Immunohistochemical Study and Clinicopathologic Correlation of Cox-2 and Her-2 Expression in Colorectal Carcinoma: A 5-Year Retrospective Study

BACKGROUND

Colorectal cancer (CRC) is the fourth most common cancer in Nigeria, and it affects mostly persons in their middle age. In a bid to gain some insight into the molecular characteristics of CRC in our environment, we set out to investigate the expression of COX-2 and HER-2 among Nigerian subjects.

OBJECTIVES

To evaluate the expression of COX-2 and HER-2 and determine their correlation with clinicopathologic parameters in surgically resected histologically diagnosed cases of colorectal cancer.

METHODS

Fifty-three paraffin-embedded tissue blocks of colorectal resections and corresponding patient information were retrieved from the archives of the Anatomic and Molecular Pathology Department of Lagos University Teaching Hospital. A 4-micron slide section was obtained from each specimen and immunohistochemistry for COX-2 and HER-2 expression was performed.

RESULTS

Mean age of cases was 53.9years with an almost equal M:F ratio of 1.12:1. Half of the cases were moderately differentiated adenocarcinoma and 17% were high grade tumors. Eighty three percent of the tumours showed positive cytoplasmic COX-2 expression and extremely low membranous HER-2 positivity was observed in 2%. There was no significant correlation between COX-2 expression and age, gender, tumour location, tumour size, depth of invasion or lymph node status. However, COX-2 expression revealed a significant correlation with tumour grade (p= 0.013).

CONCLUSION

This study detects a high COX-2 and low HER- 2 expression in colorectal cancer using immunohistochemistry, suggesting a possible role for COX-2 in CRC pathogenesis. This report should trigger further investigations of both markers vis-à-vis the management of CRC in our environment.

Application of the research electronic data capture (REDCap) system in a low- and middle income country- experiences, lessons, and challenges

The challenges of reliably collecting, storing, organizing, and analyzing research data are critical in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa where several healthcare and biomedical research organizations have limited data infrastructure. The Research Electronic Data Capture (REDCap) System has been widely used by many institutions and hospitals in the USA for data collection, entry, and management and could help solve this problem. This study reports on the experiences, challenges, and lessons learned from establishing and applying REDCap for a large US-Nigeria research partnership that includes two sites in Nigeria, (the College of Medicine of the University of Lagos (CMUL) and Jos University Teaching Hospital (JUTH)) and Northwestern University (NU) in Chicago, Illinois in the United States. The largest challenges to this implementation were significant technical obstacles: the lack of REDCap-trained personnel, transient electrical power supply, and slow/intermittent internet connectivity. However, asynchronous communication and on-site hands-on collaboration between the Nigerian sites and NU led to the successful installation and configuration of REDCap to meet the needs of the Nigerian sites. An example of one lesson learned is the use of Virtual Private Network (VPN) as a solution to poor internet connectivity at one of the sites, and its adoption is underway at the other. Virtual Private Servers (VPS) or shared online hosting were also evaluated and offer alternative solutions. Installing and using REDCap in LMIC institutions for research data management is feasible; however, planning for trained personnel and addressing electrical and internet infrastructural requirements are essential to optimize its use. Building this fundamental research capacity within LMICs across Africa could substantially enhance the potential for more cross-institutional and cross-country collaboration in future research endeavors.

Mismatch Repair Protein Expressions in Cohort of Colorectal Carcinoma Patients in Lagos

Background

Colorectal carcinoma (CRC) is a major cause of morbidity and mortality worldwide. Microsatellite instability pathway is important in the pathogenesis of CRC. Immunohistochemistry expression of mismatch repair (MMR) proteins serves as surrogate marker for MMR gene mutation.

Aims

This study aimed to determine MSI status of a cohort of CRC cases using immunohistochemistry.

Materials and Method

Surgical pathology blocks of resected colonic carcinoma (CC) between 2011 and 2015 were extracted from our departmental archives and The Specialist Laboratories in Lagos. Immunohistochemical expression profile of 4 MMR proteins was assessed in the representative blocks and this was correlated with the demographic and pathological characteristics.

Results

There were 19 males and 16 females with CC, mean age of 51.6 years, and 40% of them were below 50 years of age. Twenty (57.1%) out of the 35 CC cases seen were mismatch repair proficient (pMMR) while the remaining 15 (42.9%) were mismatch repair deficient (dMMR). Seven dMMR cases were seen equally on the right and left colonic tumors respectively. Five (71.4%) out of the 7 mucinous tumors in this study were dMMR, right sided with 3 of them in patients who were below 50 years of age.

Conclusion

The frequency of mismatch repair deficiency in CC among Nigerians is high, and presence of right-sided mucinous colon cancer in patients below 50 years is highly suggestive of dMMR status. Mutation studies of larger patient samples to determine the percentage with germline mutation will further our knowledge, and influence therapeutic options for CC.

Autopsy Study of the Liver in Adult Nigerians at Lagos University Teaching Hospital

BACKGROUND

Liver diseases are one of the major causes of morbidity and mortality in Nigeria. Detection of liver involvement in many disease conditions is often delayed till after death when autopsy is conducted, hence the importance of this study.

STUDY DESIGN AND METHOD

This was a prospective study to assess the pathologic findings in the liver of one hundred (100) consecutive adults (without pre-mortem diagnosis of liver disease) at autopsy, at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. The organs were examined macroscopically, weighed and representative biopsies taken for histopathological assessment. Special histochemical stains to confirm diagnosis were carried out as appropriate. The biodata and other clinical information were obtained from the case notes. Analysis was carried using descriptive statistics.

RESULTS

One hundred cases were studied, comprising of 46 males and 54 females, with overall mean age 47±15.6 years. The mean weight of the liver was 1737±586.02 grams (normal 1200-1400gm). In 19.0% of the cases, the liver showed normal histology. Of the others with pathological findings (81%), the three most common pathologies were chronic venous congestion, steatosis, and metastatic tumours. There was significant correlation of liver pathologies diagnosed with causes of death at autopsy (p=0.001).

CONCLUSION

In view of the fact that major liver diseases may be asymptomatic and may not be diagnosed until death, there is need for a high index of suspicion by clinicians. It is therefore important that clinicians properly assess the functional state of the liver to prevent, detect and promptly treat these disorders.

THE DISTRIBUTION, HISTOLOGIC PROFILE AND CLINICAL PRESENTATION OF GASTROINTESTINAL MALIGNANCIES IN LAGOS, NIGERIA

BACKGROUND

Gastrointestinal malignancies have continued to record higher incidence and therefore pose significant public health burden in terms of morbidity and mortality.

AIM

To evaluate the sociodemographic, histologic and clinical distribution of patients with gastrointestinal malignancies diagnosed between July 2009 and March 2016.

SETTING

Lagos University Teaching Hospital, Idi-Araba, south-west Nigeria.

METHODOLOGY

Using a retrospective study design, all the patients with histologic diagnosis of gastrointestinal malignancies were recruited and their bio-data, clinical, histologic and treatment data were extracted from their hospital records.

RESULTS

Of the 106 cases of gastrointestinal malignancies in this study, the age range was 30-82 years with a mean of 55.9±13 years and a peak age bracket of 50-59 years; the male/female ratio was 1.2:1. The most common sites were colorectum (79.3%), stomach (7.6%), anus (6.6%), liver (4.7%), and pancreas (0.9%). Adenocarcinoma was the most common histologic subtype (89.62%), followed by squamous cell carcinoma (2.83%) and gastrointestinal stromal tumors (1.89%). The most common complaints were abdominal pain (54.7%), constipation (38.7%), palpable abdominal swelling/masses (35.9%), bleeding (33.0%), and weight loss (17.0%). The tumors were treated with chemotherapy, surgery, and radiotherapy, either singly or in combination, in 97.2%, 83.0%, and 30.2% respectively.

CONCLUSION

In this study, colorectal cancers are still the most prevalent type of gastrointestinal malignancies with a male preponderance, and individuals between 40-59 years are at greater risk. The significant involvement of individuals who constitute the bulk of the workforce and are the most productive labor in the country points at the need to develop strategies aimed at reducing the incidence of gastrointestinal malignancies.

Endoprosthetic replacement of distal femoral tumors in Nigeria: A case series

In this observational study, three consecutive patients who were treated for distal femur tumours using endoprosthetic replacement between June 2013 and June 2014 were studied. The patients were within the ages of 28-47 years at the time of surgery. All three patients had modular endoprosthesis fixation and were evaluated using the Musculoskeletal Tumour Society (MSTS) Scoring System. Numerical values from 0 to 5 points were assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added and the functional score was presented as a percentage of the maximum possible score. The results for each patient were graded according to the following scale: Excellent - 75-100%; good - 70-74%; moderate - 60-69%; fair - 50-59% and poor - <50%. Of the 3 patients evaluated, 2 had a diagnosis of Giant Cell Tumour (GCT) of the distal femur; the third patient was diagnosed to have plasmacytoma. All underwent wide local resection with modular endoprosthetic distal femur reconstruction. The MSTS functional scores calculated were 70%, 78%, and 52% respectively. Complications noted included wound dehiscence in two patients and thrombosis of the Pulmonary artery needing an arterial embolectomy in one of these two patients. The same patient also had a post-operative loss of motor and sensory function below the level of the ankle.

Nonalcoholic fatty liver disease: Synopsis of current developments

Non-alcoholic fatty liver disease (NAFLD) which is defined as the accumulation of fat>5% of liver weight is increasingly becoming an important cause of chronic liver disease. This article tries to chronicle advances that have occurred in the understanding of the pathogenesis, pathology as well as the management of this disease. We have done a Medline search on published work on the subject and reviewed major conference proceedings in the preceding years. The Pathogenesis involves a multi-hit process in which increased accumulation of triglycerides in face of insulin resistance results in increased susceptibility to inflammatory damage mediated by increased expression of inflammatory cytokines and adipokines, oxidative stress and mitochondrial dysfunction, endoplasmic reticulum stress and gut derived endotoxemia. An interplay of multiple metabolic genetic expression and environmental factors however determine which patient with NAFLD will progress from simple steatosis to non-alcoholic steatohepatitis (NASH) and liver cirrhosis. The minimum criteria for diagnosis of NASH are steatosis, ballooning and lobular inflammation; fibrosis is not required. The NASH Clinical Research Network (CRN), histological scoring system is used to grade and stage the disease for standardization. The management of NAFLD consists of treating liver disease as well as associated metabolic co-morbidities such as obesity, hyperlipidaemia, insulin resistance and type 2 diabetes mellitus (T2DM). Patient education is important as their insight and commitment is pivotal, and lifestyle modification is the first line of treatment. Improvement in liver histology in non-diabetic NASH patients has been reported with use of Vitamin E. Other liver-related therapies under investigations include pentoxyfiylins, Caspar inhibitors, Resveratrol as well as probiotics. The prognosis (both overall and liver-related mortality) for simple steatosis is not different from that of the general population however.

Her-2 Over-Expression in Gastric Carcinoma:A 5-Year Retrospective Study in A Lagos Cohort Population

BACKGROUND

Gastric cancer is the fifth most common cancer and the prognosis has remained poor over the decades due to a high percentage of advanced stage presentation.

OBJECTIVE

To determine the frequency of HER-2 over-expression in gastric carcinoma in a Lagos cohort population, comparing it with known clinico-pathologic and prognostic factors.

MATERIALS AND METHODS

Data on 54 patients with gastric carcinoma were retrieved from the Histopathology Department of Lagos University Teaching Hospital. Haematoxylin and Eosin slides were made from the patients' paraffin blocks. These were reviewed for confirmation of diagnosis and determination of pathological prognostic factors. HER-2 over-expression was assessed using immunohistochemistry. The data was analyzed using SPSS 16.

RESULTS

Forty-two gastric biopsies and twelve gastrectomy specimens were available for study from the 54 patients. The ages ranged from 30 to 83 years (mean = 55.96 years). The male to female ratio was 3.2:1. Majority of the carcinomas were intestinal type (83.3%), with diffuse, mixed and indeterminate types accounting for 13%, 1.9% and 1.9% respectively. About 44% of the cases were moderately-differentiated grade and patients who had gastrectomies presented mostly with stage T3 disease (75%). HER-2 was over-expressed in 13% of cases, with one equivocal case. There were no statistically significant associations between HER-2 over-expression and the prognostic factors.

CONCLUSION

HER-2 over-expression occurs in a small percentage of gastric carcinoma in Lagos and is independent of most of the pathological parameters. Further work, with larger cohort, is needed to better characterize the possible prognostic benefits of targeted anti-HER-2 therapy in gastric carcinomas.

Bone malignancies in orthopaedic hospital Igbobi Lagos, Nigeria

AIMS AND OBJECTIVES

To document the pattern of bone malignancies in a highly populated orthopaedic hospital in Lagos Nigeria;

PATIENTS AND METHODS

A total of 21 cases of primary malignant bone tumours were studied. This comprised 12 cases of Osteosarcoma, 7 cases of Malignant Fibrous Histiocytoma (MFH) and 2 cases of Chondrosarcoma. Males (13) were affected more than females (8) giving a male to female ratio of 1.6 to 1. The age range was 7 to 45 years with a median age of 24 years. The diameter of the swelling ranged from 6 to 20 cm with a median of 12 cm. All patients had ablative surgery except for those with affectation of the ilium. Data was analysed using the Statistical Package for Social Sciences (SPSS 16). Enneking's classification was used to grade the tumour. The duration of symptoms of all the patients before presentation ranged from 3 weeks to 4 years with a mean of 7 months. The commonest site affected was around the knee (76.2%); distal femur had 42.9% and proximal tibia 33.3%.

RESULTS

Osteosarcoma was the most common malignant bone tumour in this series and accounted for 57.1%. The peak incidence was found in the 2nd decade of life. The youngest patient was 7 years old and the oldest 43 years. The tumour was found primarily around the knee. 7 cases were in the distal part of the femur, 4 in the proximal part of the tibia and 1 case was found in the distal radius. Out of the 12 patients with osteosarcoma, 8 had paraosteal type (5 high grade, 3 intermediate grade), the remaining 4 had periosteal (all high grade) Malignant Fibrous Histiocytoma was found in 7 patients and accounted for 33.3%. The peak incidence was found in 3rd and 4th decades. 4 out of the 7 patients were high grade pleomorphic osteosarcoma, 2 were myxoid high grade dedifferentiated and one was low grade giant cell tumour type. Chondrosarcoma was found in 2 patients, accounting for 9.5%. both cases were in the ilium

CONCLUSION

Primary malignant bone tumours occurred in children and young adult in this study. It is commoner among males and most of the patients presented late to the hospital. Osteosarcoma is the commonest followed by Malignant Fibrous Histiocytoma, both occurred commonly around the knee and chondrosarcoma on the ilium.

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.

Idiopathic pulmonary calcification and ossification in an elderly woman with a missed diagnosis of subarachnoid haemorrhage

This is a case of idiopathic pulmonary calcification and ossification in a 70 year old with long-standing diabetes and hypertension. Thirteen years prior to her demise, she was first noticed to have multiple calcific deposits in her lungs on a chest X-ray film. She had no risk factors for soft tissue calcification and ossification. Histology of tissue from autopsy showed intraparenchymal pulmonary calcification and ossification with marrow elements. Idiopathic pulmonary calcification and ossification is rare. At autopsy, she was also found to have had bilateral subarachnoid haemorrhage (SAH), a diagnosis missed during clinical evaluation. We highlight the pertinent details in our patient's management that could have helped to prevent a missed diagnosis of SAH. Even though SAH occurs most commonly following head trauma, the more familiar medical use of SAH is for non-traumatic SAH occurring following a ruptured cerebral aneurysm. This patient had notable risk factors for cerebral aneurysm formation but an aneurysm was not identified at autopsy. The location of the blood high on the cerebral convexities further suggests a traumatic origin rather than a ruptured aneurysm. Heterotopic calcification and ossification (HO) is known to occur in the setting of severe neurologic disorders such as traumatic brain injury but the fact that the lung calcification in our patient predated the brain injury by over 10 years makes it unlikely for the HO to have been due to the brain trauma. Other organ pathologies found at autopsy include chromophobe renal cell carcinoma, renal papillary necrosis, lymphocytic thyroiditis, and seborrheic keratosis.

Deep calf cavernous haemangioma in a 10 year- old girl: a case report

Haemangiomas are abnormal proliferation of blood vessels in any vascularised tissue. They can be capillary or cavernous varieties. Cavernous are either of cutaneous or deep types. Cavernous when compared with the capillary haemangioma is rare. Rarer still is the deep type of cavernous haemangioma. This is a report of a 10 year old Nigerian girl who presented with a right posterior leg swelling of 8 year duration, size initially was that of a peanut but increased to fill the entire calf region causing pain to the patient as well as cosmetic and anxiety concern to the parents. No preceding history of trauma, no associated systematic symptoms. She had exploratory laparatomy at 1 year of age at a private hospital for an abdominal mass which was excised. Pre-operative plain radiograph, Magnetic Resonance Imaging(MRI), Abdominopelvic ultrasound scan (USS) were done, fine needle aspiration cytology (FNAC) though done was not helpful. Histo-pathology result of excised leg mass confirmed diagnosis; there was a free margin of excision. Post-operatively, clinical improvement was marked.

KRAS and BRAF mutations in Nigerian colorectal cancers

PURPOSE

Activation of the KRAS oncogene is implicated in colorectal carcinogenesis and mutations have been reported in 30-50% of cases. BRAF mutation, though less common, is also reported and importantly associated with shorter progression-free interval. This study aims to determine the KRAS and BRAF mutation statuses of Nigerian colorectal cancers (CRC).

METHODS

Mutation analysis was carried out on archival paraffin-embedded blocks of CRC tissues. KRAS codons 12, 13 and 61 and BRAF V600E were assessed by pyrosequencing after DNA extraction from 200 cases at the Leeds Institute of Molecular Medicine, St. James's University Hospital, UK. Mutation rates and the spectra were determined.

RESULTS

Pyrosequencing was successful in 112 of 200 cases. KRAS mutation in codons 12 and 13 was demonstrated in 23 of 112 cases (21%); none in codon 61. BRAF mutation in codon 600 was demonstrated in 4.5%.

CONCLUSION

This study shows that 21% of Nigerian CRC patients carry a KRAS mutation; half the rate in Caucasians; and that BRAF mutation also occurs in Nigerian CRC cancers.

Surgical consideration for benign bone tumors

BACKGROUND

The surgical management of symptomatic benign bone tumor has been described in various manners in medical literature. However, there are few published reports on the presentation and surgical management of benign bone tumors in black African patients.

OBJECTIVES

To determine the pattern of presentation of benign bone tumors and evaluate the common indications for surgery in a Nigerian Orthopedic Center.

MATERIALS AND METHODS

This is a prospective study of 67 patients, surgically treated for benign bone tumors, over a three-year period, at the National Orthopedic Hospital, Lagos, Nigeria.

RESULTS

The common histological types include, osteochondroma, giant cell tumor, and the simple bone cyst. These tumors have varying anatomic locations, but are more commonly located around the knee joint. In this series, most of the patients have presented with an active or aggressive stage of the disease. The most common indication for surgery is painful swelling; other indications include a pathological fracture, restricted range of movement, and peripheral nerve compression. The surgical procedures performed are simple excision, curettage, and stabilization; and 1-stage and 2-stage wide resection with reconstruction. Patients with significant bone defects have autologous bone grafting or methylmethacrylate cement application. Further stabilization is achieved with intramedullary or compression plate and screw fixation. Amputation has only been necessary in one patient with a huge aneurysmal bone cyst. At the average follow-up period of 28.6 months, five patients showed recurrence. All were with a histological diagnosis of giant cell tumor.

CONCLUSIONS

The mode of presentation of benign bone tumors in this group of black African patients is heterogenous, demanding various surgical options. Limb sparing is a largely feasible option, but the recurrence rate is particularly higher for giant cell tumors. Increase in the number of patients presenting with giant cell tumors raises the possibility of an increase in the incidence of this condition in the black African population. Larger multicenter studies in the black African population may shed more light on the actual incidence of giant cell tumors and other bone tumors in this group of patients.

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.

Clinico-pathological review of malignant gastric tumours in Lagos, Nigeria

BACKGROUND

Gastric cancer is one of the most common cancers and the 2d most common cause of cancer deaths worldwide. Contrary to earlier reports from Africa, prevalence of this cancer has been found to be comparable to that of other parts of the world.

OBJECTIVE

To describe the clinico-pathological features of gastric cancer diagnosed in Lagos and determine the prevalence of H. pylori infection in gastric adenocarcinoma.

METHODS

This was a retrospective histopathological study of all gastric cancer seen between 1995 and 2007 in the Morbid Anatomy Department of Lagos University Teaching Hospital as well as two other private histopathology laboratories in Lagos (2002-2007). The blocks and slides of gastric cancer tissue were the materials used for the study. The patients' bio data and relevant clinical details were extracted from the demographic records.

RESULTS

There were 105 cases of gastric cancer (M:F = 2:1, mean age-55.3 years), 81% of which occurred above 45 yrs. There were 95 cases (90%) of adenocarcinomas, 8 (7.6%) mesenchymal tumours with one case each of small cell non-Hodgkin's lymphoma and carcinoid tumour. H. pylori was detected in 15.5% of 45 cases of adenocarcinoma with 36% showing evidence of chronic gastritis in adjacent non cancerous gastric tissue. All patients with clinical data had one or more alarm features; most recurring being abdominal fullness, recurrent vomiting, anorexia and weight loss.

CONCLUSION

This study suggests that gastric malignancies are not uncommon in Lagos and often manifest with alarm features which should raise a suspicion particularly in our setting with poor diagnostic endoscopic facilities.

Immunophenotyping of gastrointestinal mesenchymal tumours in Lagos, Nigeria

BACKGROUND

Gastrointestinal stromal tumour (GIST) represents only 1% of all malignant tumours of the gastrointestinal tract (GIT) but it is the most common gastro-intestinal mesenchymal tumour (GMT) with majority arising from the stomach and small intestine.

OBJECTIVE

To determine the prevalence of GIST using immunophenotypic characteristics.

METHODS

Materials were formalin fixed paraffin embedded blocks of GMT diagnosed in Lagos Nigeria between January 1995 and February 2007. Sections were stained with CD117, CD34, SMA, S100 and Desmin antibodies at the research Laboratory of The Leeds General Infirmary, United Kingdom following standard procedure.

RESULTS

Thirty-two cases of GMT (aged 10 to 78 years with a mean age of 46 and M: F=1.3:1) were analyzed. GIST accounted for 13 (40.6%), smooth muscle tumours 7(22%), vascular three(9.3%), de-differentiated liposarcoma two (6.2%), and unclassified (3%) of the GMT cases. Immuno-staining was not done for six cases of lipoma (18.7%). GIST patients had a mean age of 45.4 years with a M: F of 1.6:1; 54% was located in the stomach. Histologically, spindle cell type predominated accounting for 46% followed by mixed (31%) and epithelioid types (23%). Only 30.7% the GIST were suspected before immuno-staining.

CONCLUSION

Gastrointestinal stromal tumour is the most common gastro-intestinal mesenchymal tumour in Lagos with a male preponderance. The most common site is the stomach. The immunophenotypic characteristics are comparable with gastrointestinal stromal tumours reported from other parts of the world.

Indications for ablative surgery in extremity musculoskeletal tumours

BACKGROUND

Surgical options for treatment of extremity musculoskeletal tumours include excision [limb sparing] surgery or amputation [limb ablation]. Ablative surgery is for advanced extremity musculoskeletal tumours when limb salvage surgery is not feasible.

OBJECTIVE

To determine the indications for ablative surgery in extremity musculoskeletal tumours in our centre.

METHOD

This is a 6 year prospective study of patients presenting with extremity musculoskeletal tumours at National Orthopaedic Hospital Lagos. Data such as age, gender, presenting complaints, anatomic location of the tumour, clinical stage, type of ablative surgery and adjuvant treatment offered, histologic type of tumour, and treatment outcome were documented.

RESULTS

Nineteen patients had ablative surgery as a mode of treatment. 11 were male while 8 were female with a M:F of 1.3:1. The age range was 3 - 69 years. Seven patients [6 males and 1 female] refused ablative surgery and voluntarily discontinued treatment. Most tumours were located in the lower limb and all patients that had ablative treatment presented with stage 3 or 4 disease. Osteogenic sarcoma was the most common diagnosis, accounting for 4 cases [21.1%]. Six patients [31.6%] with non-malignant tumours had ablative surgery due to either late presentation or inaccurate preoperative diagnosis. Trans-femoral amputation was the most common level of amputation and this was done in 9 patients [47.4%]. Adjuvant chemotherapy was prescribed for all patients. The recurrence and survival rates could not be determined for each tumour as the patients were lost to follow-up soon after surgery with average post operative follow up of 5.5 months.

CONCLUSION

Late presentation with locally advanced disease remains the dominant indication for ablative surgery in extremity musculoskeletal tumours.

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.

Clinico-pathologic patterns of extremity liposarcoma

BACKGROUND

Liposarcoma is a tumour derived from primitive cells that undergo adipose differentiation.

OBJECTIVE

To describe the clinico-pathological pattern of extremity liposarcoma in Lagos, Nigeria.

METHODS

This is a descriptive study of patients with histologically established liposarcoma affecting the extremities seen at the Oncology unit of the National Orthopaedic Hospital, Lagos Nigeria. Demographic and clinical data ( including age, gender, presenting complaints anatomic location of lesions ), histologic type, clinical stage and treatment outcome were collected using a prepared proforma and analysed.

RESULTS

Liposarcoma accounted for 6 [27.3%] of 22 cases of soft tissue sarcomas seen within the study period. All 6 were males with a M:F of 6:0. The age range was 36- 59 years. Lesions were mostly located in the thigh 5/6 (83.3%). The most common histologic type was myxoid seen in 3/6 [50%]. All presented at stage T2bNoMo. Five (83.3%) had limb salvage surgery with adjuvant radiotherapy while one had ablative surgery. Survival and recurrent rates could not be determined as all patients were lost to follow-up soon after surgery.

CONCLUSION

Liposarcoma is the commonest extremity soft tissue sarcoma seen in our centre, the myxoid type being the commonest histologic subtype.

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.

Tumours of the submandibular salivary gland: a clinicopathologic review of cases over a 17-year period

OBJECTIVE

This study presents a clinicopathologic review of cases of submandibular salivary gland tumours at the Lagos University Teaching Hospital, Nigeria, over a period of 17 years.

METHODS

The records of all patients with histological diagnosis of submandibular salivary gland tumours at the Lagos University Teaching Hospital over a period of 17 years (January 1990 to December 2006) were retrospectively reviewed. Parameters studied were; age and gender of patients, symptoms and duration of symptoms, and histological diagnosis.

RESULTS

A total of 36 patients with submandibular gland tumours were seen during the period. Male-to-female ratio was 1.8:1 (male=23, female=13). Mean age (+/- SD) at presentation was 43 (+/- 19) years (age range, 17-84 years). There were 19 malignant tumours and 17 benign ones. Pleomorphic adenoma (36.1%) was the most frequent tumours, followed by adenoid cystic carcinoma (11.1%), anaplastic carcinoma (11.1%) and malignant lymphoma (11.1%). Patients with histological diagnosis of malignant tumours were significantly older than those with benign tumours (p = 0.01). Most patients (80.6%) presented with painless swelling.

CONCLUSION

Malignant submandibular salivary gland tumours were slightly more than the benign ones in the studied population. Painful swelling or ulceration is indicative of a malignant submandibular gland tumour

Immunophenotypical categorization of omental and liver metastatic tumours in Lagos, Nigeria

INTRODUCTION

Immunohistochemistry(IHC), used routinely in developed countries to identify primary sites of metastatic tumours has scarcely available I Nigeria where majority of patients present with advanced metastases. This study was aimed at evaluating the use of immunohistochemistry in differential diagnosis of omental and liver metastases.

MATERIALS AND METHODS

Materials consisted of the formalin fixed paraffin embedded blocks of omental and liver metastatic tumours diagnosed in Lagos between January 1995 and February 2007. Ethical clearance was obtained and sections were stained with CK 7, CK20, CA-125, ER, PSA, and TTF1 antibodies at the research Laboratory of The Leeds General Infirmary, United Kingdom following standard procedure.

RESULTS

A total of 83 cases of omental (67) and liver (16) metastatic tumours were identified representing 11.6% of all gastrointestinal (GIT) malignancies. Immunostaining was carried out on 44 cases (53%) consisting of 32 (75%) of omental and 11 (25%) of liver tumours; M: F of 1.4:1 and mean age of 43 years. They were categorized as arising from the upper GIT (CK7 +/CK20-) in 17(38.6%), lower GIT (CK20+/CK7-) in 16 (36.3%), gynaecological (CA-125+/ER+) in 4 (9.1%). One case each was categorized as arising from the prostate (PSA+) and breast (ER+) and lung (TTF-1+) while one with histological appearance of neuro-endocrine was focally positive for both CK7 and CK20. Three liver metastases negative for all the 6 antibodies could not be classified.

CONCLUSION

This study has further corroborated previous studies that adenocarcinoma is the most common metastatic omental and liver metastases and the common primary sites are within the gastrointestinal tract. Since many patients in Africa present late with advanced metastases, immunohistochemistry is will be useful in identifying primary sites before initiating specific treatment.

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.

Trends in acute emergency room hypertension related deaths: an autopsy study

INTRODUCTION

Hypertension is associated with increased morbidity and mortality. Paradigm shift and novel drugs that go beyond blood pressure control have debuted in the last decade globally and in Nigeria. The study therefore proposed to investigate the effect of the above if any on hypertension related acute deaths in patients admitted to the emergency room of the Lagos University Teaching Hospital.

METHOD

Autopsy reports for bodies deposited from the medical emergency room (ER) were reviewed. Details of the time of admission, time of death and blood pressure status prior to the event were obtained. Subjects were batched into two groups 1982 1991 and 1992 2001 based on periods of paradigm shift in hypertension diagnosis and management.

RESULT

There were 297 hypertension related deaths but 252 were analyzed. There were 168 (66.7%) males and 84 (33.3%) females (M:F 2:1) and mean age was 47.33 +/- 12.18 years (14-85 yr). Two thirds of the subjects (65.5%) were = 50 yrs of age. The mean duration of admission was 5.88 +/- 6.41 hours. One third (35.3%) died within an hour of admission. The commonest causes of death were stroke (52.8%) and heart failure 103 (40.9%). Intra-cerebral hemorrhage was the commonest type of stroke seen, 69 (52.3%). There were fewer cases of acute deaths in the second decade under review 95 (37.7%) vs. 157 (62.3%), p = 0.02 and strokes during this period, 47 (49.47) Vs 86 (54.78), p = 0.06.

CONCLUSION

There is a trend towards reduction of hypertension related acute deaths. However stroke remains a major cause of acute hypertensive death and the patients are still dying young.

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.

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.

Pathological study of bone tumours at the National Orthopaedic Hospital, Lagos, Nigeria

BACKGROUND

Although primary bone tumours are relatively uncommon, they constitute the most important tumours in patients under 20 years.

OBJECTIVE

To update the literature on the relative frequency and clinico-pathologic characteristics of bone tumours in this environment.

MATERIALS AND METHODS

The clinical and histopathological records of patients presenting with diagnosis of bone tumours between 1999 and 2004 and managed at the National Orthopaedic Hospital, Igbobi, (NOHI) Lagos, Nigeria were review and where necessary, new ones were prepared from the paraffin blocks and stained with routine haematoxylin and eosin stain. The clinical data such as the age, sex, presenting signs and symptoms, site distribution of lesions, radiological finding as well as the record of other investigation and management were extracted from the clinical case notes of patients.

RESULTS

Seventy-seven cases were recorded; 61 (79.2%) benign and 16 (15.6%) malignant. The male:female ratio for all tumours was 2:1. The commonest benign bone tumours were osteochondroma and giant cell tumour accounting for 52 (67%) of all cases with > 60% in males. The most common primary malignant bone tumour was osteosarcoma, all in males. The peak incidence was in the second and third decades and commonest sites were the distal femur and proximal tibia. Four (5.2%) cases of metastatic bone tumours located commonly in the proximal femur and humerus were also recorded.

CONCLUSION

Osteochondroma and giant cell tumours are the commonest benign tumours while osteosarcoma is the most common primary bone tumour all occurring in the first two decades of life. The age and sex distribution and morphology are similar to those already established in the African and international literature.

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.

Pattern of osteochondromas in Lagos, Nigeria

Osteochondromas are the most common benign tumours of bone. It is a problem of rapidly growing skeleton. Most of them are asymptomatic. The most common reason for presentation being perception of the lesion as a cosmetic blemish. This study aims to study the epidemiology of osteochondromas at National Orthopaedic Hospital, Igbobi (NOHI), Lagos, Nigeria. This is a five year prospective study of osteochondromas that presented at NOHI, Lagos, Nigeria. NOHI is the largest orthopaedic reference centre in Nigeria. This study was necessitated by the paucity of epidemiological data on the subject in Nigeria and the sudden increase in the number of cases presenting to us. Sixty eight patients with histologically established osteochondromas were studied. Clear majority (42) were males. Forty two patients (61.8%) were aged 20 years or less. An overwhelming majority were pedunculated (88.2%) and solitary (97.1%). The commonest reason for presentation and request for treatment by patients was the lesion being a cosmetic blemish (85.3%). They all had excision and 2 patients (2.9%) had recurrence with malignant transformation. The study showed that osteochondromas were preponderant in Nigerian males in the second decade of life. Excision was the treatment of choice.

Challenges in the diagnosis and management of musculoskeletal tumours in Nigeria

The management of musculoskeletal tumours is important because of the high mortality rates associated with the available treatment modalities. A 5-year prospective study of bone and soft-tissue tumours is presented, along with the difficulties encountered in diagnosis and treatment. There were 71 patients (male:female ratio of 1.7:1, age range 5-85 years, mean age 32 years) with an average duration of 24.7 weeks (range 1 day to 34 years) before presentation. No patient had computed tomography (CT) scanning or magnetic resonance imaging (MRI) due to financial constraints, 95% had biopsies and X-rays, 15% could afford chemotherapy/ror chemotherapy is a sad consequence. 50% agreed to amputation. In the soft-tissue sarcoma group, only one of three patients could pay for limb-sparing surgery. In the benign group, 65% had limb-sparing surgeries and 15% had amputation. Fifty percent (50%) of patients were lost to follow up within 3 months and 39% of the malignant group died within the same period. Musculoskeletal tumours are a reality in our environment and a significant portion of our population have financial limitations. Ignorance and cultural beliefs promote late presentation to our hospitals, which are poorly equipped to give optimal care, despite the presence of trained personnel.

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.

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.

Histological Review of Thyroid Lesions: A 13-year Retrospective Study (1989-2001)

OBJECTIVE

We present a 13-years retrospective histological study of 444 thyroidectomies received between 1989 and 2001 at the Morbid Anatomy department of the Lagos University Teaching Hospital, Nigeria. The aim of the study is to update the available literature on the frequencies of the common thyroid lesions as well as compare with previous studies.

MATERIALS AND METHODS

The materials for this study consist of slides and paraffin embedded blocks of all thyroidectomies received from within and outside the teaching hospital. The clinical data such as the age, sex, and clinical summary were extracted from the request forms.

RESULTS

The male: female ratio is 1: 7. The most common entity was goiter (74%); most of which occurred in the age group 30-39 yrs. Thyroid adenomas (majority; follicular), constituted 10%. There were 29 cases of thyroid carcinoma accounting for 7% of all lesions and occurring more in females than males (17:12). Histologically, follicular carcinoma predominated (48.3%), followed by papillary carcinoma (34.5%) and medullary carcinoma (13.8%). Thyroiditis was uncommon (only 2%).

CONCLUSION

Goiter, adenoma and carcinoma remain the commonest pathologic entities of the thyroid gland in Lagos. The age and sex incidences as well as the histological characteristics concur with reports from other parts of Africa and Nigeria. However, unlike many of the Nigerian series except the latest from Ibadan, 4 cases of medullary carcinoma were encountered in this study. The frequencies of toxic hyperplasia and thyroiditis are also lower than those recorded in previous studies.

KEYWORDS

thyroidectomy, histopathology, thyroid lesions.