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Annals of African Medicine
Annals of African Medicine Society
ISSN: 1596-3519
Vol. 5, Num. 3, 2006, pp. 129-131

Annals of African Medicine, Vol. 5, No. 3, 2006, pp. 129-131

Orbito-Ocular Malignant Tumours in Zaria, Nigeria: A 10-Year Review

1A. Mohammed, 1S. A. Ahmed, 2N. E. Ahmedu and J. S. Maisamari

 1Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria and 2National Eye Centre, Kaduna, Nigeria
Reprint requests to: Dr. A. Mohammed, Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. E-mail: medvisory@yahoo.com

Code Number: am06030

Abstract

Background: Malignant orbito-ocular tumours are common, frequently affect the young and cause morbidity and mortality. There was no prior published report from our centre.
Method:This study was a ten-year retrospective histopathological analysis of orbito-ocular malignant tumours seen at the Department of Pathology of the Ahmadu Bello University Teaching Hospital Zaria (January 1993 to December 2002).  Histopathology diagnosis of specimens of the eye and adnexae were retrieved from the laboratory bench books and relevant information on the age of the patient and histopathologic type were analysed.
Results: A total of 124 orbito-ocular malignant tumours were recorded. There were 2480 malignant tumours and these constitute 5% of all malignant lesions seen. The most frequent histological types encountered were retinoblastoma (40.3%), squamous cell carcinoma (33.1%) and Burkitt’s lymphoma (9.6%). There was equal sex distribution and infants were affected in 49.2% of cases with a mean age of 4.5 years. The most common sites in 82 cases were intraocular (54.8%), the orbit (23.2%) and conjunctiva in 17.1% of cases.
Conclusion: Malignant orbito-ocular tumours are not uncommon in this environment and frequently affect infants; therefore appropriate medical facilities should be put in place to aid in diagnosis and management of these lesions.

Key words:Orbito-ocular, malignancies

Résume

Arrière-plan : Les tumeurs malignes orbito-ocullaires sont fréquent et affectent les jeunes et est une cause de mortalité et de morbidité. Aucune étude n’a été publiée de ce centre.      
Méthode : Cette étude  est une analyse histopathologique  rétrospective,  des tumeurs malignes orbito-ocullaires vues au Département d’Anatomie Pathologie du centre Hospitalier Universitaire Ahmadu Bello Teaching Hospital Zaria, durant dix ans,  de Janvier 1993 à Décembre 2002.  Les données utilisées ont étaient récupérées de la banque des données du Département d’Anatomie Pathologie et les informations telles que l’age des patients et le type de cancer a été analysé.  
Résultats : Un total  de 124 tumeurs orbito-ocullaires a été enregistré sur un total de 2480 tumeurs vues durant la période d’étude. Ceci représente 5% de toutes les tumeurs malignes.  Le type histologique fréquemment rencontre fut le retinoblastoma (40.3%),  les carcinome cellulaire squameux (33.1%), et les lymphome de Burkitt (9.6%).  La distribution entre sexe été égale et les enfants étaient les plus affectes, 49.2% de toute les tumeurs avec une age moyen de 4.5 ans. Les sites les plus affectés fut la conjonctive 17.1% des cas, l’orbit 23.2% des cas et œil intraoculaire 54.8%.
Conclusion : les tumeurs orbito0ocullairs ne sont pas rare dans cette région et affectent fréquemment les enfants, il est donc nécessaire de mettre sur place des structures sanitaire capable de diagnostiquer et de prendre en charge ces lésions.

 Mots clés : orbito-ocullaires, malignes

Introduction

Orbito-ocular malignancies are unsightly and may contribute to visual disturbances. Although thought to be rare, they contribute to significant morbidity and mortality.1 - 3 Visual loss in children has implications for all aspects of the child’s development.4

The most common histopathological types are retinoblastoma, squamous cell carcinoma and Burkitt’s lymphoma.5, 6

Materials and Method

This study was a ten-year retrospective histopathological analysis of orbito-ocular malignant tumours seen at the Department of Pathology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria (January 1993 to December 2002), using the laboratory bench book.

Results

One hundred and twenty four (5%) orbito-ocular malignancies were seen out of a total of 2480 malignancies.

Retinoblastoma which accounted for 50 (40.3%), squamous cell carcinoma 41 (33.1%) and Burkitt’s lymphoma 12 (9.6%) of the cases (Table 1).

The M:F ratio was 1:1, with a peak age in the first decade (mean 4.5 years) (Table 2). The pattern of anatomic distribution of 82 cases is shown in Table 3. The commonest site was intraocular 45 (54.8%), orbital in 19 (23.2%) and conjuctiva in 14 (17.1%).

Table 1: Histology of orbito-ocular malignancies in 124 patients

Histological diagnosis

Total (%)

Retinoblastoma

50(40.3)

Squamous cell carcinoma

41(33.1)

Burkitt’s lymphoma

12(9.6)

Rhabdomyosarcoma

4(3.2)

Lymphoma(other)

3(2.4)

Adenocarcinoma

4(3.2)

Astrocytoma

2(2.6)

Melanoma

2(2.6)

Basal cell carcinoma

2(2.6)

Kaposi sarcoma

1(0.8)

Lacrimal gland carcinoma

1(0.8)

Metastatic nasopharyngeal carcinoma

1(0.8)

Osteogenic sarcoma

1(0.8)

Total

124(100)

Table 2:Age and sex of 124 patients with orbito-ocular malignancies

Age

M

F

Total (%)

0 - 10

31

30

61(49.2)

11 -20

7

5

12(9.7)

21 - 30

9

10

19(15.3)

31 - 40

9

5

14(11.3)

41 - 50

3

7

10(8.1)

51 - 60

0

3

3(2.4)

61 - 70

2

2

4(3.2)

71 – 80

1

0

1(0.8)

Total

62

62

124(100)

Table 3: Anatomical site of 82 orbito-ocular malignancies

Anatomical site

No. (%)

Intraocular

45(54.8)

Orbit

19(23.2)

Conjunctiva

14(17.1)

Eyelid

3(3.6)

Lacrimal gland

1(1.2)

Total

82(100)

Discussion

One hundred and twenty four malignant orbito-ocular tumours were analysed during a ten-year period. This constituted 5% of all malignant tumours seen in the department during the study period. This figure however is higher than the 2.2% reported in Ibadan5 and 3.3% in Kampala.7

Retinoblastoma was the commonest tumour encountered which constituted 40.3%, and this is followed by squamous cell carcinoma (33.1%) and Burkitt’s lymphoma in 9.6% of cases. The predominance of these three malignancies are similar with reports from Kaduna and Uganda5, 8and several reports from Ibadan.7, 9, 10 This contrasts a report from Ile-Ife where no case of orbito-ocular Burkitt’s lymphoma was recorded in a ten-year study.1 Basal cell carcinoma and choroidal melanoma which constituted 2% each in this report contrasts a Caucasian report6 which showed it to be common and is similar to other reports in Nigeria.9, 10

Retinoblastoma occurs in sporadic and familial forms, both require mutation involving the Rb gene located on chromosome 13q14.11 However, Burkett’s lymphoma has been well characterized in malarial endemic regions and it involves translocation at 14q32 following complex mechanisms in B – cell lymphocytes.12 

The equal sex distribution observed in this study is comparable to studies from Ile-Ife1 and Ibadan, 5, 10 but contrasts with the male to female ratio of 3.4:1 from Maiduguri, North Eastern Nigeria.13 Orbito-ocular malignancies are found to be commoner within the first decade with a mean age of 4.5 years. This conforms to previous reports from Ile-Ife, Maiduguri and Ibadan.1, 5, 13

The predominant site of orbito-ocular malignancies in 82 cases was intraocular constituting 54.8%, followed by the orbit in 23.2% and conjunctiva in 17.1% of cases. Malignancies of the lacrimal glands are rare accounting for 1% of cases. No case of eyelid malignancy was seen in this study. This report however agrees with a study in Ibadan by Olurin et al.4

One case of uveal melanoma (2.6%) was encountered in this study. Another African5 study show similar trend; where 3.7% of Ocular melanoma was reported. While reports from Caucasian series show that melanoma arising from the pigmented or potentially pigment producing cells of the uvea are the most frequent primary intraocular neoplasms in adults; and can occur in children and adolescents, even in neonates.14, 15 Most of them arise from pre-existing benign nevi.16-18

Orbito-ocular malignancies are common and frequently affect infants. Retinoblastoma, squamous cell carcinoma and Burkitt’s lymphoma are the commonest histopathological types encountered and most of these malignancies are intraocular. Further researches into the clinical behaviour and management options of these malignancies in Nigerian patients should therefore be encouraged.

Acknowledgement

We are grateful to Mrs. Aishetu Umar of Mathematics and Mr. Raoul Dasi of Pathology Departments, for preparation of the manuscript.

References

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Copyright 2006 - Annals of African Medicine

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