Annals of African Medicine

Calcified and Impacted Cervical Fibroid in a Young Female in a Low-resource Setting Mistaken for Bladder Mass: Case Report and Literature Review

Female pelvic masses could be difficult to diagnose given the fact that there are so many structures within the pelvis that could be related to the mass. These benign or malignant neoplasms could be diagnosed through careful and systematic evaluation by history, biochemical, imaging, and surgical approaches. Although an ultrasound scan is often the first-line imaging modality for the evaluation of pelvic masses, it could be limited by poor acoustic windows and poor depth penetration. However, in low-resource settings, its usage is nonnegotiable. The case of a 26-year-old female with a 5-year history of lower abdominal swelling is hereby presented. The swelling was gradual in onset and associated with occasional dull lower abdominal cramps that radiate to the back, urinary retention, dysuria, and urinary frequency. An ultrasound scan diagnosed an ovarian mass and uterine fibroid with the suspicion of a bladder mass. She had a laparotomy, in which a left ovarian mass and a huge calcified pelvic mass extending from the region of the isthmus of the uterus through the posterior bladder wall and the anterior vaginal wall were discovered. Left ovariectomy and removal of the mass were done; a histologic diagnosis of mature ovarian teratoma and cervical fibroid was made. She had a smooth postoperative recovery on antibiotics and analgesics. The diagnostic challenge of pelvic masses even with the use of USS is demonstrated, and laparotomy has shown to be a diagnostic procedure here. Preoperative magnetic resonance imaging could be helpful when available and affordable.

Human Papillomavirus Vaccine Hesitancy and Barriers in Achieving 100% Vaccine Coverage: A Web-based Cross-sectional Study

Introduction: The human papillomavirus (HPV) vaccine is one of the most effective primary measures to prevent HPV-related infections and deadly cancers. Despite the availability of the HPV vaccine in the market for almost 17 years, it still remains underutilized. This study is planned with the objective to find out the reasons for vaccine hesitancy (VH) among the Indian population. Materials and Methods: Web-based cross-sectional study done using a snowball sampling method. A prevalidated questionnaire containing 15 items was circulated through social media, and responses were evaluated for causes of VH. Results: Out of 1018 study participants, the majority were between 15 and 20 years (64.1%) of age. Most participants were females (60.5% vs. 39.5%). Out of all, 37.8% were sexually active. Most (99%) of the study participants did not have any children. The majority were students (72.2%). Most (87%) had heard about HPV vaccination, and teachers (46.2%) were the most common source of their information. Only 15.4% of the participants were aware that the vaccine was for both boys and girls. Only 15.9% knew that HPV vaccination can protect from genital warts, oropharyngeal carcinoma, cervical cancer, anal cancer, and vulvar and vaginal cancers. The majority (80.9%) were unvaccinated, and unawareness about the vaccine was the most common reason (38.2%) for that. Among vaccinated, majority experienced no major side effects (90.2%). Conclusion: VH is one of the major barriers limiting 100% utilization of HPV vaccine across the country and needs to be addressed to combat the HPV virus-related disease.

The Role of Micronucleus Scoring in Cervical Papanicolaou Smears

Aims and Objectives: To compare the micronucleus (MN) score in all the major diagnostic categories as per “The Bethesda System for Reporting Cervical Cytology” 2014 including negative for intraepithelial lesions and malignancy (NILM), inflammatory, abnormal squamous cells of undetermined significance (ASC-US), abnormal squamous cells cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H), low-grade squamous intraepithelial lesion (LSIL), HSIL, and invasive carcinoma (IC) and to assess the role of MN scoring as a biomarker for predicting risk of carcinoma. Materials and Methods: A total of 1000 conventional cervical smears stained with Papanicolaou (Pap) stain, comprising unsatisfactory for evaluation (86), NILM (140), inflammatory (696), ASC-US (23), ASC-H (16), LSIL (18), HSIL (15), and IC (6) were studied independently by two pathologists, and the number of MN cells per 1000 epithelial cells in high-power (×400) and oil immersion (×1000) was counted and expressed as MN score per 1000 cells. Results: The mean MN score ± standard deviation was found to be 0.99 ± 0.744 in NILM cases, 0.67 ± 0.782 in inflammatory cases, 1.57 ± 0.507 in ASC-US cases, 1.63 ± 0.50 in ASC-H cases, 1.56 ± 0.511 in LSIL cases, 2.47 ± 0.516 in HSIL cases, and 3.0 ± 0.00 in IC cases. A step-wise increase was observed in MN score from inflammatory to IC categories. Conclusions: MN score is a reliable and easy test that can be used in conjunction with routine cervical PAP to assess the risk of malignant transformation in the uterine cervix as a biomarker for predicting the risk of carcinoma.

Cervical Cytopathological Changes in Pregnancy: An Experience from a Low Resource Setting

Background: Cervical cancer is the leading cause of death among women in developing countries. It is preventable through effective cervical cancer screening program. However, in Nigeria, screening programs are opportunistic and coverage is insufficient to make an impact. Aim: This study assessed the cervical cytopathological changes among pregnant women at booking using liquid-based cytology (LBC) in Aminu Kano Teaching Hospital (AKTH). Methodology: This was a cross-sectional study that was carried out at the antenatal Clinic of AKTH, Kano, Nigeria. A total of 161 pregnant women who fulfilled the criteria and gave their consent were recruited into the study using systematic sampling technique at booking for antenatal care. LBC was employed using standard procedure and samples sent to histopathology department for analysis. Pro forma developed for the study was used to obtain the socio-demographic and reproductive characteristics of the women and the risk factors for abnormal cervical cytology. Results: Out of the 161 pregnant women that had cervical cytology screening using LBC on their first prenatal visit during the study, 22 had abnormal cervical cytology, giving a prevalence rate of 13.7%. Out of this, six (27.3%) were atypical squamous cells of undetermined significance, 3 (13.6%) were Atypical Squamous Cells, Cannot Rule Out HSIL (ASC-H), 11 (50.0%) were low-grade Squamous Intraepithelial Lesions while 2 (9.1%) were high grade squamous intraepithelial lesions. Negative smears were seen in 104 women (64.6%). Inflammatory and other conditions of the cervix which are technically negative smears made up the remaining 21.7%. There was a statistically significant association between cervical cytology results and advanced age (P < 0.01), increasing number of lifetime sexual partners since coitarche (P < 0.01), high parity (P < 0.01), absent previous Pap test (P < 0.027), previous history of sexually transmitted infections (P < 0.040), and positive HIV status (P < 0.001). Following binary logistic regression, advanced maternal age, increasing number of sexual partners, high parity, and positive HIV status stood out to be independent predictors of premalignant lesions of the cervix in pregnancy in this study. Conclusion: Advanced maternal age, increasing number of sexual partners, high parity, and positive HIV status stood out to be independent predictors of premalignant lesions of the cervix in the study. Routine cervical cytology screening using LBC should be offered to all antenatal clients in our setting to increase coverage and detection rate of preinvasive lesions of the cervix, and/or pregnant women with increased risk of abnormal cervical cytology from this study.

Ovarian Cell Tumor in a Child with Neurofibromatosis Type 1

Juvenile granulosa cell ovarian tumor is a rare cause ofpseudo-precociouspuberty. We report a case of a 6-year-old female with neurofibromatosis type 1 (NF1), associated with pseudo-precocious puberty (PPP). A thorough workup revealed a large multi-cystic right ovarian mass, which turned out to be a juvenile granulosa cell tumor (JGCT). This report documented a rare case of PPP caused by JGCT in a child with NF1. Verbal consent was taken from the family.

Surgical Intervention of Huge Uterine Polyp and its Oncogenic Potential and Clinical Implications

Abstract Background: Endometrial polyps are common benign growths; however, exceptionally large polyps are rare and may present with severe clinical symptoms. Surgical intervention is often necessary to manage complications, and histopathological evaluation is crucial to assess their oncogenic potential. Accordingly, the aim of this study is to evaluate the clinical presentation, surgical management, and oncogenic potential of unusually large uterine polyps to emphasize the importance of early diagnosis and timely intervention. Materials and Methods: This retrospective study analyzed data from 200 patients undergoing hysteroscopic polypectomy for uterine polyps exceeding 3 cm in size. Preoperative assessments included ultrasonography, hysteroscopy, and histopathological evaluation. Surgical outcomes, histopathological findings, and postsurgical follow-up data over 2 years were documented. Results: Among the 200 patients examined, three cases were identified with unusually large endometrial polyps, each presenting with severe clinical symptoms. Case 1 involved a 35-year-old woman with severe suprapubic pain, anemia, and a protruding vaginal mass. Magnetic resonance imaging (MRI) revealed an 8.49 cm posterior endometrial polyp extending to the posterior cervical wall. Case 2 was a 32-year-old woman with urinary difficulty, menorrhagia, and anemia. MRI identified two uterine polyps, the largest measuring 11.45 cm × 6.1 cm, extending up to the cervix. Case 3 was a 43-year-old woman with urinary retention, continuous vaginal bleeding, and a massive 21.4 cm × 8.65 cm × 8.0 cm polyp originating from the fundal region. Hysterectomy was performed in all cases, and histopathological evaluation confirmed benign polyps without malignancy. Conclusion: The occurrence of massive uterine polyps is rare but can lead to severe symptoms and significant morbidity. While histopathology confirmed benign pathology in these cases, the potential for malignant transformation underscores the need for early diagnosis and timely surgical intervention. MRI plays a crucial role in preoperative assessment, and hysterectomy remains the definitive treatment for large polyps causing severe clinical symptoms.