Clinicopathological features and androgen receptor expression in triple negative breast cancer at Lagos, Nigeria

INTRODUCTION

Androgen receptor (AR) is one of the predominant nuclear hormone receptors in invasive breast cancer and can be explored as a biomarker of response for targeted anti-androgen therapy, especially in the setting of triple negative breast cancer (TNBC). Luminal AR is a distinct subtype amongst TNBC cases following gene expression studies. TNBC is higher in Africans (23%-82%) and African-Americans (29.8%) compared to Caucasian (10%-15%) breast cancer patients; however, there is a paucity of data on AR expression in this population. The aim of this study is to determine the expression of AR and the proportion of AR positive cancers in TNBCs at the Lagos University Teaching Hospital, Lagos, Nigeria.

METHODOLOGY

Out of 99 reviewed cases, 78 formalin fixed, paraffin embedded TNBC cases were assembled into a tissue microarray, stained and analysed for AR expression using immunohistochemistry.

RESULTS

The mean age of the TNBC patients was 49.3 years (range: 20-80 years). The histologic types in this study were invasive carcinoma (no special type) 75.4%; metaplastic carcinoma 21.4%; lobular carcinoma and mucinous carcinoma 1.6% each. Of 61 TNBC cases analysed, 37.7% were AR positive and 62.3% were AR negative, making the latter to become quadruple negative breast cancers. There was a significant association between age and AR expression (p = 0.02). In the subjects that expressed AR positivity, patients below 50 years accounted for 34.8% (8 of 23) while 65.2% (15 of 23) were above 50 years. There was no significant association between AR expression and histologic type or tumour grade.

CONCLUSION

Over a third of this Nigerian TNBC cohort study is AR+. This warrants further exploration of the predictive and prognostic significance of its expression amongst TNBC and the potential for targeted therapy, specifically androgen antagonists to improve the outcome of this disease with limited therapeutic options.

Plasma Levels of a Product of Free Radical Injury and Antioxidant Status of Patients with Different Grades of Plasmodium Falciparum Infection

BACKGROUND

Plasmodium falciparum infection, like any other clinical condition, is prone to generating free radicals. This can worsen patients' clinical presentations. Antioxidants do help in ameliorating these free radical effects. These antioxidants, especially vitamins, are sometimes given routinely to patients with Plasmodium falciparum infection of which it can be given according to the severity of this free radical injury.

METHODOLOGY

A total number of qualified 245 patients that came for malaria parasite test between March and October, 2020 were recruited into the study. Patients on arrival at the laboratory had their samples collected for malaria parasite test and for the proposed biochemical parameters (MDA, GPx, SOD and TAS). Malaria parasite test was used to categorize the severity of Plasmodium falciparum infection.

RESULTS

There were statistically significant differences (p<0.0001) in MDA, GPx, SOD and TAS among patients with negative MP, 1+ and >2+ on blood film for malaria parasite. Patients with >2+ MP had highest levels (2.21±0.40) while patients with negative blood film had lowest levels(0.8194±0.33) of MDA. Patients with >2+ had lowest levels of GPx (2406.41±1272.10), SOD (104.54±30.62) and TAS (1.18±.35) as against patients with negative MP that had highest levels (5229.85±.2957.95)( 206.41±36.70)( 2.40±.53), respectively.

CONCLUSION

There was evidence of free radical generation as evidenced with raised plasma malondialdehyde in patients with Plasmodium falciparum infection. This was associated with severity of this infection. There was also corresponding decrease in measured antioxidants (GPx, SOD and TAS).

The diagnostic utility of cell block in fine needle aspiration cytology of palpable breast lesions in a Nigerian tertiary health institution

BACKGROUND

Although fine needle aspiration cytology (FNAC) is highly accurate for detecting breast malignancies, concerns remain among cytopathologists about false-positive and false-negative diagnoses. Cell block (CB) preparations have been advocated by some cytopathologists as one of the methods to improve and consolidate the diagnostic accuracy of FNAC. The aim of this study was to determine the diagnostic utility of CB in FNAC of palpable breast lesions among female patients.

METHODS

Following FNA, CBs were prepared using 10% neutral-buffered formalin from the residual breast aspirates of 100 consecutive female patients attending the FNAC clinic. The slides of the conventional smears, CB and excisional biopsies were examined, and results were analysed using the SPSS.

RESULTS

Of the 100 patients that had FNAC, 44 (44%) had excisional biopsy performed. An additional 13% diagnostic yield for malignancy was obtained with the use of CB preparations. CB reduced equivocal diagnoses by 25%, corresponding with 90.9% improvement on definitive diagnoses.

CONCLUSION

In our setting, the addition of CB to smear remarkably improved the diagnostic utility of breast FNAC by minimising atypical and suspicious for malignancy diagnostic categories.

Audit of fibroepithelial tumors of the breast in a Nigerian tertiary institution

BACKGROUND AND OBJECTIVES

Fibroepithelial lesions are the most common lesions of the breast seen in our laboratory consisting of fibroadenomas (FAs) and phyllodes tumors (PT). The aim of the study was to audit all fibroepithelial lesions and to reclassify all confirmed cases of PTs seen in the study period according to standard criteria.

METHODOLOGY

Records and slides of fibroepithelial lesions of the breast received at the department between January 2008 and December 2013 were retrieved and reviewed by the authors.

RESULTS

Out of the 1242 fibroepithelial lesions of the breast retrieved, all but 19 were FAs. The 19 were initially reported as PT: 11 benign, 2 borderlines, 2 malignant, and 4 not classified; however, only 16 of these 19, PTs (84%) met the WHO criteria on review. The remaining 3 (16%) turned out to be FAs based on the absence of stroma overgrowth and hypercellularity. The PTs were reclassified into benign PT, borderline PT, and malignant PT accounting for 75% (12/16), 18.7% (3/16), and 6.3% (1/16), respectively. All of the PTs previously not classified turned out benign on review. One of the borderline PTs was originally reported as malignant PT. All cases initially diagnosed as FAs did not change on review.

CONCLUSION

These results show that FAs are rarely misdiagnosed. The three cases misdiagnosed as phyllodes may have been prevented if standard data sets were in use. Cases simply referred to as PT without further classification, limit the patients' access to appropriate management as accurate classification helps in the overall management and prognostication.

Histopathology practice and training in Nigeria – a model

OBJECTIVES

Contemporary histopathology practice and training in Nigeria have been plagued by the fundamental issue of inadequate exposure to surgical pathology material by both trainees and trainers. This paper critically examines the factors that affect the discipline and profers practical solutions to aid its advancement.

MATERIALS AND METHOD

This review is based on the authors experience and observations of histopathology practice in Nigeria.

RESULTS

The Nigerian health sector is plagued by many ills including poor funding, weak policies, dilapidated structures, disgruntled and frustrated practitioners, amongst others - and pathologists are not immune to all these. In recent times, there has been a proliferation of accredited training centres as well as medical graduates interested in the specialty of histopathology. The busiest histopathology laboratories in the country ascession between 2200 and 5500 surgical samples yearly. Thus there is inadequate exposure by histopathologists and trainee pathologists to surgical materials with the attendant consequences. Many centres still rely principally on routine haematoxylineosin stains. There are no nationally agreed standard reporting formats for most diseases.

CONCLUSION

The development of a deanery or regional system of accredited histopathology laboratories may form the fulcrum for improving the overall quality of histopathological services and training in Nigeria. This will help develop local expertise and ensure adequate exposure to teaching aids and surgical materials. We hope that the proffered solutions will help encourage local pathologists to continue and increase their efforts to raise the profession up to enviable heights.

Histological Features and Tissue Microarray Taxonomy of Nigerian Breast Cancer Reveal Predominance of the High-Grade Triple-Negative Phenotype

INTRODUCTION

Little is known about the biology, molecular profile and hence optimal treatment of African Nigerian breast cancer. The aim of this work, therefore, was to characterize the histology and molecular profile of Nigerian breast cancer.

METHODS

Breast carcinomas from women at 6 centres of similar tribal origin in Nigeria were reviewed and assembled into tissue microarrays (TMAs), and sections were stained for hormone receptors, i.e. estrogen receptor (ER)α, ERβ1, ERβ progesterone receptor (PR) and androgen receptor, cyclin D, HER2, Ki67 and cytokeratins (CKs), i.e. CK5/6 and CK14 (basal) and CK18 and 19 (luminal).

RESULTS

A total of 835 tumours were analysed. The mean age at diagnosis was 48.62 ± 12.41 years. The most common histological subtype was ductal NST (no-special-type) carcinoma (87.3%). Over 90% of the tumours were grade 2 or 3. The predominant molecular phenotype was the non-basal, triple-negative type (47.65%) followed by the HER2-positive group (19.6%). The percentage of ER-, PR- and HER2-positive tumours was 22.4, 18.9 and 18.8%, respectively.

CONCLUSION

Nigerian breast cancer predominantly has a high-grade, triple-negative profile. It occurs at a younger age and bears similarities at the molecular level to pre-menopausal breast cancer in white women, with remarkably lower levels of ERβ expression. The early presentation and histological and molecular phenotype may explain the poor prognosis, and tailoring treatment strategies to target this unique profile are required.

Acute toxicity effect of Croton penduliflorus (Euphorbiaceae) Seed Oil

BACKGROUND

Croton penduliforus (Euphorbiaceae) is a tropical evergreen plant widely distributed in Africa. Its seeds are used in folklore medicine as laxative, as well as a major component of herbal contraceptive and antifibroid decoction.

OBJECTIVE

This study is to investigate the oral acute toxicity and histological effects of Croton penduliflorus seed oil in mice.

METHODS

Croton penduliflorus seed oil (CPSO) was prepared by Soxhlet extraction of shelled, oven dried, ground seed sample with 40-60 degrees C petroleum ether. Albino mice of both sexes aged 6-7 weeks old were randomly divided into seven groups of five. Graded doses of 200, 400, 600, 800, 1000 and 1200 mg/kg body weight of the extract were administered orally to groups 2-7 respectively. The control group was administered with 0.1 ml of Tween 20. The numbers of deaths over a period of 24 hours were recorded. Acute toxicity (lethal dose) was estimated from the graph of % cumulative death against log dose of the extract. The animals that survived after 24 hours were monitored daily for 14 days for appearance of delayed toxicity signs. At the end of 14 days all the animals were sacrificed and blood sample were collected from each animal into a plain sterilized bottle. Internal organs namely kidney, liver, heart and lungs were isolated and fixed in 10 % formal saline for histopathological examination.

RESULTS

The LD50 was estimated to be 570 mg/kg body weight. CPSO caused weight loss at doses greater than 600 mg/kg with significant increases in AST and ALP activities and fluctuation of serum electrolytes.

CONCLUSION

Croton penduliflorus seed oil is toxic to the kidney and liver of mice.

Abstract P1-09-09: Breast cancer reporting in Lagos, implications for training and education in Africa

INTRODUCTION Breast lesions, particularly neoplasms, form a significant proportion of the histopathology laboratory work in Africa. In Nigeria about a quarter of breast neoplasms are malignant but there is no existing national programme for, early detection and management of the disease. Within a large tertiary referral centre in Lagos, attempts to standardize breast cancer reporting have been ongoing since 2005. Before this time less than 25% of breast carcinomas were graded, however, between 2007 and 2011 this has increased to an average of 75% of cases. This period of improvement corresponded to periods of increased collaboration with colleagues in Diaspora through various training and educational initiatives. OBJECTIVE The aim of this study is to determine the rate of concordance of breast cancer reporting in a large Nigerian laboratory with the minimum dataset adopted by the Royal College of Pathologists (RCPath), UK. MATERIALS AND METHODS Breast cancer cases were identified from the pathology database of a large tertiary referral centre in Lagos, Nigeria. Data was extracted from histopathology reports covering a period from January 2011 to March 2013. Only reports of female patients with DCIS and/or invasive carcinomas were included. Representative tumour slides and paraffin blocks were collected and all tumours were jointly reviewed by a UK specialist breast pathologist and a Nigerian pathologist following the RCPath guidelines to confirm diagnosis, type, grade and nodal status. Patients age and clinical data were collected from the original pathology reports. Histological parameters were compared to the RCPath minimum datasets for reporting breast carcinoma. In addition, representative tumour areas were selected and marked for tissue microarray (TMA) construction. TMA sections were stained for a range of markers including hormone receptors (ER, PR) and HER2 RESULTS A total of 115 breast carcinoma specimens were reviewed. Invasive carcinoma of no special type (NST) was the most common histological type seen(63.5%). An unusual high proportion (2.6%). of metaplastic carcinomas was recorded. Ductal carcinoma-in-situ was seen as the sole lesion in 7% of cases, no case of pure LCIS was seen. The histologic types of breast tumour stated on the report were concordant in 53.1% of cases and discordant in 46.9%. With respect to grading, 89.62% lesions were graded in the original report; 50.5% were correctly graded, 35.8% were under-graded, while 8.5% were over-graded. The lymph node status was included in 40% of cases. Hormone receptor and HER2 testing revealed 26.9% ER and 15.8% PR positivity; 6.1% positivity for HER2 overexpression and 5.1% borderline 2+. No further testing was done on the latter group. Only 26% of the 115 cases reviewed had prior hormonal and HER2 testing done. This number was insufficient to assess for concordance and discordance CONCLUSION Histopathological parameters when missing or inaccurate within histopathology reports affects standardization. In recent years, moderate progress made towards standardization of reports have been through exposure to training opportunities. Continuous training and education would ensure that all reports contain international accepted minimum dataset and enhance patient management.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-09.

Skin tumors at the Lagos University Teaching Hospital, Nigeria

INTRODUCTION

Skin tumours can be malignant or benign. Skin cancer is the most common malignancy among Caucasians and noted to be rare in Africans and negroid skin. In view of the rarity of skin cancers in Africans, there is delayed diagnosis; and consequent advanced presentation and poor prognosis.

OBJECTIVE

This is to document the frequency of skin tumours (benign and malignant) from a 7-year review (January 2001 to December 2007) of histology reports of all skin samples seen at the pathology department of the Lagos University Teaching Hospital.

METHODS AND MATERIALS

Reports of all skin samples seen at the pathology department between January 2001 and December 2008 were reviewed. The frequencies of various skin tumours (both benign and malignant) were determined and the result displayed using frequency tables.

RESULTS

Skin tumours represented 19.8% of all reports made on skin during the study period. One hundred and twenty one (68.7%) were benign tumours while 55 (31.2%) were malignant tumours. There is a female preponderance for both malignant and benign tumours. The male to female ratio was 1:1.28 for benign tumours and 1:1.39 for malignant tumors. Squamous cell carcinoma (SCC) was the commonest malignant tumor, followed by malignant melanoma, Kaposi's sarcoma and dermatofibrosarcoma protuberans. Cutaneous papilloma was the commonest benign tumour.

CONCLUSION

A wide range of skin tumours, benign and malignant were documented; hence there is need for more vigilance in order to diagnose them early.

Prostate diseases in Lagos, Nigeria: a histologic study with tPSA correlation

OBJECTIVE

To present a 10year retrospective histologic study of prostate diseases in Lagos, Nigeria. The aim is to document the prevalence, histologic pattern, age distribution and PSA values of prostatic diseases.

MATERIALS AND METHODS

The materials consisted of slides, paraffin embedded tissue blocks, patients case files and histology request forms of all prostatic biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1999 to 2008. Each sample represents a different patient.

RESULTS

Prostatic biopsies comprised 3.6 % of all biopsies in LUTH. BPH was the commonest prostatic lesion and accounted for 70.9% of all cases. The age range was 40 to 94 years with a mean of 67 years and a peak age group at 60-69 years. Stromoglandular pattern was the most common histological type of BPH accounting for 72.2 %( 393) of the cases. Malignant tumours constituted 28.9% of all prostatic biopsies. Most (93.7%) of these malignancies were seen in trucut biopsies. Adenocarcinoma accounted for 99.1% of the total 222 malignant tumours. It showed an age range of 40 to 98 years, a mean age of 66 years and peak prevalence in the 60-69 year age group. Gleason score nine was the most frequent (16.8%) in occurrence. Most adenocarcinomas were poorly differentiated (40%). Incidental carcinoma was seen in 4.2% of prostatectomy samples. High grade PIN was seen in 19.1% of adenocarcinoma cases. The most common inflammatory lesion was chronic non-specific prostatitis accounting for 76.4% of all inflammatory lesions. Malignant and benign lesions were accountable for PSA levels of 1 to 49.9ng/ml while values of 50ng/ml and above were seen exclusively in malignant lesions.

CONCLUSION

Prostatic lesions constitute a significant source of morbidity among adult males in Lagos. Adenocarcinoma is the commonest histologic subtype of prostatic cancer and most are of poorly differentiated variety. Elevated levels of tPSA in Nigerian males may be as a result prostate cancer, BPH or BPH with prostatitis. PSA should in our opinion be used as a component of a strategy integrating multiple diagnostic approaches for prostate cancer screening and not to be used alone in our environment.

Pattern of lymph node pathology in Lagos

BACKGROUND

Enlarge lymph node is a common finding in clinical practice, which can be caused by several factors, such as infections, drugs etc.

OBJECTIVE

To review the pathology of lymph node diseases in children and adults with both deep seated and peripheral lymphadenopathy in Lagos.

METHODS

A 12- year retrospective study of lymph node biopsies at Histopathology Department of LUTH, and two main histopathology private laboratories in Lagos; The specialist Laboratory (TSL) and Histolab was carried out.

RESULTS

733 samples of lymph nodes were seen. Of these, 229 (31.37%) were reactive, 109 (14.93%) were chronic granulomatuos lesions while lymphoma was seen in 123 cases (16.85%) and metastatic lesions in 269 cases (36.50%). The male to female ratio was 1:1.5. (286:436). In 670 cases, the lymph nodes were peripheral in location with the distribution of 249, 140 and 42 from the axilla, cervical and inguinal regions respectively. Only 60 of the samples were deeply seated lymph nodes; 55 from the intra-abdominal cavity and 5 from the mediastenium. About 239 samples did not have their sites indicated and majority of these (106) were diagnosed to be reactive lymphadenitis.

CONCLUSION

The categories of lymphoid disease are similar to that of other third world countries but there is slight disparity in the frequency distribution of these diseases compared with findings in literatures within the countries.

Accuracy of fine needle aspiration in the diagnosis of peripheral lymph node enlargements. Lagos University Teaching Hospital, Nigeria

BACKGROUND

The usefulness of fine needle aspiration technique for cytology diagnosis of lymph node lesions has been a subject of controversy over years.

OBJECTIVE

This study aims to determine the accuracy of this technique in the diagnosis of peripheral lymph node lesions, in our center, using histology diagnosis as a gold standard.

METHODS

The cytopathological diagnosis of 49 cases of peripheral lymph node lesions seen in the Morbid Anatomy Department of the Lagos University Teaching Hospital, Lagos from Jan. 2000 to December 2009 were compared with their corresponding histological diagnosis. Lymph node lesions were categorized into inflammatory, Hodgkin's lymphoma, Non Hodgkin's lymphoma and metastatic. The sensitivity, specificity and positive as well as the negative predictive values of the technique were determined.

RESULTS

The overall sensitivity, specificity and positive and negative predictive values were 79.6%, 95.9.0%, 79.6% and 95.9% respectively. For non neoplastic lesions, FNAC has a high false negative report. For primary lymphoid neoplasm, the sensitivity, specificity and both predictive values were above 80% while the procedure produced sensitivity and specificity values of 100 and 97.1 percent respectively in the diagnosis of metastatic lesions.

CONCLUSION

Despite the pitfalls and limitations of the procedure, the study demonstrated that fine-needle aspiration is a valuable tool for the evaluation of peripheral adenopathy. But FNAC technique for cytological diagnosis of lymphoid lesions using H and E and Giemsa stains alone cannot be used as the sole diagnosis of lymphoid enlargements. Its accuracy can be improved with the availability immunocytochemistry and flow cytometry.

Morphological pattern of childhood solid tumours in Lagos University Teaching Hospital

BACKGROUND

There is a wide variation in the incidence of childhood tumors world wide. The relative incidence of childhood tumors in developing countries is increasing and might add significantly to the high childhood morbidity and mortality caused by infectious diseases. There is need to determine the incidence of childhood cancer in different centers of the country and contribute to the National cancer register.

OBJECTIVE

The aim of this study is to determine the burden and patterns of childhood tumour in our environment.

METHODS

A retrospective review of histologically diagnosed cases of childhood tumours seen from January 2000 to 2007 from the records of the Department of Morbid Anatomy of the Lagos University Teaching Hospital (LUTH), Nigeria was carried out. All the cases were analyzed for age and gender distribution as well as histological types.

RESULTS

Malignant tumours constituted 30.50% of the tumours of which retinoblastoma is the most common. The most common benign tumour was fibroadenoma accounting for 36.2% of all benign tumours. The female to male ratio for malignant and benign tumours are 1:1 and 1:1.3 respectively. The peak age incidence was 11 - 15 years for benign and 1 - 5 for malignant tumours.

CONCLUSION

The study showed decrease in the annual incidence of childhood tumours in Lagos. There was however no difference in the pattern when compared with other centers in Nigeria and in other African countries.

Malignant gastrointestinal tumours in south western Nigeria: a histopathologic analysis of 713 cases

BACKGROUND

Malignant tumours of the gastro-intestinal tract are not as rare as previous studies suggest. Recent studies have indicated increasing incidence.

OBJECTIVE

To document the pattern, age and sex distribution as well as histopathology characteristics of malignant tumours of the gastro-intestinal system in Lagos and Sagamu in Southwestern Nigeria.

METHODS

The paraffin embedded blocks and slides as well as pathology reports of malignant tumours of the gastrointestinal (GIT) organs collected from five laboratories (Morbid Anatomy Departments of the Lagos University Teaching Hospital and Olabisi Onabanjo University Teaching Hospital in Sagamu, Ogun State as well as the three private histolopathology laboratories in Lagos State) were reviewed. The clinical data such as the age, sex, and clinical summary were extracted from the records.

RESULTS

About 80% (578 cases) of all the 713 malignant GIT tumours were epithelial; sarcomas, carcinoid and non-Hodgkin's lymphoma being less common. The ages ranged from 4-96 yrs (mean of 48.9 years) with the peak in patients 60-69-year age group and M:F ratio of 1.35:1. Colorectal tumours topped the list with 402 cases (56%), followed by liver 105 (14.7%), stomach 85 (12%) and omental metastases 67 (9.4%). The oesophagus, pancreas, small intestine and gall bladder represented 18 (2.5%), 16 (2.2%), 12 (1.7%), and eight (1.1%) respectively. Colorectal cancers peaked in the 60-69 year age group, liver and stomach cancer occurred mostly between the 50-59 years age group. Over half of the colorectal adenocarcinomata were located in the ano-rectum with 93 (23%) occurring in those below 40 years of age.

CONCLUSION

Colorectal cancer remains the commonest GIT tumour in the region. Molecular studies are imperative to identify the common subtypes of GIT tumours in order to ascertain their specific pathogenetic and prognostic features.

Bladder cancer in Lagos: a 15 year histopathologic review

OBJECTIVE

To present a 15 year retrospective pathologic study of bladder cancers. The aim is to document histologic pattern, prevalence, sex and age distribution of urinary bladder cancer.

MATERIALS AND METHODS

The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all urinary bladder biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1991 to 2005. Each sample represents a different patient. The study did not include information regarding the clinical or pathological stage of the tumours.

RESULTS

Bladder malignancies comprised 39 (72.2 %) cases of all bladder biopsies and 0.86% of all diagnosed cancers in LUTH. The malignant lesions of the bladder showed a male preponderance with a M:F ratio of 4.6:1. The age range was 4-75 years with a mean age of 51.37 years and peak at 61-70 years age group. Transitional cell carcinoma was the commonest histological type accounting for 61.5% with a male to female ratio of 5:1 and mean age of 59 years. Squamous cell carcinoma accounted for 20.5% with a M:F ratio of 3:1 and showed a mean age of 47 years. Adenocarcinoma, anaplastic carcinoma and embryonal rhabdomyosarcoma accounted for 5.1%, 5.1% and 7.8% of cases respectively.

CONCLUSION

Bladder cancer is not common in Lagos. The histopathologic pattern, prevalence, sex and age distribution of bladder cancer are similar to previous reports from schistosomiasis non endemic regions of Nigeria, Africa and the rest of the world.

Autopsy as a tool in the prevention of maternal mortality

Maternal mortality rates are an index of the state of a nation's health system. Maternal autopsies help to determine these rates, provide information on avoidable/unavoidable causes of mortality, consequently leading to the development of strategies for treatment and prevention of maternal mortality and morbidity. The lesson from post-mortem examinations, using the vehicle of confidential enquiries into maternal deaths, can save the lives of many; causing reduction in both maternal and perinatal mortality as well as reductions in morbidity. However for autopsies to fulfil this role they must be of a very high standard and must be subjected to quality control measures.

Biochemical and toxicological studies of aqueous extract of Syzigium aromaticum (L.) Merr. & Perry (Myrtaceae) in rodents

The effects of long-term administration of boiled aqueous extract of Syzigium aromaticum (SYZ), commonly known as clove (which has been locally employed for treating gastrointestinal tract diseases and also used as food spices), on some biochemical indices, such as body weight, liver functions and blood parameters were studied in adult albino rats of both sexes. Selected doses of 300 and 700 mg kg(-1) were given orally through cannular to groups of animals for a period of 90 days, while the control group received distilled water throughout the duration of study via the same route. Blood samples collected after therapy and assayed for activities of some liver enzymes recorded a significant (p<0.05) and prominent effect on ALP and AST. Measurement of haematological parameters also revealed significant effects (p<0.05; p<0.001) on Hb, RBC (p<0.05), PCV (p<0.001), platelets (p<0.001) and granulocytes (p<0.001). An insignificant reduction was recorded for total WBC. The histopathological study conducted was in consonance with the results of the biochemical investigations that the aqueous extract of SYZ even at moderate doses, significantly affects body organs, their enzymes as well as the various functions. LD(50) for both intraperitoneal and oral routes of SYZ were 263 and 2500 mg kg(-1) respectively. The present work has revealed the toxicity of sub chronic administration of SYZ, which suggests that its prolonged usage must be avoided.

Review of the histopathologic patterns of superficial lymph node diseases, in Lagos (1991-2004)

OBJECTIVE

This is a 14-year retrospective histopathologic study of 720 lymph node biopsies. The aim is to document the causes of lymphadenopathy, the age and sex distribution in Lagos.

MATERIALS AND METHODS

The materials consisted of slides and paraffin embedded blocks of all lymph node biopsy specimens received from within and outside Lagos University Teaching Hospital, Lagos.

RESULTS

A total of 720 biopsies from 276 males and 444 females were analysed. Chronic non specific lymphadenitis 245 (34%), tuberculosis 125 (17.4%), metastatic lymph node lesions 242 (33.6%), and lymphomas 102(14.2%) were the common causes of lymph node enlargement. The commonest lymph node group affected was the cervical 283 (39.3%).

CONCLUSION

Malignancy (47.8%) is the most common cause of superficial lymphadenopathy in Lagos metropolis. The age, sex and site prevalence agree with reports from other parts of Nigeria and Africa with minimal variations.

Colorectal carcinoma in Lagos and Sagamu, Southwest Nigeria: A histopathological review

AIM: To study the frequency, gender and age distribution as well as pathological characteristics of colorectal carcinoma (CRC) in Lagos and Sagamu in SW Nigeria.

METHODS: This is a retrospective pathological review of histologically diagnosed CRC from 5 laboratories in Lagos & Sagamu. The clinical data, such as age, sex and clinical summary were extracted from demographic information. Cases of anal cancer were excluded from this study.

RESULTS: There were 420 cases (237 males and 183 females) of CRC. It peaked in the 60-69 year age group (mean: 50.7; SD: 16.2), M:F ratio 1.3:1 and 23% occurred below 40 years. The majority was well to moderately differentiated adenocarcinoma 321 (76.4%), mucinous carcinoma 45 (10.7%) and signet ring carcinoma 5 (1.2%), and more common in patients under 40 years compared to well differentiated tumors. The recto-sigmoid colon was the most common site (58.6%). About 51% and 34% of cases presented at TNM stages II and III, respectively.

CONCLUSION: CRC is the commonest malignant gastrointestinal (GIT) tumor most commonly located in the recto-sigmoid region. The age and sex prevalence and histopathological features concur with reports from other parts of the world.

Metastatic alveolar rhabdomyosarcoma to the breast: a case report

OBJECTIVE

To present the unusual occurrence of a Metastatic Alveolar Rhabdomyosarcoma to the right breast in a young woman, six years after the primary in the right thigh had been surgically excised and treated. A search of the literature from this part of the world showed that this is quite rare as no report of a similar case was found.

METHODOLOGY

Breast lumpectomy samples submitted were routinely processed to obtain paraffin sections which were then stained routinely with haematoxylin and eosin. Reticulin stain and immunohistochemistry were used to exclude an epithelial lesion.

CONCLUSION

Metastatic Rhabdomyosarcoma to the breast is a rare condition and is almost exclusive to adolescent females. Routine breast examinations should be mandatory for long term female survivors of primary Rhabdomyosarcomas.

The effect of quinine and ascorbic acid on rat testes

BACKGROUND

We have previously demonstrated that quinine is a testicular toxicant in Sprague-Dawley rat.

OBJECTIVE

To describe the changes in the testicular levels of testosterone and lipid peroxidation secondary to quinine and ascorbic acid administration in rats.

METHODS

Twenty male Sprague-Dawley rats per group were assigned to one of three treatment groups: 0 mg quinine and 0 mg ascorbic acid/kg body weight (control); 10 mg quinine/ kg BW; and 10 mg quinine plus 0.1 mg ascorbic acid/kg BW. Rats were intramuscularly administered their respective doses of quinine five days in a week and ascorbic acid three days in a week for eight weeks. All the animals were sacrificed at the end by decapitation. Seminal analysis was performed on tubular fluid from caudal epididymides. Evaluations were made for testicular levels of testosterone and lipid peroxidation through malondialdehyde (MDA). Testicular specimens were also processed for histology under light microscopy.

RESULTS

Quinine significantly (p < 0.01) increased free radicals (from elevation of MDA) and decreased testosterone in the testis compared with those of the control group and those treated with a combination of quinine and ascorbic acid. The semen of rats treated with only quinine demonstrated a significantly (p < 0.001) lower sperm concentration and motility compared to the controls and those treated with quinine plus ascorbic acid. Microscopic examination of cross-sections of seminiferous tubules also showed that ascorbic acid partially protected against quinine -induced testicular effects.

CONCLUSION

Ascorbic acid has beneficial effect and protects against quinine-induced testicular reduction of testosterone.

Adult lymphomas in Lagos Nigeria: a fourteen year study

OBJECTIVE

we present a 14 year retrospective histopathological study of 92 cases of adult lymphomas in Lagos. The aim is to document the histologic types, age and sex distribution.

MATERIALS AND METHOD

The materials consisted of slides and paraffin embedded blocks of all cases of lymphoma in adults above the age of 16 years seen between 1991 and 2004 at the Morbid Anatomy Department of Lagos University Teaching Hospital Idi-Araba Lagos.

RESULTS

Of ninety two cases of lymphoma studied, male and female patients accounted for 59(64%) and 33(36%) cases respectively, giving a M: F ratio of 1.8:1. The most frequently biopsied site is the cervical lymph node. Non-Hodgkin's lymphoma (NHL) which accounted for 60 cases occurred most frequently in the 46-55 years age group and gives a male: female ratio of 2:1. Intermediate grade, high grade and low grade variants of NHLs accounted for 39%, 34% and 27% respectively. Hodgkin's lymphoma mostly affected patients of younger age group, 25-35 years with a M:F ratio of 1.7:1. Mixed cellularity 17 (55%) was the commonest subtype of Hodgkin's lymphoma.

CONCLUSION

Non-Hodgkin's lymphoma is commoner than Hodgkin's lymphoma. The age and sex distribution agrees with reports from other parts of Nigeria and Africa with minimal variations.

Ascorbic acid and the effect of cigarette smoke on tissues--a preliminary report

BACKGROUND

Smoke from the average cigarette contains chemicals, which are highly toxic, causing chronic airways diseases in smokers as well as non-smokers exposed to environmental tobacco smoke (ETS). It is associated with an increased risk of developing asthma, pneumonia, bronchitis and cancer.

OBJECTIVE

To investigate the effect of ascorbic acid on the degenerative effect of passive cigarette smoke on some vital organs.

METHODS

A total of 16 male rabbits divided into four groups (A, B, C, D) of 4 rabbits each, were used. Group A rabbits were exposed to passive cigarette smoke for 45-60 minutes daily; group B was treated similarly but also had 5 mg/g body weight of ascorbic acid daily. Group C had ascorbic acid only and Group D was the untreated control group. After six weeks of the above treatment, the animals were sacrificed for histological investigation of some of their vital organs.

RESULTS

Tobacco smoke had deleterious effects on the lungs, testes and kidneys; no significant changes were seen in the liver, brain and.heart. Ascorbic acid appeared to have some attenuating effect on inflammatory processes as observed in the lungs. Varying degrees of hypospermatogenesis were observed in the seminiferous tubules while the epididymis contained no spermatocytes in both groups A and B.

CONCLUSION

Ascorbic acid has some attenuating effect on inflammatory processes but it neither stops inflammation (as seen in the lungs) nor declining function (as signified by hypospermatogenesis in the testes). Therefore, it is doubtful that the long-term effects of tobacco smoke can be prevented by the use of ascorbic acid.

Conjunctival melanoma in a 55 year old male Nigerian: a case report

BACKGROUND

Conjunctival melanoma is a rare occurrence in the Negroid race.

PURPOSE

To report a case of a 55 year old security man with right conjunctival melanoma.

METHOD

A 55 old man was operated on to remove a pigmented right bulbar conjuctival growth. The specimen was submitted to Lagos University Teaching Hospital Lagos and Harold Wood Hospital England for histopathologic examination and confirmation.

RESULTS

Surgery was successful and histopathologic and immunohistochemical studies confirmed a diagnosis of a nodular malignant melanoma.

CONCLUSION

The need for the provision of definitive investigative tool (immunohistochemical studies) to facilitate definitive diagnosis and management of such cases in some recognised centres in Nigeria cannot be overemphasised.

Alloxan-induced and insulin-resistant diabetes mellitus affect semen parameters and impair spermatogenesis in male rats

The purpose of this study was to determine the effects of diabetes mellitus and insulin resistance on semen parameters, histology of reproductive organs and serum concentrations of testosterone and luteinizing hormone (LH). Male Sprague-Dawley rats weighing 180 - 200g were made diabetic by intravenous injection of alloxan (40 mg/kg): and insulin resistant by chronic fructose feeding (25% fructose) for 12 weeks. Rats were anaesthetized, followed by laparatomy. Blood was obtained by cardiac puncture for measurement of testosterone and LH concentrations by radioimmunoassay. Semen analysis was carried out; reproductive organs were isolated, fixed in Bouin's fluid and processed for histological studies. All semen parameters analyzed were significantly reduced (P < 0.05) in the diabetic and insulin resistant rats compared to control rats. Body weight and weight of reproductive organs were also significantly reduced (P < 0.05). Furthermore, tissue fixation studies revealed changes in the cytoarchitecture of reproductive organs in the diabetic and insulin resistant rats compared to control rats. However, serum concentrations of testosterone and LH were not significantly different in all the groups. We conclude that diabetes mellitus and insulin resistance affect semen parameters and impair distinct phases of spermatogenesis in male rats. Some mechanisms responsible for this impairment are suggested.

Idiopathic interstitial pneumonias in LUTH--A morphologic study of three cases

OBJECTIVE

Idiopathic interstitial pneumonias are rarely diagnosed in our environment. However in in the year 2000 a group of new cases were histologically diagnosed in the Department of Morbid Anatomy of the Lagos University Teaching Hospital (LUTH). This study aims to review the clinical and morphologic features of the three cases or Idiopathic Interstitial Pneumonias seen at surgicals and autopsy over a 10 year period (March 1995 to March 2005) in LUTH; as well as discuss some clinicopathologic features of interstitial pneumonias.

MATERIALS AND METHODS

A review of the cases seen at surgicals and autopsy from March 1995 to March 2005 was done by retrieving the relevant reports. Cases described with interstitial pneumonitis were re-evaluated and their respective paraffin blocks re-cut for special staining to better demonstrate the changes in morphology.

RESULTS

A total of 3 cases were retrieved from the ten year period reviewed. Incidentally, all occurred in the year 2000. Their mean age was 57 years and the male to female ratio was 2:1. The 'Usual Interstitial Pneumonitis' pattern was more common.

CONCLUSION

Interstitial pneumonias are rare in our environment; the apparent emergence of three cases in the year 2000 alone is a curiosity as a search over a ten year period (March 1995 to March 2005) yielded no other histologically convincing case. An increased index of clinical suspicion on the part of our clinicians and pathologists as well as collaborative research involving several specialists and Medical Institutions will be required to determine the true frequency of this disease in our environment and its peculiar clinicopathological features.

Burn scar carcinoma: two case reports and review of literature

The development of carcinoma within a burn scar is an uncommon sequelae. When it does occur, the diagnosis is often delayed and consequently outcome less favourable. We present two cases seen and review existing literature on the aetiology, diagnosis and treatment of this problem. Delay in presentation and treatment is often the norm rather than the exception in this part of the world. We recommend early closure of all burn wounds and frequent biopsies of chronic leg ulcers.

Histopathological study of liver diseases at the Lagos University Teaching Hospital, Nigeria (1989-2000)

OBJECTIVE

We present a retrospective histopathological study of 345 liver biopsies over a 12-year period. The study sought to record the frequencies of the range of histopathological changes observed in liver biopsy specimens.

MATERIALS AND METHODS

the materials consisted of slides and paraffin embedded blocks of all liver biopsy specimens received from within and outside the hospital. The clinical data such as the age, sex, and clinical summary were extracted from the request forms.

RESULTS

there were 222 males and 123 females; M: F=1.8:1; peak age incidence of 41-50 years. The three common histopathological diagnoses were hepatocellular carcinoma-33%, chronic hepatitis-17.7%, and liver cirrhosis-17.7%. Thirty per cent of hepatocellular carcinoma was post-cirrhotic. The peak age incidence of chronic hepatitis precedes that of liver cirrhosis and hepatocellular carcinoma by one decade.

CONCLUSION

the common forms of liver disease diagnosed histologically are hepatocellular carcinoma, chronic hepatitis and liver cirrhosis. The age and sex distribution are similar to those already established in the African literature.

Medical audit of maternal deaths in the Lagos University Teaching Hospital, Nigeria

OBJECTIVES

To determine the rate of autopsy certification of maternal deaths; evaluate concordance and/discordance rates between autopsy and clinical diagnoses of maternal deaths, and to compare these with findings from other parts of the world.

DESIGN

Retrospective study.

SETTING

The Lagos University Teaching Hospital (LUTH), Nigeria between January 1989 and December 1998.

SUBJECTS

Women who died from pregnancy-related complications having been on admission in or having presented as emergencies to LUTH.

RESULTS

In the study period, 445 maternal deaths were registered in the LUTH mortuary. Autopsies were performed on 371 of these, giving an autopsy rate of 83.37%. Only 230 cases were found suitable for evaluation of concordance and discordance. Two hundred and six of these (89.57%) had related clinical and autopsy diagnoses (concordance) while 24 (10.43%) had completely unrelated diagnoses (discordance).

CONCLUSION

Adequate investigation of cause of death using the autopsy will assist in accurately determining the sequence of events that result in death and hence provide required statistics for the planning of appropriate interventions.

Maternal deaths in the Lagos University Teaching Hospital: a ten-year review (1989 - 1998)

To determine the causes and frequencies of maternal deaths in the Lagos University Teaching Hospital (LUTH) as seen at autopsy; to find their age associated frequencies; and to compare these findings with previous studies done in this hospital as well as those from other parts of the world.

MATERIALS AND METHODS

Those cases for which autopsies were requested and performed between January 1989 and December 1998 (inclusive) formed the material for this study. Excluded were patients who were dead on arrival, as well as badly autolysed cases. Records including autopsy protocols were retrieved from the Morbid Anatomy Department and relevant information was extracted and analysed from these records.

RESULTS

About 81% of autopsy certified were due to direct causes. The three leading causes of maternal death were obstetric haemorrhage (25.61% ), genital sepsis (19.68% ) and pregnancy-induced hypertension (16.71% ). The most common indirect cause of death was anaemia (7.01% ) making it the fifth leading cause of death in this study. Majority of deaths (70% ) occurred in those between 11 and 30 years. Maternal mortality Ratio was 2,920/100,000 live births.

CONCLUSION

Though maternal mortality figures from hospital-based studies are usually over-estimates of the true picture in the community they tend to provide a more thorough assessment of the underlying causes of death and their contributing factors, hence providing useful data for planning interventions.

Fatal head injuries: the Lagos University Teaching Hospital experience (1993-1997)

Head injuries are a universal problem and they constitute a major public health problem both in terms of morbidity and mortality. The aim of this study is to examine the causes and pattern of fatal head injuries in the Lagos University Teaching Hospital (LUTH). A retrospective autopsy study of fatal head injuries in LUTH between January 1993 and December 1997 was done by retrieving autopsy reports, extracting relevant information and analysing them. Two hundred and fourteen such cases were reviewed (7% of all autopsies during that period). Majority were consequences of road traffic accidents (52%) and assault (12%). Adults between the ages of 21 and 40 years were the most affected (44%), followed by children 10 years and below (17%). Seventy seven percent of all cases were males. Common lesions identified include skull fractures (73%), intracranial haemorrhages (69%), lacerations and contusions (31%).