Demographic and Diagnostic Spectrum of Neurosurgical Biopsies: Initial Experience From a Re-established Neurosurgical Unit in a Tertiary Hospital in North Central Nigeria

Introduction Neurosurgical biopsies are obtained from lesions of the central nervous system, comprising the skull, brain, spine, spinal cord, and nerves. Neurosurgery practice is a highly specialized field with wide disparities related to access to care, especially in developing countries where there are few specialists and poor support care for patients. After over 20 years of redundancy, the neurosurgical unit in Jos University Teaching Hospital (JUTH), Jos, Plateau State, Nigeria, was re-established to meet the needs of patients in the area of neurosurgery. The aim of the study is to document the demographic and diagnostic spectrum of neurosurgical biopsies obtained in JUTH in the first five years of the re-establishment of its neurosurgical unit, highlighting the need for inclusion of neurosurgical services in health planning and resource allocation; and to compare these findings to similar studies elsewhere. Materials and methods This was a retrospective, descriptive, hospital-based study of neurosurgical lesions diagnosed in the Department of Histopathology at JUTH between January 2011 and December 2015. One hundred and forty-five lesions met the inclusion criteria out of 151 in the records and were studied. Archival slides of these neurosurgical biopsies were retrieved, and fresh sections were re-cut and stained with hematoxylin and eosin (H&E) where necessary. The diagnoses of some of the neoplastic lesions were confirmed by immunohistochemistry. The data obtained was analyzed, and the results are presented as tables, bar charts, ratios, and percentages. Results Thirty-one different lesions were diagnosed. The lesions most commonly diagnosed were traumatic/degenerative intervertebral disc, 54/145 (37.2%); neoplastic, 48/145 (33.1%); and congenital, 31/145 (21.4%), while inflammatory/infectious, 9/145 (6.2%); and vascular, 3 (2.0%) lesions were the least. Bimodal peak frequencies involving the 0-14 years and 30-44 years age ranges were noted for the neoplastic lesions, occurring 37.5% (18/48) in the 0-14 years and 25% (12/48) in the 30-44 years, respectively. The 31 congenital anomalies diagnosed were all neural tube defects, and of these, occipital encephalocele, 10/31 (32.3%) and myelomeningocele, 9/31 (29.0%) were diagnosed most frequently. Of the neoplastic lesions, 66.7% (32/48) were benign and low-grade, and 33.3% (16) were malignant. Meningioma, 14/32 (43.8%), was the most common benign and low-grade neoplasm and accounted for 29.1% (14/48) of all neoplastic lesions. Astrocytoma (WHO grades I, II), 25% (8/32), was the next most common benign and low-grade neoplasm and accounted for 16.7% (8/48) overall. Astrocytoma (WHO grades III, IV), 8/16 (50%), was the most common malignant neoplasm and accounted for 16.7% (8/48) overall. Overall, neuroepithelial tumors, both benign and low-grade, and malignant, 43.8% (21/48), were the commonest neoplastic lesions. Most neoplastic lesions occurred in the brain, 75% (32/48), followed by the spine, 10.4% (5/48), and skull, 8.3% (4/48); while the least common was the spinal cord, 2.1% (1/48). The sex distribution of the neoplastic lesions showed almost equal frequency between males and females, 23/48 (47.9%) and 25/48 (52.1%). Conclusion The spectrum of neurological lesions highlighted in this study demonstrates that neurosurgical lesions abound in our environment with a similar prevalence to other regions of the world, and therefore speaks to the need for neurosurgical services.

Analysis of the genomic landscapes of Barbadian and Nigerian women with triple negative breast cancer

PURPOSE

Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype that disproportionately affects women of African ancestry (WAA) and is often associated with poor survival. Although there is a high prevalence of TNBC across West Africa and in women of the African diaspora, there has been no comprehensive genomics study to investigate the mutational profile of ancestrally related women across the Caribbean and West Africa.

METHODS

This multisite cross-sectional study used 31 formalin-fixed paraffin-embedded (FFPE) samples from Barbadian and Nigerian TNBC participants. High-resolution whole exome sequencing (WES) was performed on the Barbadian and Nigerian TNBC samples to identify their mutational profiles and comparisons were made to African American, European American and Asian American sequencing data obtained from The Cancer Genome Atlas (TCGA). Whole exome sequencing was conducted on tumors with an average of 382 × coverage and 4335 × coverage for pooled germline non-tumor samples.

RESULTS

Variants detected at high frequency in our WAA cohorts were found in the following genes NBPF12, PLIN4, TP53 and BRCA1. In the TCGA TNBC cases, these genes had a lower mutation rate, except for TP53 (32% in our cohort; 63% in TCGA-African American; 67% in TCGA-European American; 63% in TCGA-Asian). For all altered genes, there were no differences in frequency of mutations between WAA TNBC groups including the TCGA-African American cohort. For copy number variants, high frequency alterations were observed in PIK3CA, TP53, FGFR2 and HIF1AN genes.

CONCLUSION

This study provides novel insights into the underlying genomic alterations in WAA TNBC samples and shines light on the importance of inclusion of under-represented populations in cancer genomics and biomarker studies.

Abstract PO-142: Analysis of the genomic landscapes of Barbadian and Nigerian women with triple negative breast cancer

Women of African ancestry (WAA) are disproportionately affected by the aggressive triple negative breast cancer (TNBC) subtype that is often associated with high recurrence rates and metastasis. Although there is a high prevalence of TNBC across West Africa and in women of the African diaspora, there has been no comprehensive genomics study to investigate the mutational profile of ancestrally related women across the Caribbean and West Africa. To shed more light on this phenomenon, whole exome sequencing (WES) was performed on 31 formalin-fixed paraffin-embedded TNBC tissues from ancestrally related Barbadian and Nigerian women. We compared these genomics profiles with data from The Cancer Genome Atlas (TCGA) for African American (TCGA-AA), European American (TCGA-EA) women with TNBC. With an average coverage of 382x for tumour samples (n= 31) and 4335x for pooled germline (n=22) non-tumor samples, the most mutated genes in our cohorts include NBPF12, PLIN4, TP53 and BRCA1. For TCGA TNBC cases, these genes had a lower mutation rate, except for TP53 (32% in our cohort; 63% in TCGA-AA; 67% in TCGA-EA). For all altered genes, there were no differences in frequency of mutations between WAA TNBC groups including the TCGA-AA cohort. Additionally, we observed a high frequency of copy number variant alterations in PIK3CA, TP53, FGFR2 and HIF1AN genes. This study provides in-depth insights into the underlying genomic alterations in WAA-TNBC samples and shines light on the importance of inclusion of non-European populations in cancer genomics and biomarker studies.

Citation Format: Shawn M. Hercules, Xiyu Liu, Blessing I. Bassey-Archibong, Desiree H.A. Skeete, Suzanne Smith Connell, Adetola Daramola, Adekunbiola A.F. Banjo, Godwin Ebughe, Thomas Agan, Ima-Obong Ekanem, Joe E. Udosen, Christopher Obiorah, Aaron C. Ojule, Michael A. Misauno, Ayuba M. Dauda, Ejike C. Egbujo, Jevon C. Hercules, Amna Ansari, Ian Brain, Christine MacColl, Yili Xu, Yuxin Jin, Sharon Chang, John D. Carpten, André Bédard, Gregory R. Pond, Kim R.M. Blenman, Zarko Manojlovic, Juliet M. Daniel. Analysis of the genomic landscapes of Barbadian and Nigerian women with triple negative breast cancer [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-142.

Quackery as a Cause of Maxillofacial Infections and Its Implications

BACKGROUND

In recent times, the prevalence of quackery in oral and maxillofacial practice has become rampant with complications, one of which is odontogenic infections. This study was aimed to identify how common quackery is among our patients with odontogenic infections and the outcome of the patients.

MATERIALS AND METHODS

The study was a descriptive cross-sectional study of all patients presenting with odontogenic infections seen at the accident and emergency unit and the oral and maxillofacial surgery clinics of a tertiary hospital in North Central Nigeria from January 2017 to December 2021. Information obtained included sociodemographic characteristics, presenting complaints, duration of illness, prehospital care, diagnosis, duration of hospital stay, where the patient was first managed, what is the "doctor/dentist" status, and outcome.

RESULTS

A total of 237 patients were recruited with a male to female ratio of 1:1.3. The commonest presenting complaints were toothache and jaw swelling with patients been ill for up to 2 weeks before presenting. About 41.8% of the patients have a co-existing health condition, and 46.4% of the patients had tooth extraction by a quack, with 82.7% taking antibiotics prescribed by a chemist before presentation. About 11.0% of the patients died; 96.2% of those that died had their tooth extracted by quacks. Patients with preexisting health conditions and preadmission tooth extraction were more likely to die with odds ratio (OR) = 2.230; 95% confidence interval (CI) = 1.06-4.71 and OR = 28.9; 95% CI = 3.97-209.6, respectively.

CONCLUSION

Quackery is very common in our society. The odds of death are increased in patients with odontogenic infection if the patient has a preexisting health condition and even more significant if they had their tooth extracted by quacks.

The epidemiology, treatment, and determinants of outcome of primary head and neck cancers at the Jos University Teaching Hospital

Introduction:

This study aims to evaluate the epidemiology, treatment, and factors that determine the outcomes of head and neck cancers (HNC).

Patients and Methods:

Retrospective analytical review of HNC managed at the Jos University Teaching Hospital between May 2007 and April 2017 using the International Classification of Diseases version 10.

Results:

Of 487 head and neck neoplasms, 129 (26.5%) were malignant and 122 health records met the criteria for analysis consisting of 83 (68.0%) males and 39 (32.0%) females aged 13 years to 85 years (mean = 51 years; standard deviation = ±16.0 years). The most common presenting feature was nasal obstruction (n = 47; 38.5%). The most common tumor site was the nasopharynx (n = 34; 27.9%). Mean duration of symptoms was 13.3 months. Alcohol (P = 0.02), cigarette smoking (P = 0.01), and cooking wood smoke (P = 0.01) were associated with advanced tumor stage. Squamous cell carcinoma was the most common histological type. Posttreatment complication rate was 47.5%. Lost to follow-up rate was 55.7%. The lungs were the most common distant metastatic site. The case fatality rate was 18.0%.

Conclusion:

HNC constitutes almost a quarter of head and neck tumors affecting twice the number of males in their sixth decade with nasopharyngeal cancers being the most common in both genders. Several modifiable variables are noted to target appropriate future cancer education for lifestyle modification, screening for early detection and treatment.

The predictive factors of primary head and neck cancer stage at presentation and survival in a developing nation's tertiary hospital

Background:

Stage of head and neck cancers at presentation is a strong determinant of outcomes.

Objective:

To evaluate predictors of stage of head and neck cancers at presentation and survival in a Nigerian tertiary hospital.

Patients and methods:

Health records that met the inclusion criteria for head and neck cancers were retrieved using the International Classification of Diseases, 10th revision and analyzed with associations between variables modeled using logistic regression analysis.

Results:

From a record of 487 head and neck neoplasms, 129 (26.5%) were malignant of which 122 health records met the criteria for analysis consisting of 83 (68.0%) males and 39 (32.0%) females aged 13–85 years (mean = 51 years; standard deviation = ±16 years). Alcohol (odds ratio = 1.99; 95% confidence interval = 1.08–3.69; p = 0.02) and tobacco exposure (odds ratio = 3.07; 95% confidence interval = 1.32–7.16; p = 0.01) were associated with increased odds for advanced tumor stage at presentation. Stage IV cancer (hazard ratio = 1.44; 95% confidence interval = 1.80–2.59), alcohol (hazard ratio = 2.19; 95% confidence interval = 1.18–4.10) and tobacco use (hazard ratio = 3.40; 95% confidence interval = 1.22–8.74) were associated with increased hazards for death.

Conclusion:

Alcohol, tobacco use and smoke from cooking wood are predictive factors for advanced HNC stage at presentation. Stage IV cancer, alcohol and tobacco use were associated with an increased hazard for death.

Erratum to: Outcome of HIV-associated lymphoma in a resource-limited setting of Jos, Nigeria

[This corrects the article DOI: 10.1186/s13027-017-0144-7.].

Outcome of HIV-associated lymphoma in a resource-limited setting of Jos, Nigeria

BACKGROUND

Lymphoma is a leading cause of cancer-related death among human immunodeficiency virus (HIV)-infected individuals in the current era of potent anti-retroviral therapy (ART). Globally, mortality after HIV-associated lymphoma has profound regional variation. Little is known about HIV-associated lymphoma mortality in Nigeria and other resource-limited setting in sub-Saharan Africa. Therefore, we evaluated the all-cause mortality after lymphoma and associated risk factors including HIV at the Jos University Teaching Hospital (JUTH) Nigeria.

METHODS

We conducted a ten-year retrospective cohort study of lymphoma patients managed in JUTH. The main outcome measured was all-cause mortality and HIV infection was the main exposure variable. Overall death rate was estimated using the total number of death events and cumulative follow up time from lymphoma diagnosis to death. Cox proportional hazard regression was used to assess factors associated with mortality after lymphoma diagnosis.

RESULTS

Out of 40 lymphoma patients evaluated, 8(20.0%) were HIV positive and 32(80.0%) were HIV negative. After 127.63 person- years of follow-up, there were 16 deaths leading to a crude mortality rate of 40.0 per 100 person-years. The 2-year probability of survival was 30% for HIV-infected patients and 74% for HIV-uninfected. Median survival probability for HIV-infected patients was 2.1 years and 7.6 years for those without HIV. Unadjusted hazard of death was associated with late stage, HR 11.33(95% CI 2.55, 50.26,p = 0.001); low cumulative cycles of chemotherapy, HR 6.43(95% CI 1.80, 22.89,p = 0.004); greater age, HR 5.12(95% CI 1.45,18.08,p = 0.01); presence of comorbidity, HR 3.43(95% CI 1.10,10.78,p = 0.03); and HIV-infection, HR 3.32(95% CI 1.05, 10.51,p = 0.04). In an adjusted model only stage was significantly associated with death, AHR 5.45(1.14-26.06, p = 0.03).

CONCLUSION

Our findings suggest that HIV- infection accounted for three times probability of death in lymphoma patients compared to their HIV-uninfected counterparts due to late stage of lymphoma presentation in this population. Also initiation of chemotherapy was associated with lower probability of death among lymphoma patients managed at JUTH, Nigeria. Earlier stage at lymphoma diagnosis and prompt therapeutic intervention is likely to improve survival in these patients. Future research should undertake collaborative studies to obtain comprehensive regional data and identify unique risk factors of poor outcomes among HIV-infected patients with lymphoma in Nigeria.

CLEFT LIP, ALVEOLUS AND PALATE IN AFRICAN NATIVES: AN UPDATE ON DEMOGRAPHICS AND MANAGEMENT OUTCOME

BACKGROUND

Development of craniofacial structures is a complex process and disruption of any of the numerous steps can lead to development of oro-facial clefts. This is a surgically amenable anomaly as from early life that has had conflicting pattern of demographics reported by various researchers globally. There are several factors that are critical to the surgical outcome.

OBJECTIVE

Study the demographics and the management outcome of cleft lip, alveolus and palate and highlight factors responsible for improved care in recent time.

DESIGN

Descriptive cohort study.

SETTING

Tertiary health institution.

METHOD

All consecutive patients managed for cleft lip, alveolus and palate (CLAP) over 7years and 10months were studied.

OUTCOME

Cleft lip, alveolus and palate repair was performed on 149 patients, January 1, 2001- December 31, 2008 with an incidence of 2.1/1000 live births. From this, 27 patients, averaging 4.5 patients per year were operated for the first 6 1/3 years while the remaining 122(81.9%) the next 1 1/2 years, averaging 81.6 patients yearly. Their ages ranged from 3 months - 60 years with 77 (51.7%) males and 72 (48.3.0%) females. Cleft lip was the main presentation in 108(72.5%) of which 72(66.7%) were left sided. Bilateral cleft lip were14 (9.4%). Five (3.4%) patients had associated anomalies out of which 3(60.0%) had CLAP while 2(40.0%) isolated cleft lip or palate. The technique for cleft lip repair was Millard's and Noordhoof's while palatal cleft was the two-flap palatoplasty with intravelar veloplasty. Success was recorded in 142(95.3%) with complication observed in 7(4.7%) patients.

CONCLUSION

The rarity of cleft lip, alveolus and/or palate in the African native documented previously may no longer be tenable as observe in this study. Management outcome has improved owing to the collaboration with SmileTrain, USA, along with multidisciplinary approach.

Histopathological types of breast cancer in Gombe, North Eastern Nigeria: a seven-year review

This was a retrospective analysis of all consecutive breast cancer specimens submitted to the Pathology Department Of Federal Medical Centre, Gombe which renders histopathology services to four states in the North Eastern region of Nigeria. A total of 172 cases of malignant breast tumours were recorded during the 7 years under review. Out of the 172 cases of breast cancers analysed, 7 (4%) were in males while the remaining 165 (96%) were in females giving a male: female ratio of 1:24. The most common histopathological type of breast cancer found in this study was Invasive Ductal Carcinoma no special type (NST) accounting for 78.8% of cases.

Histopathological analysis of endometrial biopsies in Jos University Teaching Hospital (JUTH), Nigeria. A 5-year critical review

AIMS

This study is aimed at giving an insight into the pattern and age distribution of endometrial analysis as seen at Jos University Teaching Hospital.

METHODS

This is a retrospective reviewed cases of endometrial biopsies diagnosed between January 1998 to December 2002 in the Histopathological Department ofJos University Teaching Hospital

RESULTS

A review of endometrial biopsies slides from 556 patients revealed that pregnancy related diagnosis was the commonest, representing 302 (54.3%) of histopathological diagnosis, followed by endometrial hyperplasia, accounting for 97 cases (17.5%) and majority of which was categorised as mild hyperplasias. Hydatidiform mole, which ranked third, constituted 58 (10.4%) of the cases studied. Choriocarcinoma was the leading malignancy representing 10 cases (45%) of the malignant tumours and 1.8% of all the endometrial biopsies. Endometrial adenocarcinoma, stromal sarcoma and metastatic cancer constituted 6 (1.0%), 3 (0.5%) and 3 (0.5%), respectively.

CONCLUSION

The commonest endometrial pattern seen in JUTH over the study period was products of conception which peak in the third decade of life; primary malignancies of the endometrium are uncommon in JUTH and they represented just about 2%.

Paediatric laryngeal granular cell tumour

Granular cell tumour (GCT) affecting the larynx is not common, especially in children. Most cases are apt to be confused with respiratory papilloma and may even be mistaken for a malignant neoplasia. We present a case of laryngeal GCT in a 12-year-old child to emphasize that the tumour should be regarded in the differential of growths affecting the larynx in children.