Infections Mimicking Malignancy in Kano, Nigeria: A Teaching Hospital Experience
Abdulrazaq Jimoh Ajanaku1, Akinfenwa Atanda Taoheed1,2, Usman Bello Mohammed3, Muhammad Haruna Sanusi 4, Zubaida Adamu Gwaram 1
1Department of Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria
2Department of Pathology, Aminu Kano Teaching Hospital/College of Health Sciences, Bayero University, Kano, Nigeria
3Department of Surgery, Aminu Kano Teaching Hospital/College of Health Sciences, Bayero University, Kano, Nigeria
4Department of Morbid Anatomy and Forensic Medicine, Usman Danfodiyo University, Sokoto, Nigeria
Received: 13 Aug 2021; Revised: 11 Dec 2021; Accepted: 23 Jan 2022; Available online: 25 Mar 2022
Objective: This study aimed to evaluate the pattern of presentation of infectious lesions mimicking malignancy. This will serve to heighten clinical indices of suspicion and prevent unwarranted aggressive management. Methods: This is a 19-year (1999-2017) audit review of all morphologically diagnosed infection-related lesions in which malignancy was primarily clinically suspected. Results: Fifty-six cases of infection-related mimics of malignancy were diagnosed in the study period: schistosomiasis related, 22 (39.2%); actinomycosis, 21(37.5%); tuberculosis-related, 10 (17.9%); fungi-related, 3(5.4%). Twenty-one cases of actinomycosis of the lower limbs and oropharynx were mistaken for melanoma, squamous cell carcinoma, sarcoma, and oropharyngeal carcinoma. The mean age was 33±17years.The 10 patients with atypical Mycobacterium tuberculosis-mimicking malignancy had mean age of 37±14 years and included three in the testes, testicular cases, one from the jaw, and two cases each from ovary, breast, and uterus. Of the three fungal lesions, there was a case each from the brain, skin, and bone. All were males with mean age of 21±7 years. Conclusion: For accurate diagnosis of infection-related mimics of malignancy, a high index of clinical suspicion, knowledge of and attention to characteristic radiological signs, and obtaining representative tissues for histopathologic and cytopathologic diagnoses are paramount.
Keywords: Schistosomiasis, Tuberculosis, Actinomycetoma, Fungal, Malignancy, Mimics
Ann Afr Surg. 2022; 19(2): 79-85
© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
Mimics of malignancy pose diagnostic challenges clinically, radiologically, and sometimes, morphologically. Incorrect diagnosis of these entities may lead to patient anxiety, delayed diagnosis, disease progression, unnecessary intervention, increased hospital costs and exposure of patients to risks (1-5).
These mimics, which include infections (bacterial, fungal, and parasitic infections) and benign neoplastic lesions, have varied pathological entities with uncommon presentations similar to malignancy (1,3-5).
Inadequate clinical evaluation, history of cancer in a patient with swelling, similarities in radiological features, overlapping symptoms, and unusual clinical presentation appear to underlie misdiagnosis in these cases (1-5).Infections mimicking malignancy have geographical variation base on their patterns and prevalence and hence the need for this study in our locality(1-5).This study aimed to present an audit of infections that mimic malignancy in a bid to improve clinical index of suspicion in such cases.
Materials and methods
This is a 19-year (January 1999 to December 2017) retrospective hospital-based descriptive study carried out in the Department of Histopathology and Surgery of Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. The study conforms to the Health and Research Ethical committee of AKTH (ethical review reference number: AKTH/MAC/SUB/12A/P-3/VI/3190).
AKTH is a tertiary hospital with a bed capacity >700 and receives referrals and histological samples (with an annual average of 5500 samples) from cities and rural areas of Kano state (population,>13.4 million) and neighboring areas of Jigawa, Bauchi, Kaduna, and Katsina states. The study included all cases of infection in which malignancies were the sole clinical or radiological assessments during the study period. The point of data collection is from the time samples were received in Histopathology Department. Detailed clinical information was sought from clinicians, and cases with inadequate clinical information and other lesions in which non-malignancies were also suspected were excluded. A total of 56 cases were analyzed. The data, includingclinical history, examination, clinical and radiological assessment, and histological diagnosis,were obtained from hospital request forms (histopathological request forms), patients’ case notes,and duplicate copies of histopathology reports, reviewed slides, and electronic records of the Histopathology Department. The histopathological request forms were well archived upon receipt, and the information they contain has been electronically converted in the past 15years. This information includes pre-analytical diagnosis, detailed findings, including imaging, and contacts of physician. The keywords searched in histopathological electronic records and request forms were clinical assessment and sole clinical/radiological assessment of malignancy.
The collected information was tabulated and analyzed by descriptive statistics using the SPSS for Windows version 23.0 (IBM Corp., Armonk, NY, USA). The limitatio