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Summary:The present autopsy study has revealed that infection, contributing to 47 percent of the deaths, was the leading cause of child hood mortality from early neonatal period through school age period, with the highest incidence of 40 percent in the pre-school age period. The six leading infections, in descending order of frequency included pneumonia, meningitis, tuber culosis, measles, malaria and neonatal tetanus. Other common causes of mortality in the series included asphyxia in 11.0 percent, congenital malformations in 10.4 percent and malignancies in 8.7 percent of the total deaths. While preventable conditions generally, including infections, birth asphyxia, malnutrition, birth injuries and accidents accounted for 66.4 percent of the deaths, neonatal problems of asphyxia, birth injury and low birthweight contributed to 18.0 percent of the mortality. On the basis of the present findings, it is suggested that in order to reduce childhood mortality to acceptably low levels, improvement in obstetric and perinatal services in our institution should be undertaken. Furthermore, health education to parents, immunizations and economic improvement of parental status, should he carried out to prevent infections, malnutrition and accidents.

Summary:. Clinical and pathological features in 23 children who developed acute renal failure from what was subsequently proven to be diethylene glycol poisoning are presented. Symptoms of cases included anuria, fever, diarrhoea and vomiting. Eighteen (78.3%) had hepatomegaly, 11 (47.8%) had evidence of respiratory dis tress and 7 (30.4%) had acidotic breathing. Seven (30.4%) of the children were dehydrated on physical examination. Alteration in the level of consciousness was observed in 13 (56.5%) children. The major biochemical abnormalities were acidosis and elevated blood urea nitrogen. Although serum bilirubin was normal in those in whom it was determined, the liver enzymes were elevated in the 2 patients in whom they were determined. Patients were treated as for acute renal failure of renal origin and four children had peritoneal dialysis. Twenty-two (95.6%) of the patients died and outcome was unknown in the remaining patient who was dis charged against medical advice. Autopsies in 7 patients revealed a characteristic nephrotoxic acute tubular necrosis and centrilo bular hepatic necrosis characterized by vacuolar and ballooning degeneration of the metabolically active renal tubular cells and hepatocytes.

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.

Objective: To determine the pattern of histopathological variants of intracranial neoplasms, relative distribution of the variants in the age groups and also to determine the gender differences that exist in these tumours., Design: Case control study., Setting: Department of Pathology, University College Hospital, Ibadan, Nigeria., Patients: Two hundred and ten histologically confirmed cases of intracranial neoplasms seen during eleven-year period (1980 to 1990) were analysed., Interventions: Slides of tumours stained with haematoxylin and eosin, reticulin and phosphotungstic acid haematoxylin., Results: Two hundred and ten intracronial neoplasms comprising 172 primary and 48 secondary neoplasms were seen. One hundred and thirty five neoplasms occurred in adults and 75 in children. There was no gender difference, the ratio being 1:1. Gliomas accounted for the largest group of tumours followed by metastases to the brain. Of the gliomas, astrocytoma was the commonest. Craniopharyngiomas were found to be common in children. Germ cell tumours were found to be uncommon., Conclusion: Gliomas are the commonest group of intracranial neoplasms in both adults and children. This is followed by metastatic tumours. Tumours of the sella turcica are predominantly found in children. Involvement of the brain in disseminated Burkitt's lymphomas is predominantly found in Africans as the Burkitt's tumour is uncommon in non Africans.

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.

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.

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.

Histological slides of seventy four patients with testicular malignancy found in the records of the cancer registry, University College Hospital, Ibadan over a thirty-five year period (1960-1994) were reviewed. Three (4%) cases occurred in undescended testes. Overall, eighteen (24.3%) patients were found to have seminomas. All the tumours seen in undescended testes (100%) were seminomas while about seventeen percent of seminomas were seen in undescended testes. There was a statistically significant difference between the mean ages of those with seminomas (37.6 years) and those with non-seminomatous testicular cancers (30.3 years); t = 1.69; p < 0.05. The numbers seen corroborate the fact that testicular cancers are not very common in this environment. The incidence of undescended testes is not established in this environment either. However, it seems that 100% of tumours arising in undescended testes are seminomas. It is recommended that abdominal testes seen after puberty should be removed and older patients presenting with abdominal masses should have a differential diagnosis of testicular cancer entertained.

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.

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.

This study reviews the influence of different clinicopathological features of retinoblastoma on outcome and prognosis in 44 Nigerian patients. Twenty-five of the patients had a fatal outcome. These patients were younger and more frequently had bilateral retinoblastomas, orbital tumour recurrence and tumour metastases, compared to patients who had disease free survival. Postoperative tumour recurrence occurred in eleven patients and was commoner in patient who had tumour metastases. Tumour metastases occurred in eighteen of the patients. Though there has been an improvement in the prognosis of retinoblastoma at Ibadan with the advent of radiotherapy, the outlook for children with this neoplasm in this environment is still bleak in comparison with what obtains in developed countries.

The postmortem findings in 672 Nigerian children with lethal congenital malformations are reviewed. Eighty-six percent of the patients were less than 1 year of age and the male-to-female sex ratio was 1.3:1. The alimentary tract was the most common anatomic site involved (30%), intestinal and biliary atresia being the two lesions most frequently identified in this location. Twenty-six percent of the children had cardiovascular malformations, of which ventricular septal defect, patent ductus arteriosus, and tetralogy of Fallot were most important. There was an accentuated male predominance among cases with urogenital malformations due to the high frequency of posterior urethral valve. Hydrocephalus, spina bifida, and anencephaly were the most common lesions observed in the craniospinal axis. One-fifth of the children had complex malformations of multiple organ systems, 20% of which were associated with chromosomal anomalies, rubella, and other malformation syndromes.

Childhood teratomas are uncommon neoplasms worldwide. They are nonetheless important because their exact histogenesis has not yet been resolved. The weight of the evidence points to a germ cell origin for these neoplasms. Eighteen percent of 407 teratomas reviewed in the Department of Pathology, University College Hospital, Ibadan, Nigeria, between 1960 and 1985 occurred in children up to 15 years of age. There was a bimodal peak age incidence among these children, the first being due to sacrococcygeal and the second to ovarian teratomas. The female to male ratio was 5:1. The two most common sites of occurrence were the sacrococcygeal region and the ovaries. Eighty-one percent of all childhood teratomas were mature, 15% were immature, and 4% were malignant. Both malignant neoplasms arose in the sacrococcygeal region and occurred in patients relatively older than those with benign sacrococcygeal teratomas. These two malignant teratomas contained yolk sac elements.

We report two cases of the rare occurrence of prostatic epithelium in ovarian teratomas with associated transitional epithelium in one of the cases. This association of prostatic tissue with urothelium tends to reinforce the well-established embryogenetic derivation of the prostate from the urogenital sinus. Local hormonal events may influence the formation of prostatic tissue from female urothelium. The histologic and immunohistological differences between adult prostate as seen in our cases and female paraurethral (Skene's) glands are discussed.

This study reports the findings of a ten year review of autopsy records at the University College Hospital, Ibadan, Nigeria of patients who died of malignant tumour metastases to the lungs and pleurae. During the study period 1977 to 1986, a total of 3,549 autopsies were performed out of which 339 cases 10.5 pc died of malignant tumours. One hundred and thirteen of these tumours (33.3 pc) metastasised to the lungs and pleurae among other sites. Further analysis of these 113 patients showed that 49 were male and 64 females giving a male:female ratio of 1:1,3. In addition, the ages of the patients ranged between 9 months and 90 years with a mean of 38.3 years. The uterus was the commonest organ from which pulmonary metastases occurred (28.3 pc), with choriocarcinoma being the predominant historical type of uterine tumour. The liver was the next most common organ 26.5 pc with male to female ration of 3:3,1. Twenty other organs were also identified, the breast, kidney and oesophagus 7 pc each; pancreas ovary and thyroid 3 pc each being the most important. Other organs are adrenals, foot, neck, cervix and rectum--2 pc each.

The management of Nigerian patients with cutaneous T-cell lymphoma (CTCL) is beset with various problems which are presented in this study. These problems include dearth of specialists medical personnel, shortage of radiotherapy facilities, high cost of chemotherapy drugs which an average patient cannot afford to buy. Cases of eight patients seen and managed over a 21 years period (1968-1989) were analysed. However, many CTCL cases might have been missed since we have acute shortage of medical specialists to carry out accurate diagnosis of this disease in Nigeria. The patients reviewed, received radiotherapy, and cytotoxic chemotherapy. Radiotherapy was found to be the optimum treatment for patients with stages I and II CTCL, who in this study had recurrence free periods of 30 to 60 months post radiotherapy. The authors recommend systemic cytotoxic chemotherapy and local radiotherapy for patients with late stages of CTCL as mainstay of treatment.

Two cases of primary liver cell carcinoma simulating extra-hepatic biliary obstruction are presented. In order to avoid false diagnosis and preventable laparotomy, it is suggested that peritoneoscopy and target liver biopsy should be preferred to blind liver biopsy in the investigation of biliary obstruction.

We report the case of a 5-year-old Nigerian boy in whom conus medullaris and cauda enquina compression was due to an intradural lipoma, a rare tumour of the spinal canal in the tropics. The literature on the subject is briefly reviewed and the differential diagnoses are discussed. The occurrence of the lesion in this child, without other features of spinal dysraphism, is noteworthy.

Nasopharyngeal cancer, once considered to be non-existent or rare in the African, is now accepted as being far from uncommon. Experience of this disease in Nigeria over a 15-year period is presented. As elsewhere there is a preponderance of males over females, but the peak age of incidence is lower than that observed in the Western world. Cancers of epithelial origin predominate. The commonest early sign of the disease is upper deep cervical adenopathy usually, but not always, with nasal and/or aural symptoms. Cranial nerve involvement has been observed early in about 30% of cases and occasionally this may be the only symptom or sign at first presentation and so may require a high index of suspicion to discover its origin. Viral, environmental and other possible etiological factors are considered. Delay in seeking or being referred for hospital treatment is common, and patients often present at such an advanced stage that only palliation can be offered. The cure and survival rates, not surprisingly, are low. Increasing awareness of the prevalence of the disease at all ages and alertness in recognizing its various presenting features are essential, as are early diagnosis and improved facilities for treatment. Elimination of suspected environmental and other controllable etiologies, and efforts to provide immunization against the viruses concerned are needed to help in reducing the incidence of the disease.

A 27-year-old promiscuous male who denied homosexuality, intravenous drug abuse or having received blood transfusions, had disseminated Kaposi sarcoma. The aggressive nature of the tumor in a young man with the Acquired Immune Deficiency Syndrome (AIDS) presenting as lymphogranuloma venereum (LGV) is highlighted. The relation of the HTLV III virus to a diffuse membranoproliferative glomerulonephritis with sclerosis and associated hyaline degenerative changes in the juxtaglomerular apparatus are discussed.

Analysis of 89 intracranial tumors in children presenting at the University College Hospital, Ibadan, Nigeria, between 1960 and 1982 is reported. These tumors are commonest in the first decade of life and occur more in males than in females. Fifty-three per cent of the primary brain tumors are supratentorial. The commonest sites are cerebellum, cerebrum, and the pons. The common histological types are astrocytomas, medulloblastomas, ependymomas, and oligodendrogliomas. Craniopharyngiomas are among the most frequent supratentorial neoplasms in Ibadan children and the central nervous system involvement in cases of Burkitt's lymphoma is a frequent complication.

In a 16-year study of 703 cases of female breast carcinomas seen at the University College Hospital, Ibadan, Nigeria, seven cases were found in pregnant women and another seven cases in lactating women. Thus, pregnancy and lactation complicated breast carcinoma about two times per 100 female breast carcinomas. During the same period there were 51,058 deliveries, for a rate of three breast carcinomas per 10,000 deliveries. When women in the most active reproductive age group (20-40 years) were considered, there were 309 cases of female breast carcinomas. Therefore, 5% of women with breast carcinoma in this age group had concurrent pregnancy or lactation. The patients presented late, and the prognosis was generally poor. While the clinical features of inflammatory carcinoma are similar in most countries, the characteristics of some of the histologic types of breast neoplasia encountered in pregnancy and lactation in Nigerian women appear to differ from those reported in most European and American studies.

The case of an aggressive and malignant ameloblastoma of the maxilla in a 22-year-old Nigerian man has been presented. The features that may lead to the development and diagnosis of malignancy in this type of tumor are briefly described and discussed. The relatively young age of this patient, especially in an environment in which medical advice is sought very late, is noteworthy.

Male breast cancer accounts for 0.4% of all male neoplasia in Ibadan, and about 3.4% of all breast cancers in both females and males. The clinical features often presented include mass in breast, skin involvement by fixation and ulceration, sanguinous and serous discharge from the nipple. Symptoms are often delayed, the longest duration in the current series being 36 months. Geographical comparison of the histological types of male breast cancer appears to show that, while papillary carcinoma is commoner in Nigerian than in American and Danish males, on the other hand, infiltrating duct carcinoma appears much more common in the latter than in the former male races. Invasive lobular carcinoma occurs more in Nigerian than in American and Danish males. Mucinous carcinoma, on the other hand, appears much more common in the Danish than in the Nigerian and American males. In all the compared races, prognosis in male breast cancer appears to depend on the age at onset of the disease, the histological type, and presence or absence of lymph node metastases. In Nigerian males mucinous carcinoma appears to offer an excellent prognosis compared with papillary carcinoma, which has better prognostic features in American male patients.

The clinical, operative, and pathological findings associated with a huge extracranial teratoma in a Nigerian neonate are described. Especially noteworthy are the site and size of the tumor, the surgical treatment and the good prognosis. The child has remained well and developed normally 4 years after surgery.

The case is described of an eight-year-old Nigerian boy who died from olfactory neuroblastoma which presented with nasal obstruction and epistaxis. Autopsy showed intracranial extension of the tumour into the frontal lobe, and histology revealed undifferentiated neuroblasts, forming rosettes in some areas and producing tangled neurofibrils in others. The histogenesis of the tumour and its diagnosis are briefly discussed.

During a 2 year-period 12 Nigerians with sarcoidosis were diagnosed at the chest and dermatology clinics of the University College Hospital, Ibadan, Nigeria. Intrathoracic involvement was the commonest presentation followed by the skin, lymph nodes and liver. Histological diagnosis was obtained in all cases either from skin biopsy, transbronchial lung biopsy, lymph node or liver biopsy where applicable. This study suggests that sarcoidosis is not as rare as previous literature on the subject portrays.