Benign Lipomatous Soft Tissue Tumors in Nigerians: An Analysis of the Clinical and Morphological Features of a Common but Important Entity

Introduction Benign lipomatous tumors are soft tissue tumors that exhibit a predominant adipocytic phenotype. Lipomas are the archetype and are the most common benign soft tissue tumors in adults but relatively uncommon in children. Their sex incidence is equivocal. They sometimes occur in combination with other mesenchymal elements, giving rise to variants including fibrolipoma, angiolipoma, myolipoma, spindle cell lipoma, chondroid lipoma, osteolipoma, and chondrolipoma. Their clinical significance is mainly due to the cosmetic disfigurement of patients and the differential diagnosis of malignant soft tissue tumors. Occasionally, due to their large size or presence near vital organs, they may cause life-threatening and/or excruciating pressure symptoms. This study was purposed to address the dearth of local studies on the clinical and morphological characteristics of benign lipomatous tumors in Nigerians, to compare these with those of other populations, and to establish baseline data. Materials and methods This was a retrospective study of all benign lipomatous tumors seen in the anatomic pathology and forensic medicine department of Asokoro District Hospital, Abuja, Federal Capital Territory, Nigeria, over an eight-year period. Surgical pathology reports were retrieved for patients' biodata and clinical information. The appropriate slides were retrieved, and reviewed, and new sections were cut where necessary. The tumors were classified according to the 2020 World Health Organization (WHO) guidelines and categorized based on size as small, medium, or giant. The data obtained were analyzed, and the results were presented as tables, bar charts, ratios, and percentages. Results Four hundred and eighteen cases met the inclusion criteria. Of these, 58.4% (244/418), occurred in females, while 41.6% (174/418) occurred in males. The age range was six to 91 years, while the median age was 42 years. The least number of cases, 0.5% (2/418), were seen in patients aged less than 10 years, while the majority, 35.4% (148/418), occurred in the fifth decade, followed by 27.8% (116/418) in the fourth. Size-wise, the majority of tumors, 60% (253/418), were medium, followed by small, 22.8% (95/418). Giant-sized tumors significantly accounted for 16.7% (70/418) of the cases. The diagnostic spectrum comprised conventional lipoma and variants such as fibrolipoma, spindle cell lipoma, pleomorphic lipoma, angiolipoma, chondrolipoma, intramuscular lipoma, and osteolipoma. Lipoma and fibrolipoma dominated with 87.1% (364/418) and 10.0% (42/418), respectively, while the rest accounted for <3%. The majority, 31.8% (133/418), occurred in the back/shoulder region, followed by the lower limb with 18.2% (76/418). Only two cases occurred in the abdominal/pelvic region. More tumors occurred in females in all the regions except the head and neck, which had a male-to-female ratio of 1.5:1. Multiple site tumors were more common in males in a ratio of 2.5:1. Most, 41.1% (39/95), of the small-sized tumors, occurred in the head/neck region, largely involving the face, 48.7% (19/39). Conclusion Our study showed many similarities in the clinical and morphological features of benign lipomatous tumors between Nigerians and other regions of the world. A notable finding, however, was the significantly higher proportion of giant benign lipomatous tumors when compared to studies from other regions, a finding that warrants further studies.

Cysticercosis Mimicking Fibroadenoma of the Breast in a Young Female: A Case Report From North Central Nigeria

The parasitic infestation, cysticercosis, arises when humans are infested with the larvae (cysticerci) of the pork tapeworm, Taenia solium (T. solium). Epidemiologically, cysticercosis presents a worldwide distribution due in part to endemicity in developing countries in Latin America, Asia, and sub-Saharan Africa, and increased migration from these countries to more developed countries in Europe and North America. Cysticercosis may be asymptomatic or may manifest clinical symptoms and signs depending on which part of the body cysticerci are found, including skeletal and heart muscle, skin, subcutaneous tissues, the lungs, liver, the central nervous system (CNS), and less commonly, the oral mucosa and breast. We report a case of a mass in the left breast in an 11-year-old Nigerian girl, which was diagnosed clinically and on ultrasonography as fibroadenoma but was confirmed on histology to be cysticercosis. Cysticercosis should be included in the differential diagnoses of breast lumps in persons of all ages and sex, especially in endemic areas and in places with significant immigration from endemic areas.

Demographic and Diagnostic Spectrum of Neurosurgical Biopsies: Initial Experience From a Re-established Neurosurgical Unit in a Tertiary Hospital in North Central Nigeria

Introduction Neurosurgical biopsies are obtained from lesions of the central nervous system, comprising the skull, brain, spine, spinal cord, and nerves. Neurosurgery practice is a highly specialized field with wide disparities related to access to care, especially in developing countries where there are few specialists and poor support care for patients. After over 20 years of redundancy, the neurosurgical unit in Jos University Teaching Hospital (JUTH), Jos, Plateau State, Nigeria, was re-established to meet the needs of patients in the area of neurosurgery. The aim of the study is to document the demographic and diagnostic spectrum of neurosurgical biopsies obtained in JUTH in the first five years of the re-establishment of its neurosurgical unit, highlighting the need for inclusion of neurosurgical services in health planning and resource allocation; and to compare these findings to similar studies elsewhere. Materials and methods This was a retrospective, descriptive, hospital-based study of neurosurgical lesions diagnosed in the Department of Histopathology at JUTH between January 2011 and December 2015. One hundred and forty-five lesions met the inclusion criteria out of 151 in the records and were studied. Archival slides of these neurosurgical biopsies were retrieved, and fresh sections were re-cut and stained with hematoxylin and eosin (H&E) where necessary. The diagnoses of some of the neoplastic lesions were confirmed by immunohistochemistry. The data obtained was analyzed, and the results are presented as tables, bar charts, ratios, and percentages. Results Thirty-one different lesions were diagnosed. The lesions most commonly diagnosed were traumatic/degenerative intervertebral disc, 54/145 (37.2%); neoplastic, 48/145 (33.1%); and congenital, 31/145 (21.4%), while inflammatory/infectious, 9/145 (6.2%); and vascular, 3 (2.0%) lesions were the least. Bimodal peak frequencies involving the 0-14 years and 30-44 years age ranges were noted for the neoplastic lesions, occurring 37.5% (18/48) in the 0-14 years and 25% (12/48) in the 30-44 years, respectively. The 31 congenital anomalies diagnosed were all neural tube defects, and of these, occipital encephalocele, 10/31 (32.3%) and myelomeningocele, 9/31 (29.0%) were diagnosed most frequently. Of the neoplastic lesions, 66.7% (32/48) were benign and low-grade, and 33.3% (16) were malignant. Meningioma, 14/32 (43.8%), was the most common benign and low-grade neoplasm and accounted for 29.1% (14/48) of all neoplastic lesions. Astrocytoma (WHO grades I, II), 25% (8/32), was the next most common benign and low-grade neoplasm and accounted for 16.7% (8/48) overall. Astrocytoma (WHO grades III, IV), 8/16 (50%), was the most common malignant neoplasm and accounted for 16.7% (8/48) overall. Overall, neuroepithelial tumors, both benign and low-grade, and malignant, 43.8% (21/48), were the commonest neoplastic lesions. Most neoplastic lesions occurred in the brain, 75% (32/48), followed by the spine, 10.4% (5/48), and skull, 8.3% (4/48); while the least common was the spinal cord, 2.1% (1/48). The sex distribution of the neoplastic lesions showed almost equal frequency between males and females, 23/48 (47.9%) and 25/48 (52.1%). Conclusion The spectrum of neurological lesions highlighted in this study demonstrates that neurosurgical lesions abound in our environment with a similar prevalence to other regions of the world, and therefore speaks to the need for neurosurgical services.

Biopsy-Proven Melanosis Coli Initially Diagnosed As Candidiasis on Colonoscopy: A Report of Two Cases From North Central Nigeria

Melanosis coli is a benign condition, often identified as an incidental finding during colonoscopy, characterized by brown or black pigmentation of the colonic mucosa due to lipofuscin deposition within the cytoplasm of cells. It has been linked to the excessive use of laxatives, particularly those that are anthraquinone-based but also stimulant laxatives and herbal remedies. White patches on colonoscopy in this condition are an extremely rare finding. We present two cases of 31- and 38-year-old, male Nigerians, with a history of chronic constipation and prolonged stimulant laxative use in whom colonoscopy findings of white patches on the colonic mucosa were confirmed on histology to be melanosis coli. Melanosis coli should be considered in the differential diagnosis of patients with chronic constipation and/or prolonged use of laxatives or herbal remedies who exhibit mucosal changes on colonoscopy even if these changes are not black or brown discolorations.

Presentation and Management Outcomes of Goitres at a District Hospital in Abuja, North Central Nigeria: A 15-Year-Review

BACKGROUND

The clinical and pathologic spectrums of goitres are wide. Even though Nigeria's Federal Capital Territory is within the geographic goitre bed, there is a paucity of thyroidrelated data from this region. The objective of this study was to determine the clinical presentation, management and outcomes of patients with goitre operated-on at the Department of Surgery, Asokoro District Hospital, in Abuja, Nigeria.

METHODOLOGY

This is a retrospective study involving patients managed between January 2001 and December 2015. Data were extracted from patients' medical records, operation registers, and histopathology records. Variables were; age, sex, diagnosis, types of operation performed, post-operative complications and histological findings. All patients had general anaesthesia via cuffed endotracheal intubation and the surgical technique used was skin crease transverse collar stud incision.

RESULTS

One hundred and thirty four (134) patients were involved in the study: 124(92.5%) were females and 10(7.5%) males. Mean age was 38years±11.0SD. Seventy-seven (57.5%) patients had simple multi-nodular goitre, followed by simple left nodular goitre 20(14.9%) and simple right nodular goitre 17(12.7%). One hundred and twenty-one (90.5%) patients did not have any complications. On histologic examination, most of the lesions were multinodular goitres 60(44.8%), followed by simple nodular goitres, 23(17.2%). Follicular adenoma was the commonest neoplastic variant accounting for 12(9.1%) cases.

CONCLUSION

The pattern of goitres in Abuja simulates that from other parts of Nigeria and many other African countries though with fewer malignancies in the present study. The management and outcome of goitres in Asokoro District Hospital Abuja is comparable to those obtained from other centres in Nigeria. Pre-and postoperative complications were also minimal.

ADVANCED, RECURRENT, INVASIVE CRIBIFORM CARCINOMA OF THE BREAST IN A 17-YEAR-OLD MALE: A CASE REPORT

INTRODUCTION

Male breast cancers (MBC) are relatively rare, accounting for about 1% of all male cancers in the US and 0.6% of breast cancers worldwide. In Nigeria, though the incidence varies per region, with a range of 3.4 to 9%, it is noted to be increasing. Gynaecomastia is a well-documented predisposing factor as well as endogenous and exogenous oestrogen. The most common histological subtype of male breast cancer is the invasive ductal carcinoma. Invasive cribriform carcinoma, ICC, is an extremely rare variant, with no more than 10 cases reported worldwide and, when present, has been diagnosed in patients above 40 years old.

CASE REPORT

We present the case of a 17 year-old, male undergraduate student, who presented to our clinic on account of a recurrent, painless, right breast lump. Three years earlier he had had a right breast lump excised at another health facilityand this was diagnosed histopathologicallyas invasive cribriform carcinoma. The only known predisposing factor was an initial lump, excised when he was 10 years old, and diagnosed histologically as gynaecomastia.He had surgical excision and axillary lymph node clearance,and histopathology re-confirmed high grade invasive cribriform carcinoma with multiple lymph node metastases, while immunohistochemistry showed a triple negative signature. He was thereafter referred for adjuvant treatment and has responded well to radiotherapy.

CONCLUSION

There is need for a high index of suspicion in all cases of gynaecomastia, and all such patients should be followed up. Prompt intervention, recourse to histology, and where indicated, immunohistochemistry, are important.

Biopsy-proven renal disease in Ile-Ife, Nigeria: A histopathologic review

Although various patterns of renal diseases have been reported from different renal biopsy registries worldwide, data from Nigeria remain scanty. A 10-year retrospective review of renal biopsies was conducted in our tertiary health care facility. All cases were reclassified based on their light microscopic features after the application of standard histochemical stains. A total of 165 cases were reviewed with a male:female ratio of 1.8:1 and a mean age of 15.4 ± 12.0 years. About 69.7% of the cases were below the age of 16 years, while only 2.4% were older than 50 years. The most common indications for biopsy were nephrotic syndrome (72.1%) and acute renal failure of unknown etiology (11.5%). Overall, glomerulonephritis (80%) was the most common histologic category and occurred only in individuals younger than 50 years old. Minimal change disease (22.9%) and membranoproliferative glomerulonephritis (21.9%) were the most common varieties in children, while membranous glomerulonephritis (30.6%) and focal segmental glomerulosclerosis (27.8%) were the commonest among the adult population. The initial histologic diagnosis was revised in 18 cases while a diagnosis was arrived at in seven cases initially adjudged as inadequate for assessment. This study showed that renal biopsy was predominantly performed in children and adolescents. Although glomerulonephritis was the predominant disease, the predominant histologic patterns varied with the patient age. Despite the scarcity of advanced diagnostic tools in resource-poor environments, routine use of histochemical stains is helpful in the evaluation of renal biopsies.

Lymphomas in Ile-Ife, Nigeria: Immunohistochemical Characterization and Detection of Epstein-Barr virus Encoded RNA

BACKGROUND

The proper histopathological characterization of malignant lymphomas requires the use of immunohistochemistry along with other molecular pathology techniques.

MATERIALS AND METHODS

Malignant lymphomas histologically diagnosed in our hospital were reclassified according to the WHO scheme using immunohistochemistry while in-situ hybridization was performed for the detection of Epstein-Barr virus encoded RNA.

RESULTS

There were 83 cases of lymphoma. The male to female ratio was 1.9:1 while the overall mean age was 41.7 years. Non-Hodgkin lymphomas (NHL) constituted about 79.5% of cases. The majority of cases (98.8%) were B-cell lymphomas. Nine subtypes of lymphomas were identified with diffuse large B-cell lymphomas (56.4% of which were of the germinal centre type) constituting the largest group (47.0%). Intermediate and high grade subtypes were more common. The majority of cases (72.3%) were nodal lymphomas with cervical lymph node being the commonest site (48.2%). Only classical Hodgkin lymphoma (HL) (20.5%) was seen of which the mixed cellularity subtype was the most common. Epstein Barr virus (EBV) encoded ribonucleic acid was detected in 7 cases (8.4%) including 4 cases of HL, 2 cases of Burkitt lymphoma and the only case of plasmablastic lymphoma. About five cases were reclassified as non-lymphoid malignant lesions.

CONCLUSION

Immunohistochemistry is vital to the proper classification of lymphomas even in a resource poor environment. Although nine subtypes of lymphomas were identified, diffuse large B-cell lymphomas formed the largest single group. Epstein-Barr virus probably plays an important role in lymphomatogenesis in this environment. A larger multicentre study is required to prove this.