Pulmonary artery systolic hypertension is common and associated with increased mortality among adult sickle cell disease (SCD) patients in the United States. Although the prevalence of SCD is highest in subSaharan Africa, the frequency of pulmonary artery systolic hypertension and the risk factors for the development of pulmonary hypertension have not been reported from Africa. We studied 208 hydroxyurea naïve Nigerian SCD patients at steady state and 94 healthy controls. Pulmonary artery systolic hypertension was defined prospectively as tricuspid regurgitant jet velocity ≥2.5 m/sec. Results were compared with a previously published US prospective SCD cohort. Only 7% of Nigerians compared with 46% of US adults with SCD were >35 years. Tricuspid regurgitant jet velocity was ≥2.5 m/sec in 25% of Nigerian SCD patients. Higher jet velocity was associated with greater serum globulin (P 5 0.002), blood urea nitrogen (P 5 0.019) and lactate dehydrogenase concentrations (P 5 0.026) and with inability to walk >300 m in 6 min (P 5 0.042). Compared with the US cohort, Nigerian patients had more hemolysis as indicated by lower hemoglobin and higher lactate dehydrogenase concentrations (P ≤ 0.003). Pulmonary hypertension is common among Nigerian SCD patients. The public health implication of this finding is significant considering the potential number of individuals at risk for this complication. Better understanding of the long term outcome of pulmonary hypertension and causes of death in SCD and the institution of preventive measures are major public health challenges for Africa. The inclusion of African sites in sickle cell pulmonary hypertension clinical trials should be encouraged. Am. J. Hematol. 83:485-490, 2008. V

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A prostatic lesion characterized by atypical epithelial hyperplasia and pleomorphism of the stromal elements is presented. The features bear a strong resemblance to cystosarcoma phyllodes of the female breast and probably represent a comparable lesion. Such atypical hyperplasia has not been described previously.

Hyperplastic lesions of the prostatic stroma with atypical changes are presented and discussed. One lesion was a leiomyoma with atypical organization and a limited area of nuclear pleomorphism without mitotic figures. One was a lesion which in many portions was histologically indistinguishable from leiomyosarcoma. It, however, had certain features probably connoting less sinister behavior, and at autopsy 16 months after resection there was no evidence of recurrence or metastasis. One lesion histologically resembled fibroadenoma of the female breast. These three lesions occurred in patients more than 50 years who had symptoms and signs of prostatism. Reference is made to two previously reported lesions reminiscent of cystosarcoma phyllodes of the female breast. All the lesions were located in the craniad prostate, which is estrogen-influenced. A parallel is drawn between these atypical changes in prostatic fibromuscular stroma and atypical changes in the connective tissue stroma of the female breast.