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Head and neck cancers display diverse patterns of biological behavior and considerable variation in geographical distribution. This study presents an analysis of head and neck cancer in a Nigerian tertiary healthcare center. It comprises cases diagnosed at the University College Hospital, Ibadan, Nigeria, 1991-2005. Out of 1,750 head and neck tumors, 972 (55.5%) were malignant and 778 (44.5%) were benign. Cancers displayed male predominance, with a gender ratio of 1.8:1. The mean age of cancer patients was 43.8 +/- 19.6 years. Carcinomas constituted 71.7% of head and neck cancers, with 2.4% occurring in children and overall mean age of 48.2 years. Squamous cell carcinoma comprised 66.7% of carcinomas and 47.8% of all head and neck cancers. Hematopoietic malignancies constituted 20.4% of head and neck cancers, and comprised mainly lymphomas, which accounted for 19.3% of all head and neck cancers. The mean age of patients with hematopoietic malignancies was 34.9 years. The most common childhood malignancy was Burkitt's lymphoma, which comprised 28.2% of pediatric head and neck cancers. Connective tissue tumors constituted 7.9% of all cancers, the most common being rhabdomyosarcoma, accounting for 44.2% of sarcomas. The mean age of patients with sarcomas was 26.5 years. There is a need for uniformity in the definition of head and neck cancer so as to permit comparison of international studies. In addition, prospective population-based studies are required to determine the national incidence and to identify risk factors for head and neck cancer in the Nigerian population.

Amyloidosis is a rare disease characterised by the deposition of insoluble extracellular fibrillar proteins in various tissues of the body. The pattern of manifestation is organ dependent and also on whether the disease is localised or systemic, primary or secondary.Though the disease is usually fatal with a 5-year survival rate of 20%, there is still paucity of literature on this disease entity worldwide. Diagnosis has remained mostly at autopsy.A case of amyloid angiopathy involving the submandibular gland and floor of the mouth with an associated fatal bleed is reported. The purpose of this case report is to reiterate the importance of a high index of suspicion in the approach to the management of head and neck swellings.

Background: Cavernous lymphangioma is a rare lesion in the breast of adults. Only a few cases have been documented in literature., Case Presentation: We describe a 38-year-old woman who presented with a palpable breast lump, which measured 5 x 4 cm. A local excision of the lump was performed and a diagnosis of cavernous lymphangioma was made. The patient is alive and well, after five years of follow-up, with no complaints or recurrence., Conclusion: To the best of our knowledge, this is the first case to be documented in a black African woman. Complete surgical excision seems to be the best modality of treatment of this lesion.

Background: Teratoma is a rare developmental neoplasm that arises from totipotential tumor stem cells. Head and neck teratomas constitute about 10% of all cases. Only two cases of mature teratoma of the nasal septum have previously been documented in the world literature., Case Presentation: We present a case of histologically confirmed mature teratoma arising from the nasal septum in an eighteen month old Nigerian female who presented with a history of noisy breathing associated with recurrent rhinorrhea since birth. Physical examination revealed obstruction of the right nasal cavity by a pale fleshy mass. She underwent a total surgical excision and to date, after thirty one months follow-up, she is free from recurrence., Conclusion: The prognosis for benign teratoma of the nasal septum is good following total surgical excision.

Background: Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is extremely rare. It can arise as a result of osseous metaplasia in a pre-existing benign or malignant neoplasm of the breast or as non-phylloides sarcoma from the soft tissue of a previously normal breast., Case Presentation: A 40 year-old Nigerian woman was clinically diagnosed to have carcinoma of the left breast. The histology report of core-needle biopsy of the mass showed a malignant neoplasm comprising islands of chondroblastic and osteoblastic stromal cells. This report changed the diagnosis from carcinoma to osteogenic sarcoma of the breast. She had a left modified radical mastectomy, however there was significant post surgery skin deficit. A latissimus dorsi musculocutaneous flap was used to cover the anterior chest wall defect. Sections from the mastectomy specimen confirmed the diagnosis of osteogenic sarcoma. She died six months after mastectomy., Conclusion: A diagnosis of osteogenic sarcoma of the breast was made based on histology report and after excluding an osteogenic sarcoma arising from underlying ribs and sternum. This is the second documented case of primary osteogenic sarcoma of the breast coming from Nigeria.

An unusual case of malignant schwannoma with involvement of the forehead, external nose, right nasal cavity, paranasal sinus system (bilateral frontal sinus, right ethmoidal sinus), right orbit and anterior cranial fossa is reported in a Nigerian. Malignant schwannomas of the paranasal sinus are extremely rare, as only 20 well-documented cases have been previously published in English literature. No report in black Africans has been found in extant literature. The clinical features of this tumour are presented with detailed management. The patient had a wide surgical resection of the lesion with reconstruction of the resultant fronto-nasal defect using forehead musculofascial flap plus full thickness skin graft and adjuvant radiotherapy with satisfactory outcome. The good result of combined surgery and radiation regimens in this case demonstrates the usefulness of adjuvant radiation therapy in this condition.

Background: this study aimed at assessing the utility of silver nucleolar organizer region (AgNOR) staining in categorization and prognostication of salivary gland tumors., Methods: Twenty-seven malignant salivary gland tumors, 16 benign neoplasms, and 6 chronic sialadenitis lesions were stained using the technique described by Ploton et al. (1986)., Results: The mean AgNOR counts for inflammatory lesions (1.67 +/- 0.19) and benign neoplasms (1.67 +/- 0.11), were less than for malignant neoplasms (3.59 +/- 0.55), P < .05. There was no significant difference between the mean AgNOR counts of different specific histological types and grades of malignant neoplasms. In addition, no correlation was found between mean AgNOR counts and the clinical course of malignant or benign salivary gland neoplasms., Conclusion: Our results suggest that AgNOR staining is useful for distinguishing benign from malignant lesions, but is neither helpful for discriminating between histological types and grades of malignant neoplasms, nor prognostication of malignant salivary gland neoplasms.

Background: Helicobacter pylori is a significant aetiological factor for acid peptic diseases and gastric cancer. Detection of the organism in gastric mucosal biopsies is important, hence the need to ascertain the optimal site for biopsy that will facilitate identification of the organism., Study Design: The study was carried out by obtaining directed gastric and duodenal endoscopic biopsies from twenty-five adult Nigerian patients clinically diagnosed to have gastroduodenitis at the University College Hospital, Ibadan, Nigeria. Biopsies were obtained from the gastric body, pyloric antrum, first and second parts of the duodenum at endoscopy. The biopsy specimens were tested for H. pylori by Campylobacter-like organism (CLO) test and histology., Results: Positive results for H. pylori by CLO test were detected in 67% each for the biopsies taken from the gastric antrum and incisura angularis; and 28% and 17% for those taken from first and second parts of the duodenum respectively. There was no benefit in taking additional biopsy from incisura angularis to that from the antrum. Helicobacter pylori was better detected in the mucosa of the antrum (72%) than that of the duodenum (28%), p < 0.05. The organism was detected in 28% by histological examination of the tissue specimen of the patients compared to 72% by CLO test, p < 0.05., Conclusion: The study shows that the detection of H. pylori by invasive technique is better obtained by taking biopsy at the gastric antrum in Nigerian patients with gastroduodenitis. Furthermore, the CLO test yields more positive results than histological evaluation in the detection of the infection.

Venous thromboembolism (VTE) remains a fatal complication and a frequent cause of death among patients hospitalized for remediable and often minor conditions. Various prevalence and associated risk factors of VTE have been documented in different parts of the world. It has been reported that the prevalence of VTE in Africans and Asians is not as pronounced as it is in the Caucasians. However, there is still a relative paucity of information about the prevalence of VTE and its associated risk factors in Nigeria, which is an African population. Data was collected retrospectively from records of post-mortem reports at the University College Hospital, Ibadan, Nigeria between January 1991 and December 1998. Of the 989 autopsies documented within the 8-year period, 29 autopsies confirmed VTE. This indicates a prevalence of 2.9%. Sixty five percent of the subjects were older than 40 years and male to female ratio was 2.6:1. Hence the condition is more prevalent in males than females. Malignancy was the commonest predisposing risk factor for VTE (37.9%). Other predisposing factors included immobility for more than 4 days (27.6%), neuromuscular paralysis (24.1%), septicaemia (20.7%), multiple trauma involving the pelvis, abdomen and head (17.2%), major surgery (13.8%), congestive cardiac failure (3.4%) and obesity (3.4%). This study highlights the need to have a closer look at this grave but preventable and treatable health condition. VTE is a preventable and treatable condition, especially where haematological services, intensive care management and good pre-emptive physiotherapy are available. Thus, mortality from this condition should be considered as a cause for concern even in a poorly funded health care delivery system such as in Africa. It is therefore recommended that appropriate physical and pharmacological methods of prophylaxis should be prescribed according to the degree of risk of VTE in individual patients.

We retrospectively analysed the impact of selected clinicopathological factors on visual and clinical outcome in patients with histologically verified cranial meningioma. The 60 patients analysed for tumour characteristics consisted of 32 females and 28 males (sex ratio 1.1:1) aged 9-77 years (mean 40 years) seen between 1977 and 1999 at the University College Hospital, Ibadan, Nigeria. The patients for whom sufficient clinical data was available (n=35) presented within 2-60 months (mean 18 months) of symptom onset with large tumours (mean size 52 mm), and perifocal oedema (26/35), poor vision, focal neurological deficits, seizures and clinical evidence of intracranial hypertension. The most common tumour site was the convexity. There was loss of vision in 30/35 (85.7%) patients. Loss of vision was significantly related to tumour site and tumour size as well as perifocal oedema, (P<0.05). The case-mortality rate was 11.4% at 1 month and 20% at 6 months post-operation and was significantly correlated with intracranial hypertension. Neither age nor sex affected the outcome (P>0.05).

We studied the effects of dexamethasone, ascorbic acid, and metronidazole on the irradiated spinal cord of Wistar rats. Thirty adult Wistar rats were randomly assigned into 3 groups. Five rats served as the control group. Another group of 5 rats were irradiated in the neural axis with 2.5 Gy of gamma rays. The last group of 20 rats were irradiated and then divided into four subgroups of 5 rats each: one subgroup was administered dexamethasone alone, a second subgroup had metronidazole alone, a third subgroup was treated with dexamethasone and metronidazole combined, and a fourth subgroup had ascorbic acid alone, given intraperitoneally for 7 days before exposure to radiation, and also for 5 days after-irradiation. All irradiated animals demonstrated similar vascular changes in form of splitting of the smooth muscle layers of the arterioles of the anterior spinal arteries. Similarly, all the irradiated spinal cord demonstrated shrinkages as noted in the diminution of the neuronal sizes measured by a microscope with a micrometer embedded in the eye-piece objective. The drugs did not individually protect neurons from damage at the level of our investigation. However, the combination of dexamethasone and metronidazole produced a reduction of the degenerative effect of radiation on the neurons when the post-irradiation diameters of the neurons were compared with the control and those of the other experimental groups. We conclude that gamma ray induced damage in the spinal cord may be ameliorated by combining dexamethasone with metronidazole but not by individual treatment with any of the three drugs.

The teratogenic effect of maternal cyanide consumption on the gross morphology of the post-natal phase of the developing rat cerebellum was studied. Twenty pregnant female rats weighing between 170 g and 190 g were separated into control and experimental groups. The control animals were fed a standard diet of mice cubes, while the experimental animals were fed 500 ppm potassium cyanide, mixed with the standard diet. The diets were fed to the animals and their litters in separate cages and water provided ad libitum during gestation and to the offspring after birth. After birth, the offspring (five per group) of days 1, 9, 14, 21, 28 and 50 were weighed, killed by cervical dislocation and the gross parameters studied. In the experimental animals, no significant differences were observed in the studied parameters between the control and experimental animals on day 1. A significant reduction in body weight was observed on day 14 (P < 0.05). The brain weight was significantly reduced on day 9 (P < 0.05). Similarly, the cerebellar weight was significantly reduced on days 14,21 and 28 (P < 0.05). The maximum vermal length was significantly reduced on day 50 (P < 0.05), and the maximum side-to-side dimension of the cerebellum was also reduced on day 28 (P < 0.05). There was no reduction in the thickness (anteroposterior dimension) of the cerebellum in the experimental group (P > 0.05). From the result, it is inferred that maternal consumption of 500 ppm cyanide causes reduction in the cerebellar weight, vermal length and side-to-side dimension of the developing cerebellum in postnatal life in rats.

Objective: To investigate the microscopic effect of maternal cyanide consumption on the developing cerebellum of Wistar rats., Materials and Methods: Twenty pregnant female rats weighing between 160 g and 180 g were used in this study. The rats were separated into two groups comprising ten control and ten experimental animals. The control animals were fed a standard diet of mice cubes, while the experimental animals were fed 500 ppm potassium cyanide, mixed with the standard diet. The diets were fed to the animals and their litters in separate cages and water provided ad libitum during pre and postnatal life. After birth, the offspring (five per group) of days 1,9,14,21,28 and 50 were weighed and killed by cervical dislocation. The cerebellar tissues were processed and microscopic parameters studied., Results: A thicker external granular layer (EGL) was seen in the control group on day 1(39+/-9.2microm) compared with the experimental group (29+/-5.8microm) and on day 9(83+/-7.1microm) compared with the experimental group (78+/-13microm). However, these were not significantly different statistically. A thicker and persistent EGL was observed in the experimental group on days 14 and 21. A significant (P<0.05) reduction in the thickness of molecular layer (ML) was observed on days 28 and 50 in the experimental group. The density and size of the Purkinje cells were the same in both the control and experimental groups (P>0.05)., Conclusion: Maternal consumption of 500 ppm cyanide in rats does not significantly affect light microscopic prenatal cerebellar development, but causes mild changes in the post-natal life. Maternal cyanide consumption causes delayed maturation of the cerebellum, as evidenced by the thicker EGL, and reduction in the ML in the experimental group which become noticeable only at about 28th day of postnatal life.

The wound healing effect of leaf extracts of Ocimum gratissimum was investigated in adult male Wistar rats. Two groups of adult male Wistar rats, average body weight 170g, had a 2cm by 2cm square wound inflicted on the dorsolateral aspect of their trunk with Paniculus Carnosus removed. Experimental group had their wound dressed with methanolic leaf extracts of Ocimum gratissimum while control group had their wounds dressed with normal saline dressing. All animals had wound dressing done every five days; wound dimension measured and, wound morphometry assessed. Wound biopsy was done by random selection in each group on day 10 and the day of complete re-epithelisation. Routine paraffin wax processing was done, slides stained with haematoxylene and eosin for histological assessment of fibroblast count, neovascularisation and granulation tissue profile. The result revealed significant wound contraction (P<0.05) on day 10 in the experimental group (mean 73.40 +/- 3.30)cm2 compared with the control group (mean 53.50 +/- 4.32)cm2. Histology of the healed scar showed non-significant (P>0.05) decrease in the mean fibroblast count forthe experimental group (83.80 +/- 5.70) relative to fibroblast count of 90.20 +/- 17.90 in the control group. The mean blood vessel count was also non-significantly lowered (P>0.05) in the experimental group (9.20 +/- 1.20) relative to the control group (13.40 +/- 2.40). Granulation tissue histology on day 10 showed denser inflammatory infiltrate as reflected by increased cellularity in the control group relative to that of the experimental group which though appeared adequate was not as dense as the control group. Thus we suggest that the methanolic extracts of O. gratissimum could be a potential wound healing agent due to its ability to enhance wound contraction.

The present study investigates the wound healing properties of methanolic extracts of Ageratum conyzoides leaves compared with those of honey. Thirty Wistar rats were randomized into 3 groups of 10 animals each. They were fed with standard rat cubes and Tap water weighed and acclimatized to laboratory conditions for one week. Under anesthesia, each animal had the skin of its dorsolateral flank shaved after which an area of the skin was excised. On achieving haemostasis, the wounds were packed with gauze soaked in the appropriate dressing for each group. Measurement of wound size, and wound biopsies were taken on the 10th day post-wound creation. Together with healed wound samples, these were processed for histology. Fibroblast and blood vessel densities per unit area of wound were determined for the healed wound samples. Histologically, the day 10 Ageratum sections showed fewer inflammatory cells compared with similar honey and Control sections. Also, healed scar sections of wounds dressed with the herb extract showed more fibrosis. Honey and Ageratum caused significant greater wound contraction than controls (p = 0.001 and 0.005 respectively). Healed wounds from the Ageratum group had significantly fewer fibroblasts than honey and controls (p = 0.012 and 0.036 respectively).

Background: The aim of this study was to examine the relationship between waist-hip ratio and the risk of breast cancer in an urban Nigerian population., Methods: Between March 1998 and August 2000, we conducted a case-control study of hospital-based breast cancer patients (n = 234) and population-based controls (n = 273) using nurse interviewers in urban Southwestern Nigeria., Results: Multivariable logistic regression showed a significant association between the highest tertile of waist-hip ratio and the risk of breast cancer (odds ratio= 2.67, 95% confidence interval = 1.05-6.80) among postmenopausal women. No association was found in premenopausal women., Conclusion: The present study, the first in an indigenous African population, supports other studies that have shown a positive association between obesity and breast cancer risk among postmenopausal women.

Bone tumours are relatively rare tumours as compared with all other tumours. The relative frequency has not been well documented in this environment. The aim of the study was to define the frequency of primary malignant bone tumours in an African University teaching hospital in Ibadan. The medical records of 114 patients with malignant bone tumours recorded in the Cancer Registry of the University College Hospital, Ibadan, Nigeria between January 1977 and December 2000 were reviewed retrospectively. Primary malignant bone tumours represented 0.53% of all the 21390 cancers seen in the teaching hospital in the period studied, with a male female ratio of 1.4:1. About 45% oftumours occurred among patients < 20 years of age. Osteogenic sarcoma was the most common primary malignant bone tumour while the mandible was the most commonly affected bone. In contrast to previous studies, Burkitt's lymphoma affected the mandible more commonly than the maxilla. The relative frequency of primary malignant bone tumours is low in our environment as observed in other developing countries.

Dementia with Lewy bodies (DLB) is the second most common neuropathologically diagnosed cause of degenerating dementia after Alzheimer's disease. We report the first autopsy-confirmed case in sub-Saharan Africa in a Nigerian patient. The case presented highlights the varied clinical presentation of DLB, and is intended to raise awareness about another possible cause of dementia in Nigerian subjects.

Burkitt's lymphoma is the commonest childhood malignancy in tropical Africa and the predisposing factors include malaria and infection with the Epstein-Barr virus. Recent studies suggest that the prevalence of this neoplasm is declining in this environment. The present study was undertaken to investigate whether there is a real decrease in the occurrence of Burkitt's lymphoma. We analysed 665 cases of childhood malignancies reported in the Ibadan Cancer Registry between 1991 and 1999. Burkitt's lymphoma and retinoblastoma remained the two commonest specific childhood malignancies, accounting for 19.4% and 17.9% of all childhood cancers, respectively. However, this represents a significant decline in the relative frequency of Burkitt's lymphoma when compared with similar surveys for the periods 1960 to 1972 and 1973 to 1990 when Burkitt's lymphoma accounted for 51.5% and 37.1%, respectively, of all childhood malignancies. In Ibadan, it seems that what appeared to be minor changes might actually be a real decline in the incidence of Burkitt's lymphoma and that it might be partly ascribed to improved living conditions and greater control of malaria.

Head injury is an important cause of mortality worldwide. The objective of the present study was to analyse the pattern of fatal head injury among patients seen in University College Hospital, Ibadan. The study was based on retrospective investigation of cases of fatal head injury referred by the coroner to the Department of Pathology, University College Hospital, between 1991 and 2000. Pertinent clinical and postmortem findings were extracted from available coroner's autopsy records. There were 529 cases (402 males and 127 females). Their ages ranged from <1 year to 90 years (mean=33 years), the average age of females (27.8) being less than that of males (34.6) (p=0.00003). 83.8% were road traffic accidents, 8.9% falls from a height, 3.8% assault, and 3% gunshot injuries. 79.1% had a GCS of 8 or less at presentation. The mean survival period of children aged less than 15 years was 2 days while that of adolescents and adults aged 15 years and above was 5.6 days (p=0.02). Subdural (62.4%), subarachnoid (24.6%), epidural (10.2%), and intracerebral (10%) haemorrhages were the major causes of death. Skull fractures occurred in 38.2%, while cerebral contusions occurred in 22.1%. Intracranial infection was relatively uncommon in these patients. The present study has shown that young adults, predominantly males in their most productive years of life, are especially prone to fatal head injury.

Vitamin A deficiency (VAD) and protein energy malnutrition (PEM), sharing common aetiological factors, are important public health problems in many developing, countries. A cross-sectional survey of the vitamin A status of 128 well nourished and 230 malnourished pre-school children was carried out in order to define factors associated with increased risks of VAD and also to determine the predictive values of CIC-T in identifying serum retinol of < 10 microg/dl in these children. The proportional morbidity rates of VAD defined by serum retinol concentrations (7.3%) and CIC-T (6.2%) was similar (p>0.05), and children aged < 3 years accounted for 70% of VAD cases. VAD occurred in 6.3% and 7.8% of well-nourished and malnourished children respectively. The risk of VAD was increased following measles, history of persistent diarrhoea and wasting. The predictive value of CIC-T is highly dependent on CIC-T such that abnormal and normal smears classification appears to be very robust and predictive of serum retinol of < 10 microg/dl, with sensitivity of 83.3% (95%CI: 61.8-94.5), and specificity of 73.3% (95%CI: 68.3-78.5). Judging by the proportional morbidity rate in this study, VAD appears to be a significant public health problem in both malnourished and well-nourished Nigerian children, especially in children < 3 years of age. The history of measles and persistent diarrhoea appear to increase the risk of VAD. The simplicity, sensitivity and specificity of CIC-T suggest that this procedure is a good screening tool for epidemiological survey of vitamin A status.

Collagenous colitis is an established cause of chronic watery diarrhoea of unknown aetiopathogenesis, characterised by normal colonic endoscopic findings, and a prominent collagen band in the sub-epithelial layer on colonic mucosal histology. We report a case of a 65-year old male who presented with recurrent episodes of watery diarrhoea of 38 years duration. There was a positive family history of similar diarrhoea in the mother and two siblings. Colonoscopy done was macroscopically unremarkable except for a redundant sigmoid colon. Mucosal biopsy of the rectum and colon showed at histology atrophy of the mucosal lining, infiltration of the lamina propria by plasma cells and lymphocytes, and a thick band of collagenous tissue in the sub-epithelial zone of the lining mucosa. A high index of suspicion is necessary to make the diagnosis in patients with chronic diarrhoea, especially when common causes of chronic diarrhoea like intestinal parasitoses, HIV/AIDS, diabetic autonomic neuropathy, thyrotoxicosis have been excluded. It is suggested that colonoscopic examination with adequate biopsy should be performed in patients with chronic diarrhoea with no aetiologic agent identified.

There is presently no uniformly accepted grading system for mucoepidermoid carcinoma, largely due to a lack of consensus as to what criteria should be used to formulate histological grades. The present study was undertaken to determine the relationship between histological grade, clinical stage and survival in these neoplasms. Clinical and histological data from 34 patients with mucoepidermoid carcinoma were reviewed. Mucoepidermoid carcinoma was most common in the parotid gland (44.1%), while 25% of patients had tumors in the minor salivary glands. Low, intermediate, and high-grade neoplasms accounted for 61.7%, 26.5%, and 11.8% of tumors, respectively. There was a general trend towards increasing clinical aggressiveness with increasing histological grade. Similarly, postoperative tumor recurrences were marginally more common in high-grade than in low-grade mucoepidermoid carcinomas. However, both of these findings were statistically insignificant, mainly due to small sample size, late clinical presentation, poor clinical follow-up, incomplete management and incomplete records. These factors explain the relatively low survival figures in the present study, as compared to higher survival figures in white patients with mucoepidermoid carcinoma.

The present study updates the experience of salivary gland tumours in Ibadan. All cases of benign and malignant salivary gland neoplasms histologically diagnosed between 1975 and 1995 in the Oral Pathology Department and Cancer Registry of the University College Hospital, Ibadan were reviewed. Salivary gland neoplasms accounted for 3.5% of head and neck neoplasms, the majority (46.5%) occurring in the parotid, followed by the submandibular (18.1%) and palatal glands (10.7%). The ratio of benign to malignant neoplasms was 1.1 to 1. Mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant neoplasms. There was a predilection of adenoid cystic carcinoma for the submandibular gland.

Breast cancer is the leading cancer in females worldwide, the vast majority being carcinomas, and only 0.2-0.3% being sarcomas. Of the mammary sarcomas, extra-osseous osteogenic sarcomas constitute a small heterogeneous group. This communication reports a case of primary extra-osseous osteogenic sarcoma occurring in the breast of a48-year-old female, and presents a literature review of this condition. A pre-requisite for the diagnosis of primary mammary osteogenic sarcoma is the exclusion of an osteogenic sarcoma arising from the underlying ribs or sternum. Like all other osteogenic sarcomas in general, these neoplasms are characterized by the direct formation of osteoid matrix by the tumour cells. Primary osteogenic sarcoma of the breast may arise from metaplastic sarcomatous transformation of neoplastic cells in a primary breast carcinoma, fibroadenoma, malignant phyllodes tumour, or may exceptionally represent a nonphyllodes sarcoma of the breast arising from the soft tissues of an otherwise normal or previously irradiated breast.

A case of endometriosis presenting to a general surgeon as a groin mass in a 22-year old lady with no abdominal or pelvic symptoms and who had previously been pregnant is reported. Though similar presentations have been reported previously, we believe this is the first case to be reported from Ibadan in this form and we wish to emphasis the importance of consideration of this diagnosis in any groin swelling in a young female as well as the necessity of having a histological examination done on all excised lumps.

Background/aims: Intussuception was a common cause of intestinal obstruction at the University College Hospital, Ibadan. A peculiar type characterized by being ceco-colic, and found most commonly in adults, was the commonest variety found, but over the last few years this type of intussusception appears to have reduced in incidence. The aim of the study is to define the relative incidence of intussusception and the contribution of the various types of the overall incidence as seen at the University College Hospital, Ibadan, Nigeria., Methodology: Review of case notes and the surgical pathology records of all cases of Intussusception seen at the University College Hospital, Ibadan between 1975 and 1994 was done., Results: There was a 48.1% decline in the absolute number of cases seen during the period of the study, and this decline was more among adult cases than infantile intussusception. The mean age of presentation of infantile intussusception was 8 months, while it was 42 years for adults. The classical triad of vomiting, pain and bloody stool was seen in only 15% of cases. Morbidity and mortality rates were high at 18 and 8.5% respectively and this was related to delayed presentation., Conclusions: The incidence of intussusception has fallen in the community studied and this decline has affected the adult age group and the ceco-colic type of intussusception more. Late presentation is a feature of most cases and is related to the high mortality and morbidity rates seen.

Retinoblastomas are primary malignant intraocular neoplasms of childhood displaying photoreceptor differentiation. The present study reviews clinicopathological features of these neoplasms in Ibadan, Nigeria. Clinical, surgical pathology, and histological material of 44 histologically verified cases of retinoblastoma indexed in the Cancer Registry, University of Ibadan were analyzed. Retinoblastomas accounted for 1.1% of all malignant neoplasms and were equally frequent in male and female children. The mean age of our patients at the time of diagnosis was 32.3 months, which exceeds a corresponding age of 16-21.5 months recorded among Caucasian children. Leukocoria was the most common clinical manifestation. Eighteen percent of our patients had bilateral neoplasms. These patients were significantly younger than those with unilateral retinoblastomas. Flexner-Wintersteiner rosettes occurred in 61% and optic nerve involvement in 78% of the cases and the sites of predilection were regional lymph nodes, scalp, jaw, brain, skull, long bones, and gum.

The histological findings in renal biopsy specimens obtained from 41 children with the nephrotic syndrome in Ibadan, Nigeria, between July, 1989 and June, 1996 are presented. The patients consisted of 26 male and 15 female children and their ages ranged from 2-13 years. The predominant histological type was membranoproliferative glomerulonephritis (MPGN) which occurred in 21 (51.2%). Membranous nephropathy and minimal change nephropathy (MCN) accounted for 4 (9.8%) patients each. The prevalence of MPGN was 33.3% in children less than 5 years of age compared with 56.2% amongst children who were > or = 5 years. All the three patients with MCN who were treated with a course of prednisolone had complete remission of the disease. It is concluded that MPGN is the predominant histological lesion seen in childhood nephrotic syndrome in Ibadan and that MCN remains an uncommon lesion. Therefore, renal biopsy is recommended as a prelude to a trial of steroid therapy in these patients since MCN (which is generally associated with steroid-responsiveness) is an uncommon finding among them.

Objective: To determine vitamin A status by conjunctival impression cytology with transfer (CIC-T) and assess its ability to predict low and deficient serum retinol concentrations., Study Design: CIC-T was performed on 128 healthy, well-nourished and 230 malnourished children aged under 6 years by a 3-5-second application of cellulose acetate paper to each bulbar conjunctiva followed by transfer of the adhered cells onto glass slides. The slides were stained with Alcian green 2GX, and smears were classified as normal, borderline normal, borderline abnormal and deficient. Corresponding serum retinol levels were determined in each subject., Results: The results showed that CIC-T is a simple procedure with a failure rate of 7.3% caused by tearing and agitation. The power of CIC-T to predict vitamin A status varied with both the CIC-T smear classification used and serum retinol concentration threshold. CIC-T smear classification as abnormal and normal appears to be the most robust and predictive of serum retinol, < 10 and > 10 < 20 micrograms/dL, respectively., Conclusion: The simplicity, sensitivity and specificity of CIC-T suggest that this procedure is a good screening tool for epidemiologic survey of vitamin A status.

A review of 7,211 endometrial biopsy reports in a University Teaching Hospital in Nigeria, over a 6 year period revealed that 90.5% of samples from 5,795 patients with infertility and 83.4% of 1,416 patients with abnormal uterine bleeding were essentially normal. The yield for tuberculosis endometritis (0.49%) and uterine corpus malignancy (0.58%) was low. Eighty percent of patients with uterine malignancy were aged 40 years and above. In an era of medical audit and scarce human and financial resources, the wisdom of routine endometrial biopsy in all women with infertility and those with abnormal uterine bleeding who are younger than 40 years, is called to question.

A study of young Nigerians aged 30 years and below with invasive and in-situ cervical carcinoma confirms the notion that cervical cancer occurs in all age group. All patients except one were married while all were parous. Forty four percent of the patients presented with stages III and IV disease and hence, were unsuitable for surgery. The youngest patient was aged 17 years, indicating the need tare cancer screening among adolescents and a vigorous family planning programme that emphasizes barrier contraception.

The relative rarity of pharyngeal lipomas and paucity of clinical manifestations in the early stages of tumour growth conspire to task the diagnostic acumen of the clinician. A high index of suspicion and meticulous examination are essential in order to arrive at the diagnosis, which may be achieved pre-operatively by computerized axial tomography, revealing a mass lesion with a characteristic low attenuation value. A case of pharyngeal chondrolipoma in a 25-year-old male is reported. It is suggested that this conceptually intriguing and rarely encountered lesion can be explained on the basis of neoplastic transformation of the second to fourth pharyngeal cleft mesenchymal rests displaying both adipose and cartilaginous differentiation. Alternatively, the cartilage could represent vestigial remnants of non-neoplastic pharyngeal cleft tissue entrapped within a primarily lipomatous neoplasm. Slow growth may occur over a period of several years, prior to overt clinical manifestation.

This was a retrospective analysis of 177 histologically confirmed cases of oesophageal carcinoma seen in the University College Hospital, Ibadan, Nigeria over a period of 30 years. Oesophageal carcinoma constituted 0.6 per cent of all malignant neoplasms and 1.4 cases per 1000 surgical biopsies during the study period. Dysphagia and weight loss were the most common clinical manifestations. Ninety three patients presented within one year of onset of clinical symptoms. The peak age incidence occurred in the seventh decade of life. Sex distribution was equal. The middle third of the oesophagus was the most common location of the neoplasm and the vast majority (94.5%) were squamous cell carcinomas. Achalasia of the cardia and Barrett's oesophagus were not associated with oesophageal carcinoma in this study. Regional lymph nodes and lungs were the most common sites of metastasis. Surgical complications included mediastinitis and bronchopneumonia, both occurring within seven days postoperatively. Late clinical presentation and high postoperative mortality are responsible for the persistently poor prognosis of oesophageal carcinoma despite significant advances in the diagnosis and management of these neoplasms.

Purpose and Methods: To describe the clinical and histopathologic features of a patient with viral retinitis secondary to subacute sclerosing panencephalitis., Results: The patient was a human immunodeficiency virus-negative intravenous drug abuser with an acute retinitis that later progressed to encephalitis despite aggressive treatment for possible viral, protozoal, bacterial, and rickettsial infections. The patient had many of the characteristic findings of subacute sclerosing panencephalitis, including a history of measles in early childhood, myoclonus, periodic complexes on electroencephalographic testing, persistently elevated serum and cerebrospinal fluid antimeasles immunoglobulin G (IgG) titers, and a cerebrospinal fluid oligoclonal IgG gammopathy. Ultrastructural examination demonstrated numerous filamentous microtubular intranuclear viral inclusions in the nuclear layers of the retina consistent with the measles virus. This case is unusual in that our patient developed subacute sclerosing panencephalitis later in life and because there was an 8-year period between presumed viral infections in the two eyes., Conclusions: An acute retinitis in an intravenous drug abuser is not always caused by human immunodeficiency virus-related infections; not all viral retinitis responds to therapy; and mortality as well as the usual morbidity may be associated with viral retinitis. One might consider the diagnosis of subacute sclerosing panencephalitis in a young person with an acute retinitis with little or no vitreal inflammation and lack of response to anticytomegalovirus and antitoxoplasmosis therapy.

Cervicovaginitis emphysematous is a rare self-limiting disease in which multiple gas-filled cysts are present in the submucosa of the upper vagina and ectocervix. We report a case in a 40 year-old trader who presented with clinical features suggestive of carcinoma of the cervix. It is hoped that this case report will heighten the awareness of clinicians and pathologists in the recognition of this unusual condition.

The present study reviews 876 consecutive coroner's autopsies performed in the Department of Pathology, University College Hospital, Ibadan over a two-year period (1 February 1991 to 31 January 1993). The hospital autopsy rate during the study period was 36.2%, and 62.5 per cent of these post-mortems were medico-legal cases. The most common indications for coroner's autopsies were sudden natural deaths (55.6%), followed by accidental deaths (35.3%). The proportions of maternal (4.3%), homicidal (3.1%) and suicidal (0.3%) deaths were much lower. The male to female ratio was 1.7 to 1. Ninety-one (10.4%) of the cases fell within the paediatric age group and the peak age incidence for these cases was in the 5-14 years age group. The remaining 785 (89.6%) cases were adults and the peak age incidence for these cases was in the fourth decade of life. The most common cause of sudden natural death was cardiovascular disease, of which hypertension constituted the majority of cases. Other major causes of sudden death included pneumonia, meningitis, typhoid fever and neoplastic diseases. Road traffic accidents accounted for 78 per cent of accidental deaths followed by falls (13.3%) and burns (4.6%). Abortions, post-partum haemorrhage and eclampsia were the major causes of maternal deaths in the present study. Homicidal deaths were eight times more frequent in male than female victims and the commonest mode of death was gunshot injuries. Suicidal deaths remain extremely uncommon in African patients, as confirmed by our study.

Neurological manifestations occur in about one-quarter of patients with chronic myelogenous leukaemia (CML), usually as a result of hyperleukocytosis, predisposing to intravascular thrombus formation. We report the clinical and pathological findings in a 16-year-old female with CML who presented with deafness, blindness and paraplegia, and discuss possible aetiopathogenetic mechanism.

Childhood neoplasms provide a fertile field for epidemiological research and afford a unique opportunity for studying possible mechanisms of carcinogenesis. The present study reviews 1881 malignant childhood neoplasms in children less than 15 years of age seen in the University College Hospital, Ibadan during an 18-year period. The male-to-female ratio was 1.4:1 and modal age of occurrence was 10 years. The most common childhood neoplasms were lymphomas (45.4%), retinoblastomas (9.7%), and malignant renal neoplasms (8.5%). Burkitt's lymphoma constituted 92% of all lymphomas and 37% of all childhood tumors. Comparison of two clinicopathological studies of childhood cancer in Ibadan between 1960-1972 and 1973-1990 revealed a dramatic upsurge in the relative frequencies of intracranial neoplasms, leukemias, renal neoplasms, and retinoblastomas, with a decline in the relative frequencies of bone neoplasms and Burkitt's lymphoma during the latter period. Whether these changes reflect actual changes in the distribution of childhood cancer in the local population will require further study.

This is the first reported case of rhinosporidiosis in Ibadan, Nigeria. A review of literature shows that the patient came from northern Nigeria where the first case was reported in the country. The organism is difficult to culture and the diagnosis was based on microscopy and histological examination of the polyp. We present the case of recurrent rhinosporidiosis in a 16 year old girl a year after polypectomy in Zaria, northern Nigeria.

Purpose: Colorectal malignancies are less common in developing than developed nations because of lower per capita income and higher dietary fiber consumption. This clinicopathologic study attempts to determine changes in the pattern of these neoplasms in Ibadan, Nigeria, during the last two decades., Methods: The present study is based on the clinical Cancer Registry records and gross and morphologic surgical pathology findings of 526 patients with histologically verified malignant colorectal neoplasms received in the Department of Pathology, University College Hospital, Ibadan, between 1971 and 1990., Results: Colonic malignancies increased by 81 percent, whereas rectal malignancies decreased 16.1 percent in frequency (P < 0.05). The modal ages were 55 to 60 years and 45 to 50 years for colonic and rectal neoplasms, respectively, in contrast to reported peak occurrence in the seventh decade among Caucasians. Colonic neoplasms were predominantly right-sided (34.3 percent cecal), abdominal mass and pain being major clinical manifestations. This differs from the pattern in American Negroes, among whom colonic carcinomas are predominantly left-sided, dyschezia being an important presentation. As in most other studies, adenocarcinomas were the predominant neoplasms., Conclusions: Further work is required to determine prognostically significant features of colorectal cancer in our environment.

Prostatic tumours accounted for 10.2% of all surgical specimens from male patients received in the Department of Anatomic Pathology of the University of Benin Teaching Hospital, Nigeria between 1973 and 1990. Nodular prostatic hyperplasia accounted for 83% of the cases and the peak age incidence was in the sixth decade of life. Prostatic cancer occurred in the remaining 17% of the cases and the peak age incidence for occurrence was in the seventh decade of life. The commonest malignant neoplasms encountered were adenocarcinomas, out of which 64% were-well 27% moderately-and 9% poorly-differentiated. Sixty-one adenocarcinomas were classified as cases of incidental carcinoma of the prostate. Rare histological variants of prostatic cancer encountered in the present study included a case each of mucinous carcinoma, transitional cell carcinoma and rhabdomyosarcoma.

A fatal case of paraquat poisoning in an adolescent girl is reported. Death resulted from respiratory failure because of extensive interstitial and intra-alveolar fibrosis.

Cryptococcal meningitis is an uncommon infection globally, including Nigeria. This systemic fungal infection often is associated with immunodeficiency. The most common causes of meningitis in Nigeria in the 2-3 year age group are the malaria parasites and bacteria. The concomitant infections of Cryptococcal neoformans and Plasmodium falciparum are uncommon. We present here the report of a case of fatal cryptococcal meningitis with malaria infection in a 2 year old child from Nigeria (one of the malaria endemic regions of the world). This case emphasizes the importance of doing a combination of fungal and bacterial cultures as well as looking for malarial parasites in the determination of etiological agents of meningitis in any hospital in Africa. We suggest that cerebrospinal fluid from meningitis cases must be cultured using Sabouraud dextrose agar and any growth on the agar must be examined using Indian ink.

This study reviews the clinicopathological features and survival of 18 Nigerian women with simultaneous bilateral breast cancer. Twelve (67%) of these patients had bilateral Burkitt's lymphoma of the breast. The average age of these patients was 22 years, and all of the women were pregnant or lactating at the time of initial clinical presentation. The remaining six patients (33%) had bilateral malignant epithelial neoplasms, with lobular carcinoma being present in four cases. The average age of patients with bilateral malignant epithelial tumors was 37 years. None of the 18 patients with simultaneous bilateral breast cancer survived for up to 2 years after diagnosis, indicating that bilateral synchronous breast cancer in Nigerian women is a rapidly progressive and aggressive disease.

Teratomas accounted for 3.4 cases per 1,000 surgical biopsies received in the Pathology Department of UCH Ibadan, between 1960 and 1985. The commonest site of teratomas was in the ovaries which accounted for 83.2% of the cases, followed by the sacrococcygeal region which accounted for a further 6.3%. Other sites of occurrence included the neck, testes, mediastinum, abdominal cavity and buccal cavity in descending order of frequency. Rare sites of occurrence were extracranial, intracranial, uterine cervix and intraocular regions. There was a female to male ratio of 18 to 1 and the average age of the patients was 25.8 years. Sixty per cent of ovarian and mediastinal teratomas contained hair and sebaceous material permitting their gross identification. Eighty-eight per cent of the teratomas reviewed histologically were classified as mature, a further 8% were immature, and 4% were malignant.