Moa Samaila

ADNEXAL SKIN TUMORS IN ZARIA, NIGERIA

BACKGROUND Adnexal skin tumors share many features in common and differentiate along one line. Their detailed morphological classification is difficult because of the variety of tissue elements and patterns seen. They may be clinically confused with other cutaneous tumors. The aim of this report is to review and classify all adnexal tumors seen in a pathology department over a 16-year period. METHOD A 16-year retrospective analysis of all adnexal skin tumors seen in a large University Teaching Hospital in Nigeria from January 1991- December 2006. All tissue specimens were fixed in 10% formalin, processed in paraffin wax and stained with Haematoxylin and Eosin. Histology slides were retrieved, studied and lesions characterized. RESULTS Fifty-two adnexal tumors were seen, accounting for 0.9% of all cutaneous tumors seen within the same period. The median age was 33 years (range: 4 days-70 years). Clinical presentations varied from discreet swellings and nodules to ulcerated masses. Five patients presented with recurrent lesions. Only two cases had a clinical diagnosis of adnexal tumor. Twenty-four (46%) of the lesions were distributed in the head and neck region. Duration of symptoms was 2 months to 15 years (median: 12 months). Tumours of the sweat gland were the commonest--41 (78.8%); they comprised predominantly eccrine acrospiroma (17), characterized histologically by solid nests of round to polygonal cells with clear to eosinophilic cytoplasm, forming tubules in areas. Tumours of sebaceous gland were 7 (13.5%); they comprised mainly Nevus sebaceous of Jadassohn (6), composed of immature sebaceous glands and pilar structures microscopically and a solitary sebaceous adenoma. Tumours of hair follicle were 4 (7.7%) and included trichoepithelioma, characterized microscopically by multiple horn cysts and epithelial tracts connecting abortive pilar structures and a trichofolliculoma. Forty-six lesions (88.5%) were benign and six (11.5%) malignant. CONCLUSION Adnexal skin tumors have distinct histological patterns which differentiates them from other cutaneous tumors. They are commonly distributed in the head, neck and trunk. The commonest variants are those of eccrine sweat gland origin. Malignant adnexal tumors are uncommon in our setting.

Extrapulmonary tuberculosis: Fine needle aspiration cytology diagnosis

BACKGROUND The increasing prevalence of extrapulmonary manifestation of tuberculosis with the HIV scourge is a cause for concern. OBJECTIVE To determine the role of fine needle aspiration cytology (FNAC) in the diagnosis of extrapulmonary tuberculosis. PATIENTS AND METHODS This is a consecutive 9-year analysis of patients with peripheral lymphadenopathy. All the patients had fine needle aspiration. Smears were made, fixed in 95% alcohol and stained with hematoxylin and eosin and Zeihl Neelsen stains. RESULTS 48 patients, 31 males and 17 females, were analyzed. The mean age was 27.9 years. Aspirates were mainly from cervical lymph nodes. Four patients were HIV 1 seropositive. Macroscopically, 23 (48%) of the aspirates were purulent and 7 (14.6%) had caseous material. Microscopy showed granular eosinophilic material (caseation), multinucleated giant cells, epithelioid cells, neutrophils and lymphocytes. Staining for acid-fast bacilli was positive in 23 (48%) cases. CONCLUSION Early diagnosis of extrapulmonary tuberculosis in a resource-limited setting can be achieved with fine needle aspiration cytology technique (FNAC). This will ensure prompt treatment and thus reduce attendant morbidity and mortality.

Reconstruction of the chest wall after excision of a giant malignant peripheral nerve sheath tumor.

Primary chest wall tumors are uncommon and constitute 0.2-2% of all tumors. Metastatic tumors and tumors of local extension are more common. Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on the chest wall not stated in the literature. The incidence in the general population is 0.0001% while the risk is approximately 4600 times higher in patients with type I neurofibromatosis and 3-13% of them will finally develop into MPNST, usually after latent periods of 10-20 years. Clinically, these tumors are aggressive, locally invasive, and highly metastatic. Excision of giant chest wall tumor leaves a defect that is reconstructed using musculocutaneous flaps with or without a mesh. We report the case of a 24-year-old man who presented at the surgical outpatient clinic with 7 months history of persistent left sided chest pain minimally relieved by analgesics, 5 months of cough and worsening dyspnoea, and 3 months history of anterior chest swelling on the left side of the manubrium. Following evaluation and investigations, the tumor was excised and the residual defect closed with methylmetacrylate sandwiched between two prolene meshes and overlaid with both pectoralis major muscles. The histology of the excised mass revealed MPNST He made an uneventful postoperative recovery, but died barely 3 months later from widespread pulmonary metastases. A review of the literature revealed that such tumors hardly ever reach such large-size as in our case.

Foetal chondrodysplasia: intrauterine diagnosis.

Chondrodysplasias are rare occurrence. We present a case of short-limbed chondrodyplasia diagnosed in a 22 week fetus of a 28 year old. She was para 4(+0) with two children alive. She had similar occurrences in her last two pregnancies. The index pregnancy and the last two eventful pregnancies were preceded with ingestion of trado-herbal drug to treat subfertility.

Cutaneous squamous cell carcinoma in HIV-infected patients: a report of two (2) cases

Cutaneous squamous cell carcinoma (SCC) is a malignant neoplasm of the keratinizing epidermal cells and it accounts for 20% of all cases of nonmelanoma skin cancer. Important etiologic factors to the development of SCC are host characteristics, such as male gender, age, skin pigmentation, and environmental elements, the most important being long-time exposure to sunlight. Other predisposing factors include ionizing radiation, exposure to UV light, exposure to chemical carcinogens and chronic immunosuppression which is not HIV-associated. Though cutaneous SCC had been reported in several regions of the body, we are reporting two cases of cutaneous squamous cell carcinoma in the penile shaft and left gluteal region.

Incidental appendectomy after esophageal bypass for treatment of dysphagia

Background: The lifetime risk of acute appendicitis is 7-14%. Incidental appendectomy is defined as the removal of a clinically normal appendix during non-appendiceal surgery. Guidelines have tried to determine candidates for incidental appendectomy, but the practice continues to attract controversies. This paper presents our observation after appendectomy performed during oesophageal bypass/replacement procedures for treatment of dysphagia. Patients and Method: The histology results of all who underwent oesophageal bypass/replacement patients for the treatment of dysphagia was trace from the patients hospital records and histopathology register. Results: A total of 28 patients underwent oesophageal bypass /replacement procedure between 2008 – 2015, during which 25 had incidental appendectomy. We were able to retrieve the histology of only 7 patients (3 males and 4 females). Of these, one male had a normal appendix another had lymphoid hyperplasia. Four patients had acute recurrent appendicitis (3 females with corrosive stricture and one male with HIV associated inflammatory stricture). Conclusions: There is a high incidence of incidental appendicitis in patients with dysphagia justifying the need for incidental appendectomy as prophylaxis against future exploration which may put the conduit in harms way.

Cancer pattern in a hospital-based registry

Background: The Zaria Cancer Registry (ZCR) documents cancer cases within Zaria and environ with the objective of monitoring, planning, and screening of population at risk of developing cancer. The objective of this paper is to review the pattern and distribution of cancers as documented in the ZCR. Materials and Methods: A 5-year analysis of cancer cases recorded from January 2009 to December 2013 was made. Data sourced were grouped into those primarily from the hospital (A) and referrals from hospitals within (B) and outside (C) Kaduna state. Data compilation was done using CANREG4 software and the International Classification of Diseases (ICD)-0 classification and coding system. Results: A total of 2,536 new cancers were recorded with 1,014 males and 1,522 females. Cancer diagnosis from the histology of primary disease cases accounted for 86.3%, while cytology diagnosis cases comprised 10.6%. Over 90% of the diagnosis was based on symptomatic presentation by patients, while 81.6% were well-differentiated cancers. The peak age distribution was in 4 th -6 th decades of life in 58.9% cases, while 138 cancers were recorded in children aged 10 years and below. A total of 68 (2.7%) cases were also recorded in adolescents. Morphologically, squamous cell carcinoma (SCC), adenocarcinoma (not otherwise specified (NOS)), and infiltrating duct carcinoma were the commonest. About 60% of patients received two or more treatment modalities. Conclusion: The cancer distribution pattern from this registry is reflective of the cancer distribution in the larger population. Breast cancer was most common in females and ranked first overall, while prostate cancer was the commonest in males. This information is useful in planning for effective cancer screening, prevention, and management.

Age distribution, site of origin and HIV status of cases of gynaecological malignancies seen at a radiotherapy facility in Northern Nigeria

Background: Gynecological malignancies are very common in Northern Nigeria. Although cervical cancer has been classified as HIV-related malignancy, little information is available on the pattern of presentation of gynecological malignancies in HIV patients. The objective of this study was to analyze the age distribution, site of origin, stage, and HIV status of cases of gynecological malignancies seen at a radiotherapy facility in Northern Nigeria. Patients and Methods: Between January 2006 and December 2011, consecutive patients with histologically confirmed gynecological malignancies were studied retrospectively and evaluated with respect to age, site of tumor, histological type, stage of disease, and retroviral status. Patients′ folders were reviewed using a standardized structured proforma. Results were analyzed using Epi Info software 3.4.1, 2007 edition. Results: A total of 350 gynecological malignant cases were reviewed. The age range was 21-86 years, with a mean age of 49 years, a modal age group of 41-50 years, and a median age of 50 years. The commonest gynecological malignancy observed was cervical cancer (81.7%), followed by ovarian epithelial cancer (6%), endometrial cancer (4%), ovarian germ cell tumor (3.14%), vaginal cancer (2.3%), vulvar cancer (2.3%), and myometrial sarcoma (0.6%). In all, 85.1% patients had locally advanced disease, 9.4% had metastatic disease, and 5.4% had early stage disease at presentation. HIV seropositivity was 10.3%; however, 94.4% of those with HIV had cancer of the cervix. Conclusion: In this review, the peak modal age group for gynecological malignancies is the fifth decade of life. Cervical cancer is the commonest gynecological malignancy seen with preponderance of late stages of the disease at presentation. HIV seropositivity is highest among women with cervical cancer than among women with other cancers, as seen in the facility.

Leiomyosarcoma uteri in a white woman

Sarcoma of the corpus uteri should be considered as a differential diagnosis in postmenopausal women presenting with severe abdominal pain, thought to be due to degenerative changes of leiomyoma uteri. We present a rare case of leiomyosarcoma in a postmenopausal White woman. Diagnosis was missed preoperatively for degenerating uterine fibroid.