PECULIARITIES OF PSORIASIS IN A BLACK AFRICAN COHORT: A HISTOPATHOLOGIC STUDY.

Background: Clinical and histopathologic observations have indicated that psoriasis is not rare in our population as previously thought. The initial rarity also led to paucity of studies on the disorder including histopathologic features in our practice setting. To date, there is no report on the histopathologic features of psoriasis indigenous to our practice environment. Objective: To evaluate the frequency of occurrence of the various histopathologic features of psoriasis in patients from this environment and identify any peculiarities that exist in black African patients. Methods: A cross-sectional study of patients diagnosed clinically with psoriasis at the University College Hospital, Ibadan between January 2015 and October 2016. After baseline sociodemographic data, all patients had baseline clinical examination and were offered skin biopsy after obtaining informed consent. The biopsy specimen was examined for histopathologic features of psoriasis after routine processing and staining using a pretested proforma with the frequencies of each diagnostic feature reported in percentages. Results: Forty-four patients with plaque psoriasis were analyzed. The mean age of the patients studied was 39.84 ± 20.97 years with a male to female ratio of which was almost equal. The most consistent epidermal changes in decreasing other of frequency were acanthosis, hypogranulosis, hyperkeratosis followed by elongation of rete ridges while dermal features were dermal infiltration by inflammatory cells, and dilatation of superficial dermal vessels. Munro's microabscesses were found in less than half of the patients biopsied. Some of the patients were found to have atypical changes. Conclusion: Histopathological features of psoriasis in the study is similar to what has been previously established universally but typical features such as Munro's micro abscesses and Kogoj's spongiform pustules are less frequently seen than expected. Atypical changes such as dermal melanophages and periadnexal infiltration by inflammatory cells may also be seen.

Axillary nodal metastasis and resection margins as predictors of Loco Regional Recurrence in Breast Cancer Patients.

Background: Surgical resection margins (RM), axillary nodal involvement and lymph node ratio (LNR) determine loco-regional control (LRC) in breast cancer management. Late presentation precludes breast conservation therefore surgical option is usually mastectomy and adjuvant chemoradiation minimize loco-regional recurrence (LRR). Objective: We investigated the prognostic role of lymph nodes positive for malignancy (pN), LNR and RM on LRR of breast cancer in a tertiary hospital in Ibadan, Nigeria. Methods: Longitudinal cohort study of 225 females with breast carcinoma managed and followed up for 5-years with end point of LRR or not. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with LRR. The receiver-operator curve was plotted to determine the proportion of metastatic lymph nodes which predicted LRR. Results: Ninety-nine percent had modified radical mastectomy and 163 (72.4%) had negative resection margins. A mean of 11 axillary lymph nodes were harvested at surgery. The age, positive resection margin and number of harvested nodes with malignant cells are associated with LRR. The overall 5-year LRR rate was 16%. Conclusion: LRR is dependent on lymph node involvement as well as and tumor aggressiveness.

Co-existing sickle cell anaemia and inflammatory bowel disease: case report and review of the literature.

Sickle cell anaemia (SCA) is a chronic haemolytic anaemia associated with vaso-occlusive painful crises which may affect several systems including the gastro-intestinal system, resulting in abdominal pain. The concurrence of inflammatory bowel disease and haemoglobinopathy is rare. No previously reported concurrent cases of both SCA and ulcerative colitis (UC) in sub-Saharan Africa were found in the literature. A 16-year-old girl with concurrent SCA and UC is presented. She was admitted to University College Hospital, Ibadan with a 1-year history of recurrent peri-umbilical pain and bloody stools. These symptoms were mainly attributed to SCA at the referring hospital, and she was managed for chronic tropical diarrhoea without a remarkable clinical response. This case illustrates the concurrent presentation of SCA and ulcerative colitis which led to the missed and delayed diagnosis of ulcerative colitis.

Rosai-Dorfman Disease in Cervical Lymph Nodes: The Challenges of Diagnosis in a Resource Limited Setting and Use of Immunohistochemistry in the Diagnosis.

We report a case of Rosai-Dorfman disease in a 28-year-old Nigerian woman with a 7-year history of painless prominent bilateral neck swelling which waxed and waned over the years. She had two misdiagnosis hence appropriate therapy was not initiated over the years. She was eventually referred for independent opinion and was diagnosed correctly with review of the histology sections and with the use of CD45, S100, CD 68, CD 15, CD 20, synaptophysin and AE1/AE3 immunohistochemistry markers. Classic features on Haematoxylin and eosin stained sections and positivity of the lesional cells for S100 and CD68 were diagnostic of Rosai-Dorfman disease. She was subsequently placed on oral steroids with minimal objective reduction in the neck circumference from 57 to 46 cm. After two months, she was managed with three courses of chemotherapy (cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone) which resulted to a significant sustained reduction in her neck circumference to 36 cm. She has been on follow up for about a year without a recurrence.

Nous rapportons un cas de maladie de Rosai-Dorfman chez une femme nigériane de 28 ans avec des antécédents de 7 ans de gonflement bilatéral indolore du cou qui a augmenté et diminué au fil des ans. Elle a eu deux erreurs de diagnostic et une thérapie appropriée n'a donc pas été initiée au fil des ans. Elle a finalement été référée pour opinion indépendante et a été diagnostiquée correctement avec la revue des coupes histologiques et avec l'utilisation des marqueurs immunohistochimiques CD45, S100, CD 68, CD 15, CD 20, synaptophysine et AE1 / AE3. Les caractéristiques classiques des coupes colorées à l'hématoxyline et à l'éosine et la positivité des cellules lésionnelles pour S100 et CD68 étaient diagnostic de la maladie de Rosai-Dorfman. Elle a ensuite été placée sous stéroïdes oraux avec une réduction objective minimale de la tour de cou de 57 à 46 cm. Après deux mois, elle a été prise en charge par trois cours de chimiothérapie (cyclophosphamide, chlorhydrate de doxorubicine, vincristine et prednisolone) qui ont entraîné une réduction significative et soutenue de la circonférence de son cou à 36 cm. Elle fait un suivi depuis environ un an sans récidive. Mots clés: maladie de Rosai-Dorfman, immunohistochimie, ganglions lymphatiques cervicaux, chimiothérapie, diagnostic erroné.

TESTICULAR ADNEXAL MESENCHYMAL TUMOURS IN IBADAN, NIGERIA: HISTOPATHOLOGIC SPECTRUM AND CHARACTERISTICS.

BACKGROUND: Most testicular adnexal tumours are mesenchymal in origin and have a high tendency to be malignant. An earlier study from our centre found 10 cases, all malignant. The present study reviewed and updated testicular adnexal mesenchymal tumours diagnosed at the University College Hospital, Ibadan, Nigeria. AIMS AND OBJECTIVES: To document the histopathologic spectrum and characteristics of testicular adnexal mesenchymal tumours diagnosed in our centre over a 20 year period and to compare these with earlier studies from our center and other parts of the world. STUDY DESIGN: This was a descriptive retrospective study. SETTING OF THE STUDY: This study was carried out at the Departments of Pathology and Surgery (Urology Division), University of Ibadan/ University College Hospital, Ibadan Nigeria. MATERIALS AND METHODS: All testicular adnexal mesenchymal tumours from the files and records of the Department of Pathology, University College Hospital Ibadan from January 1, 1997 to December 31, 2016 were reviewed. Age, tumour size and histopathologic diagnosis were retrieved. The tumours were re-evaluated, immunohistochemistry was applied where appropriate and the tumours were reclassified histologically using the 2016 World Health Organisation classification of mesenchymal tumours of the spermatic cord and testicular adnexa. Descriptive statistics was applied on the data generated using SPSS version 20. RESULTS: Twenty-one cases of testicular adnexal mesenchymal tumours were found over the study period. Three (14.3%) were benign and comprised one case each of lipoma, leiomyoma, and fibrous pseudotumour. The remaining 18 (85.7%) cases were malignant. Rhabdomyosarcoma was the commonest tumour seen accounting for 12 (66.7%) of all the sarcomas followed by liposarcoma 3(16.7%). A case each of malignant peripheral nerve sheath tumour, fibrosarcoma and giant cell sarcoma were also documented. The overall mean age of the patients was 25.8±15.2 years with a range of 7-71 years, while the mean age of the patients with rhabdomyosarcoma was 22.0±8.7 years (8-42 years). CONCLUSION: The outcome of this study suggests that the incidence of sarcomas of the testicular adnexa might be on the rise compared to previous report from our centre.

Case reports of adult colo-colonic intussusception.

BACKGROUND: Adult colo-colonic intussusception is a rare abnormality and it may pose a diagnostic challenge. OBJECTIVE: To report two cases of adult colo-colonic intussusception with benign lesion as the lead points. METHODS: The Clinical records of the two patients containing the management details were retrieved and reviewed. RESULTS: The 1st case was a 60 year old man presenting with a year history of recurrent left abdominal pain a two week history of fullness left upper and lower abdomen. Examination showed an 8cm by 6 cm mass in the left hypochondrium continuing with another 16cm by 8 cm mass spanning the left lumbar and left iliac fossa. Abdominal ultrasound scan showed a huge mixed echogenic mass in the central abdomen spanning the left hypochondriac, left lumber and suprapubic regions. He had exploratory laparotomy which revealed cob-cobonic intussusception involving the ascending colon up to sigmoid colon. He had subtotal colectomy done. The lead point was a hamartomatous polyp The 2nd case was a 35 year old man with a two month history of recurrent abdominal pain and haematochezia, a month history change in bowel habit and five day history of abdominal distension. Examination showed distended abdomen with generalised tenderness. There was a firm mass in the left hypochondrium extending to the left iliac fossa. Abdominal ultrasound scan confirm intussusception: Exploratory laparotomy showed perforation of transverse colon at the neck of cob-colonic intussusception involving the distal third of the transverse colon to the rectum. He had extended left hernicolectomy and Devine colostomy done. He died 36 h6urs post operation. The lead point was an inflammatory polyp. CONCLUSION: Adult colo-colonic intussusception is an uncommon disease which may not present in a typical feature of intussusception as occur in children thus posing diagnostic dilemma. High index of suspicion with radiological investigation will serve to aid rapid and accurate diagnosis.

Pattern of childhood cancer in University College Hospital, Ibadan during 1991-2010 and comparison with the previous three decades.

BACKGROUND: Cancer is an important cause of morbidity and mortality worldwide in children under 15 years of age, with the incidence and mortality rate varying from 40 to 155 per million children. AIM: To describe the pattern of childhood cancer in Ibadan, Nigeria. OBJECTIVE: To compare the findings of this study with those of previous studies in Ibadan and internationally. METHODS: A retrospective review of histologically and cytologically confirmed cases of cancer in children aged <15 years diagnosed at University College Hospital (UCH), Ibadan between January 1991 and December 2010 was undertaken. The cases were categorised using the International Classification of Childhood Cancer, third edition (ICCC-3). RESULTS: There were 625 cases comprising 360 (57·6%) males with a modal age of 3 years. The most common neoplasms were lymphomas (140, 22·4%), of which 90% were non-Hodgkin lymphomas, with Burkitt lymphoma constituting the majority of cases (73). Other common neoplasms were retinoblastomas (21%), soft tissue sarcomas (14·9%), leukaemias (10·2%) and CNS tumours (6·9%). Lymphomas, bone tumours, malignant hepatic tumours and other malignant epithelial neoplasms had the highest mean and modal ages, while retinoblastomas, neuroblastomas, germ cell tumours and renal tumours had the lowest mean and modal ages. During 1960-72 there were 1326 cases and during 1973-90 there were 1881 cases and the proportion of lymphomas was 58·9% and 45·4%, respectively. The present study demonstrated a marked decline in the number of cases and proportion of lymphomas (22·4%), particularly Burkitt lymphomas. CONCLUSION: During the last 20 years, there has been a decline in the number of cases of childhood cancer seen at UCH, Ibadan. This may be due to the establishment of additional specialist centres in the sub-region. Owing to a persistent decline in the frequency of Burkitt lymphoma, retinoblastoma is now the most common individual childhood cancer seen at Ibadan.

Pattern of childhood leukaemia in University College Hospital, Ibadan.

BACKGROUND: Leukaemias are haematological malignancies characterized by unregulated clonal proliferation of haematopoietic cells. OBJECTIVE: To determine the pattern of childhood leukaemia in Ibadan. METHODOLOGY: This was a retrospective study of leukaemia cases diagnosed at the University College Hospital (UCH), Ibadan between January 1991 and December 2010 in children less than 15 years of age. Data obtained was subjected to statistical analysis using the Statistical Package for Social Sciences version 20. RESULTS: There were 64 cases of childhood leukaemia, accounting for 10.2% of childhood cancers seen during this study period. The male to female ratio was 2:1 and modal age group was between 10 and 14 years. Thirty (46.9%) cases were acute lymphoblastic leukaemia (ALL), 22 (34.4%) were acute myelogenous leukaemia (AML) and 12 (18.8%) were unspecified acute leukaemias. There was no case of chronic myeloid or lymphocytic leukaemia. CONCLUSION: There has been a relative increase in the frequency of leukaemia cases at UCH, Ibadan, which may be largely explained by increased awareness and referrals. There is a need for further collaborative multicentre studies of childhood leukaemias in Nigeria and other developing countries and focused research on childhood leukaemias in order to unravel the aetiology.

HER 2 expression status in gastric carcinomas in Ibadan, Nigeria: a preliminary study using immunohistochemistry.

MATERIALS AND METHODS- Archival formalin fixed paraffin embedded gastric Adenocarcinoma tumour tissue from the Department of Pathology, University College Hospital, Ibadan were studied for HER 2 protein status using immunohistochemistry. RESULTS- HER 2 protein receptor status was determined in 36 cases using immunohistochemistry. The male: female ratio was 1.4:1. The age range of the patients was 30 to 86 years, with peak age-groups being in the 6th and 7th decade of life. Mean age of the patients was 57.6 years while the median age was 56years. Four cases were positive for the HER 2 receptor protein representing about 11% of the cases. Two cases had staining score of 2+ while another 2 cases had score of 3+. The four positive cases were intestinal variants of gastric adenocarcinomas based on Laurens classification. Three were well differentiated tumours and one was moderately differentiated. CONCLUSION- HER 2 protein overexpression by immunohistochemistry can be demonstrated in black Africans with gastric carcinoma. More detailed and multicentre studies will be needed to draw firm conclusions in this regard.

Squamous papillomas of the conjunctiva: a retrospective clinicopathological study.

BACKGROUND: There is very limited literature on squamous papillomas of the conjunctiva from Nigeria and sub-Saharan Africa. In an attempt to contribute to the literature on the subject, we studied the clinicopathological characteristics of patients histologically diagnosed with squamous papilloma of the conjunctiva in Ibadan, Nigeria. MATERIALS AND METHODS: Clinical and pathological records of patients with histological diagnosis of squamous papilloma of the conjunctiva made in the Department of Pathology, University College Hospital, Ibadan, between January 1985 and December 2004, were reviewed. RESULTS: There were totally 26 cases. Patients' ages ranged from 2 to 58 years with a mean age of 32 years. Male to female ratio was 1.4:1. Size of tumors ranged from 2 to 10 mm. Duration of presenting complaints was from 2 months to 10 years. The lesions in 10 cases were located in the medial canthus, at or close to the limbus in another 10 cases, and in the tarsal conjunctiva in a single case. Five cases had no documentation of location. Sixteen cases (61.5%) had multiple papillomas. Four cases had a history of chemical injury (alkaline based - hair relaxer in a single case, acid based - wet cell car battery fluid in two cases, and unknown chemical in a single case) preceding the lesion by at least 6 weeks. Fourteen cases had koilocytosis on histology suggestive of Human Papilloma Virus (HPV) etiology. HIV screening test was negative in the three patients who had the screening done. Preoperative clinical diagnosis was squamous papilloma in 16 cases, pterygium in 6 cases and squamous cell carcinoma in 2 cases. CONCLUSION: In the environment where we practice, conjunctival squamous papilloma occurs most commonly in the fourth decade of life. Only very few cases are submitted for histological diagnosis. HPV infection and chemical injury are the main etiology. We strongly advocate that all excisions of the conjunctiva, irrespective of the clinical impression, should be submitted routinely for histological assessment.

Kaposi's sarcoma in HIV-infected women and men in Nigeria.

Abstract Kaposi's sarcoma (KS) in women with HIV infection is observed to have increased from recent studies. To understand the gender-related differences of AIDS-KS in Nigeria, we conducted a prospective study of the clinical, virologic, and immunologic features of newly diagnosed AIDS-KS patients. Prevalence was similar in both genders. There were differences in the distribution of the lesions and the CD4 count in women was significantly lower.

Retrospective analysis of intra-oral salivary gland tumours in Ibadan, Nigeria.

BACKGROUND: Salivary gland neoplasms constitute an important group of intraoral tumours, with their malignant histological types being the second most frequently diagnosed intraoral malignancy. The incidence as well as the anatomical distribution of this heterogeneous group of neoplasms varies from one racial group and geographical location to the other. However, studies from Africa on intraoral salivary gland neoplasms are relatively sparse in the medical literature. OBJECTIVE: To report the frequency and anatomical distribution of the various histological types of minor salivary gland neoplasms diagnosed at the University College Hospital, Ibadan and to provide data for comparison with other epidemiological findings in different geographic locations. METHODS: A retrospective study of intraoral salivary gland neoplasms diagnosed at the University Teaching Hospital, Ibadan between January I991- December 2007. Included in the study were charts of patients with minor salivary glands in the mouth. Information obtained about each patient included age, sex, tumour location and histological classification based on the 1991 WHO recommendations. RESULTS: Of a total of 309 neoplasms of salivary gland origin, 92 were from the intra-oral minor salivary glands constituting 4.5% of head and neck neoplasm. There was no significant gender predilection. Fifty-seven (62%) cases were malignant, while 35 (38%) were benign. The most frequently diagnosed tumour was adenoid cystic carcinoma 35(38%), followed by pleomorphic adenoma 30(32.6%). About 73% of the salivary gland neoplasms affected the palate, followed by the buccal mucosa (16.3%). Patients with malignant neoplasms were about 10 years older than those with benign tumours (p=0.012). CONCLUSION: A large proportion of intraoral salivary gland neoplasms are malignant, the most frequently affected site being the palate.

Orbital solitary fibrous tumor. Another rare case from Africa.

Solitary fibrous tumor (SFT) of the orbit, initially thought to be rare, is being increasingly documented in the medical literature. We here present the case of a 37-year-old Nigerian man who presented with left sided painless, vision-sparing proptosis. Cranial computed tomography scan showed a globular, left medial, orbital extraconal mass. The mass was excised, en bloc, via a medial orbitotomy procedure aided by left ethmoidectomy. Surgery was uncomplicated and histology of the excised tissue was reported as compatible with SFT. There was also a strong and diffuse immunostaining with CD 34. At 6-month follow-up, the left-sided proptosis has completely regressed. To the best of our knowledge, this is the second case of orbital SFT to be reported in an African.

Paediatric head and neck malignancies in Ibadan, Nigeria.

Studies on paediatric head and neck cancer are limited in the medical literature. Most studies have been restricted to specific histological types such as rhabdomyosarcoma, osteogenic sarcoma or Burkitt's lymphoma. This study describes the relative frequency of cancers seen in the head and neck region of children below 16 years of age at the University College Hospital, Ibadan, Nigeria. A total of 281 cases of paediatric head and neck tumours were diagnosed within the study period, out of which 84 cases were malignant. Fifty-four of these cases were males while 30 were females, giving a male to female ratio of 1.8:1. The age range for these cases was 3 days to 15 years with a mean age of 9.03 +/- 4.63 years. The most frequently diagnosed tumours were haematopoietic malignancies, accounting for 47.6% of cases, followed by sarcomas (27.4%) and carcinomas (21.4%). Burkitt's lymphoma constituted 28.6%, followed by rhabdomyosarcoma accounting for 17.9% of cases. Malignant neoplasms of the head and neck region are rare in the paediatric age group. The pattern of these neoplasms also differs from that in the adult population. However, malignant head and neck neoplasms in the paediatric age group also showed the male preponderance characteristic of head and neck malignancies in the adult population.

Enteric fever with suspected intestinal perforation and incidental renal cell carcinoma--a case report.

Enteric fever presents with protean manifestations, at times eluding the treating physician. We report the case of a 19-year-old woman whose clinical presentation suggested enteric fever, however, autopsy revealed occult renal cell carcinoma. We emphasise here, the need to investigate non-infective causes of pyrexia.

Trends in clinical autopsy rate in a Nigerian tertiary hospital.

The benefits of autopsy in medical practice are undisputed. In spite of these benefits, autopsy rates worldwide are on a precipitous decline. This study aims to determine trends in autopsy rate in a Nigerian tertiary institution from 1984-2003.A retrospective study of the autopsies conducted between 1984 and 2003. The post mortem registers of the department of Pathology University College Hospital Ibadan were reviewed for records of autopsy over the two decades. A total of 30,899 deaths and 3385 autopsy requests were registered during the period of study, giving average annual deaths of 1626 and average annual autopsies of 178 respectively. Autopsy rates at the hospital declined from an average of 19% in 1984 to 3.6% in 2003. The decline affected all clinical departments and both sexes. The highest autopsy rate of 19.9% was in 1986, while the lowest rate of 3% was recorded in the year 2000. There has been a remarkable decline in hospital autopsy rate in the University College Hospital Ibadan over the last 2 decades. The decline affected both adult and pediatric patients, both sexes and all principal medical units. There is need for active involvement of all stake holders including clinicians, pathologists and family members of deceased patients in strategic measures aimed at reversing this trend. An investigation into the factors responsible for this decline with the view to improving the autopsy services in the hospital is also required.

Holoprosencephaly in Ibadan, Nigeria: a report of three cases and review of literature.

Holoprosencephaly is a rare congenital malformation resulting from failure of cleavage of midline structures of the forebrain and face. It affects 0.49-1.2 in 10,000 births around the world. The nature of this condition in African children is not well documented in literature. We present a cluster of three cases of holoprosencephaly with varying degrees of facial and intracranial malformations seen within a 6 month period at the University College Hospital, Ibadan, Nigeria.