Search

Accessory breast and the diseases affecting these aberrant breast tissues are relatively uncommon, and with variable prevalence among different populations. These are commonly located in the axilla, chest wall, and vulva. The most common disease in these tissues is carcinoma; however, other benign neoplastic and nonneoplastic lesions do occur. In this review, we present a clinicopathologic analysis of all the consecutive cases seen in a major referral teaching hospital over a period spanning 10 years (2006–2015).

Background: The increased prevalence of hitherto uncommon tumours in children in our geographic setting formed the basis for this study. This study aimed to determine the current histopathologic distribution pattern of paediatric malignancies in Zaria. Materials and Methods : An eight year (2000-2007) consecutive analysis of malignant tumours in children ages 0 to 15 years in a referral University laboratory. All tissue biopsies were fixed in 10% formalin and processed in wax. Tumours were characterised histologically into tissues of origin and categorised into three age groups; < 1 year, 1-5 years and 6-15 years. Result : 189 children with malignant tumours were analysed. They showed a male preponderance (M: F; 1.2: 1.0) and their ages ranged from 5 days to 15 years. Tumours of mesenchymal origin were the commonest (115: 60.8%) while epithelial tumours including germ cell tumours accounted for 74 (39.2%) cases. The age group 1-5 years had the highest epithelial tumours while age group 6-15 years had the most tumours with 102 (54%) cases overall. The five commonest tumours over-all were rhabdomyosarcoma, Burkitt lymphoma, retinoblastoma, non-Hodgkin′s lymphoma and nephroblastoma. Germ cell tumours affected the ovary predominantly and two of the endodermal sinus tumour cases were seen in the testis of an eighteen month child and sacrococcygeum of a 5 year old girl, respectively. Of the six immature teratoma cases, four were cutaneous in distribution. The vascular tumours included epithelioid haemangioendothelioma, haemangioblastoma and Dabska tumour and they accounted for (5.8%) of all tumours seen. The commonest sites of occurrence of these tumours were the oculo-orbital, jaw, head and neck regions with 82 cases (43.4%) while lymph nodes were involved in 31 (16.4%) cases. Conclusion : The distribution and occurrence of malignant tumours in children is age related. Lymphomas were the commonest tumours overall while retinoblastoma and Burkitt lymphoma were the commonest tumours affecting children below 5 years and 6-10 years old, respectively, in our centre. The head region and lymph nodes were the sites of predilection for majority of these tumours.

Background: The incidence of cancer continues to rise all over the world and current projections show that there will be 1.27 million new cases and almost 1 million deaths by 2030. In view of the rising incidence of cancer in sub-Saharan Africa, urgent steps are needed to guide appropriate policy, health sector investment and resource allocation. We posit that hospital based cancer registries (HBCR) are fundamental sources of information on the frequent cancer sites in limited resource regions where population level data is often unavailable. In regions where population based cancer registries are not in existence, HBCR are beneficial for policy and planning.Materials and Methods: Nineteen of twenty-one cancer registries in Nigeria met the definition of HBCR, and from these registries, we requested data on cancer cases recorded from January 2009 to December 2010. 16 of the 19 registries (84%) responded. Data on year hospital was established; year cancer registry was established, no. of pathologists and types of oncology services available in each tertiary health facility were shown. Analysis of relative frequency of cancers in each HBCR, the basis of diagnosis recorded in the HBCR and the total number of cases recorded by gender was carried out.Results: The total number of cancers registered in these 11 hospital based cancer registries in 2009 and 2010 was 6484. The number of new cancer cases recorded annually in these hospital based cancer registries on average was 117 cases in males and I77 cases in females. Breast and cervical cancer were the most common cancers seen in women while prostate cancer was the commonest among men seen in these tertiary hospitals.Conclusion: Information provided by HBCR is beneficial and can be utilized for the improvement of cancer care delivery systems in low and middle income countries where there are no population based cancer registries. [ABSTRACT FROM AUTHOR]

Background: There are relatively few studies in Nigeria, and indeed, sub-Saharan Africa that have documented the relative frequencies and histomorphological patterns of endometrial carcinoma. This study aimed to determine the relative frequencies and clinic-epidemiological characteristics of endometrial carcinoma and its histological variants in Kano, North-Western, Nigeria., Method: A 10-year retrospective study of all endometrial carcinoma cases in the Department of Pathology, Aminu Kano Teaching Hospital, Kano. All relevant information was retrieved and data was analysed using Statistical Package for Social Sciences version 22., Results: Endometrial carcinoma showed an increment in prevalence from 0.5% of all gynaecologic admission in 2008 to 1.0% in 2017. Type I endometrial carcinoma, specifically endometrioid adenocarcinoma accounted for 80% of cases, while endometrial serous carcinoma was the most common type II endometrial carcinoma representing 20% of cases. Over 75% of endometrial carcinomas occurred in postmenopausal women with a mean age of 59 years., Conclusion: There is a rise in the prevalence of endometrial carcinoma and endometrioid adenocarcinoma is the most common histologic type., Competing Interests: There is no conflict of interest both financially and non-financially during this study, (© the authors; licensee ecancermedicalscience.)

Actinomycosis of the tonsils is uncommon even though the causative organisms are normal commensal of the oropharyngeal tract that may colonise the tonsillar crypts with resultant infection in apparently healthy individuals. Diagnosis is often incidental in tonsillectomy specimens sent to the pathology laboratory for varied diseases. This is a 10-year study of tonsillectomy specimens diagnosed with actinomycosis. Specimens were formalin-fixed and paraffin processed and stained with haematoxylin and eosin, gromott methenamine silver and periodic acid-Schiff. Four cases of tonsillar actinomycosis were diagnosed from a total of 772 tonsillectomy specimens. Histologically, characteristic oeosinophilic granules with peripheral radial protuberances surrounded by microabscesses were seen. Tonsillar actinomycosis is often an incidental diagnosis; however, a high index of suspicion should be entertained in patients with recurrent tonsillitis and/or tonsillar hypertrophy of unknown cause.

Lateral proboscis is a rare congenital anomaly. Lateral proboscis is a rare craniofacial malformation characterized by a rudimentary tubular, nose-like structure occurring in association with a wide spectrum of other anomalies. We presented a seven-month-old girl's lateral proboscis, cleft lip, and palate. Proboscis was excised by an elliptical incision, and the cleft was repaired at the same surgery.

Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign mesenchymal tumor of the breast. Majority occur as diffuse lesions, and diagnosis is often incidental or in a background of other breast pathologies. Bilaterality with multiple tumoral masses in giant breasts is a rarity. We report a 34-year-old nonlactating female with 2-year history of rapid progressive painless bilateral enlargement of the breasts following surgical excision of ill-defined breast lumps which were not subjected to histopathological evaluation a year earlier. Examination revealed bilateral nontender giant breasts extending to the umbilical area with masses which were not attached to overlying skin, Grade 2 pressure ulcers on the lateral posterior breast aspects bilaterally and peau d'orange. There were no other palpable masses or lymph nodes. A clinical assessment of bilateral gigantomastia was made. Bilateral mastectomy revealed giant PASH which was confirmed with positive immunohistochemical reactivity for CD34 and vimentin. No other breast pathologies were seen with extensive sectioning. Diffuse multiple breast lesions with incomplete excision are associated with rapid growth in PASH as seen in this case. The presence of concurrent bilateral giant tumoral masses without any underlying breast pathology is a novelty. The mainstay of treatment in this case is mastectomy despite its benign nature., Competing Interests: There are no conflicts of interest

Context: Majority of the previous studies on thyroid diseases in Northern Nigeria focussed mainly on neoplastic lesions. The non-neoplastic lesions are more common and constitute more public health burdens., Aim: To determine the histopathological pattern of thyroid diseases in our region and compare our findings with similar studies in Nigeria and elsewhere., Settings and Design: This is a retrospective study carried out at the Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, from January 2005 to December 2014 using specified criteria., Subjects and Methods: All cases of thyroid diseases diagnosed histologically within the study period had their histology reports as well as their haematoxylin and eosin-stained slides reviewed and analysed., Statistical Analysis: Statistical package for the social sciences (SPSS) software for windows version 20.0 (IBM SPSS Inc. Chicago, IL) was used., Results: There were 302 thyroid diseases diagnosed during the study period. Only 297 cases fulfilled the study inclusion criteria. There were 255 females and 42 males with a male-to-female ratio 1:6. Ages ranged from 4 months to 80 years, with peak age incidence between 31 and 50 years. Thyroglossal cysts accounted for 17 (5.7%) cases. Non-neoplastic diseases composed of colloid goitre, Graves' disease, Hashimoto thyroiditis and lymphocytic thyroiditis. They accounted for 214 (72.1%), 12 (4.0%), 3 (1.0%) and 1 (0.3%) cases, respectively. The neoplastic diseases comprised 36 (12.1%) adenoma cases and 14 (4.7%) carcinomas, with papillary carcinoma being the most common (71.4%) thyroid cancer., Conclusion: This study showed that thyroid diseases in Zaria had a female predominance with a peak age frequency between 30 and 50 years of age. The most common diseases were colloid goitre, follicular adenoma and papillary carcinoma. These findings are comparable with several studies on thyroid diseases in Nigeria and globally., Competing Interests: There are no conflicts of interest

Ovarian vein thrombosis is a rare clinical entity that may present in the puerperium. We report the clinical outcomes of two cases of postpartum ovarian vein thrombosis, incidentally diagnosed at laparotomy in 16-year-old and 23-year-old females. They had preoperative diagnosis of torsion tuboovarian mass and twisted pedunculated uterine fibroid, respectively. Both patients had transection and ligation of right thrombosed ovarian vein. Postoperative management included a week course of anticoagulant, antibiotics and analgesia. Postpartum ovarian vein thrombosis is a diagnosis of exclusion in the puerperium and a high index of suspicion will reduce associated morbidity and mortality.

Unlabelled: Summary, Aims and Objectives: To evaluate the Pattern of Paediatric solid cancers seen over 5 years in the Radiotherapy and Oncology Department of Ahmadu Bello University Teaching Hospital, Zaria-Nigeria., Materials and Methods: The study involved patients aged 16 years and below diagnosed with solid cancers referred to the Radiotherapy and Oncology Centre for further management. Between January 2006 and December 2010, a total of 136 new patients with paediatric solid cancers were seen and evaluated. Only patients with histological confirmation were included in the study (136 out of 141 patients) irrespective of cancer type, sex, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patients folder included age, sex, histological type, stage and types of treatments received. Results were presented in tables., Results: A total of 136 patients were evaluated with a mean age of 6.9 years (median of 5 years, age range 1.5 - 16 years). 74 patients (54.4%) were 5 years and below and 98 patients (72%) were 10 years and below. The sex ratio M:F was 1.3:1. At presentation at the Radiotherapy and Oncology centre, only 4 (3%) patients had early stage disease, 100 (73.5%) with locally advanced disease and 32 (23.5%) with metastatic disease. Retinoblastoma 48 (35.3%) was the commonest cancer seen followed by soft tissue sarcoma 20 (14.7%, all rhabdomyosarcoma), lymphomas 15 (11%) (9 Burkitt's and 6 Hodgkin's lymphoma), nephroblastoma 13 (9.6%), bone sarcoma 12 (8.8%) (8 Osteosarcoma and 4 Ewing's sarcoma), nasopharyngeal cancers 8 (5.9%), brain cancer 6 (4.4%), sacrococcygeal tumours 6 (4.4%) and other cancers accounted for 8 (5.9%). 116 (85.3%) patients received chemotherapy, 86 (63.2%) patients were scheduled for radiotherapy but only 21 (15.4%) received local field irradiation due to financial constraints and 43 (31.6%) had definitive surgery. Palliative care with medications was done in 22 (16.2%) patients. Of 48 patients with retinoblastoma, 30 affected left eye, 16 affected right eye and 2 patients were with bilateral retinoblastoma. The mean age for retinoblastoma was 3.8 years (median age of 3 years and mode is 3 years). The mean age for rhabdomyosarcoma was 8.7 yr (median age of 6.5 years)., Conclusion: Paediatric solid cancers were found to be more common in males than females with more than half being diagnosed in children aged 5 years and below. Retinoblastoma and rhabdomyosarcoma were the most common neoplasms. Most patients presented with locally advanced and metastatic cancers. Geographic variation exists with histological types.

Aims and Objectives: To evaluate the Clinico-pathologic Characteristics of Metastatic prostate cancer patients seen in the Radiotherapy and Oncology Department, Ahmadu Bello University Teaching Hospital, Nigeria., Materials and Methods: Between January 2006 and December 2009, a period of 4 years, 72 new patients with prostate cancers were seen of which 43 patients had distant metastases. Only patients with histologic confirmation of prostate cancer and having metastases were included in the study irrespective of age, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patient's folder included age, histology, Gleason score, co-morbidities, interval between diagnosis and referral to oncology unit, interval between referral and presentation at oncology unit, PSA at diagnosis and presentation at oncology unit, sites of metastases, bones sites involved in bone metastases, types of treatment received and follow up status. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition., Results: 43 patients had distant metastases from prostate cancer during initial evaluation at presentation in the radiotherapy and oncology centre. The mean age was 66.2 years (range, 47-82 years, median age 66 years and modal age group was 65-69 years). Co-morbidity was seen in 18 patients, with hypertension being the commonest (HT=14, DM=2 and HIV 2 patients). No morbidity seen in 25 patients. The range of duration from diagnosis to referral was 1-84 months. Only 20 patients presented at radiotherapy and oncology centre within 6 months of diagnosis and 18 patients presented after 12 months of diagnosis. 33 patients presented within 1 month of being referred for further management. 6 patients reported within 2 months and 2 patients within 3 months and another 2 patients within 4 months. Only 27 patients had PSA done at diagnosis. No PSA was done in 16 patients. The PSA range at diagnosis was 10.0-232 ng/ml, mean PSA was 67.46 ng/ml while only 40 patients did PSA on presentation for further management with a range of 1-245 ng/ml and a mean of 57.95 ng/ml. The histology report revealed adenocarcinoma and transitional carcinoma in 42 and 1 patients respectively. The Gleason score range was 6-10, with a mean score of 7.8. The Gleason score was not reported in 3 patients. Multiple organs involvement by metastases was seen in 16 patients. Bone metastases was the commonest (35), followed by lungs (8), liver (7), Virchow's lymph nodes (6), brain (5), and soft tissue (5). The lumbar vertebrae was the commonest site of bone metastases (32) followed by the sacrum (17), pelvis (11), and long bones (7). 3 patients had metastases to the ribs and 2 patients each to the skull, sternum and cervical spines. All the patients received hormonal therapy, 30 patients received palliative radiotherapy, 29 patients had surgical castration, 25 patients had radical radiotherapy to pelvis, 18 patients had systemic chemotherapy and definitive surgery was done in 16 patients. Only 6 patients received Ibandronate due to cost. 13 patients are alive and attending follow up, 11 confirmed dead and 19 lost to follow up., Conclusion: The patients were referred for management late after surgery. Bones, predominately the lumbosacral spines was the commonest organ involved in metastases. Skeletal survey with bone scan and plain x-rays especially lumbosacral spines should be part of the staging investigation for all patients with advanced stage. There is need for more awareness on other treatment modalities emphasizing the multidiscipline and multimodality management of prostate cancer.

Aims and Objectives: To evaluate the Pattern of Oncologic Emergencies seen in Adult cancer patients and the treatment modalities used., Materials and Methods: Between January 2004 and December 2008, a total of 1824 (M:F = 1:1.8) new patients were seen. 196 (M:F = 1:1.4) consecutive patients with histologically confirmed malignancies presenting with or having oncologic emergencies were treated and have been reviewed. Patients' folders were reviewed retrospectively with a structured pro forma. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition., Results: The median age was 49 years and mean age of 42 years (range, 15 - 82 years). M: F = 1:1.4. 162 patients had oncologic emergencies at presentation while 21 during treatments and 13 during follow up. At the time of diagnosis of oncologic emergency, 126 were not on any treatment, 42 patients on hormonal therapy and 28 patients were on diverse chemotherapy. All the patients presented late with 108 patients presenting with metastatic disease and 88 patients with locally advanced disease. Only 35 patients were treated within 1 week of onset of emergency. 59 patients had cervical cancer, 31 patients with breast cancer and 28 patients with prostate cancer. Tumour haemorrhage wass the commonest oncologic emergency seen in 107 patients followed by bone pain with imminent cord compression from bone metastases in 59 patients. Of 107 patients with tumour haemorrhage, 54 patients had cardiovascular collapse with 7 having acute renal failure. Similarly, of the 107 with tumour haemorrhage, 56 patients bled from cervical cancer, 12 patients from breast cancer and 8 patients from urinary bladder. 129 patients were treated with teletherapy, 31 patients had chemotherapy, 27 patients had emergency surgery and 5 patients had chemoradiation. Oncologic emergencies were corrected in 126 patients., Conclusion: Tumour haemorrhage is the commonest oncologic emergency in this environment and teletherapy is the commonest therapy used. More radiotherapy centres are needed for prompt treatment and their usefulness in managing emergencies should be made known. Oncologic emergencies are commonly seen in metastatic and locally advanced disease.

Renal metastasis from prostatic origin is an uncommon event. Advanced prostate cancer locally invades the seminal vesicles, bladder and regional lymph nodes. Other metastatic sites are the lung, bone and other visceral organs. We present a 55-year old, Hausa man from Northern Nigeria who was managed as a case of infected renal cyst which later turned out to be a metastatic prostatic adenocarcinoma with a rare pattern of widespread bony metastases.Renal metastasis from prostate adenocarcinoma is a rare occurrence, however, high level of suspicion is needed in order to avoid potential diagnostic pitfall.

Gynaecological malignancies frequently metastasize to contiguous structures, internal organs and bones. Cutaneous metastasis as a primary or recurrent presentation of these malignancies is rare and only a few cases have been reported in the literature. A twenty year (1991-2010) retrospective search for umbilical metastasis from gynaecological malignancies in our departmental case records showed only four cases. Four post-menopausal females presented with painful cutaneous umbilical (Sister Joseph's) nodules. The clinical examinations of all four patients revealed well delineated nodules of varying sizes and degrees of ulceration. Other findings were matted axillary and inguinal lymph node enlargement, intra-abdominal and pelvic masses, vaginal discharge and vaginal bleeding. Incisional tissue biopsies from the nodules were processed in paraffin wax and stained with haematoxylin and eosin. Histology of the sections showed pigmented skin overlying metastatic malignant tumours consistent with adenocarcinoma from the endometrium and ovary in three cases, and squamous cell carcinoma, large cell keratinizing from the cervix uteri in the fourth case. Gynaecological cancers have a global spread and varied geographic distribution. Cervical cancer is the commonest in our setting and patients often present to hospital with advanced stage disease. Ovarian and endometrial cancers are infrequent and their diagnosis may be delayed by non- specificity of presenting clinical symptoms from other benign tumours at these sites. Although umbilical metastasis is commonly associated with gastro-intestinal malignancies, its presence may be the first harbinger of occult gynaecologic cancer.

Kaposi's sarcomas (KS) are vascular lesions which usually originate from multiple sites in the mid-dermis extending to the dermis. The aetiology is unknown, but infection from human herpes virus type 8 has been suggested. Several reports of KS had come from Africa initially and from worldwide later due to the close association with HIV/AIDS. Prior to this however, KS was very frequent in Eastern Europe, Italy and the United States where it existed in an indolent form in the elderly men of Jewish ancestry. KS may also be due to iatrogenic immune suppression from chronic use of steroids, elevated degree of expression of numerous cytokines and angiogenic growth factors including TNF alpha, IL-6, bFGF, HIVtat protein and oncostatin M. Lymphadenopathic KS involves the lymph-nodes, viscera and the gastrointestinal tract and may run a disseminated and aggressive course. We are reporting one such case in an immunocompetent male.

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.

Background: Cutaneous manifestations of deep mycotic infection are fraught with delayed or misdiagnosis from mainly cutaneous neoplastic lesions., Aim: This study is designed to present our experience of these mycoses in a pathology laboratory in the tropics., Materials and Methods: A clinicopathologic analysis of deep mycotic infections was conducted over a 15 years period Formalin fixed and paraffin wax processed biopsies were stained with hematoxylin and eosin, periodic acid Schiff (PAS), and Grocott's methenamine silver (GMS) for the identification of fungus specie. Patients' bio-data and clinical information were obtained from records., Results: Twenty males and seven females presented with 6 months to 6 years histories of varying symptoms of slow growing facial swellings, nodules, subcutaneous frontal skull swelling, proptosis, nasal blockage, epistaxis, discharging leg sinuses, flank mass, convulsion and pain. Of the 27 patients, four gave antecedent history of trauma, two had recurrent lesions which necessitated maxilectomy, two presented with convulsion without motor dysfunction while one had associated erosion of the small bones of the foot. None of the patients had debilitating illnesses such as diabetes mellitus, tuberculosis, and HIV infection. Tissue histology revealed histoplasmosis (10), mycetoma (9), subcutaneous phycomycosis (6), and phaeohyphomycosis (2)., Conclusion: Deep mycoses may present primarily as cutaneous lesions in immunocompetent persons and often elicit distinct histologic inflammatory response characterized by granuloma formation. Diagnosis in resource constraint setting can be achieved with tissue stained with PAS and GMS which identifies implicated fungus. Clinical recognition and adequate knowledge of the pathology of these mycoses may reduce attendant patient morbidity.

Background: Cervical cancer is the commonest cancer in northern Nigeria. There are only two radiotherapy centers in the north and four centres in the south, each with only one megavoltage machine for a population of over 140 million. The number of patients requiring radiotherapy for various malignancies is beyond the available facilities and expertise leading to long waiting time and disease progression with its attendant sequelae. This is the basis of using other orthodox treatment modalities as first line., Patients and Methods: Between January 2006 and December 2007, 116 patients with histologically confirmed cervical cancer with vaginal bleeding as the predominant symptom were treated. Patients presenting with torrential haemorrhage were excluded from this study as they constitute oncologic emergencies. Patients were interviewed with a structured pro forma on a 3-weekly basis during chemotherapy schedules to assess and evaluate per vaginal bleeding and discharge. Dose of chemotherapy was 70 mg/m² every 3 weeks. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition., Results: The median age was 49 years (27-80 yrs). 62 patients were having per vagina bleeding for more than 6 months before commencement of chemotherapy (range 1-60 months). 49 patients had blood transfusion before chemotherapy, average of 2.7 pints of blood transfused per patient. 84 had at least FIGO stage IIIA disease. Squamous cell carcinoma is the commonest histology type followed by adenocarcinoma with 95 and 16 patients respectively. 81 patients had complete cessation of per vagina bleeding with 69 having complete cessation on or before 4th course of chemotherapy (9th week) and complete cessation of per vagina discharges was seen in 52 patients. 115 patients had a performance status KPS of below 80 prior to chemotherapy, and after completing 6 cycles, 100 patients had KPS of 80 and above., Conclusion: In resource-poor setting, Cisplatin based chemotherapy can be used by medical, gynaecological oncologists and general practitioners to control vaginal bleeding and improve the quality of life of patients pending radiotherapy. For optimal treatment with chemoradiotherapy, government and non-governmental agencies must do all it takes to remedy the problems of shortage of resources.

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.

Objective: Ruptured ectopic gestation is a life threatening medical emergency especially in developing countries. However, the occurrence of hydatidiform mole in ruptured tubal pregnancy is uncommon., Material and Methods: A consecutive analysis of patients with hydatidiform mole in ruptured tubal gestation over a 9-year period in a tertiary hospital., Results: Of a total of 101 females with ectopic gestations, only five had ruptured tubal hydatidiform mole. The ages ranged from 20-37years and they all presented with acute abdominal symptoms which necessitated emergency surgical intervention. Intra-operative findings revealed ruptured/ leaking tubal gestation. The excised tissue specimens showed hydatidiform mole characterized by circumferential trophoblastic proliferation, hydropic degeneration and stromal karyorrhexis. Patients' serial HCG levels were monitored before discharge., Conclusion: Ruptured tubal hydatidiform mole is uncommon and strict histologic criteria are important in diagnosis. Serial HCG levels must be monitored in individual patients to forestall development of malignant trophoblastic disease.

Human infection by Dicrocoelium dendriticum, a zoonotic liver fluke, is uncommon and soft tissue manifestation is extremely rare. The infection has no specific clinical signs or symptoms and diagnosis may be missed completely, thus treatment may be delayed. Diagnosis in humans is by identification of the eggs in the stool, while a living or dead fluke is rarely seen. The present report concerns the case of a 7-year-old child who presented with recurrent right flank subcutaneous nodules containing a live fluke on excision, and tissue histology showed characteristic brown operculated ova of D dendriticum. This is the first extraintestinal soft tissue presentation in such a setting. It is important to know the life cycle and natural habitat of this rare human parasite in order to make a correct diagnosis and institute early treatment in patients who have become infected.

Filariasis is a helminthic infection caused by tissue nematodes. It is estimated that at least 120 million people are infected worldwide and another 1 billion are "at risk" of infection. The prevalence is increasing due to uncontrolled urbanization in many of the endemic countries. The geographical distribution is determined mainly by climate and the distribution of the mosquito vector. We report a case of huge filarial elephantiasis of the vulva, in a 40-year-old multipara with background history of secondary infertility. She had excision of the elephantoid vulva lesion under general anaesthesia. A nontender irreducible pedunculated mass (25 cmx21 cm) with a large stalk arising from the right groin down to the ipsilateral labia majora was removed. A similar mass on the left groin, measuring 10 cmx6 cm was removed. Diagnosis was confirmed at histopathologic analysis of the excised masses. Patient was placed on diethyl carbamazine.

Ovarian squamous cell carcinoma is usually associated with germ cell tumours (dermoid cyst) or endometriosis in primary cancer. While tumour metastasis to the ovary is common and often bilateral in over 50 percent of cases, metastatic cervical squamous cell carcinoma to the ovary is infrequent compared to adenocarcinoma from other extraovarian primaries and the cervix. We report two cases of unilateral metastatic ovarian squamous cell carcinoma from the uterine cervix in two women aged 38 years and 48 years, respectively. They presented with abdominopelvic masses, clinically thought to be tuberculosis and primary ovarian tumour, respectively. Both had laparotomy which revealed multinodular ovarian masses with extensive extra-ovarian involvement of the corpus and uterine cervix by tumour and omental seedlings. Tissue microscopy showed total replacement of ovarian stroma by tumour with necrotic foci and containing infiltrating nests and cords of malignant squamous cells with prominent intercellular bridges. No evidence of teratoma or endometriosis was seen in the histology sections. They were both diagnosed with metastatic ovarian squamous cell carcinoma with advanced stage disease primary in the uterine cervix. Ovarian metastatic squamous cell carcinoma from the uterine cervix may occur with advanced stage cervical carcinoma. Unilateral multinodular ovarian mass with extensive extra-ovarian tumour involvement should raise suspicion of metastasis rather than of primary tumour. Early and prompt diagnosis is desirable in the management of these patients.

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.

Background: Mycetoma is a tropical superficial fungal infection endemic in parts of Africa. It affects the foot and leg commonly, but any part of the body may be involved. Mycetoma presents with characteristic discharging sinuses containing fungal granules, a picture that is pathognomonic. However, the disease may present without these characteristic features, thus causing diagnostic difficulty with other chronic granulomatous infections such as tuberculosis or benign skin lesions., Methods: A review of four male and three female patients aged 28-70 years with mycetoma seen during a six-year period., Results: The duration of the lesion before presentation was between two and six years (median five years). Clinical presentation included pigmented cutaneous nodules, depigmented spots, multiple discharging sinuses, or a fungating mass with bone erosion, involving almost any part of the body (face, trunk, and leg). The range of clinical misdiagnoses included skin tuberculosis, fibroma, amelanotic melanoma, basal-cell carcinoma, and brain tumor. Histologic examination of tissue biopsies showed amorphous aggregates of eosinophilic granules in a background of chronic suppurative inflammation., Conclusion: Mycetoma is a disease with sporadic occurrence in our environment. The presentation and clinical course may be confused with those of many skin diseases. Knowledge of mycetoma pathology is important for prompt diagnosis and treatment of this indolent clinical entity.

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.

We present 2 cases of ovarian masses diagnosed as tumours but turned out to be pregnancy. Ovarian pregnancy, a form of ectopic gestation has a distinct pathology though it can be a source of diagnostic difficulty clinically and intraoperatively. A total of 71 ectopic pregnancies were seen in the department from January 2001 to December 2005, of these only two were ovarian ectopics. Both patients were nulliparous and presented with lower abdominal pains, abdominal masses and menstrual irregularity. They both had laparotomy and total right salpingo-oophorectomy. Grossly, the ovaries were enlarged, grey tan and globular. Focal ruptures in the wall of the ovaries showed protruding fetal parts. Microscopy showed chorionic villi within and in continuity with ovarian stroma and corpus luteum. They were both diagnosed ovarian ectopics. A good knowledge and understanding of the gross pathology, combination of imaging studies and high index of suspicion should help in making an intra-operative diagnosis.

Objective: To determine the underlying cause of superficial skin ulcers over a 15-year period., Methods: A retrospective histopathological analysis of 670 cases of superficial skin ulcers diagnosed in the Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria from January 1991 to December 2005., Results: A total of 670 superficial skin ulcers were analyzed. The male to female gender ratio was 409:261(1.5:1.0) and a peak age frequency of 44.3% (297) in the 5th and 6th decades. Spectrum of lesions encountered was categorized into inflammatory, infections, benign and malignant diseases. The malignant lesions were 309 (46.1%), non-specific inflammation 302 (45.1%), granulation tissue 25 (3.7%) and pseudoepitheliomatous hyperplasia 14 (2.1%). A total of 18 (2.7%) specific infections were encountered, which included bacterial, fungal and viral infection. Benign lesions were 2 (0.3%), comprising of neurofibroma and Bowen's disease. The most common malignant lesion was squamous cell carcinoma 203 (30.3%) with a male to female ratio of 128:75 (1.7:1.0). Of these, 161 were well-differentiated tumors. The lower limb was the prevalent site distribution of all the ulcers., Conclusion: Superficial ulcers may be harbinger of malignant diseases. Squamous cell carcinoma remains the most common malignant lesion arising from chronic superficial ulcers in our setting. Adequate tissue biopsy and early diagnosis may reduce the attendant morbidity of these ulcers.

Objective: A histopathologic analysis of epidermal skin tumours and tumour-like lesions seen between 1991 - 2000 in the Department of Pathology, Ahmadu Bello University Teaching Hospital [A.B.U.T.H], Zaria is presented., Patients and Method: These tumours were classified according to World Health Organisation's International Histological Classification for Skin Tumours and were tabulated., Results: A total of 350 such lesions comprising 9.9% of all cutaneous neoplasms seen within the study period were collected. Overall, they have a male to female ratio of 1.7:1. Malignant tumours constituted 72.5%; benign tumours 18.3% and tumour-like lesions 9.2%. The commonest malignant lesion was squamous cell carcinoma, which constituted 68.3% of all the lesions with a male to female ratio of 1.7:1. Epidermal cyst comprised 16.3% with a male to female ratio of 1.5:1., Conclusion: It is concluded that epidermal tumours and tumour-like lesions are not uncommon in Zaria and they show a male preponderance with squamous cell carcinoma being the commonest epidermal tumour and it also predominantly affects males.