate exposure by histopathologists and trainee pathologists to surgical materials with the attendant consequences. Many centres still rely principally on routine haematoxylineosin stains. There are no nationally agreed standard reporting formats for most diseases. Conclusion: The development of a deanery or regional system of accredited histopathology laboratories may form the fulcrum for improving the overall quality of histopathological services and training in Nigeria. This will help develop local expertise and ensure adequate exposure to teaching aids and surgical materials. We hope that the proffered solutions will help encourage local pathologists to continue and increase their efforts to raise the profession up to enviable heights.

Malignant tumors of the upper aerodigestive tract as seen in a Nigerian tertiary health institution.

BACKGROUND: Cancers of the upper aerodigestive tract constitute a diverse heterogeneous group of malignant neoplasms with unique epidemiological, pathological, and treatment considerations. Only few studies have been conducted so far on these tumors in Nigeria. This study aims to study in greater detail, the pathological features of these cancers in Nigerian patients. MATERIALS AND METHODS: The surgical specimens of patients diagnosed with malignant tumors of the upper aerodigestive tracts in the Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Ile-Ife, Nigeria, over a 10-year period, formed the basis of this study. Analysis was done for differences in proportion using the Chi-square test (P is significant at < 0.05) by SPSS version 15. RESULTS: There were a total of 62 cases. The overall mean age was 50.7 years, while the age range was from 3 years to 90 years. The male to female ratio was 3.1:1. A majority of the patients (67.7%) were older than 40 years. About 30.6, 27.4, and 16.1% of cases occurred in the larynx, nasopharynx, and nasal cavity, respectively, while 93.5% of the tumors were carcinomas. Squamous cell carcinoma was the most common histological variety. Nonepithelial tumors were not seen below the age of 20 years. CONCLUSION: This study shows that malignant upper aerodigestive tract tumors seen in our environment are mainly diseases of adulthood that tend to occur about seven to nine years earlier than in other populations. Squamous cell carcinoma is the predominant histological variety. Although the larynx is the most frequent anatomic site, the nasopharynx and nasal cavity are more commonly affected than the oral cavity unlike in other populations. Nonepithelial tumors are extremely rare below the age of 20 years.

Malignant Tumors of the Upper Aerodigestive Tract as Seen in a Nigerian Tertiary Health Institution

Background: Cancers of the upper aerodigestive tract constitute a diverse heterogeneous group of malignant neoplasms with unique epidemiological; pathological; and treatment considerations. Only few studies have been conducted so far on these tumors in Nigeria. This study aims to study in greater detail; the pathological features of these cancers in Nigerian patients. Materials and Methods: The surgical specimens of patients diagnosed with malignant tumors of the upper aerodigestive tracts in the Department of Morbid Anatomy and Forensic Medicine; Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Ile-Ife; Nigeria; over a 10-year period; formed the basis of this study. Analysis was done for differences in proportion using the Chi-square test (P is significant at 0.05) by SPSS version 15. Results: There were a total of 62 cases. The overall mean age was 50.7 years; while the age range was from 3 years to 90 years. The male to female ratio was 3.1:1. A majority of the patients (67.7) were older than 40 years. About 30.6; 27.4; and 16.1 of cases occurred in the larynx; nasopharynx; and nasal cavity; respectively; while 93.5 of the tumors were carcinomas. Squamous cell carcinoma was the most common histological variety. Nonepithelial tumors were not seen below the age of 20 years. Conclusion: This study shows that malignant upper aerodigestive tract tumors seen in our environment are mainly diseases of adulthood that tend to occur about seven to nine years earlier than in other populations. Squamous cell carcinoma is the predominant histological variety. Although the larynx is the most frequent anatomic site; the nasopharynx and nasal cavity are more commonly affected than the oral cavity unlike in other populations. Nonepithelial tumors are extremely rare below the age of 20 years

Testicular schistosomiasis: a case report.

AIMS AND OBJECTIVES: To report a case of testicular Schistosomiasis with a suspicion of testicular cancer. PATIENT AND METHODS: Hospital record of a 16 year old patient with histopathology confirmation of testicular Schistosomiasis was reviewed and summarised. The patient who had painless testicular nodules and ultrasound features of heterogenous echotexture and hypoechoic focus was diagnosed as testicular cancer and treated with radical orchidectomy. Histopathology confirmed testicular Schistosomiasis and the patient had additional praziquantel therapy. RESULTS: Patient was followed up for over 26months post-operative. CONCLUSIONS: Testicular Schistosomiasis can mimick malignant testicular tumour. Hard nodular testicular mass in a patient with recent past history of schistosomiasis should arouse suspicion of testicular Schistosomiasis. Awareness and early presentation will prevent unwarranted orchidectomy.

Ileal endometriosis presenting as acute small intestinal obstruction: a case report.

BACKGROUND: the gastrointestinal tract is the most common site of extrapelvic endometriosis, affecting 5%-15% of women with pelvic endometriosis. Among women with intestinal endometriosis, rectum and sigmoid colon are the most commonly involved areas. Terminal ileum is rarely involved in endometriosis. Similarly, bowel endometriosis is an uncommon cause of intestinal obstruction. OBJECTIVE: to present a rare occurrence of ileal endometriosis presenting with acute small intestinal obstruction. METHODS: a 34-year-old woman presented with a two-month history of intermittent, colicky abdominal pain which became more intense with associated vomiting of three days prior to presentation. Besides full clinical evaluation, she had other investigations including abdominal X-rays, ultrasonography, ECG, and echocardiography. The results of these informed the need for myomectomy. RESULTS: besides the abdominal pain, the patient also complained of a supra-pubic swelling and menorrhagia. Physical examination showed an incisional hernia, and a suprapubic mass. The results of evaluation were consistent with incisional hernia complicated by imminent adhesive intestinal obstruction. She had had secondary infertility and has had myomectomy due to copious menstrual flow which was complicated with incisional hernia. She was managed initially conservatively for adhesive small bowel obstruction which failed. She had exploratory laparotomy with small intestinal resection and end to end anastomosis. Histopathology of the resected mass revealed ileal endometriosis. CONCLUSION: this report highlights the importance of histopathological assessment of resected specimens in the diagnosis of intestinal obstruction due to intestinal endometriosis. This disease should, therefore, be considered during the evaluation of women of child bearing age.

Eosinophilic colitis presenting as a right iliac fossa mass--a case report.

BACKGROUND: Eosinophilic colitis is an inflammatory condition characterized by infiltration of the colonic wall by eosinophils with submucosal oedema. Involvement of caecum, appendix, ascending colon and the omentum by the inflammatory process could mimic a right iliac fossa neoplasm. OBJECTIVE: To highlight the diagnostic challenges posed by eosinophilic colitis and the import of histopathological diagnosis in the treatment of such a patient. METHODS: A47-year old perimenopausal woman presented to hospital with a 6-month history of intermittent lower abdominal pain. Besides clinical evaluation, an abdominal ultrasonography and full blood count were carried out. She subsequently had exploratory laparatomy. RESULTS: The lower abdominal pain was intermittent but not associated with vomiting or diarrhea. There was a tender right iliac mass extending to the suprapubic region. The ultrasound revealed a right-sided tubo-ovarian mass. At surgery, the mass was found to be a complex of caecum, ascending colon, appendix and the omentum. Histological diagnosis of the resected mass was eosinophilic colitis with peritonitis. She was placed on steroid therapy following a course of antihelminthics with sustained clinical improvement six months after surgery. CONCLUSION: Eosinophilic colitis is rare and could mimic a right iliac neoplasm if it is right-sided. Histopathological diagnosis of all specimens removed at surgery particularly in a peripheral district hospital is very important in patient's management.

Lymphoreticular diseases in Nigerians

Background: The lymphoreticular system plays a major role in both the innate and adaptive immune responses. This study reviews retrospectively cases of lymphoreticular disea-ses seen at a tertiary institution in Nigeria. Materials and Methods: This is a retrospective study in which biopsies from the bone marrow; spleen; lymph nodes and extra-nodal lymphoid tissues reported within a period of 16 years were reviewed with respect to age; sex and pathological diagnosis. Statistical analysis was performed for differences in proportion using Chi square by SPSS version 12. Results: Nine hundred and forty four cases comprising 559 biopsies from lymph nodes and extranodal lymphoid tissues; 272 bone marrow biopsies and 113 spleen biopsies were studied. Non Hodgkin's lymphoma (NHL) and tuberculosis were the most common lesions in lymph nodes and extranodal lymphoid tissues. The axillary and cervical nodes accounted for most cases of metastasis. Breast cancer accounted for the majority of metastasis to lymph nodes. The most common pathological changes in bone marrow were NHL and reactive hyperplasia. Patients with chronic lymphocytic leukaemia (CLL) had the highest mean age; which was significantly higher than in those with NHL (p=.001; 95confidence interval -27.91 to -7.76). The most common finding in the spleen was splenic rupture and haemoperitoneum from road traffic accident. Conclusion: NHL and tubercu- losis should be high on the list of differential diagnosis of lymphadenopathy in Nigerians. Whereas trauma from RTA was the major reason for splenectomy in Nigerians; in the elderly splenic biopsy would likely show CLL