Laryngeal Cancers at the Pathological Anatomical Laboratory (ACP) in Dakar about 215 Cases

Introduction: Laryngeal cancer is the first cancer of upper aerodigestive tract. Dysphonia, dyspnea and dysphagia are evocative signs. Diagnosis is histological and squamous cell carcinoma is the most common type. The objective of our study was to discuss epidemiological and anatomo-pathological characteristics of laryngeal cancers diagnosed in different pathological anatomy and cytology (ACP) laboratories of Dakar hospitals. Material and method: This was a retrospective study spanning from January 2013 to December 2018 at the pathological anatomy laboratories of Fann, Aristide Le Dantec and Idrissa Pouye hospitals. All patients with laryngeal cancer confirmed at histology were included. Data collection was based on clinical records of the patients and archives of histological reports of the pathological laboratories. Data analysis was performed under the Excel software. Results: We collected 215 cases of laryngeal cancer. The average age was 58.01 years with extremes of 07 and 94 years. The male sex was predominant with 183 patients (85.12%) against 32 women (14.88%). The most noted risk factor was tobacco which affected 14 patients, or 60.87%. Three patients (13.04%) did not present any alcohol-smoking impregnation. Clinically, dysphonia was noted in 22 patients (26.51%). It was associated with dyspnea in 0.48% of cases and dysphagia in 3.61%. Laryngoscopy was performed in 62 patients or 28.83% of cases, nasofibroscopy in 6.45% of cases. Cord arythenoid fixity was noted in two patients (3.23%) and hypo-mobility in 1 patient (1.61%). The most frequent local extension was involvement of the piriform sinus with 11.29% of cases. Palpable lymphadenopathy reported in 17 patients (20.48%). Pathological examination was performed in all patients after post endoscopic biopsy in 92 patients (42.79%), and after obtaining the operative specimen in 123 cases (57.21%). The three floors affected 76 patients (35.35%). The ulcerative budding aspect most noted concerned 108 patients (60.97%). Histologically, it was a squamous cell carcinoma in 205 patients (95.34%). The most site invaded by the tumor was cricoid cartilage.T4 type was most found (45 patients or 40.90%) followed by the T3 type with 34.55%. There was no lymphadenopathy invasion (Type N0) in 74 patients (67.27%), capsular rupture was reported in five patients (6.77%), no evaluable metastasis in 110 patients (97.27%), and stage IVA predominated in 66 patients (60%). Conclusion: laryngeal cancer is a reality in our contexts, however, its incidence is poorly understood in Senegal. The main risk factors remain tobacco and alcohol. Histology confirms the diagnosis. Its management is multidisciplinary and must be early.

Epidermal Inclusion Cyst: A Rare Benign Breast Lesion

Epidermal inclusion cyst in the breast is an uncommon condition. It may be congenital, originating from hair follicles or occurring after trauma (breast reduction or breast cytology puncture) or consists of squamous metaplasia of the regular columnar epithelium within an ectatic ductus galactophorus. We report the case of a 22-year-old woman, with two pregnancies and with no particular pathological history, who presented with a 3 cm nodule of the right breast at the union of the upper quadrants, firm, mobile and painless. The skin, areola and nipple were unaffected. The axillary areas and the contralateral breast were unremarkable. The breast ultrasound showed a heterogeneous and well circumscribed hypoechoic mass classified as ACR3. Macroscopic examination revealed a unilocular cyst with a discretely thickened wall, abundant yellowish contents and measuring 2 cm on a long axis. Histologically, it was a cystic cavity whose wall was lined with a pseudo stratified keratinized squamous epithelium with a granular layer and whose lumen contained keratin lamellae. This cyst is surrounded by a more or less fibrous pallial tissue containing regular, sometimes dilated or even cystic milk ducts. The diagnosis of epidermal inclusion cyst of the breast on a background of fibrocystic mastopathy was thus concluded. The importance of this benign lesion lies in the differentiation between other non-neoplastic and neoplastic breast lesions.

Rhabdomyosarcoma in Dakar: An Update on Pronostics Factors

Rhabdomyosarcoma (RMS) belongs to the soft tissue sarcomas that have striated muscle differentiation. It is most common in young children under 5 years of age and adolescents. The definite diagnosis of rhabdomyosarcoma is based on histology and the positivity of striated muscle markers in immunohistochemistry. Our objective was to describe the prognostic characteristics of RMS diagnosed in Dakar. MATERIAL AND METHODS: This was a retrospective and descriptive study spread over nine (09) years from 1 January 2011 to 31 December 2019. It was conducted from the histological report archives of the anatomy and pathology laboratories of Dakar. Paraffin blocks were reread and immunohistochemically studied by manual method. Antidesmin and antimyogenin antibodies were used. RESULTS: We collected 44 patients with rhabdomyosarcoma out of 228 cases of soft tissue cancers, i.e. 19.29% of all malignant soft tissue tumours. The mean age of the patients was 25.41 ± 23.95 (standard deviation) years with a median age of 16 years and extremes of 6 months and 81 years. Patients were less than or equal to 17 years of age in 61.4% of cases. A clear male predominance was observed with 29 men (65.9%) against 15 women (34.1%). Rhabdomyosarcomas were located in the limbs in 34.1% of cases, in the head and neck in 29.5% of cases and in the genitourinary tract in 25% of cases. The average tumour size was 7.45 cm ± 4.64 (standard deviation) with a minimum of 2 cm and a maximum of 17 cm. It was greater than or equal to 5 cm in 15 patients (68.2%). Embryonal rhabdomyosarcoma (ERMS) was the most frequent histological type with 34 cases (77.3%), followed by pleomorphic rhabdomyosarcoma 7 cases (15.9%) and alveolar rhabdomyosarcoma 3 cases (6.8%). The histological subtypes of ERMS consisted of conventional ERMS (91.18%);botryoid RMS (5.88%) and spindle cell RMS (2.94%). The correlation between histological type and age was statistically significant (p = 0.039). A relationship was also observed between histological type and site (p = 0.026). According to the American IRS classification, the tumour was classified as group I in 41% of cases, group II in 50% of cases and groups III and IV in 4.5% each. CONCLUSION: Rhabdomyosarcoma is a rare malignant tumour in Dakar. It is often a voluminous tumour of the limbs which affects mainly males. The embryonal type is the most frequent histological form.