ORIGINAL

Niger J Paed 2015; 42 (2): 111 –115

Okocha EC

Aneke JC

Ulasi TO

Ezeudu CE

Umeh EO

Ebubedike UR

Ukah CO

Pattern of childhood and adolescent

malignancies at a tertiary health

institution in South-east Nigeria : A

ten year study

Onwukamuche ME

Anyiam DC

Onyiaorah IV

Ndukwe CO

Ugwu JO

Ekwunife OH

DOI:http://dx.doi.org/10.4314/njp.v42i2.8

Accepted: 29th November 2014

Abstract: Background: Cancer

remains a major cause of death in

children and adolescents, and dif-

fers in adults in nature, distribu-

malignancy were treated at

NAUTH, Nnewi between Janu-

ary2004 and December 2013. Me-

dian age of the study population

was 9years, with a range of 0.1–

18years, more males (56.50%)

than females (43.50%). Common-

est tumours were the Lymphomas

(11.76%) comprising Non-

Hodgkin’s lymphoma (80%),

Hodgkin’s lymphoma (10%) and

Large-cell lymphoma (10%), the

Leukaemias (11.76%) comprising

Acute myeloblastic leukaemia

(80%) and Acute lymphoblastic

leukaemia (20%). Others were

Rhabdomyosarcoma (11.76%),

Nephroblastoma (11.76%), Retino-

blastoma (5.88%), Ovarian tu-

mours (4.71%), the Soft tissue

sarcomas-excluding rhabdomyo-

sarcoma (3.53%) and Osteogenic

sarcoma (3.35%)’.

Okocha EC⁽

Aneke JC

)

Department of Haematology

1

tion and prognosis . A culture of

case documentation is lacking in

our environment and many cases

go unreported.

Study objectives: To document the

pattern of childhood and adoles-

cent malignancies at a tertiary

health institution in south-east

Nigeria over a ten year period

Ulasi TO, Ezeudu CE

Department of Paediatrics

Umeh EO, Ebubedike UR

Department of Radiology

Ukah CO, Onwukamuche ME

Anyiam DC, Onyiaorah IV

Ndukwe CO

(

January 2004 to December 2013)

Department of Histopathology

Methodology: Details of all chil-

dren and adolescents aged 18

years and below treated for malig-

nancy were extracted from the

cancer registry and the records

unit of the histopathology depart-

ment for the period beginning at

January 2004 to December 2013

at Nnamdi Azikiwe University

Teaching Hospital (NAUTH),

Nnewi, Nigeria. Information re-

trieved was verified against the

hospital admission register, as

well as the medical and histopa-

thology records for all cancer pa-

tients over the period of interest.

Results: Eighty-five cases of

childhood and adolescent

Ugwu JO, Ekwunife OH

Department of Paediatric Surgery

Nnamdi Azikiwe University Teaching

Hospital (NAUTH), Nnewi, Nigeria

E-mail: onyichideokocha@yahoo.com

Conclusion: Study findings sug-

gest that lymphoma, leukaemia,

rhabdomyosarcoma and nephro-

blastoma are the commonest child-

hood and adolescent malignancies

in south-east Nigeria.

Keywords: Childhood, Adoles-

cent, Malignancy

5

Introduction

constitute approximately one percent of all cancers .

Annual number of new cases of childhood cancer report-

edly exceeds 200,000 worldwide, with over 80percent of

There is significant worldwide variation in the reported

incidence of childhood cancer, which ranges from 80 to

1

these occurring in the developing world . Cancer re-

mains a major cause of death in children and adoles-

cents, and differs in adults in nature, distribution and

2,3

1

50 per million children . Also put at 1.0 – 2.5 per

4

thousand children , childhood and adolescent cancers

1

12

1

prognosis . Children and adolescents in developing na-

shun conventional medical centers and resort to tradi-

tional practitioners, churches and patent medicine deal-

ers for treatment. Also, in poor resource settings, diag-

nosis of some childhood and adolescent cancers may be

done clinically, and treatment commenced without his-

tology or cytological confirmation. These all result in

inaccuracy of diagnosis and under reporting of malig-

nancy in this age group. The incidence of childhood and

adolescent malignancy and assessment of disease pattern

are best estimated from hospital archives orhistopathol-

ogy records, as there is often no₅reliable nationwide

population based cancer registration .

tions are afflicted by malignancies in addition to the

perennial problems of infectious diseases and malnutri-

tion. Data from Nigeria suggest that cancers in children

constitute a small proportion of total admissions in pae-

diatric wards . Also, there are observable differences in

the incidence of childhood cancer between northern and

6

southern N_,₈igeria, with higher incidence documented in

7

the south . Study findings from Kenya, Tanzaniaand

Ghana put childhood malignancies at 0.5 to 2% of over-

all malignancies .

8

9

Linet et al (1999) reported leukaemia and CNS tumours

as the commonest childhood malignancies in the United

States, and together with skin cancers and retinoblas-

toma have shown further increase in prevalence over a

There is the need to update and document the current

pattern of childhood and adolescent malignancies within

the south-east Nigerian environment. This will create

necessary awareness among parents, medical practitio-

ners and relevant authorities about the most prevalent

malignancies in this age group. Greater awareness

among relevant groups will facilitate advocacy for more

effective institutional healthcare planning and resource

allocation for the management of the affected individu-

als in this environment. Our retrospective hospital based

study is under taken for this purpose. The objective of

this study was therefore to determine the pattern of

childhood and adolescent malignancies at a tertiary

health institution in south-east Nigeria over a ten year

period (January2004 to December 2013).

2

0 year period (1975-1995). On the contrary, lympho-

mas showed a downward trend in prevalence during the

same perio₀d. Similarly, a study report from the United

1

Kingdom indicated a high prevalence of leukaemia

compared with other childhood malignanc₁ies for Asian

1

and Caucasian groups. However, a report from a hos-

pital based study done in northern and south-west Nige-

ria put lymphomas as the commonest childhood malig-

nancy in both regions of the country, followed in north-

ern Nigeria by retinoblastoma, nephroblastoma and leu-

kaemia in descending order. In south-west Nigeria the

prevalence of leukaemia was higher than that of retino-

1

7

blastoma . Also, Obioha et al reported that lymphoma

constituted nearly 40% of total cases of childhood ma-

lignancy in eastern Nigeria, followed by wilm’s tumour,

leukaemia and CNS tumours in descending order. A

high incidence of lymphoma has been reportedly associ-

Materials and Methods

7

ated with poor living standards . Also, childhood cancer,

Using a pre-designed data sheet, details of all children

and adolescents aged 18 years and below treated for

malignancy were extracted from the cancer registry and

the records unit of the histopathology department for the

period January 2004 to December 2013 at Nnamdi

Azikiwe University Teaching Hospital (NAUTH),

Nnewi, Nigeria. The information retrieved was verified

against the hospital admission register obtained from the

hospital medical records department as well as histopa-

thology records for all cancer patients over the period of

interest. The overall age and sex distribution of the af-

fected individuals were described using percentages, and

the relevant data displayed in tables. Inclusion criteria

were both genders, age eighteen years and below, and

malignant nature of tumour confirmed on histology or

cytology. Patients with borderline histological or cyto-

logical findings were excluded.

especially leukaemia which is prevalent in high income

countries reportedly emerges as an important cause of

morb₁i₂d_,i₁t₃y with improvement in socio-economic condi-

tions

. This is so when infectious diseases and para-

12, 13

sitic conditions are brought under control

.

In high income countries, improvement in the survival

for children with cancer has been documented (75 - 80%

long term survival), and is considered one of the great

5

medical achievements of the last 50 years . However,

over eighty percent of cases of childhood malignancy

live in low to middle income countries were survival for

childhood cancer ranges from ten to thirty percent. In

developing nations, an estimated 100,000 children die

each year from malignancies, with no chance of a cure,

2

,3

adequate pain relief or other supportive care . Poor

outcome in low income countries may be due to late

detection, misdiagnosis, poverty, non-availability of

drugs, co-morbidities, refusal or abandonment of treat-

ment sometimes due to ₄s_,u₆_,p₁₁erstition, as well aspoorly

Results

equipped health facilities

. A culture of case docu-

mentation is lacking in many developing countries and

several cases go unreported . Also, various environ-

Eighty-five cases of childhood malignancy confirmed on

either histology or cytology were treated at NAUTH,

Nnewi in the period between January 2004 and Decem-

ber 2013. The study population had an age range of 0.1

years to 18 years, and a median age of 9 years. More

males (56.50%) than females (43.50%) were diagnosed

with malignancies during the study period. Table 1

1

mental factors negatively impact on accurate documen-

tation of childhood and adolescent malignancies, such as

parental cultural practices, the traditional belief system,

influence from religious bodies, and economic consid-

erations. These influence parents of affected children to

1

13

shows the annual numbers for childhood and adolescent

malignancies, paediatric /adolescent hospital admissions

and overall malignancies during period of study. Paedi-

atric and adolescent malignancies constituted 0.9% of

paediatric and adolescent hospital admissions and 5.6%

of overall malignancies treated during the same period.

As shown in the graphical illustration (figure1), the year

to year incidence of childhood and adolescent malignan-

cies peaked at 2.56% of hospital admissions for this age

group in 2005, and at 7.69% and 9.35% of overall ma-

lignancies managed at NAUTH (2005 and 2012 respec-

tively). As seen in Table 2; Commonest tumours were

the Lymphomas (11.76%) comprising Non-Hodgkin’s

lymphoma (80%), Hodgkin’s lymphoma (10%) and

Large-cell lymphoma (10%), the Leukaemias (11.76%)

comprising Acute myeloblastic leukaemia (80%) and

Acute lymphoblastic leukaemia (20%). Others include

the Rhabdomyosarcoma (11.76%), Nephroblastoma

Fig. 2: bar chart showing proportion of various paediatric ma-

lignancies.

Table 2: Paediatric malignancies and proportions in relation to

gender

Tumour

No

Male

Female M:F Ratio

(

11.76%), Retinoblastoma (5.88%), Ovarian tumours

4.71%), the Soft tissue sarcomas-excluding rhabdomy-

Nephroblastoma

Lymphoma

Rhabdomyosar-

coma

10

6

5

7

4

5

3

3:2

1:1

7:3

osarcoma (3.53%) and Osteogenic sarcoma (3.35%).

These are illustrated in the histogram (Fig 2). Table 2

also shows the frequency distribution of childhood and

adolescent malignancies in relation to patient’s gender.

Lymphomas showed equal gender ratio (1:1),however,

retinoblastoma and ovarian malignancies were more

prevalent among females (ratios 2:3and 0:4 respec-

tively). More prevalent among males were leukaemia

Leukaemia

10

5

4

3

6

2

0

2

18

4

3

4

1

12

37

3:2

2:3

0:4

2:1

3:2

48:37

Retinoblastoma

Ovarian Neoplasm

Osteogenic sarcoma

Soft tissue Sarcoma

Others

(

3:2%), nephroblastoma(3:2%), rhabdomyosarcoma

7:3%), other soft tissue sarcoma (2:1%) and osteogenic

30

85

Total

(56.5%) (43.5%)

sarcoma(2:1%).

Table 3 shows the age range and the median age for

patients diagnosed with the commonest malignancies,

ranging from a median age of 3 years for patients diag-

nosed with nephroblastoma and retinoblastoma, to 5.5,

Table 1: Yearly numbers of childhood malignancies,

paediatric /adolescent hospital admissions and overall

malignancies and percentages

Year

No of

paediatric

admissions

Childhood

malignancies

as % of

paediatric

admissions

Total

number

of

malig-

nancies

Childhood

malignancies

as % of over-

all malignan-

cies

7

.5, 10 and 10.5 years for rhabdomyosarcoma, leukae-

childhood

malignan-

cies

mia, ovarian malignancies and lymphoma respectively.

Patients diagnosed with osteosarcoma and soft tissue

sarcoma (excluding rhabdomyosarcoma) had median

ages of 14 and 17 years respectively.

2

004

005

006

007

008

009

010

011

012

013

5

358

1.40

2.56

2.42

1.78

0.50

0.38

0.53

0.42

0.05

1.53

0.90

129

130

227

257

171

133

156

83

3.88

7.69

5.29

5.06

5.26

4.51

5.77

4.82

9.35

5.56

5.60

10

12

13

9

6

9

4

10

7

390

496

732

1818

1580

1687

928

951

458

Table 3: Age range and median age for patients diagnosed

with the commonest malignancies.

Tumour

Age range (yrs) Median age (yrs)

Nephroblastoma

Lymphoma

0.1 - 8

1.7 – 18

3

10.5

107

126

1519

Rhabdomyosarcoma

0.2 – 16

5.5

Total

85

9398

Leukaemia

1.8 – 18

3 – 4

0.4 – 13

12 – 15

16 - 17

7.5

3

10

14

17

Retinoblastoma

Ovarian neoplasm

Osteosarcoma

Fig 1: Year by year number of childhood malignancies in rela-

tion to overall malignancies and paediatric/adolescent hospital

admissions

Soft tissue sarcoma

Discussion

Our study findings show a peak in 2005 for new cases of

childhood and adolescent malignancies in relation to

paediatric and adolescent hospital admissions and the

overall malignancies respectively. However, the chart

also shows a reduction in the incidence of cancers in the

1

14

subsequent half decade thereafter, and a second peak in

012 in relation to paediatric admissions. The first peak

also due to the aforementioned factors, especially better

living conditions. The pattern of childhood cancer in

Europe is reportedly similar to that in the United States .

2

1

in 2005 was likely due to a generally increased parental

awareness about access to conventional treatment for

childhood and adolescent malignancies at our institu-

tion. However, the second peak in 2011 appears to cor-

respond to period of newly-introduced, improved, diag-

nostic facilities and availability of trained personnel for

the evaluation of a variety of cancer patients, especially

at the radiology and pathology departments of this insti-

tution.

The lymphoma group showed equal gender ratio, and

equal proportions seen below and above the age of 10

years. However, below 10 years of age, lymphomas pre-

dominantly occurred between 5 -9years, which is in

agreement with study findings in Bangladesh by Jabeen

1

et al . Leukaemia on the other hand was diagnosed more

among males than females in the ratio of 3:2, with the

largest affected group aged 5 – 9years. This i₁s₀ at vari-

ance with findings in Bradford by Mckinney and in

This study shows that paediatric and adolescent tumours

constitute 5.6% of total malignancies, slightly higher

than reported from Bangladesh (4.4%) 5 and India

1

Bangladesh byJabeen who both reported leukaemia as

most common under age of 5 years. This difference may

be due to delayed case presentation among the Nigerian

study population, as well as differences in the forms of

leukaemia that may be prevalent at different age groups

in the UK, Bangladesh and Nigeria. Nephroblastoma

was more common in boys (M:F = 6:4) and occurred

exclusively among individuals below the age of 10

years, with peak age at 0 – 4 years. T₁₇h_,i₁s₈ is consistent

. The rhabdo-

14

3.58%) , and much higher than reported in the United

15

(

States (0.8%) . Differences may be due to our hospital

based data which may be unrepresentative of the true

1

cancer burden, or as noted by Jabeen et al , children and

adolescents form a larger proportion of the population of

developing countries due to lower life expectancy than

in the developed world. Our study population was

5

6.5% male and 43.5%female, giving a male to female

with sprevious literature on the disease

rat₆io of 1.3:1, similar to the 1.5:1 reported by Agboola et

myosarcoma group was separated from other soft tissue

sarcomas due to their high relative frequency of occur-

rence. They are most commonly seen at 5 - 9 years of

age, and show a wide difference in gender ratio (M:F =

7:3). The group of soft tissue sarcomas in exclusion of

rhabdomyosarcomas constitute 3.35% of childhood ma-

lignancies, affecting more males than females (2:1) and

mo₉re prevalent in adolescents (10 – 18years). Adigun et

1

al in favour of males among children diagnosed with

malignancy in Sagamu, south-west Nigeria. However a

gender ratio in favor of young males over females pre-

senting in hospital with cancer in the south-east Nigerian

setting may also be reflective of the traditionally higher

value that parents in the region place on males.

1

This study showed that the four most common cancer

groups in our series were tied. They were the lymphoma

group (11.76%), comprising non-Hodgkin’s lymphoma

al at Ilorin, Nigeria, reported soft tissue sarcomas in-

cluding rhabdomyosarcoma as infrequent, accounting

for 6.5% of all cancers in children aged 0 - 15 years.

8

(

80%), Hodgkin’s lymphoma (10%) and large cell lym-

However, Tanko et al at Jos, Nigeria, reported rhabdo-

phoma (10%), and the group of Leukaemia (11.76%),

comprising acute myeloblastic (80%) and acute lym-

phoblastic leukaemias (20%) respectively. Others are

Nephroblastoma (11.76%)and rhabdomyosarcoma

myosarcoma as the commonest childhood malignancy

(31%), exceeding non-Hodgkin (19.5%) and Burkitt

lymphoma (13.8%).Various environmental influences,

diet and cultural habits, as well as public awareness

about childhood malignancies may all account for the

suggested variation in the incidence of soft tissue sar-

coma in the different regions of Nigeria. In this study,

retinoblastoma was the 5th commonest malignancy

(5.88%), seen exclusively in children aged 0 – 4 years

with a gender ratio of 3:2 in favour of females. Our find-

(

11.76%). These differ from study findings thirty years

earlier in the same region of Nigeria in1982 by Obioha

7

et al , who found a much higher proportion of lympho-

mas (40%),followed by nephroblastoma (14%), leukae-

mia (12.9%) and CNS tumours (9.7) among childhood

malignancies. They also reported an association between

lymphoma and poor living standards, as well as a lower

incidence of lymphomas and higher incidence of leukae-

mia than previously reported from other parts of Nigeria

1

ing is partly similar to that of Jabeen et al in Bangla-

desh who reported 70% of Retinoblastoma occurring

below the age of 5 years and second only to lym₁p₆homa

among childhood malignancies. Agboola et al also

reported Retinoblastoma (21%) as second only to lym-

phoma among children diagnosed with malignancies at

Shagamu, Nigeria. A future population based study in

south-east Nigeria may be needed to determine the ac-

tual regional prevalence of retinoblastoma. Ovarian ma-

lignancies (4.71%) occurred equally among females

aged above and below the age of10 years. This is ₂i₀n par-

7

and Africa . Our study findings suggest a relative reduc-

tion in the proportions of lymphoma and leukaemia, and

an associated increase in the proportions of nephroblas-

toma and rhabdomyosarcoma among childhood and ado-

lescent malignancies in this environment. Improved di-

agnostic facilities, greater number of trained health

workers, improved living conditions and an increased

parental awareness about childhood malignancies result-

ing in a wider variety of cases presenting in hospitals,

may all account for changes in disease pattern within the

region over the years. Our study finding are also at vari-

ance with those from the United States were leukaemia

tial agreement with the study report by Junaid

who

also described ovarian tumours as relatively uncommon,

with larger proportion occurring at 10 years and above

among children aged 0 – 20 years in south-west Nigeria.

Osteogenic sarcoma (3.35%) occurred exclusively in

children aged 12 - 18 years, with median age of 14 years

(

are the commonest childhoodmalignancies , possibly

30.2%), CNS cancers (21.7%) and lymphoma (10.9%)

15

1

15

and a gender ratio of 2:1 in favour of males. Parkin

Authors’ contribution

2

1

etal had earlier put bone tumours at 5% of all child-

hood malignancies worldwide, with osteogenic sarcoma

comprising a large proportion of this.

Okocha EC, Aneke JC, Onyiora IV, Anyiam DC,

Uka CO, Onwukamuche ME, Ndukwe CO. Data

retrieval/ review and manuscript preparation:

Ulasi TO, Umeh EO, Ebubedike UR, Ezeudu CE,

Numerous histological and cytological entities not indi-

vidually mentioned in this text are relatively few as indi-

vidual cases and are grouped as ‘Others’. They collec-

tively constitute 35.29% of the study population, and

considered individually as rare in our environment (see

footnotes). The CNS tumours are not featured in this

study, possibly due to a dearth of relevant facilities for

proper overall neuro-paediatric diagnosis and clinical

management at the centre during the period of study.

Ekwunife OH, Ugwu JO: Literature review and manu-

script preparation.

Ebubedike UR, Umeh EO, Uka CO: Data analyses

Conflict of interest: None

Funding: None

Acknowledgement

Conclusion

The authors acknowledge the help of our resident doc-

tors, without whom data gathering would have been

very difficult and our patients who put forth their best in

the face of extreme difficulty.

Findings from this hospital based study suggest that

lymphoma, leukaemia, rhabdomyosarcoma and nephro-

blastoma are the commonest malignancies afflicting

children and adolescents in the south-east region of

Nigeria.

References

1

2

3

Jabeen S., Haque M., Islam M.J.,

Talukder M.H. Profile of paediat-

ric malignancies. A five year

9. Linet S.M., Ries L.A.G., Smith

15. Ferlay J., Bray F., Pisani P., Parkin

D.M., GLOBOCAN 2002: Cancer

Incidence,Mortality and Preva-

lence Worldwide. Lyon: IARC

Press. 2004

16. Agboola A.O., Adekanmbi F.A.,

Musa A.A., Sotimehin A.S., Deji-

Agboola A.M., Shonubi A.M. et al.

Pattern of childhood malignant

tumours in a teaching hospital in

south western Nigeria. Med J Aust

2009; 190:12-4.

17. Karen E., Owens T., Owens C. The

paediatric abdomen. In Sutton D.

(ed). Textbook of Radiology and

Imaging. 7th ed. Vol 1. Pgs 874-

875. London. Churchill Living-

stone; 2003.

18. Chapman S., Nakiely R. (ed) Aids

to Radiological Differential Diag-

nosis. 4th ed.Pg. 328. Saunders,

Edinburgh; 2003.

19. Adigun I.A. Pattern of rhabdomyo-

sarcoma in Nigerian children. J

Natl Med Associ.2008; 100: 906-9.

20. Junaid T.A. Ovarian neoplasms in

children and adolescents in Ibadan,

Nigeria. Cancer 1981; 47: 610-4.

21. Parkin D.M., Stiller C.A., Nectoux

J. International variations in the

incidence ofchildhood bone tu-

mours. Int J Cancer 1993; 53: 371

-6.

M.A., Tarone R.E., Devesa S.S.

Cancersourvellance series: Recent

trends in childhood cancer inci-

dence and mortality inthe United

States. J Natl Cancer Inst. 1999;

91: 1051-8

10. Mckinney P.A., Feltbower R.G.,

Parslow R.C., Lewis I.J., Glaser

A.W., KinseyS.E. Patterns of

childhood cancer by ethnic group

in Bradford, UK 1974-1997. EurJ

Cancer 2003; 39: 92-7.

11. Shehu U.A., Adegoke S.A., Abdul-

salam U., Ibrahim M., Oyelami

O.A., AdeoduO.O. Pattern of

childhood malignant tumours in

two tertiary teaching hospitals

inNigeria. Comparative study.

Niger J Paed 2013; 40: 175-8

12. Steliarova-Foucher E., Hery C.,

Pisani P. “The burden of childhood

cancer” in Childhood cancer-

Rising to the challenge. Interna-

tional Union Against Cancer

(UICC) 2006; chapter 1: 9-14

13. World Health Organisation

(WHO) Mortality database 2005.

Cited 2013. Available at

study. J Dhaka Med Coll. 2010;

1

9: 33-8.

.

Breitfield PP, Kreissman SG. Prin-

ciples of Paeditric oncology in

O'Neil J et al (ed)Paeditric surgery

5

th edition, Mosby Year Books St.

Louis Missouri 1998 ;367-77

Howlander N, Noone AM, Krap-

cho M, Garshell J, Neyman N,

Altekruse SF, et al.SEER cancer

statistics review 1975-2010, Na-

tional Cancer Institute. Bethesda

MDhttp//see.cancer.gov/csr/1975-

2

010 based on November 2012

SEER data submission 2013.

Stiller C.A., Parkin D.M. Geo-

graphic and ethnic variations in

the incidence ofchildhood cancer.

Brit Med Bull 1996; 52: 682 –

4

.

7

03.

5

6

.

Eden T. World child Cancer. On-

cology News 2011;5:185-7.

Offiong U.M. Childhood malig-

nancies in University of Abuja

Teaching Hospital,Gwagwalada,

Abuja, Nigeria. Niger J Paed

2

012; 39: 60-2

www.who.int/research/en

7

8

.

Obioha F.I., Kaine W.N.,

14. Rathi A.K., Kumar S., Ashu

A.,Singh K., Bahadur A.K. Epider-

miology ofpaediatric tumours at a

tertiary care centre. Indian J Med

Paediatr Oncol. 2007; 28:343-50

Ikerionwu S.E., Obi G.O., Ulasi

T.O. The pattern ofchildhood ma-

lignancy in eastern Nigeria. Ann

Trop Paediatr. 1989; 9: 261-5.

Tanko N M, Echejoh G O, Manas-

seh N A, Mandong M B, Uba

AF.Paeditric solidtumours in Ni-

gerian Children; A changing pat-

tern. Afr J Paediatr Surg 2009;

6

:7-10.