A Clinico-Pathological Study of Vulvo-Vaginal Disease at a Nigerian Tertiary Health Facility

INTRODUCTION

The vulva and vagina are of great significance to womanhood owing to the myriads of specialized functions they perform. The diseases of this organ have physical, social, mental, and psychological ramifications. The aim of this work is to study the pathological pattern and clinical presentation of diseases of the vulva and vagina at the Department of Anatomical Pathology and Forensic Medicine of the Jos University Teaching Hospital between 1st January 2011 and December 31st, 2020.

METHODOLOGY

This study is descriptive of all cases of histologically diagnosed vulval and vaginal lesions seen at the Center. Histological diagnosis, biodata, and clinical information of patients were retrieved from the medical records. Data realized were analyzed and presented in tables as simple frequencies, percentages, ranges, and measures of central tendencies.

RESULTS

Two hundred and fifteen vulval and vaginal biopsies were included in the study. Squamous cell carcinoma was the commonest histologically diagnosed lesion accounting for 70(32.6%) cases of all lesions and 77.8% of all malignancies. The second commonest lesion and the most frequent benign pathology is the Condyloma acuminatum (viral warts) which accounted for 41(19.1%) cases. The age bracket 20 to 59 years constituted 79.5% of cases (171 cases). The age range, mean, median, and mode in years were 5.0-85.0, 39.5+15.9, 38.0, and 50.0 respectively.

CONCLUSION

Squamous cell carcinoma and veneral warts are the commonest lesions of the vulva and vagina in our environment. Robust vaccination programs against the etiological agent, the human papilloma virus is highly recommended.

Rhabdomyosarcoma in All Age Groups at the Jos University Teaching Hospital

BACKGROUND

The designation Rabdomyosarcoma (RMS) is used to describe the malignant mesenchymal neoplasm that exhibits varying degree of skeletal muscle differentiation. RMS is the commonest malignancy of soft tissues afflicting children and adolescent up until age 20. It constitutes 5-10% of pediatric malignancies, and 7-9.5% of pediatric soft tissue sarcomas. The site of origin of RMS can be one of three possibilities: myogenous; extramyogenous; and ectopic (heterotopia). This was a retrospective study of consecutive cases of RMS seen at the Histopathology Department of the Jos University Teaching Hospital, Jos, between January 2007 and December 2016. The study was aimed at analyzing RMS in relation to age, sex, site, and histological type.

METHODOLOGY

Patients' information including: age; sex; anatomical site of lesion; and histopathological diagnosis were extracted from patients' records in the Medical Records Department and the Histopathology Department. Archival tissue blocks were retrieved, sectioned into 5mm slides, stained with haematoxylin and eosin, and reviewed microscopically to confirm the diagnosis of RMS and sub-classify the disease. All histologically confirmed cases were included in the study, while those with inadequate bio-data and record of topography were excluded.

RESULTS

Seventy (70) cases of RMS were seen during the study period. The age range was 3 months to 80 years. The mean age at diagnosis was 23.4±21.1 years. There were 40 (57.4%) males and 30 (42.9%) females with male female ratio of 1.3:1. The head and neck region was the commonest site of occurrence of RMS accounting for 27.1%.

CONCLUSION

The commonest histologic variants of rhabdomyosarcoma were the embryonal, alveolar, and pleomorphic types. More than half of this malignancy occurred in children, and the adolescent. The head and neck, extremities, and trunk in decreasing order were the commonest sites of occurrence of this tumor, with a male predominance.

Changing patterns of Kaposi's sarcoma in Nigerians

This is a five-year retrospective study of 32 histologically diagnosed cases of Kaposi's sarcoma (KS) who had undergone HIV antibody testing at the Jos University Teaching Hospital: 13 cases (40%) were HIV-negative. Multiple lesions were more common in HIV-positive cases and affected unusual sites such as the face, oropharynx, conjuctiva, vulva and rectum in addition to the limbs and trunk, which were more frequently involved in HIV-negative cases. This pattern of KS seen in Nigerian patients shows similarities with other African countries which have been affected by the HIV epidemic.

Histopathological analysis of endometrial biopsies in Jos University Teaching Hospital (JUTH), Nigeria. A 5-year critical review

AIMS

This study is aimed at giving an insight into the pattern and age distribution of endometrial analysis as seen at Jos University Teaching Hospital.

METHODS

This is a retrospective reviewed cases of endometrial biopsies diagnosed between January 1998 to December 2002 in the Histopathological Department ofJos University Teaching Hospital

RESULTS

A review of endometrial biopsies slides from 556 patients revealed that pregnancy related diagnosis was the commonest, representing 302 (54.3%) of histopathological diagnosis, followed by endometrial hyperplasia, accounting for 97 cases (17.5%) and majority of which was categorised as mild hyperplasias. Hydatidiform mole, which ranked third, constituted 58 (10.4%) of the cases studied. Choriocarcinoma was the leading malignancy representing 10 cases (45%) of the malignant tumours and 1.8% of all the endometrial biopsies. Endometrial adenocarcinoma, stromal sarcoma and metastatic cancer constituted 6 (1.0%), 3 (0.5%) and 3 (0.5%), respectively.

CONCLUSION

The commonest endometrial pattern seen in JUTH over the study period was products of conception which peak in the third decade of life; primary malignancies of the endometrium are uncommon in JUTH and they represented just about 2%.

Patterns of malignant salivary gland tumours in Jos University Teaching Hospital (JUTH), Jos: a ten-year retrospective study

BACKGROUND

Salivary gland tumours are common head and neck tumours and more common in western world than Africans. Most salivary gland tumours are benign but the morbidity and mortality as expected is higher with malignant tumours. This study is aimed at describing the histological pattern, age, sex and site distribution of malignant salivary gland tumours in Jos University Teaching Hospital (JUTH) Jos from January 1998 to December 2007.

METHODS

This is a descriptive study of all histologically confirmed malignant salivary gland tumours over a period of ten years. Fresh sections of tissue blocks of these lesions were made using the microtome (3 micrones). They were made into slides and stained with Hematoxylin and Eosin (H and E) and Periodic Acid Schiff (PAS) stains. The slides were reported independently by four pathologists. Diagnosis was made and classification done according to the World Health Organisation (WHO) classification of salivary gland tumours 3. Information such as age, sex and-site of distribution of these tumours was gotten from the patient's case files. The data was analyzed manually.

RESULTS

Muco-epidermoid carcinoma accounted for the highest (32 cases) histologic type. Malignant salivary gland tumours occurred more within the age range 40 to 69 years with the age group 50-59 years accounting for the highest frequency (36 cases). Most of these malignant salivary gland tumours occurred more in the parotid gland, the minor salivary being the least site of occurrence.

CONCLUSION

Mucoeperdermiod carcinoma is the commonest salivary gland tumour and that malignant salivary gland tumours in this study and it occurred more after the 5th decade of life.

Hepatocellular carcinoma in Jos, Nigeria

BACKGROUND

Hepatocellular carcinoma (HCC) is the most common abdominal malignancy, representing 80-90% of primary liver malignancies around the world. There is a disturbing trend of increased incidence of HCC around the world. We therefore, determined the trend of HCC in Jos.

METHODS

A ten-year retrospective review was done of all cases of HCC which diagnoses were histologically confirmed as recorded in the Cancer Registry of Jos University Teaching Hospital. The patients' clinical case notes (including surgical and radiological findings) were also reviewed.

RESULTS

A total of 71 cases of HCC (31.3% of 227 liver biopsies in the same period) were diagnosed within the 10-year period. There were 46 males and 25 females with a male/female ratio of 1.8:1. The age range of the patients was 23 years to 75 years, with a mean age of 45.4 +/- 13.1 years. Seventy two percent (72%) of them were between ages 21 years and 50 years. Only 28% were between 51 years and 80 years. The highest rate of 12 (17.1%) was seen in the year 2004.

CONCLUSION

The study showed that there was a high prevalence of HCC in Jos, and that HCC was more prevalent in the younger age group compared to what obtains in developed nations.

Gastric histopathological findings in mucosal biopsies of symptomatic patients in jos central Nigeria

BACKGROUND

Dyspepsia is a common disease worldwide. It is a cause of great absenteeism from work with a lot of economic loss. In Jos, it is one of the most common complaints encountered in both general outpatient and specialist clinics.

AIM

To evaluate the histopathological changes in gastric mucosa of patients presenting with symptoms of dyspepsia.

METHODS

Cross sectional study. Gastric endoscopic biopsy specimens from 100 consecutive patients with symptoms of dyspepsia were histologically evaluated using the criteria of the updated Sydney system.

RESULTS

There were 50 males and 50 females. Their overall mean age was 39.6 +/- 12.2 (S.D). The prevalence of Helicobacter pylori colonization was 79%. Males were 53.2% and females 46.8% respectively giving a sex ratio of 1.4:1. Gastritis, neutrophil activity, glandular atrophy and intestinal metaplasia were observed in 95%, 83%, 38% and 28% respectively. Gastric carcinoma was found in 3% ofthe patients.

CONCLUSION

From our study, we conclude that the majority of our patients with dyspeptic symptoms have significant histopathological changes in their gastric mucosa with implications for the development of further gastric lesions, and that the most common cause of dyspepsia in our environment is Helicobacter pylori infection.

Epidemiology of soft tissue sarcomas in Jos, North Central Nigeria

BACKGROUND

Soft tissue sarcomas are a complex heterogeneous group of tumours that often cause a diagnostic problem. Special stains are often employed for further differentiation of these tumours. As a group, soft tissue sarcomas are not uncommon as previously believed.

OBJECTIVE

To undertake a ten year retrospective study of soft tissue sarcomas in a Nigerian Teaching Hospital and to also discuss the pathology of the disease.

METHODS

The study consisted of all records of histologically confirmed cases of soft tissue sarcomas from 1994 2003, seen at JUTH. The slides were retrieved and read separately by two pathologists. Special stain such as Reticulin, PTAH, Oilred O, were used to demonstrate basement membrane, muscle striation and lipids respectively. These aided confirmation of the diagnosis. Information extracted from patients' records included age, site of lesion and sex.

RESULTS

A total number of 266 cases of soft tissue sarcomas were recorded out of 2353 histologically confirmed cancers. These accounted for 11.3% of all cancers. One hundred and eighty three occurred in males and 83 in females, with male, female ratio of 2:1. Kaposi sarcoma (KS), Rhabdomyosarcoma (RMS), Malignant Fibrous Histiocytoma (MFH), and Fibrosarcoma (FS) were the commonest histological subtypes accounting for 69 (25.9%), 63 (23.7%), 56 (21.1%) and 49 (18.4%) respectively; with Rhabdomyosarcoma occurring more in paediatric and adolescent age groups, while the rest subtypes were more prevalent in adults. The commonest sites affected were leg/foot 71 (26.7%), head/neck 68 (25.6%) and thigh 50 (19%).

CONCLUSION

Soft tissue sarcomas constituted a significant proportion of cancers in our centre and are not uncommon as previously reported in the literature.

Medicolegal autopsies in North Central Nigeria

OBJECTIVE

To determine the pattern and the causes of deaths reported to the coroner for medicolegal autopsies in North Central Nigeria.

DESIGN

A descriptive retrospective study.

SETTING

Jos University Teaching Hospital, Jos, Nigeria between January 1996 to December 2003.

SUBJECTS

Autopsies reports of 279 subjects whose causes of death were subjects of litigation.

MAIN OUTCOME MEASURES

The causes of death in medicolegal autopsies.

RESULTS

A total of 279 cases of medicolegal autopsies with identified causes of death were recorded representing 89% of all the autopsy examinations performed within the period. In 7.6% of cases, there was no identifiable cause of death. There were 127 males against 52 females with a male: female ratio of 4.5:1 and their ages ranged between two and 74 years with a mean of 34.7+/-8.2 years. Children aged < 15 years made up 29% of the cases and were distributed as follows: 4% of the children were aged 0-5 years, 9% between six to ten years while 17% were between 11 - 15 years. Accidental deaths made up 51% of the cases, homicides 36% and sudden deaths 13%. Road traffic accidents were responsible for 76% of all accidental deaths. Children were affected in 34% of the accidental deaths and half of them were pedestrians at the time of accident. The male: female ratio of deaths from road traffic accidents was 3:1 with mean age of 24 years. In all the accidental deaths, abdominal injuries were responsible for 47% while 30% died from chest injuries. Of the homicide cases male subjects outnumbered female in a ratio of 16:1 and children were affected in 28% of homicides. Injuries sustained during ethnic and religious crisis were responsible for 48% of the deaths from homicide and 15% of them were children. Armed robbery was responsible for 28% cases while physical assaults were responsible for 20% of homicides. Chest injuries were the causes of death in 54% and abdominal injuries in 36% of homicides. Cardiovascular deaths were responsible for 63% cases of all sudden natural deaths referred for Coroner's inquest during the period. Children made up 11% of all sudden natural deaths. Males outnumbered females in cardiovascular deaths in a ratio of 6:1 and 46% cases of them died of hypertensive heart failure, 32% had cerebrovascular accidents, pulmonary embolism in 13.6% and myocardial infarction in 9%. One case of myocardial infarction died during intercourse.

CONCLUSION

Road traffic accidents, violent communal unrest and armed robbery were responsible for 66% of the medicolegal autopsies in our environment. Public enlightenment, good road maintenance and safe driving culture as well as sustainable security for life and property would reduce the incidence of preventable deaths.

Clinicopathological features and molecular markers of breast cancer in Jos, Nigeria

BACKGROUND

Several studies have suggested that breast cancer in black women is associated with aggressive features and poor survival. This study examines molecular markers along with clinical stage and pathological grade in breast cancer material from Jos, Nigeria.

STUDY DESIGN

The histological diagnoses of 178 consecutive Nigerian patients with breast cancer were retrieved from their hospital records. A subset of 36 patients was staged and their tumours typed and graded. Immunohistochemical staining of sections from paraffin wax embedded tissues from these cases for the expression of oestrogen receptor (ER), progesterone receptor (PGR), Human ERBB2 (or HER2/neu), p53 and cyclin D1 (CCND1) was carried out using the avidin biotin complex (ABC) procedure.

RESULTS

A majority of the cases were invasive ductal carcinoma (92.7%), high grade (grade 3, 70.6%) and of late clinical stage (stages III and IV, 58.3%). Only 25% and 27.8% of cases expressed ER and PGR respectively. The ERBB2 and CCND1 antigens were expressed in 25%, and 5.7% of cases respectively. The p53 protein was the most frequently expressed in this study (47.2% of cases). High grade tumours were significantly more likely to be ER and PGR negative (P = 0.006 and P = 0.002 respectively). CONLCLUSION: There is predominance of high grade, invasive ductal carcinomas which are likely to be ER and PGR negative but p53 positive. These features suggest a biologically aggressive form of breast cancer in Nigerian women with the possibility of poor response to both hormonal therapy and chemotherapy.

Male breast malignancy in Jos University Teaching Hospital

BACKGROUND

Male breast malignancies are rare. Cancer of the male breast accounts for about 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment.

PATIENTS AND METHODS

A retrospective study of all cases of male breast cancer (MBC) managed in Jos University Teaching Hospital over a 17-year period (January 1987-December 2003.)

RESULTS

A total of 302 cases of breast malignancies were managed over the study period. Twenty-six (8.6%) of these were males giving a male:female ratio of 1:10.6. The ages of the 26 MBC cases ranged from 12 years to 85 years, with a mean of 57.9 years and median age of 67 years. The right breast was affected in 15 and the left in 11. Mean duration of symptoms before presentation was 6 months with a range of 3 months to 4 years. All the patients had history of breast lumps, 21 (80.8%) of which were painless. Skin ulceration and axillary node enlargement were present in 19(73.1%) and 24(92.3%) respectively. Five (19.2%) were stage II; 15(57.7%) stage III and 6(23.1%) stage IV. There were 23 (88.5%) carcinomas, 2 (7.7%) fibrosarcomas and a case of Hodgkin's lymphoma. Invasive ductal carcinoma was the most common histological type in 20 (76.9%) of all breast malignancy and 20 (87.0%) of all breast carcinomas. Modified radical mastectomy (mastectomy with axillary clearance with or without division of the pectoralis minor muscle) was done in 10(38.5%) patients. Two of these were fibrosarcomas. Simple mastectomy was done in 13 (50%) as toilet procedures for advanced disease. The only case of Hodgkin's lymphoma had chemotherapy. Bilateral orchidectomy (BO), Tamoxifen, chemotherapy and radiotherapy were offered in 7(26.9%), 13(50%), 17(65.4%) and 7(26.9%) patients respectively. Wound infection was the most common complication in 14(53.8%) patients. There was no case of hospital mortality.

CONCLUSION

MBC accounts for 8.6% of all breast cancers in our centre. It affects elderly males. Late presentation with advanced disease and ulceration is a common feature in our environment.

Thyroglossal duct lesions in childhood--a review of experience in Nigerian children

This is a retrospective study of 36 children with thyroglossal duct lesions managed at a tertiary hospital in Nigeria, between 1993 and 2003. The aim was to determine the pattern of presentation and outcome of management. The majority of patients presented with a chronic thyroglossal sinus with associated recurrent inflammation. The location and relationship of the lesions to the hyoid bone were similar to those encountered in the rest of the world. Despite their well-documented clinical features, thyroglossal duct lesions were misdiagnosed in some patients. The main complications were surgical site infections and recurrence. A plea is made for clinicians to pay attention to clinical and operative details so as to diagnose these lesions accurately and manage them properly.

A review of 101 homicide cases in Jos, Nigeria

A five-year retrospective analysis of 101 homicide cases in Jos, Nigeria was carried out between 1995 and 1999. Of the total number, 47 were killed with sharp cutting or piercing instruments, 28 with firearms and 21 died from physical assaults. Five of the victims sustained fatal burn injuries. Majority of the cases (62.4%) were aged between 21 and 40 years and males outnumbered females by a ratio of 7.4:1. It is concluded that although a significant proportion of homicides are not premeditated, communal violence and robbery attacks remain the most frequent precipitating events that result in homicide in this environment.