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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 11 | Issue 1
Page Nos. 1-99

Online since Saturday, August 8, 2020

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REVIEW ARTICLES  

The continuing pandemic threat of COVID-19 - A need for public enlightenment Highly accessed article p. 1
Adeola Fowotade, Temitayo Oluwasun Fasuyi, Mohammed Mohammed Manga, Isaac Oluwasogo Amao
DOI:10.4103/atp.atp_13_20  
A novel coronavirus 2019 now re-designated coronavirus disease 2019 (COVID-19) virus, emerged in Wuhan, China, on December 2019. Greater details about its origin and basis for high transmissibility remain largely unknown. The increasing incidence possibly linked to human-to-human transmission of the virus has resulted in rapid spread of the disease to 145 countries including Nigeria. To the best of our knowledge, the current review is one of the first locally published information on the novel COVID-19.We hereby describe the etiology, epidemiology, clinical management, and infection prevention and control of practices against COVID-19. This is to create more public awareness and sensitize health-care professionals on the urgent need for early recognition of suspect cases and practice of droplet and contact precautions to curtail the rapid spread of COVID-19.
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Applications of induced pluripotent stem cells in clinical practice p. 8
Farouk Garba
DOI:10.4103/atp.atp_34_19  
Stem cell research has shown a promising future in understanding and treating diseases from cellular level, factoring minimum patients' suffering in terms of toxicity and persistent or endless therapy. Induced pluripotent stem cells offer a variety of opportunities that were unimaginable in the past. Developments and breakthroughs from this field of science are constantly evolving with quite remarkable or rather overwhelming articles published. This is a systematic review study with the aim to simplify the basic understanding of induced pluripotent stem cells. Its journey so far and prospects to confer the solutions in clinical practice.
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ORIGINAL ARTICLES Top

Choice of histopathology as a specialty among doctors yet to commit to a specialty in a young Nigerian teaching hospital Highly accessed article p. 13
Samuel Robsam Ohayi, Nnaemeka Thaddeus Onyishi, Mark Sunday Ezeme
DOI:10.4103/atp.atp_45_19  
Objectives: The aim of this study was to determine the doctors' choice of pathology as a specialty and the factors affecting such choice. Materials and Methods: Self-administered objective-structured questionnaire was administered to doctors in Enugu State University Teaching Hospital, who were yet to commit to a postgraduate specialty by obtaining the primary postgraduate fellowship. Obtained data were analyzed using Statistical Package for the Social Sciences software (SPSS) version 16.0. Missing data were excluded from the study. Results: There were 50 (69.4%) respondents from 72 questionnaires distributed. Most of them, 76% (n = 38), have excellent knowledge of the duties of a pathologist. Except for age (P = 0.04), sociodemographic characteristics and knowledge of pathologists' duties do not significantly affect choice about pathology. A total of 29 of 47 (59.2%) respondents rejected histopathology; however, of the 24.5% who might choose histopathology, three rated it last choice while one rated it first. The most common reasons for choosing pathology include flexibility of work hours and availability of job positions. The most common reasons for rejecting pathology include desire for contact with patients, dislike for autopsy, and desire for better remuneration. Most participants, 87.5% (n = 42 of 49), have an overall positive perception of pathology and the pathologist. Course volume, quality of teachers, and pathology examination affect perception of pathology most but not significantly. However, perception does not significantly affect and has weak correlation with choice of pathology. Conclusion: Pathology is not a preferred specialty among doctors seeking postgraduate training in our center. Factors responsible for this state of affairs including desire for better remuneration and contact with patients should be addressed by all those concerned.
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The use of special stains in the detection of vascular invasion in cases of colon cancer in resource-limited settings in Africa Highly accessed article p. 21
Babatunde M Duduyemi, Derrick Andoh, Ernest Adankwah, Hannah Nyarko, Divine Agyemang
DOI:10.4103/atp.atp_1_20  
Background: Vascular invasion (VI) is a well-established independent prognostic factor in colorectal cancer (CRC) associated with the hematogenous spread and high risk of mortality. Its accurate detection is essential in identifying a high-risk group of patients who may benefit from adjuvant therapy and also to detect the risk of disease recurrence. The aim of the study was to determine the value of an elastic tissue stain in assessing vascular invasion in CRC. Materials and Methods: Formalin-fixed paraffin-embedded histologically confirmed CRC blocks were retrieved from the archives of the Histopathology Department of the Komfo Anokye Teaching Hospital. Duplicate sections were made from each block and divided into two, with one part of the sections stained with hematoxylin and eosin (H and E) and the other with Verhoeff–Van Gieson (VVG) stain. Both H and E and VVG-stained sections were assessed for vascular invasion. Findings were put in tables and charts. Results: Forty-one cases were used for our study, comprising 40 adenocarcinomas (six well differentiated, 26 moderately differentiated, and eight poorly differentiated) and one high-grade non-Hodgkin large cell lymphoma. The mean age of our patient was 55 years, with a male-to-female ratio of 1:1.4. Of the 41 sections stained with H and E, venous invasion (VI) was detected in 14 cases (34%), whereas VVG was detected vascular invasion in 18 cases of the 27 undetected by H and E in addition to all the 14 cases detected by H and E (78%). Conclusion: The application of the VVG elastic tissue stain enhanced the sensitivity of detecting VI as compared to the use of H and E alone, and thus, recommendations should be made to include elastic tissue stains in CRC pathology reporting to bring therapeutic benefits to patients in our environment.
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Clinicopathological analysis of prostatic lesions in a tertiary hospital in Nigeria Highly accessed article p. 25
Said Mohammed Amin, Paul Gowon Jibrin, Friday George Olah, Emmanuel Oguntebi, Nabilah Datti Abubakar, Isiaka Olayinka Lawal
DOI:10.4103/atp.atp_14_19  
Background: Prostatic neoplasms are important source of morbidity and mortality among men globally. A rising trend is noted worldwide especially involving sub-saharan African males where paradoxically data is grossly inadequate. We hereby present prostatic lesions from a tertiary center in sub-saharan Africa.Materials and Method: A retrospective analytic study of all prostatic samples received in the histopathology of National Hospital Abuja (NHA), a tertiary hospital in Nigeria, from 1st January 2005 to 31st December 2015 was carried out.Result: The major affected age group is the 61 – 70 year cohort. Majority of neoplastic lesions encountered are malignant adenocarcinomas of moderate differentiation. The predominant presenting symptoms are dysuria, frequency, and acute urinary retention in that order, while raised prostatic specific antigen (PSA) is a frequent sign. Conclusion: Prostatic adenocarcinoma is significant malignancy in NHA while benign prostatic hyperplasia is the commonest benign lesion. Gleason scores 5 and 7 are the predominant malignant differentiation obtained.
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Cytolytic vaginosis: A common yet underdiagnosed entity p. 29
Shailja Puri
DOI:10.4103/atp.atp_18_19  
Objective: The objective of this study is to determine the incidence of cytolytic vaginosis among patients undergoing cervicovaginal cytology for vaginal discharge, pruritus, dyspareunia, and other symptoms. Cytolytic vaginosis is also known as Lactobacillus overgrowth syndrome or Doderlein's cytolysis. It is characterized by an abundant growth of Lactobacilli resulting in lysis of vaginal epithelial cells. Methods: A total of 308 women presented to gynecological outpatient department. All of the patients were subjected to Pap test with the help of cytobrush. The cervicovaginal smears were fixed in methanol, stained with papanicolaou stain, and studied under a microscope independently by two pathologists. Results: Of 308 patients, 190 (61.7%) had an inflammatory lesion and were negative for intraepithelial malignancy. Of 190 cases, 31 (16.3%) were diagnosed with cytolytic vaginosis based on the clinical and morphological features. Conclusion: Cytolytic vaginosis is a fairly common entity often misdiagnosed as candidiasis. Morphological features play an important role in identifying cytolytic vaginosis. The results of this study may contribute to reports in the literature indicating the importance of cytolytic vaginosis which is not included in the current Bethesda system for reporting of cervical cytology.
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Challenges of pleural aspirate cytology: A 5-year review p. 33
Ikponmwosa Obahiagbon, Mojisola Olutayo Udoh
DOI:10.4103/atp.atp_30_19  
Introduction: Pleural effusion is a common medical condition, and the aspiration of the pleural cavity is a minimally invasive, cheap, and simple technique with the potential to achieve a clinically useful diagnosis. Challenges in the optimization of this investigative modality, however, occur in our everyday practice. Aim: The purpose of this review was to highlight the challenges in the cytopathological evaluation of pleural aspirates in our environment. Materials and Methods: The data regarding pleural fluid (PF) aspirates received for cytopathological evaluation between January 1, 2010, and December 31, 2014, were retrieved from departmental records and analyzed. Results: PF aspirates from 69 patients, with a male–female ratio of 1:1.03, were studied. The modal age group was 30–39 years, and the mean age was 45 ± 21.40 years. Of 69 smears, 40.6% were categorized as unsatisfactory/nondiagnostic, 44.9% were in the “negative for malignancy/normal/benign” category, 1.4% were in the “atypical-favor reactive” category, 4.3% were “atypical-suspicious for malignancy,” and 8.7% were “positive for malignancy.” The male–female ratio of patients with malignant pleural effusions was 1:5, and 66.7% of malignant smears were from persons above 50 years. Thirty-nine percent of total smears wear “inflammatory.” The large number of unsatisfactory smears is a major challenge. Conclusion: Pleural aspirate cytology can be a useful investigative tool with the potential for definitive diagnosis or other useful information for clinical decision-making. To maximize its diagnostic potential in our environment, however, the current challenges must be overcome.
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Spectrum of homicidal injuries in a tertiary hospital in North-central Nigeria p. 38
Raymond Akpobome Vhriterhire, Isaac Onah Akpor, Joseph Aondowase Ngbea, Babarinde Akinedu Ojo
DOI:10.4103/atp.atp_28_19  
Background and Objectives: There has been an upsurge in fatal crimes and violent conflicts in Nigeria, with the victims dying from a variety of injuries. This study analyzed the pattern of injuries found during postmortem examination of the bodies of victims of homicidal deaths. Materials and Methods: A retrospective audit was done on the cases of alleged homicidal deaths on which autopsies were performed over a period of 5 years in the pathology services unit of a tertiary hospital in the North-central region of Nigeria. Results: There were 236 alleged homicidal death cases and the ages ranged from 1.5 to 6 years. There were more male victims (87.7%) than females (12.3%), ratio of 7.1:1. Gunshot injuries and chop wounds accounted for 39.8% (n = 94) and 19.1% (45), respectively. The other injuries found in this study included lacerations, skull fractures, contusions, cerebral lacerations, stab wounds, burns, and incised wounds. Blunt force injuries (laceration, contusion, and abrasion) and sharp force injuries (incised, stab, and chop wounds) made up 18.6% (n = 44) and 21.2% (n = 50) of the total number of cases, respectively. Some of the victims had a combination of injuries. Most of the decedents were persons within the third decade and 67.4% of them were <40 years old. Conclusion: This retrospective review of homicidal injuries showed that most victims died from gunshot and sharp force injuries. Gunshot wounds were found to be more common on the chest and abdomen, whereas chop wound was more to the head, followed by the neck.
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Histology of the terminal end of the distal rectal pouch and fistula region in varying the severity of anorectal malformations: Is it useful? p. 43
Rajat Piplani, Sufian Zaheer, Deepak Bagga, Samir K Acharya
DOI:10.4103/atp.atp_33_19  
Aims: To Study the histology of the terminal end of distal rectal pouch and fistula region in cases of anorectal malformations (ARMs) and to get an insight on the usefulness of excising or preserving this region during its reconstruction. Materials and Methods: This was a prospective observational study of 20 consecutive cases of ARMs that underwent posterior sagittal anorectoplasty (PSARP) in our hospital over 6 months' period. The histopathological evaluation of the terminal end of the distal rectal pouch and fistula region in all cases with ARM was done. Complicated and redo cases were excluded from this study. Tissue specimen of about 0.5–1.0 cm from the most distal part of the rectal pouch and close to the fistula region was taken. Biopsy specimens were obtained from all patients undergoing a PSARP performed after a defunctioning colostomy or as a primary procedure without colostomy, and histopathological evaluation was done in all cases. Further, the internal sphincter and its morphology, hypoganglionosis or aganglionosis, anal glands and crypts, thickened nerve trunks, and other miscellaneous histopathological aberrations were studied. Based on these histological findings, conclusions were derived whether to preserve or excise this region during ARM reconstruction. Results: Out of the 20 ARM patients included, 12 patients (60%) were male and 8 (40%) were female. An internal sphincter was identified in all the patients. However, the smooth muscle bundles were disorganized in all the 20 patients (100%). While ganglion cells were absent in 90% cases, hypertrophic nerve bundles were a common histological finding (90% of patients). The abnormal mucosal finding was also noted in majority of the patients (75%). Conclusions: An atrophic or disorganized internal sphincter, absent ganglion cells, and abnormal anal mucosal findings in majority of these patients on histology would justify its excision during PSARP. However, further follow-up of these ARM patients in whom the terminal end of the distal rectal pouch and the fistula region is excised or retained is recommended.
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ABO and Rh blood group incompatibility among icteric neonates and their mothers in Jos, Nigeria p. 48
Ezra Danjuma Jatau, Julie Ochaka Egesie, Bose O Toma, Obadiah Dapus Damulak, Zakari Ayuba, Jasini James
DOI:10.4103/atp.atp_25_19  
Context: ABO and Rh blood groups play significant roles in health and diseases, one of which is blood group incompatibility, a common cause of neonatal hyperbilirubinemia. Aims: The aim of the study is to determine the frequency of ABO and Rh blood group incompatibilities among icteric neonates and their mothers for the purpose of instituting intervention for better neonatal outcomes. Settings and Design: This study was conducted at the Special Care Baby Units (SCBUs) of the Jos University Teaching Hospital (JUTH), Bingham University Teaching Hospital (BHUTH), and Plateau State Specialist Hospital (PSSH), Jos, Nigeria, from March 2013 to February 2014. It was a descriptive cross-sectional study that includes all jaundiced neonates admitted into the SCBUs and neonates who developed jaundice on admission in the neonatal wards. Subjects and Methods: A total of 150 icteric neonates admitted into the SCBUs of the JUTH, PSSH, and the BHUTH were recruited for this study with their parent's consent. Blood samples were collected from the neonates and their mothers in ethylene diaminetetra-acetic acid and plain bottles for ABO and Rh blood grouping, direct antihuman globulin test, and serum bilirubin (SB) assays. Statistical Analysis Used: Data obtained were analyzed using Epi Info Version 6 software. The results were reported in tables and frequencies, categorical variables were expressed as proportions, whereas continuous variables were expressed as mean ± standard deviation and were analyzed using Student's “t”-test. The level of statistically significant relationship was set at P ≤ 5% (P ≤ 0.05). Results: Thirty-four (22.7%) mother–neonate pair had ABO incompatibility with 14 mothers (9.3%) with blood group O, having neonates with blood group A and a mean SB of 249.5 ± 131.4 μmol/L. Three (2.0%) mothers were Rh D negative while their neonates were Rh D positive and showed a positive direct antihuman globulin test with a mean SB of 322.1 ± 246.7 μmol/L. Conclusions: Blood group O and Rh D-positive blood groups predominate while ABO and Rh incompatibilities present a risk for hyperbilirubinemia among icteric neonates in Jos, Nigeria.
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Microsatellite instability in gastric carcinomas in Kano, Nigeria p. 52
Abdullahi Muhammad Ahmad, Abdullahi Mohammed
DOI:10.4103/atp.atp_3_20  
Background and Objectives: Gastric carcinoma, though relatively less prevalent in most parts of Africa and Nigeria, usually presents at an advanced stage in most of our patients. This makes the elucidation of clinical and molecular factors relating to prognosis an important avenue to explore. Gastric carcinomas exhibiting microsatellite instability (MSI) are said to have better prognosis, but there has been no study in Northern Nigeria. We, therefore, undertook this study to evaluate the proportion of MSI gastric carcinoma in our center. Methodology: This retrospective 5-year study was done on 48 histologically diagnosed gastric carcinomas to evaluate the immunohistochemical expression of mismatch repair DNA proteins: MLH1 and MSH2. Results: Forty-eight gastric cancer (GC) biopsies fulfilled the study criteria. They were from patients aged 23–80 years, with a mean of 52.1 years (standard deviation [SD] ±12.79) and male to female ratio = 3.4:1. Twenty cases (42%) had MSI, with a mean age of 51.7 years (SD ± 12.75; P = 0.67). The remaining 28 cases were microsatellite stable (MSS), with a mean age of 53.3 years (SD ± 12.92). Male preponderance was more marked in the MSS group (6:1) than in the MSI group (2.3:1). Intestinal carcinoma was by far the most common histologic type in both MSI (75%) and MSS (70%) groups. Conclusion: Forty-two percent of gastric carcinomas were harboring MSI. Although our sample size was small, it nonetheless provided useful insight and baseline data for MSI gastric carcinoma in our center. MSI GC appears to be more common in our center than an earlier Southern Nigerian study. This is consistent with the widely differing proportion of MSI gastric carcinoma across the globe, sometimes within the same country. Further studies are therefore required to make sense of this seemingly conflicting data.
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Clinicopathological characteristics of benign prostatic hyperplasia and prostate cancer in a University Teaching Hospital in Nigeria p. 56
Musliu Adetola Tolani, Abdulsalam Ibrahim Khalifa, Ayodeji Olawale Afolayan
DOI:10.4103/atp.atp_18_20  
Introduction: Benign prostatic hyperplasia and prostate cancer are common pathologies of the prostate which could lead to morbidity and quality of life problems in urological patients. The study aimed to determine and compare the demographic, clinical, and pathologic characteristics of patients histologically diagnosed with these pathologies in our center. Methods: This was a prospective study carried out in 105 consecutive patients with the histological diagnosis of benign prostatic hyperplasia or prostate cancer over a period of 1 year. Information on demographic details, clinical presentation, prostate volume, prostate-specific antigen level, and histopathologic data was obtained. Data were analyzed using the Statistical Package for the Social Sciences with P < 0.05 considered statistically significant. Results: Benign prostatic hyperplasia and prostate cancer were diagnosed in 71.4% and 28.6% of the patients, respectively. Patients with prostate cancer had a significantly higher prostate-specific antigen (P = 0.001) and prostate volume (P = 0.005) than those with benign prostatic hyperplasia. Difficulty in urination was the most common presenting symptom in both pathologies (90% vs. 92%, P = 0.713), whereas the occurrence of erectile dysfunction was significantly higher in patients with prostate cancer (50% vs. 24%, P = 0.010). The mean Gleason's score in the patients was 7, and the majority of the prostate cancer patients (96.7%) had advanced disease. There was associated histologic prostatitis in 10.7% of patients with nodular hyperplasia. Conclusion: Benign prostatic hyperplasia is more commonly diagnosed than prostate cancer in our center. Except for erectile dysfunction, the burden of other complications is similar in these patients. There is the need for community advocacy to encourage early presentation in those with lower literacy level, especially patients with prostate cancer, in order to reduce the morbidities associated with the disease.
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The use of antithrombin as a predictive tool in determining the development of stroke in patients with sickle cell anemia based on transcranial doppler ultrasound risk group p. 61
Olusola Olowoselu, Ebele Uche, Abosede Ogunlade, Olufemi Oyedeji, Obiefuna Ajie, Vincent Osunkalu, Akinsegun Akinbami, Jeremiah Oyedemi
DOI:10.4103/atp.atp_38_19  
Background: Stroke affects up to 10% of individuals with sickle cell anemia (SCA), and its development has been linked to excessive intravascular hemolysis and arterial thrombosis Increased intracerebral blood flow (CBF) velocity as measured by the transcranial Doppler ultrasonography (TCD) identifies children with SCA with an increased risk of development of stroke. This study measured antithrombin (AT) levels among SCA patients as a predictor of TCD risk groups for the development of stroke. Materials and Methods: A total of 180 participants consisting of 135 SCA patients and 45 age-matched hemoglobin phenotype AA (HbAA) controls were enrolled into the study. CBF velocity was measured with TCD and results were used to classify the SCA group into standard risk, conditional risk, and high risk. AT functional activity, prothrombin time (PT), and activated partial thromboplastin time (APTT) of all participants were measured. Statistical tools including independent t-test, analysis of variance, Pearson's correlation, hierarchical multiple regression, and forward liner regression were used to analyze all continuous variables. P <0.05 was considered statistically significant. Results: The AT levels were 83.01 ± 15.40% and 106.12 ± 14.79% in HbAA and SCA participants, respectively, with t = −7.294 and P = 0.001. The PT and APTT of the SCA and control groups were 15.51 ± 1.22 s, 13.78 ± 0.94 s, and 35.98 ± 3.24, 33.62 ± 2.49 s, respectively. Using ANOVA, there was a statistical difference (P = 0.001) in the AT levels of the standard-risk (89.07 ± 14.26%) and high-risk groups (73.10 ± 12.35%). Using Pearson's correlation, there was a significant negative correlation between AT levels and CBF (r = −0.405). With the use of multiple regression, AT showed the highest predictive value for CBF (R2 = 0.155; P ≤ 0.001; F = 17.677). Conclusion: AT functional activity levels were reduced in the SCA group compared with the HbAA-matched controls.
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CASE REPORTS Top

Juvenile fibromatosis: Report of a rare case p. 68
Halima Oziohu Aliyu, Tunde Talib Sholadoye, Saidu Umar Abdulkarim
DOI:10.4103/atp.atp_7_20  
Fibromatosis is a rare benign tumor arising from the myofibroblast. It is a locally aggressive tumor with a high rate of recurrence but no malignant potential. Fibromatosis can occur anywhere in the body. It is rare in the head-and-neck region and even rarer in children. We report a case occurring in the neck of a child. A 7-year-old boy presented with progressive left-sided, posterior neck swelling of 4 years and 3 years history of the loss of ability to vocalize. Imaging studies revealed a mass at the base of the skull and posterior neck on the left, with the preserved surrounding bone. The patient had a complete excision of the mass and histology confirmed juvenile fibromatosis. Juvenile fibromatosis of the head-and-neck region is a rare benign tumor of childhood. Tissue biopsy confirms the diagnosis. The recurrence rate is high following wide local excision.
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Neurocysticercosis in a 14-year-old Nigerian: A case report and review of the literature p. 72
SS Soyemi, CO Akinbo, Mgbehoma AI, FE Emiogun, OO Adegboyega, JO Obafunwa
DOI:10.4103/atp.atp_12_20  
Neurocysticercosis (NCC), an infection of the brain by the larval form of Taenia solium tapeworm, has been described as the most common cause of acquired adult seizure and epilepsy in regions of the world where the worm infestation is endemic. It is acquired following ingestion of raw or partially cooked pork-containing cysts of T. solium. We report the case of a 14-year-old male patient, who presented with recurrent tonic–clonic partial seizures of 3 months duration, seizures, and progressive weakness of the left limb, while being fully conscious. He had a left facioparesis of the upper motor neuron type with plastic left hemiparesis. An impression of a right frontal cortical lesion was made. The laboratory investigations as well as the chest radiograph were reported as being essentially unremarkable. The magnetic resonance image of the brain revealed a circumscribed right parietal lesion which was circumscribed. A provisional diagnosis of intracranial tumor was then made. Surgery involved an en bloc resection of a cystic right parietal mass. The gelatinous fluid contained within was submitted for cytological examination. The latter revealed the presence of a cysticercus comprising the scolex, spiral canal, and the bladder wall. A diagnosis of NCC was made, and the patient was thereafter commenced on antihelminthics. The patient made an appreciable recovery thereafter. This report is to emphasize the continued existence of this disease, the need to improve diagnostic suspicion, and skill. This report further supports the proposal to declare NCC an international reportable disease.
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Sinonasal tuberculosis mimicking malignancy – Case report and review of literature p. 76
Sani Ibrahim Muhammad, Alfa Alhaji Sule, George Danlami Wey
DOI:10.4103/atp.atp_27_19  
Primary sinonasal tuberculosis (TB) is a rare form of TB even in developing countries where TB is prevalent, as it usually results from primary foci elsewhere in the body. It often poses a diagnostic dilemma. There are a few reported cases of primary sinonasal TB in literature. The aim of this study is to report another case of primary sinonasal TB. A 27-year-old female presented with 5 months history of nasal blockade and epistaxis. There was no history of cough, night sweat, malaise, anorexia, weight loss, or fever. Examination revealed a mass in the left nasal cavity extending up to the nasopharynx with contact bleeding. Computerized tomography scan showed a hyperdense lesion, suspected to be a tumor, involving the nasal septum and filling the entire left maxillary sinus with bony destruction of the anterolateral, posterior and medial walls. Chest X-ray, retroviral screening, and other biochemical results were essentially normal. The lesion was excised through lateral rhinotomy, and histology revealed sinonasal TB. Primary sinonasal TB is seldomly seen, meticulous and high index of suspicion in the context of clinical, radiological, and pathological characteristics remain paramount and critical in making an otherwise challenging diagnosis.
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Congenital tuberculosis: A diagnosis delayed in a child with atrial septal defect p. 79
Pallavi Sinha, Lavleen Singh, Dhulika Dhingra
DOI:10.4103/atp.atp_42_19  
Congenital tuberculosis (CTB) is a rare disease presenting in infants with very few cases reported despite a high burden of tuberculosis. The fewer reported cases reflect in part the difficulty in making a definitive clinical diagnosis as signs and symptoms are non- specific along with difficult laboratory confirmation due to several reasons. We report a case of 4-month-old male child presenting with fever and cough for 3 months and respiratory distress and feeding difficulties for 5 days with no response to antibiotics. Systemic examination revealed bilateral crepitations, pansystolic murmur, and hepatosplenomegaly. Echocardiography revealed an 8 mm atrial septal defect. The patient did not respond to decongestive therapy. Ultrasonography revealed an enlarged liver with a 12 cm liver span. Liver biopsy showed necrotizing epithelioid cell granuloma. Based on the Cantwell's criteria, the diagnosis of CTB was proffered.
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Solitary intraparotid plexiform neurofibroma: Case report and literature review p. 82
Raymond Akpobome Vhriterhire, Moses Agwa, Amali Adekwu
DOI:10.4103/atp.atp_8_20  
Solitary plexiform neurofibroma is a peripheral nerve sheath tumor with proliferation of Schwann cells accompanied by mast cells and fibroblasts laying down collagen. The occurrence of this tumor in the salivary gland of an individual in the absence of neurofibromatosis 1 (von Recklinghausen disease) is rare. We present a case of sporadic solitary intraparotid neurofibromatosis in an 8-year-old female. The 8 cm × 6 cm × 2 cm mass removed through superficial parotidectomy showed the characteristic irregular bundles of Schwann cells, fibroblasts, mast cells, and strands of collagen. Tissue biopsy is indispensable in the diagnosis of this tumor and its differentiation from other more benign condition such as pleomorphic adenoma which it mimics clinically.
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Metastatic recurrent malignant phyllodes in 17-year-old female p. 86
Asma'u Usman, Abubakar Dahiru, Usman Sulaiman Baguda, Shuaibu Adam, Umar Faruk Abdulmajid
DOI:10.4103/atp.atp_39_19  
Malignant phyllodes tumor of the breast is extremely rare but what is rarer is its occurrence in adolescent girls younger than 18 years. It has a propensity for rapid growth and metastases. We present an uncommon presentation of recurrent and metastatic malignant phyllodes tumor in a 17-year-old female.
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Hemorrhagic infarction of hyperreactio luteinalis in spontaneously conceived singleton pregnancy: An uncommon cause of late third-trimester ovarian accident p. 90
Balarabe Kabir, Almustapha A Liman, Shehu Abdullahi, Stephen O Ajani, Murtala Abubakar, Zainab A Adamu
DOI:10.4103/atp.atp_37_19  
Ovarian masses complicate about 1%–2% of all pregnancies while posing diagnostic and therapeutic challenges. Most are benign tumors but occasionally, functional cysts, such as theca lutein cysts, may be encountered in pregnancy. These are bilateral ovarian masses associated with high levels of β-human chorionic gonadotropin, thus seen mostly in the settings of trophoblastic diseases, multiple gestations, or following treatment for subfertility. It has also been reported in spontaneous singleton pregnancies. Clinical presentation is variable, ranging from asymptomatic conditions discovered incidentally to acute gynecological emergencies due to ovarian accidents. We report the case of a 29-year-old gravida 2, para 1 + 0, with estimated gestational age of 39 weeks plus 1 day, who had a previous emergency lower segment cesarean section (ELSCS) 3 years ago and presented with 1-h history of sudden-onset, sharp, right-sided, abdominal pain of increasing intensity. There were no history of trauma and no evidence of labor. On examination, she was a young gravid woman, at term, in severe painful distress. Baseline investigations were done, and she had ELSCS and exploratory laparotomy with a right salpingo-oophorectomy for twisted and hemorrhagic right adnexa discovered. Pathologic evaluation of the right ovary revealed an enlarged, dark brown, lobulated ovarian mass comprising multiple cortical cysts separated by a thin wall and containing dark brown fluid, with gray brown and hemorrhagic solid areas. A histologic diagnosis of hemorrhagic infarction on the background of multiple theca lutein cysts in pregnancy was made. She had a good postoperative recovery.
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Chronic urinary schistosomiasis in a 25-year-old man, a case of neglected tropical disease p. 94
BO Usman, AF Oyewole, A Umar, PO Ibinaye, S Lawal, MZ Ibrahim
DOI:10.4103/atp.atp_10_20  
Schistosomiasis is a parasitic disease caused by several species of trematodes, a parasitic worm of the genus Schistosoma. Out of the two major forms of schistosomiasis that exist, Schistosoma haematobium affects the genitourinary system. Radiologic imaging manifestations of urinary tract schistosomiasis are observed mainly in the ureters and bladder due to deposition of eggs on them, which elicits chronic granulomatous injury. This eventually causes nodules, polypoid lesions and ulcerations of the lumen of the ureter and bladder that manifest clinically in urinary frequency, dysuria, and terminal hematuria. It may ultimately end in renal failure or carcinoma of the bladder. This endemic but poorly reported neglected tropical disease is presented to increase the index of suspicion and reduce its complications and prevalence.
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High prevalence of triple-negative breast cancer and poor survival outcome in Nigeria: A call for further molecular subtyping of triple-negative breast cancer p. 98
Jude Ogechukwu Okoye
DOI:10.4103/atp.atp_36_19  
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