Malignant Melanoma in Lagos, Nigeria: Elucidating Histopathologic Prognostic Factors

BACKGROUND

Malignant melanoma (MM) is the most lethal of all cutaneous malignancies, accounting for about 79% of skin cancer related deaths. In blacks, it is associated with greater morbidity and mortality compared to Caucasians. Breslow thickness and ulceration status are two of the most important histopathologic prognostic factors in MM. No study on MM in Nigeria has however examined these factors.

METHODS

Formalin-fixed paraffin-embedded (FFPE) tissue blocks and corresponding Haematoxylin and Eosin (H&E) stained slides of all confirmed cases of MM from January 2005 to December 2014 in the AMP Department of Lagos University Teaching Hospital (LUTH) were retrieved.

RESULTS

Fifty-two MM cases were histologically diagnosed in LUTH during the study period which represented 1.0% of total solid malignancies. Forty-three of these occurred in the skin accounting for 19.7% of all skin malignancies and making MM the 3rd commonest skin malignancy after squamous cell carcinoma (SCC) and kaposi sarcoma (KS). Eighty eight percent (88%) of the tumour were in Clark's stage IV and V while 84% had Breslow thickness >4mm. Ulceration was present in 67%. The Clark's level and Breslow thickness were correlated with the ulceration status of the tumour. There is significant correlation between the Breslow thickness and ulceration with p-value < 0.05 while there is no significant association between the Clark's level and ulceration.

CONCLUSION

MM constituted a significant proportion of skin malignancy in LUTH and majority of the cases present at an advanced stage. Breslow thickness and ulceration statuses of the tumour are important histopathologic parameters that should be reported in all MM biopsies.

Primary vaginal leiomyosarcoma: case report of a rare gynaecological malignancy and diagnostic challenge in a resource-constraint setting

Primary vaginal leiomyosarcoma (VLMS) is an extremely rare variant of primary vaginal cancers with very poor prognosis irrespective of the stage at presentation and the type of treatment received. It is easily recurrent and has a high propensity for haematogenous spread especially to the lungs. We present the case of a 34-year-old Para 1 + 1 (1 alive) woman with recurrent vaginal mass of 8 years duration after two surgical excisions without histological evaluation. She had examination under anaesthesia and a wide local excision of the vaginal mass. Histological examination of the mass revealed poorly differentiated VLMS with positive surgical margins and she was commenced on adjuvant chemo-radiation. Histological evaluation remains the hallmark for diagnosing rare malignancies like VLMS, which unfortunately is not a standard practice in some resource-constraint settings.

Kaiso is highly expressed in TNBC tissues of women of African ancestry compared to Caucasian women

Purpose

Triple-negative breast cancer (TNBC) is most prevalent in young women of African ancestry (WAA) compared to women of other ethnicities. Recent studies found a correlation between high expression of the transcription factor Kaiso, TNBC aggressiveness, and ethnicity. However, little is known about Kaiso expression and localization patterns in TNBC tissues of WAA. Herein, we analyze Kaiso expression patterns in TNBC tissues of African (Nigerian), Caribbean (Barbados), African American (AA), and Caucasian American (CA) women.

Methods

Formalin-fixed and paraffin embedded (FFPE) TNBC tissue blocks from Nigeria and Barbados were utilized to construct a Nigerian/Barbadian tissue microarray (NB-TMA). This NB-TMA and a commercially available TMA comprising AA and CA TNBC tissues (AA-CA-YTMA) were subjected to immunohistochemistry to assess Kaiso expression and subcellular localization patterns, and correlate Kaiso expression with TNBC clinical features.

Results

Nigerian and Barbadian women in our study were diagnosed with TNBC at a younger age than AA and CA women. Nuclear and cytoplasmic Kaiso expression was observed in all tissues analyzed. Analysis of Kaiso expression in the NB-TMA and AA-CA-YTMA revealed that nuclear Kaiso H scores were significantly higher in Nigerian, Barbadian, and AA women compared with CA women. However, there was no statistically significant difference in nuclear Kaiso expression between Nigerian versus Barbadian women, or Barbadian versus AA women.

Conclusions

High levels of nuclear Kaiso expression were detected in patients with a higher degree of African heritage compared to their Caucasian counterparts, suggesting a role for Kaiso in TNBC racial disparity.

Electronic supplementary material

The online version of this article (doi:10.1007/s10552-017-0955-2) contains supplementary material, which is available to authorized users.

Clinicopathological and molecular characteristics of Ku 70/80 expression in Nigerian breast cancer and its potential therapeutic implications

Ku 70/80 is a regulator of the Non-Homologous End Joining (NHEJ) roles in clinicopathological features, and has prognostic significance in breast cancer (BC) in Caucasian populations. However, its significance in the Nigerian BC population, which is characterized by a higher rate of the triple-negative and basal phenotype, p53 mutation rate and BRCA1 deficiency, still needs to be investigated. We hypothesize that Ku70/80 expression shows adverse expression in Nigerian BC and, furthermore, that it is likely to have a therapeutic implication for Black BC management. This study investigated the biological, clinicopathological and prognostic significance of Ku 70/80 expression in a BC cohort from a Nigerian population. Ku 70/80 expression was determined in 188 well-characterized formalin-fixed, paraffin-embedded (FFPE) BC samples using tissue microarray and immunohistochemistry. Ku 70/80 expression was correlated with clinicopathological, molecular and prognostic characteristics of patients. Ku 70/80 was expressed in 113 (60.1%) tumors, and was positively associated with metastatic disease, triple-negative and basal phenotype, BRCA1 down regulators (MTA-1 and ID4), p-cadherin, PI3KCA and p53 expression. It inversely correlated with BRCA1, BRCA2, BARD1 and p27. Ku 70/80 was predictive of breast cancer-specific survival in multivariate analysis, but not of disease-free interval. This study demonstrated that Ku 70/80 expression is associated with triple negativity and down-regulation of the homologous recombination pathway of DNA repair. Therefore, the development of novel drugs to target KU70/80 may improve the patients' outcome in the treatment of Black BC.

Tumour cell membrane laminin expression is associated with basal-like phenotype and poor survival in Nigerian breast cancer

INTRODUCTION

Laminin is a glycoprotein with diverse functions in carcinogenesis including cell proliferation, invasion, metastases and epithelial-mesenchymal transition (EMT). In breast cancer (BC) laminin expression is speculated to be associated with unfavourable clinicopathological and molecular characteristics. We hypothesize that laminin expression would contributed to the aggressive nature of basal like and triple negative BC phenotype observed in Black women.

METHODS

The expression of laminin was determined in a well-characterised Nigerian cohort of 255 BC using tissue microarray and immunohistochemistry. Laminin expression was compared with clinical, pathological and survival characteristics.

RESULTS

Laminin was expressed in 146 (57.3%) cases and significantly correlated with younger age at diagnosis (p=0.005), premenopausal status (p=0.003), expression of EGFR (p=0.002), ID4 and MTA1, basal cytokeratin 5/6, p53, and triple negative tumours (all p<0.001). In addition, there was an inverse association of laminin expression with E-cadherin (p=0.03), ER and PgR (all p<0.001) and a trend with BRCA1 (p=0.05). Univariate survival analysis showed tumours positive for laminin had significantly poorer breast cancer specific survival (BCSS, p=0.009) and disease free interval (p=0.03), but not associated in Cox multivariate analysis.

CONCLUSION

This study demonstrates that laminin expression may have important roles in the aggressive nature observed in the basal-like and triple negative molecular subtype of Nigerian BC women.

Tuberculous Lymphadenitis in South-Eastern Nigeria; A 15 Years Histopathologic Review (2000-2014)

BACKGROUND

The human immunodeficiency virus (HIV) pandemic has brought about a resurgence in tuberculosis (TB), especially in developing countries. Previous studies on TB lymphadenitis (TBLN) in South-Eastern Nigeria were done before the advent of the HIV pandemic making a review pertinent.

AIM

To evaluate the role of TBLN as a cause of superficial lymphadenopathy in the post-HIV/acquired immune deficiency syndrome (AIDS) era of South-Eastern Nigeria.

MATERIALS AND METHODS

This is a 15 years (2000-2014) retrospective review of all superficial lymph node biopsies (SLNBs) received at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria.

RESULTS

One hundred and seventy-two cases of TBLN were identified in this study constituting 14.6% (172/1,180) of SLNBs received at our Hospital's Morbid Anatomy Department during the 15 years period under review. Twenty-eight cases of TBLN were clinically screened for HIV, 23 of which tested positive, representing 82.1% (23/28) of clinically screened cases. Acid fast bacilli demonstration was positive in 15.1% (26/172) of cases using Ziehl-Neelsen stain. 48.8% (84/172) of TBLN cases were males, and 51.2% (88/172) were females with most (22) cases received in 2012 and least (5) cases in 2000. Most TBLN occurred in the 21-25 years age group with a total of 21.5% (37/172) of cases and a male to female ratio of 1:1.5 The most common biopsy site for TBLN was the cervical group followed by the axillary and inguinal groups with 73.8% (127/172), 14% (24/172), and 4.7% (8/172) of cases, respectively.

CONCLUSIONS

There is a remarkable decline in the prevalence of TB lymphadenitis in South-Eastern Nigeria indicating a change in trend from the pre- to the post-HIV/AIDS era with slightly more females now presenting with TBLN and most TB lymphadenitis patients now presenting with associated HIV/AIDS disease. There is an urgent need to provide modern diagnostic facilities in our medical laboratories.

Molecular profiling of breast cancer in Nigerian women identifies an altered p53 pathway as a major mechanism underlying its poor prognosis compared with British counterpart

BACKGROUND

Advances in breast cancer (BC) research have demonstrated differences between black and white women with regarding tumour behaviour, patient outcome and response to treatment which can be explained by underlying genetic changes. The tumour suppressor gene p53 has been speculated to be involved in tumour biology of triple negative and/or basal -like BC and more commonly observed in black than caucasian women.

MATERIALS AND METHODS

In this study, the protein expression of p53 was investigated in tissue samples from a series of 308 Nigerian women, prepared as a tissue microarray (TMA), using immunohistochemistry. Clinicopathological parameters, biomarkers of functional significance in BC and patient outcome of tumours expressing p53 in Nigerian women were correlated with UK grade matched series.

RESULTS

A significantly large proportion of BC from Nigerian women showed high p53 expression compared with UK women (p<0.001). In those tumours showing positive p53 in the Nigerian series, a significant proportion were premenopausal, diagnosed before 50 years, larger in size, with evidence of metastasis into lymphatic vessels ( all p<0.001). In addition, p53 positive expression was also significantly correlated with negative expression of ER and PgR (p<0.001, p<0.03 respectively), BRCA1, MDM2 (all p<0.001), p21 (p=0.006) and E-cadherin (p=0.001) and positively associated with P-cadherin (p=0.001), triple negative phenotype, basal cytokeratin (CK) 5/6 expression (p<0.04) and basal phenotype compared with the UK series (p<0.001). Survival analyses showed Nigerian women with BC were significantly associated with poor BC specific survival (p<0.001, but no significant association with disease free interval was observed.

CONCLUSION

In this study, protein expressions of p53 pathways are different between Nigerian and UK BC women and this may also contribute to differences in tumour biology. Therefore, targeting these p53 pathways for therapeutic usage might improve the poor outcome observed in Black Nigerian women.

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.

Carcinoma of the penis: experience from the Lagos University Teaching Hospital Lagos, Nigeria

BACKGROUND

Carcinoma of penis is rare in countries where neonatal mate circumcision is the tradition and in Nigeria it is a common practice amongst almost all the tribes.

OBJECTIVE

This is to document the prevalence, age distribution, site and histologic types of penile carcinoma at the Lagos University Teaching Hospital Idi-Araba over a 20 year period.

METHODS

Cases of the penile carcinoma recorded in the surgical pathology register of the Department of Morbid Anatomy, the Cancer Registry and the Medical Records Department of the Lagos University Teaching Hospital over a twenty year period were reviewed. Information extracted included the age, site of lesion, and histopathologic type. The histopathology slides were reexamined to confirm the diagnosis and to grade the lesion. The data was analyzed using simple statistical methods.

RESULTS

There were 7 cases of carcinoma of the penis accounting for 1.9% of malignant lesions of the male genital tracts in LUTH, 3 (42.85%) of which were on the shaft of the penis. The ages of the patients ranged from 42-79 years with a mean of 52.2 years, majority (42.92) of the cases were inthe 5th decade. All the cases were well differentiated squamous cell carcinomas.

CONCLUSION

Carcinoma of the penis is rare in Lagos, Nigeria. This may be attributed to the common practice of neonatal male circumcision in Nigeria.

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.

Evaluation of the toxicity and reversibility profile of the aqueous seed extract of Hunteria umbellata (K. Schum.) Hallier f. in rodents

Hunteria umbellata (K. Schum.) Hallier f. (family: Apocynaceae) is reputed for the folkloric management of labour, pain and swellings, stomach ulcers, diabetes, obesity, and anaemia, with no scientific report of its toxicity and reversibility profile. The present study was, therefore, aimed at investigating the in vivo toxicity and reversibility profile of the aqueous seed extract of Hunteria umbellata (HU). The acute oral and intraperitoneal toxicity studies of HU were determined in Swiss albino mice while its 90-day oral toxicity and toxicity reversibility profile on anthropometric, biochemical, haematological and histopathological parameters were also assessed using standard procedures. Results showed that the LD50 values for the acute oral and intraperitoneal toxicity studies for HU were estimated to be 1000 mg/kg and 459.3 mg/kg, respectively. Visible signs of immediate and delayed toxicities including starry hair coat, respiratory distress, and dyskinesia were observed. For the chronic oral toxicity study, HU administered for 90 days produced significant (p < 0.001) reductions in the weight gain pattern and significant (p < 0.001) and dose related increases in the relative weights of liver, stomach, spleen, testis, lungs and heart, at the 100 and 500 mg/kg of HU. Chronic HU treatment also produced significant (p < 0.05, p < 0.001) dose related reductions in the serum levels of fasting blood glucose, bicarbonate, urea and creatinine while causing non-significant (p > 0.05) alterations in the serum levels of sodium, potassium, alaninine transaminase, aspartate transaminase, alkaline phosphatase, total and conjugated bilirubin, total protein and albumin. Also, chronic oral treatment with HU produced significant (p < 0.05, p < 0.01, p < 0.001) and dose-related increases in the red cell count, packed cell volume, haemoglobin concentration, platelet count, total leucocyte count and lymphocyte differential while producing significant (p < 0.05) reductions in neutrophil and granulocyte differentials. HU also produced histological features of proliferations of the stomach epithelia, lung tissues, splenic white and red pulps, and testicular spermatogenic series. Following 14 days of oral toxicity reversibility test, there was no significant (p>0.05) reversal in the serum levels of the biochemical and haematological parameters investigated, including the HU-induced histological lesions. Overall, results of this study showed that HU has a relatively low oral toxicity profile but its prolonged use, particularly, at high doses should be with great caution.

The sensitivity, specificity and accuracy of fine needle aspirational cytology in the diagnosis of oro-facial neoplasms at Lagos University Teaching Hospital, Nigeria

OBJECTIVE

The aim of the study is to compare the efficacy of fine needle aspirational cytology (FNAC) with open surgical biopsy in the diagnosis of orofacial tumours in patients seen at the Dental Centre of Lagos University Teaching Hospital from May 2005-May 2006.

PATIENTS AND METHODS

Fine needle aspiration was performed on all patients scheduled for open surgical biopsy at the Oral and Maxillofacial clinic of the hospital before the open surgical biopsy was done. Forty six patients whose final histological diagnoses were oro-facial neoplasms were involved in this study. Sensitivity, specificity and accuracy for fine needle aspirational cytology were calculated.

RESULTS

The sensitivity, specificity and accuracy of fine needle aspirational cytology in the diagnosis of oro-facial tumours were 95%, 95.8% and 95.5%, respectively. The false positive and false negative rates were 5% and 4.2%, respectively.

CONCLUSION

The high sensitivity, specificity and accuracy of fine needle aspirational cytology reported in this preliminary study suggest that the test may have a place in the management of oro-facial tumours. However, when the result of fine needle aspirational cytology is not in agreement with the clinical diagnosis, especially in suspected malignancy, open surgical biopsy should be performed.

Histopathological study of soft tissue malignancies in a teaching hospital, Sagamu, South-West Nigeria

BACKGROUND

Soft tissue malignancies constituted a heterogeneous group of rare solid tumors of mesenchymal cell origin with distinct clinical and pathological features.

OBJECTIVES

To review all the histologically confirmed soft tissue malignancies, with their age, sex distribution, and histological characteristics in Sagamu, South-West Nigeria.

METHODS

A review of all the medical and pathological records and slides of histopathologically diagnosed soft tissue malignancy cases seen between January 2003 and December 2006. Routine haematoxylin and eosin (H&E) staining as well as histochemical studies were carried out.

RESULTS

It constituted 1.84% of a total number of malignancies (1250 cases) diagnosed with a male to female ratio of 1.9:1 and 18(72.3%) cases occurring in the patients above 20 years. Rhabdomyosarcoma was the most preponderant soft tissue malignancy, constituting 13 (59.1%) cases with the embryonal type predominating (53.8%). Most cases of soft tissue malignancies were seen in the trunk as well in the lower limbs; constituting 63.0%. However, most cases of rhabdomyosarcoma in this study were seen in the lower limbs in 76.9%.

CONCLUSION

Rhabdomyosarcoma is the most common soft tissue malignancy in Sagamu especially the embryonal variant which is seen predominantly in childhood and adolescence.

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.

The use of drains in thyroid surgery

OBJECTIVE

To evaluate the necessity and benefits of the use of drains and their limitations in thyroidectomy and assess their relationship with cost of surgery and hospital stay.

METHODS

We conducted a prospective randomised study on 67 patients divided into two groups. A consisted of 35 patients with drain and B, 32 patients without drain between January 2005 and June 2007. All had subtotal thyroidectomy and the technique and method of closure were the same. No anticoagulant was used and the clotting profiles were within normal range in the two groups.

RESULTS

The sixty seven patients recruited for the study were made up of 60 females (89.6%) and 7 males (10.4%). The mean age for group A was 50.14 +/- 10.7 years, group B was 51.97 +/- 9.5 years. The P value for the mean ages of the two groups is 0.464 (p=0.05,t=3.98).There was no blood transfusion. Three patients developed features of respiratory obstruction (respiratory distress and stridor) -the first 2, one from each group was as a result of laryngeal oedema from trauma of difficult intubation. The third was from group B, as a result of hemorrhage and haematoma collection (she was one of the controlled thyrotoxic patients). Two patients (5.7%) developed wound infections in group A, which increased morbidity, hospital bill and prolonged hospital stay as compared to group B. The highest volume of drainage of 35ml was from a woman with a big goiter (120g). Average drainage was 17.7 +/- 6.9ml.

CONCLUSION

The use of drains is not necessary in all cases of thyroidectomy but for cases with large cavity post extraction and copious oozing in vascular glands. Some of the limitations to the use of drains are infections, this can prolong hospital stay and thereby increase hospital bill.

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.

A clinicopathologic review of oesophageal carcinoma in Lagos

BACKGROUND

Oesophageal cancer is the 6th most common cause of cancer death world wide. While the incidence is low in some parts of Africa such as Nigeria accounting for 0.4-0.6% of all malignant tumours, it is endemic in Transkei, in South Africa, which is regarded as an epicentre of the disease in Africa.

OBJECTIVE

To document the age and sex distribution, clinical as well as histopathological characteristics of oesophageal carcinoma in Lagos, SW Nigeria,

METHODS

The paraffin embedded blocks and slides as well as pathology reports of oesophageal carcinoma collected between 1995 and 2007 from Morbid Anatomy Department of the Lagos University Teaching Hospital and between 2002 and 2007 from two private histopathology laboratories in Lagos State were reviewed. The clinical data such as the age, sex, and clinical summary were extracted from demographic information in patients' case file.

RESULTS

Twenty cases representing 2.8% of all gastrointestinal tumours were recorded. The mean age was 65.4 years (SD-12.3) with M:F ratio of 1:1. Squamous cell carcinoma predominated; 18 cases (90%); the remaining two cases (one of which showed evidence of Barrett's oesophagus) were adenocarcinoma (10%). All presented at advanced stage with dysphagia and weight loss with or without vomiting, regurgitation, and/or haematamesis. Two third had mid oesophageal fungating masses, the remaining were located in the lower third. Two cases had surgery, the rest were not fit for any intervention.

CONCLUSION

Oesophageal cancer is not common in Lagos, Nigeria, majority are squamous cell carcinoma. Late presentation gives it a dismal outlook. Although the overall survival is poor, efforts at improving quality of life by palliative measures should be encouraged.

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.

Emergency partial thyroidectomy under cervical block to relieve severe acute airway obstruction from thyroid cancer

A 75 year old male, Nigerian, retired civil servant presented to the Surgical Endocrine Unit of the Olabisi University Teaching Hospital, Sagamu, Nigeria with features of severe acute airway obstruction from advanced thyroid cancer. He was immediately worked up for an emergency partial thyroidectomy within an hour of arrival in the hospital under superficial bilateral cervical blockage using 2% xylocaine with aderanalin (30 mls) 1:100,000 with mild sedation, using 10 mg pentazocine and 5 mg diazepam as other forms of anaesthesia were not feasible because of his worsening respiratory distress. Findings at operation were a very haemorrhagic, friable thyroid gland with all the lobes matted together. He had isthmusectomy with bilateral partial lobectomy to relieve pressure on the trachea. Respiration improved in the immediate post-operative period as reflected by the values of arterial blood gases. He was maintained on respiration and intranasal oxygen therapy in Intensive Care Unit (ICU) for 2 days. He had an uneventful recovery and was discharged 2 weeks after surgery. He had radiotherapy and was followed up in the clinic for a year.

Orbito-ocular lesions in Lagos

OBJECTIVE

we present a 10year retrospective clinicopathologic study of 135 cases of orbito-ocular lesions. The aim is to document pattern of orbito-ocular lesions, with their site, age and sex distribution.

MATERIALS AND METHODS

The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all orbito-ocular samples received at the Morbid Anatomy Department of Lagos University Teaching Hospital Idi-Araba Lagos between 1994 and 2003.

RESULTS

A total of 135 samples from 75(56%) males and 60(44%) females were analysed. The conjunctival, intraocular, orbital and eye lid lesions accounted for 27(20.1%), 75(55.5%), 18(13.4%) and 15(11%) cases respectively. The ages ranged from 20 days to 79 years with a mean age of 35 years. Sixty nine cases (51.1%) of all orbito-ocular lesions were seen in children of age 15 years and below. Squamous cell carcinoma was the commonest malignant conjunctival lesion (4 out of the 5 cases) occurring in adults with a mean age of 45 years. Retinoblastoma accounted for 46(85%) of all orbito-ocular malignancies with the peak in the 1-5year age group accounting for 37(80 %). Panophthalmitis, endophthalmitis and phthisis bulbi were common non neoplastic lesions requiring enucleation. Pseudotumour and rhabdomyosarcoma accounted for 5(27.8 %) and 4(22.2 %) cases respectively of all orbital lesions.

CONCLUSION

Retinoblastoma remains the commonest ocular malignancy while rhabdomyosarcoma was the commonest orbital malignancy with both occurring in childhood. Inflammatory lesions unfortunately are important orbito-ocular lesions requiring surgery in our environment.

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.

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.

Endometrial carcinoma following treatment for breast carcinoma in a Nigerian female. A case report and review of the literature

Tamoxifen is the primary hormonal therapy for breast cancer as well as its chemoprevention. It is used in the management of breast cancer because of its anti oestrogenic effect. It is however an agonist on the endometrium with undesirable effects of endometrial proliferation with the risk of endometrial hyperplasia and carcinoma. Several authors have reported cases of endometrial hyperplasia and carcinoma following tamoxifen therapy for breast carcinoma. No such report has been made from Nigeria . This paper presents the first case of endometrial carcinoma following tamoxifen therapy for breast carcinoma in a 52 year old Nigerian female. It also highlights the recommended guidelines for the follow up of women with breast cancer on tamoxifen therapy.

Rectal carcinoma in a nine-year-old Nigerian male child: case report

Carcinoma of the colon and rectum are rare in children and under the age of 40 years. A case of coro-rectal carcinoma in a nine-year-old Nigerian male child is reported. Family history was significant in the patient, it revealed that his father died three years earlier because of chronic diarrhoea and mucoid stool with associated on and off constipation and one of his elder brothers died eight years ago of colonic cancer at the age of twenty years. Exploratory laparotomy was done for the patient which revealed fixed rectosigmoid tumour with metastases to the liver, omentum and small intestine and ascites was also found. Hartmann's procedure with sigmoid colostomy was performed and the tumour was resected. Histological report of the biopsy specimen was consistent with poorly differentiated adeno-carcinoma. To the best of our knowledge, the youngest patient recorded in the literature is seven years old, which is younger than our patient, but this is still the youngest in our records.

Surgical complications from local herbal practitioners: report of five cases

Over a 12-month period, five patients (out of a total of 72) with serious complications resulting from use of herbs by traditional healers were seen at the surgical unit of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The age range was one and a half to five years with a mean age of 23.4 +/- SD years and a male to female ratio of 3:2. All the cases were misdiagnosed and mismanaged and ended up with various complications. Such as penile amputations, digital necrosis, upper and lower limb gangrene as well a severe sepsis among others. Ignorance, cultural beliefs and attitudes, delusion, poverty and inaccessibility to orthodox medical practice were some of the factors responsible for the patronage of traditional healers.

Prevalence of abnormal cervical smears among patients with HIV in Lagos, Nigeria

BACKGROUND

There are over four million people living with HIV/AIDS in Nigeria. Cervical cancer is the most common genital cancer in Nigeria. There are many reports on the association of HIV with increased risk of cervical dysplasia.

OBJECTIVE

To determine the prevalence of abormal cervical smears in Nigerian women who are HIV positive in Lagos.

METHODS

Cervical smears were taken from 233 HIV positive women and 235 HIV negative women who attended the HIV clinic and the family planning clinic respectively of the Lagos University Teaching Hospital during the period January-April 2004. Proportions were compared with the X2 test.

RESULTS

Data were complete for analysis in 227 of HIV positive and 228 of HIV negative women. Mean (SD) ages of HIV positive and HIV negative patients were respectively 35.2 (9.81) and 34.5 (7.37) years. Prevalence of squamous intraepithelial lesion (SIL) was higher in those who were HIV positive than in those who were HIV negative, 10.9% vs 4.3% (X2, 7.04; p=0.00798). Prevalence of high grade SIL was higher in HIV positive than HIV negative subjects, 7.9% vs 2.6% (X2, 6.38; p=0.0115). There was no significant difference in the prevalence of inflammatory smears, 15.7% in HIV positive vs 16.2% in HIV negative.

CONCLUSION

Prevalence of cervical dysplasia is high in women who harbour HIV.

Malignant Breast Lessions At Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H), Sagamu-a Histopathological Review

Various reports suggest an increasing incidence of breast cancer in Nigeria. The large volume of literature published on the subject of breast cancer bear witness to the interest shown in the subject. We therefore carried out a review of 50 cases of breast cancer recently confirmed histologically by our unit to study their characteristics and compare these with previous reports. A 2- years retrospective review of all histologically diagnosed carcinoma of the breast at Olabisi Onabanjo University Teaching Hospital, Sagamu from 2002-2003 was carried out. The peak age of occurrence was between 40-49 years with mean age of 47.5years. Invasive ductal carcinoma was predominant histologic type in 94% of cases and 72% presented late with advanced disease (Manchester stages 111 and 1V) with dismal prognosis. Surgery was the mainstay of treatment for both early and late disease. To ensure early and prompt detection, presentation and treatment, emphasis should be placed on female education, increasing awareness and encouraging breast self-examination. There is also a need for cancer registration centre in the hospital and a multicentred, controlled study of breast cancer in Nigeria.

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.

Schistosomiasis--An unusual cause of abdominal pseudotumor

Schistosomiasis is a common parasitic disease in the tropical and subtropical regions of Africa, Asia, South America and the Caribbean. It is the second most common parasitic infection of humans after malaria. Acute and chronic clinical presentations of S. monsoni are well described. Presentation as a pseudotumor is considered rare. We present a case of a 58-year-old Nigerian who presented with recurrent abdominal pain and abdominal mass of one-year duration. Stool was negative for schisostomal eggs, but histological specimen obtained from surgical resection of part of the caecum showed S. mansoni. The case was treated successfully by excisional biopsy and praziquantel therapy. A review of the literature is discussed.

Malignant orofacial neoplasms in Lagos, Nigeria

OBJECTIVES

To analyse general differences in age, gender, anatomic location of the various histological types of malignant neoplasm involving the oral and maxillofacial region at a tertiary referral centre in Nigeria and to compare this with reports in the literature.

DESIGN

Retrospective analysis.

SETTING

A tertiary referral centre in Lagos, Nigeria.

SUBJECTS

All patients with a histological diagnosis of malignancy were included provided the final surgical histology reports as well as the biopsy reports were available for review.

RESULTS

Squamous cell carcinoma (SCCA) with a peak age incidence in the 6th decade of life and a male to female ratio of 1.65 to 1 was the most common cancer (42.8%). Males with SCCA (mean = 48.7 years) were relatively younger than females (mean = 58.8 years). Eighteen percent of patients with SCCA were below 40 years at presentation and males were predominantly affected at a ratio of 5.2:1. Majority of the SCCA (75%) were well/moderately well differentiated. However, in patients below 40 years, 45.9% had poorly differentiated SCCA. The Most commonly affected sites for SCCA were the maxillary antrum (36.7%), mandibular gingiva/ alveolus (23.0%) and tongue (12.04%). Patients who presented with antral SCCA were relatively younger (mean = 48.9 years) than those who had SCCA involving the mandibular gingiva/ alveolus (mean = 57.1 years) as well as floor of mouth (mean = 56.3 years). Furthermore, males with antral SCCA were younger than their female counterparts. Similarly, males who had mandibular gingiva/ alveolus SCCA (mean = 48.4 years) were younger than their female counterparts (mean = 62.8 years). Majority of the glandular carcinomas (GLDCAs) arose from minor salivary glands (63.0%). Thirty seven per cent of these patients were below 40 years at presentation. Females who had antral GLDCA (mean = 32.4 years) were relatively younger than their male counterparts (mean = 49 years). Most of the patients who presented with sarcoma were below 40 years (77.4%) and males were younger (22. 8 years) than females (mean = 35.4 years).

CONCLUSIONS

The proportion of orofacial cancers that is SCCA in Nigerians is relatively low because of a relatively high proportion of GLDCA and Burkitt's lymphoma. A relatively high proportion of patients with SCCA were below 40 years at presentation. They were predominantly males who presented with poorly differentiated tumours.

Acute appendicitis in Olabisi Onabanjo University Teaching Hospital Sagamu, a three year review

BACKGROUND

Olabisi Onabanjo University Teaching Hospital is located in Sagamu, a suburban town with a population of 50,000 (1992 census). The hospital is a tertiary care facility in competition with a large number of private hospitals with different levels of competence.

OBJECTIVE

The objective of the study is to review the outcome of the surgical management of acute appendicitis in our hospital.

METHOD

A retrospective study of subjects who had appendectomy for the clinical diagnosis of acute appendicitis between January 2002 and December 2004 was done.

RESULT

113 subjects consisting of 52 females (46%), and 61 males (54%) were studied. The mean age was 24.1 years, 71 subjects (62.9%) were in the 10-30 years range. 57.5% of the subjects were students and 71 subjects (62.8) resided in urban area. All the subjects, had generalized in 23.9%). The mean duration of symptoms was 3.53 days with standard deviation of 3.69 days. Only 3 subjects presented on the day of onset of symptoms. Only 15 subjects (13.3%) had surgery on the day of admission. 69subjects (61.1%) had uncomplicated inflamed appendix at surgery and 2 subjects (1.8%) had clinically normal appendix. The mean duration of hospital stay was 10.6 days with standard deviation of 7.4. The commonest postoperative complication was pyrexia in 16 subjects (14.2%), followed by wound infection in 12 subjects (10.6%). One subject died (0.9%).

CONCLUSION

The outcome reflects the late presentation and delay in surgical treatment.

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.