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Histopathological Pattern of Benign Soft Tissue Tumours In HISTOPATHOLOGICAL PATTERN OF BENIGN SOFT TISSUE TUMOURS IN THE UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA-A RETROSPECTIVE STUDY: 1970-2002 BY Dr Gabriel Olabiyi OGUN MB, BS (Ilorin) Department of Pathology, University College Hospital, Ibadan, Nigeria A dissertation submitted in part fulfilment of the requirements for the award of the Fellowship of the National Postgraduate Medical College of Nigeria (FMCPath) November 2005 TABLE OF CONTENTS Page Cover page і Table of Contents іі List of Tables iii List of Figures iv Certification v Declaration vi Acknowledgement vii Dedication viii Abstract ix Introduction 1 Literature Review 2-12 Aims and objectives 13 Materials and methods 14 Results 15-24 Discussion 25-30 Conclusion 31 References 32-38 Appendix 39-49 iii LIST OF TABLES Page 2.1 Inherited benign soft tissue tumours 5 2.2 Cytogenetic characteristics 11 5.1 Frequencies of soft tissue tumours 22 5.2 Summary of benign soft tissue tumours 23 5.3 Site distribution 24 iv LIST OF FIGURES Page Figure 1 Age and sex distribution 18 Figure 2 Percentages of individual vascular tumours 18 Figure 3 Photomicrograph of cystic lymphangioma 19 Figure 4 Percentages of individual neural tumours 19 Figure 5 Photomicrograph of plexiform neurofibroma 20 Figure 6 Photomicrograph of granular cell tumour 20 Figure 7 Percentages of individual fibrous tumours 21 Figure 8 Photomicrograph of infantile fibromatosis 21 v CERTIFICATION This is to certify that the study described was done by Dr. Gabriel Olabiyi OGUN while he was a resident in Pathology in the Department of Pathology of the University College Hospital, Ibadan under our Supervision. ------------------------------------------------- Prof E.E Akang M.B, B.S, FMCPath, FWACP ------------------------------------------------- Prof J.O Ogunbiyi M.B, B.S, FWACP vi DECLARATION I hereby declare that this work is original unless otherwise acknowledged. This work has not been presented to any other college for a degree or fellowship, nor has it been submitted elsewhere for publication. ---------------------------------------------------------------- Dr. Gabriel Olabiyi OGUN vii ACKNOWLEDGEMENT This work from the very beginning had inputs of my teachers Prof E.E Akang and Prof J.O Ogunbiyi, who were also my supervisors for this study and Dr O.A Oluwasola. They suggested the topic, encouraged and directed me on the study. I am indebted to them. My profound gratitude goes to my colleagues Dr Clement Okolo and Dr Tope Oyebadejo. Your friendship has been exemplary. My gratitude also goes to Dr Gbolabo Adetunji, Dr U Eze, Dr Femi Ariyibi, Dr Seun Akinpelu, Dr Funmi Makanjuola, Dr Seun Olasunkanmi and Dr Iyabo Gbadamosi for helping with the retrieval of the records, slides and tissue blocks despite severe constraints and stress. My thanks also go to Mrs Lawal and Mr Ajibade, both laboratory scientists in the department for their help. I thank all members of staff of the Department of Pathology, University College Hospital, Ibadan. Ultimately to the Almighty God, who made it all possible. Without Him it would have been impossible. viii DEDICATION To my GOD Almighty, the giver of life, who made it all possible. To my darling and loving wife: - Olufunmilola. You have kept the home front well; I love and appreciate you very much. To my children, Seyi and Segun - wonderful and loving sons. You give me joy which is unquantifiable. Seyi, sorry for the few times I forgot you in school while this project was on. To my parents in Abeokuta and Ibadan – you have always been there. I am short of words. I appreciate you very much. ix ABSTRACT This was a retrospective study of the histopathological pattern of benign soft tissue tumours at the University College Hospital Ibadan between 1970 and 2002. The study was carried out in the Department of Pathology, University College Hospital, Ibadan. All cases with a diagnosis of benign soft tissue tumours were reviewed from the records of the department. Haematoxylin and eosin stained histological slides retrieved and where necessary the paraffin blocks were recut and stained. The tumours were classified according to the Weiss and Goldblum 2001 classification. A total of 141,088 biopsies were received in the department over the study period. Three thousand six hundred and sixty four cases which accounted for 2.6% of all the biopsies recorded during the period. However, only two thousand eight hundred and one cases of benign soft tissue tumours fulfilled the inclusion criteria. These cases constituted 2% of all biopsies in the study period. Overall for all tumours, the female: male ratio was 1.1:1; age range was 0 – 83 years, with mean age of 29 years in both sexes. The mean for males and females were 32 years and 26 years respectively. The peak age group was 30-39 years but it was 20-29 years in female and 30-39 years in males. Lipomatous tumours were the commonest which accounted for 43.9% of cases. Together with vascular, neural, fibrous, fibrohistiocytic and synovial tumours they constituted 96.6% of all the cases. Benign soft tissue tumours are fairly common in our environment from this study .The pattern of soft tissue tumour in this environment is similar to what has been observed in previous studies from Nigeria and other parts of the world. 1 1 CHAPTER ONE INTRODUCTION Soft tissue is defined as the non-epithelial, extra-skeletal tissues and structures of the body, exclusive of the haematopoietic or lymphoreticular system, glia and supporting tissues of various parenchymal organs.1,2 It is represented by the voluntary (skeletal) muscles, adipose and fibrous connective tissues, blood and lymphatic vessels. Also included is the peripheral nervous system because tumours arising from nerves present as soft tissue masses.1,2 Soft tissue tumours constitute a large and heterogeneous group of neoplasms, which can be found in virtually any location in the body. They are classified on a histogenetic basis according to the adult tissues they resemble.1,2 Within the various categories, they are divided into benign and malignant forms. Benign soft tissue tumours closely resemble their normal tissue counterparts and possess a limited capacity for autonomous growth.1 The University College Hospital (UCH) Ibadan, where this study was carried out, is located in Oyo state, in the South-western part of Nigeria. UCH is the only tertiary health centre in Oyo state and the largest in the country. There are only a few published reports on soft tissue tumours from UCH, Ibadan, and most reports from other parts of Nigeria were either case reports or focused on specific histological subtype most of which were malignant soft tissue tumours.3-25 This work therefore aimed at determining and describing the relative rates of occurrence and pattern of various benign soft tissue tumours in Ibadan. 2 2 CHAPTER TWO LITERATURE REVIEW 2.1 GENERAL CONSIDERATIONS 2.11 Embryology Soft tissue by definition is derived principally from the mesoderm with some contribution from the neuroectoderm. They first appear at about the third week of intrauterine development.26 By the end of the 8th week of development all derivatives of the mesoderm and neuroectoderm are already established.26 The derivatives of mesoderm defined as soft tissue are: (1) Fibrous (connective) tissue (2) Adipose tissue (3) Skeletal muscle (4) Smooth muscle (5) Blood and lymphatic vessels (6) Peripheral nerves are derived from the neuroectoderm. A benign tumour of soft tissue can arise from any of the above listed derivatives of the mesoderm and neuroectoderm. 2.12 Classification There have been several classifications used in the past to describe various soft tissue tumours. Earlier classifications have been largely descriptive and terms such as round cell tumour and spindle cell tumour have been employed.1 However, descriptive classifications are discouraged, because they are do not convey adequate information to the clinician as to the nature and potential behaviour of a given tumour.1 In the last few decades there have been efforts at arriving at a useful classification of soft tissue tumours. These recent classifications have been based principally on the line of differentiation of the tumour, that is, the type of tissue formed by the tumour 3 3 rather than the type of tissue from which the tumour arose (in cases of malignant forms). The Armed Forces Institute of Pathology (AFIP) and the World Health Organization (WHO) have championed the course of classification of soft tissue tumours. The AFIP classification was first published in the Atlas of tumour pathology in 1957 with a second series in 1983 with the latest edition published in 2001.27 The WHO classification was first published in 1969 with a revision in 1993, the latest revision was published in 2002.28 The classification of Weiss and Goldblum (2001)1 is used for this study, as outlined in the appendix. The various tumour types are named according to the histological type of the predominant cellular element, that is, the resemblance of the tumour to normal tissue or its embryonal counterpart (this applies only in cases of the malignant forms) 2.2 EPIDEMIOLOGY Generally, soft tissue tumours are not uncommon. The benign soft tissue tumours by far outnumber their malignant counterparts in terms of occurrence and numbers that come to clinical attention.1 This is despite the fact that many benign soft tissue tumours will go unbiopsied.1,29 The relative frequency of benign soft tissue tumours as compared to malignant ones in the general population is difficult to accurately determine.1,3
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