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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 2  |  Page : 74-78

A histopathologic review of nonsquamous cell malignancies of the cervix in Kano, Nigeria


1 Department of Pathology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Morbid Anatomy and Forensic Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria

Date of Web Publication30-Nov-2016

Correspondence Address:
M S Haruna
Department of Morbid Anatomy and Forensic Medicine, Usmanu Danfodiyo University, Sokoto
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.194979

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  Abstract 

Background: Although recent studies suggest that there is rising proportion of cervical adenocarcinoma in most part of the world, there has been no formal study in our setting. We therefore undertook this review to document and evaluate the pattern in Kano, Northern Nigeria.
Patients and Methods: This was a 10 year retrospective study from 2nd January, 2002 to 31st December, 2011 of all non-squamous cell malignancies diagnosed at the pathology department of Aminu Kano Teaching Hospital, Kano, Nigeria. Where necessary, new sections were made from formalin fixed, paraffin embedded blocks.
Results: During the ten year study period, a total of 545 cervical cancers were diagnosed. Of these, 448 (82.2%) were squamous cell carcinomas and 17.8% were non-squamous malignancies. Out of the 97 non-squamous malignancies, adenocarcinoma was by far the most common. 52 (53.6%) were endometrioid type adenocarcinomas, while clear cell and mucinous variants comprised 12 (12.4%) and 6 (6.2%) respectively. Other carcinomas in this series were adenosquamous (10 cases), small cell (6 cases), adenoid cystic {3 cases}, undifferentiated (3 cases) and metastatic (1 case). There was only one sarcoma - a leiomyosarcoma. Patients ranged from 20 to 80 years (mean 48.30 ± SD 12.61 years) with the highest occurence in the 4th–6th decade age group.
Conclusion: Non-squamous malignancies of the cervix comprised 17.8% of all invasive cervical cancers in Kano and adenocarcinomas were overwhelmingly preponderant. The study findings were consistent with most published reports in Nigeria and elsewhere. These malignancies were associated with high morbidity and mortality which necessitates data for health planning and policy decisions.

Keywords: Cervix, malignancies, non-squamous


How to cite this article:
Sule A A, Haruna M S. A histopathologic review of nonsquamous cell malignancies of the cervix in Kano, Nigeria. Arch Int Surg 2016;6:74-8

How to cite this URL:
Sule A A, Haruna M S. A histopathologic review of nonsquamous cell malignancies of the cervix in Kano, Nigeria. Arch Int Surg [serial online] 2016 [cited 2021 Jan 16];6:74-8. Available from: https://www.archintsurg.org/text.asp?2016/6/2/74/194979


  Introduction Top


Cervical cancer is the second most common cancer in women worldwide and the most common among women in developing countries.[1],[2],[3] More than 85% of approximately 529,800 cases diagnosed annually have been reported from developing countries, a proportion that is expected to increase to 90% by 2020.[2],[4] In addition, cancers of the cervix and breast are the leading causes of cancer-related death among women in developing countries.[5],[6] The high burden of cervical cancer in sub-Saharan African region is largely due to a lack of screening that allows detection of precancerous and early stage cervical cancer.[7],[8] Therefore, while approximately 75% of cases present early in developed countries, thereby making the expectation of cure realistic, in developing countries, the majority of cases present with advanced disease.[9]

Squamous cell carcinomas were overwhelmingly preponderant constituting over 80% of cervical cancer followed by adenocarcinomas. Increasing incidence of cervical adenocarcinoma has been reported in several developed nations. The rising proportion can be expained by widespread routine cervical cancer screening, which mostly picks up premalignant squamous lesions from the easily accessible ectocervix, whereas adenocarcinoma Usually from the inner endocervix. Furthermore, cervical adenocarcinoma is not strongly linked to human papilloma virus (HPV) or sexually transmitted infection like cervical squamous cell carcinoma, and therefore improved sexual hygiene and HPV vaccination have less impact on its prevalence.[10]

The nonsquamous cell malignancies of the cervix have not been documented in our setting, and hence this review. The aim of this article was to analyze the frequency and morphological patterns, as well as to compare our findings with other studies from different geographical locations of the world.


  Patients and Methods Top


This was a 10-year retrospective study conducted from 2nd January, 2002 to 31st December, 2011 of all nonsquamous cell malignancies diagnosed at the Pathology Department of Aminu Kano Teaching Hospital, Kano. It is the only tertiary health institution offering histopathological services in Kano State—the most populous state in Nigeria (2006 census).[11]

Histology slides on all cases were retrieved and reviewed by the authors. Fresh sections were cut from archival paraffin blocks when slides could not be retrieved. All specimens had been fixed in 10% formal saline and then routinely processed for paraffin embedding. Microtome sections were cut at 4 µ and stained with hematoxylin and eosin. Special stains such as mucicarmine for mucin were deployed where necessary. Biodata (age, sex) on all cases were retrieved from laboratory records. Collated results were presented in the form of tables and photomicrographs.


  Results Top


A total of 545 cervical cancers were documented during the 10-year study period. Of these, 448 (82.2%) were squamous cell carcinomas and 97 (17.8%) were nonsquamous malignancies. [Table 1] depicts the relative frequency and age distribution of different histologic subtypes. The most frequent nonsquamous malignancies were adenocarcinomas comprising 70 cases, out of which 52 (53.6%) were endometrioid type adenocarcinomas, whereas clear cell and mucinous variants comprised 12 (12.4%) and 6 (6.2%), respectively. Other carcinomas in this series were adenosquamous (10 cases), small cell (6 cases), adenoid cystic (3 cases), undifferentiated (3 cases), and metastatic (1 case). There was only one sarcoma—a leiomyosarcoma.
Table 1: Histological types and age distribution of nonsquamous cell malignancies of the cervix in Kano

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With regards to age distribution, patients' age ranged from 20 to 80 years, with (mean 48.30 ± standard deviation (SD) 12.61 years). The overwhelming majority of patients were in their 4th to 6th decade; the peak incidence was in the 40–49 years age group with 26 cases (26.8%). This was followed closely by 50–59 years with 24 cases (24.7%). The least was 20–29 years with 8 cases (8.2%). Seventy four (76.3%) of the cases occured in patients aged 40 years and above. The youngest incidence was in a 20-year-old patient.

[Table 2] and [Table 3] depicts the frequency distribution of squamous versus nonsquamous cell malignancies of the cervix in Kano before and during the study period (1998–2011), respectively. Comparing the two periods [Table 3], the X2 = 2.00 and P = 0.16.
Table 2: Frequency distribution of squamous versus nonsquamous cell malignancies of the cervix in Kano between 2001 and 2011

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Table 3: Frequency distribution of squamous versus nonsquamous cell malignancies of the cervix in Kano before and during the study period (1998-2011)

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[Figure 1] and [Figure 2] show the photomicrograph of the mucinous adenocarcinoma and leiomyosarcoma of the cervix, respectively.
Figure 1: Mucinous adenocarcinoma of the cervix (Hematoxylin and Eosin ×20)

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Figure 2: Leiomyosarcoma of the cervix (Hematoxylin and Eosin ×20)

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  Discussion Top


In this study, nonsquamous cell malignancies accounted for 17.8% of all cervical cancers in Kano, whereas squamous cell carcinomas comprised 82.2%. It is noteworthy that the proportion of nonsquamous carcinoma in this series (17.8%) is similar to other Nigerian studies—11% in Zaria,[12] 12% in Maiduguri,[13] 14.8% in Ilorin,[14] and 7% in Ibadan.[15] It also concurs with studies from other countries e.g. Tunisia (9.5%),[16] India (10%),[17] and USA (15%).[18]

Adenocarcinomas constituted majority of nonsquamous cell malignancies comprising 12.8% of all cervical cancers in Kano. This agrees with 10.5% in neighbouring Zaria,[19] 14.9% in Port-Harcourt,[20] 7.3% in Tunisia,[16] and <10% in India.[17] Increasing incidence has been reported in several developed nations, namely Canada (Liu 2007),[21] United Kingdom (Berrington 2001),[22] Iceland (Curado et al., 1999),[23] Sweden (Hemminki et al. and Stockton et al.),[24] and Spain (Levi).[25]

Endometrioid carcinoma was the most common variant of adenocarcinoma accounting for nearly three-quarters (74.3%), which is similar to 71.2% in Maiduguri,[13] northeast Nigeria. This was followed by clear cell adenocarcinoma which comprised 17.1% and mucinous adenocarcinoma (8.6%). The adenosquamous variant constituted 1.8%, which corroborates with 2.4% in Zaria.[12]

Messenchymal malignancies of the cervix are uncommon. Only one sarcoma—a leiomyosarcoma was encountered in this study representing 0.2%, which is comparable to 0.5% reported by Platz in USA.[26]

In the present study, more than half of adenocarcinmas (51.5%) occured in the 4–6th decade. This agrees with other Nigerian studies where most patients were within the 40–60 year age bracket—53.8% in Maiduguri [13] and 89.1% in Ilorin.[14] The overall age range of patients were between 20 and 80 years peaking in the 4th decade (26 cases), this was followed by patients in the 5th decade (24 cases). The mean age was 48.3 years, which corroborates 47.9 years in Egypt,[27] 53 years in Brazil,[28] and 52.4 years in Italy.[29]

From the above mentioned results, comparing the two periods with no significant association (P value of 0.16), it means that there may be no increase in nonsquamous cell malignancies over the squamous cell carcinomas in the study period compared to the pre-study period. However, there was a gradual increase in the frequencies of nonsquamous cell malignancies over the years during the study period. This is mainly due to the effectiveness of cervical screening programme, squamous cell carcinoma precursors are frequently detected in  Pap smear More Detailss, and can generally be readily visualized by colcoscopy and eradicated. On the other hand, adenocarcinoma precursors are often difficult to identify because it often arises deep in the endocervical canal, the area that is not easily sampled during routine screening; hence, invasive adenocarcinoma is often present by the time the tumor is detected. Another reason is that an increasing duration of oral contraceptive use has been linked with particularly high rate of cervical adenocarcinomas.[30]

In conclusion, the incidence of nonsquamous cell malignancies has been increasing gradually in our environment and other developing nations, which necessitates data for health planning and policy decisions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Abdul MA, Mohammed A, Mayun A, Shittu SO. Non-Squamous Cell Carcinoma of the cervix in Zaria, Northern Nigeria: A Clinico-Pathological Analysis. Ann of Am Med 2006;5:118-21.  Back to cited text no. 12
    
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Mayun AA, Nggada HA, Audu BM, Pindiga UH, Khalil MI, Musa AB. Histopathological analysis of non-squamous cell malignancies of the uterine cervix in Maiduguri, Nigeria. Afr J Med Med Sci 2008;37:369-73.  Back to cited text no. 13
    
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Mohammed A, Ahmed SA, Oluwole OP, Avidime S. Malignant Tumours of the Female Genital Tract in Zaria, Nigeria. Annals of Afr Med 2006;5:93-6.  Back to cited text no. 19
    
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Uzoigwe SA, Seleye-Fubara D. Cancers of the uterine cervix in Port Harcourt, Rivers State-a 13-year clinico-pathological review. Niger J Med 2004;13:110-3.  Back to cited text no. 20
    
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Berrington A, Sweetland S, Green J. Comparison of risk factors for squamous cell and adenocarcinomas of the cervix: A meta-analysis. Br J Cancer 2004;90:1787-91  Back to cited text no. 22
    
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Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, et al. Editors. Cancer Incidence in Five Continents, Vol. IX, Issue 160. Lyon, IARC: IARC Scientific Publications; 2007.  Back to cited text no. 23
    
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Hemminki K, Li X, Vaittinen P. Time trends in the incidence of cervical and other genital squamous cell carcinomas and adenocarcinomas in Sweden, 1958-1996. Eur J Obstet Gynecol Reprod Biol 2002;101:64-9.  Back to cited text no. 24
    
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Brenna SM, Zeferino LC, Pinto GA, Souza RA, Andrade LA, Vassalo J, et al. C-Myc protein expression is not an independent prognostic predictor in cervical squamous cell carcinoma. Braz J Med Biol Res 2002;35:425-30.  Back to cited text no. 28
    
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Giorgi Rossi P, Sideri M, Carozzi FM, Vocaturo A, Buonaguro FM, Tornesello ML, et al. HPV type distribution in invasive cervical cancers in Italy, pooled analysis of three large studies. Infect Agent Cancer 2012;7:26.  Back to cited text no. 29
    
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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