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.

CONTEXTE: Le mélanome malin (MM) est la plus meurtrière de toutes les affections malignes cutanées, représentant environ 79 % des décès liés au cancer de la peau. Chez les Noirs, il est associé à une plus grande morbidité et de mortalité plus élevées que chez les Caucasiens. L'épaisseur de Breslow et le statut d'ulcération sont deux des facteurs pronostiques histopathologiques les plus importants du MM. Aucune étude sur le MM au Nigeria n'a cependant examiné ces facteurs. MÉTHODES: Nous avons récupéré des blocs de tissus fixés au formol et incorporés en paraffine (FFPE) ainsi que les lames correspondantes colorées à l'hématoxyline et à l'éosine (H&E) de tous les cas confirmés de MM entre janvier 2005 et décembre 2014 dans le département AMP du Lagos University Teaching Hospital (LUTH). RÉSULTATS: Cinquante-deux cas de MM ont été diagnostiqués histologiquement au LUTH pendant la période d'étude, ce qui représente 1,0 % du total des tumeurs malignes solides. Quarantetrois de ces cas sont survenus dans la peau, ce qui représente 19,7% de toutes les tumeurs cutanées et fait du MM la troisième tumeur cutanée la plus fréquente après le carcinome épidermoïde (SCC) et le sarcome de Kaposi (KS). Quatre-vingt huit pour cent (88%) de la tumeur étaient au stade IV et V de Clark tandis que 84% avaient une épaisseur de Breslow e"4mm. Une ulcération était présente dans 67% des cas. Le niveau de Clark et l'épaisseur de Breslow étaient corrélés avec le statut d'ulcération de la tumeur. Il existe une corrélation significative entre l'épaisseur de Breslow et l'ulcération avec une valeur p < 0,05 alors qu'il n'y a pas d'association significative entre le niveau de Clark et l'ulcération. CONCLUSION: Le MM constitue une proportion significative des tumeurs cutanées malignes à l'hôpital LUTH et la majorité des cas sont à un stade avancé. L'épaisseur de Breslow et les statuts d'ulcération de la tumeur sont des paramètres histopathologiques importants qui devraient être rapportés dans toutes les biopsies de MM. Mots clés: Mélanome malin, épaisseur de Breslow, niveau de Clark, ulcération, facteurs pronostiques.

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.

CONTEXTE: Le cancer colorectal (CCR) est le quatrième cancer le plus fréquent au Nigeria et il touche surtout les personnes d'âge moyen. Dans le but de mieux comprendre les caractéristiques moléculaires du CCR dans notre environnement, nous avons entrepris d'étudier l'expression de COX-2 et de HER-2 chez les sujets nigérians. OBJECTIFS: Évaluer l'expression de COX-2 et HER-2 et déterminer leur corrélation avec les paramètres clinicopathologiques dans les cas de cancer colorectal diagnostiqués histologiquement et réséqués chirurgicalement. MÉTHODES: Cinquante-trois blocs de tissus inclus en paraffine provenant de résections colorectales et les informations correspondantes sur les patients ont été récupérés dans les archives du département de pathologie anatomique et moléculaire du Lagos University Teaching Hospital. Une section de lame de 4 microns a été obtenue de chaque spécimen et une immunohistochimie pour l'expression de COX-2 et HER-2 a été réalisée. RÉSULTATS: L'âge moyen des cas était de 53,9 ans avec un rapport M:F presque égal de 1,12:1. La moitié des cas étaient des adénocarcinomes modérément différenciés et 17% des tumeurs de haut grade. Quatre-vingt-trois pour cent des tumeurs présentaient une expression cytoplasmique positive de la COX-2 et une positivité HER-2 membranaire extrêmement faible a été observée dans 2 % des cas. Il n'y avait pas de corrélation significative entre l'expression de la COX-2 et l'âge, le sexe, la localisation de la tumeur, la taille de la tumeur, la profondeur de l'invasion ou le statut des ganglions lymphatiques. Cependant, l'expression du COX-2 a révélé une corrélation significative avec le grade de la tumeur (p= 0,013). CONCLUSION: Cette étude détecte une forte expression de COX- 2 et une faible expression de HER-2 dans le cancer colorectal en utilisant l'immunohistochimie, suggérant un rôle possible de COX-2 dans la pathogenèse du CCR. Ce rapport devrait déclencher des investigations plus poussées des deux marqueurs vis-à-vis de la gestion du CRC dans notre environnement.

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.

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.

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.

Congenital mesoblastic nephroma in a premature neonate: a case report and review of literature.

Congenital mesoblastic nephroma (CMN) is a renal stromal neoplasm of infancy. It comprises 3-10% of all pediatric renal tumors. We report a case of CMN in a 30 week old premature female neonate seen at autopsy who was born to a 26-year-old woman by emergency cesarean section on account of polyhydramnios.

Imatinib (Glivec) and gastrointestinal stromal tumours in Nigerians.

BACKGROUND: To assess the response and the impact on the overall survival (OS) on c-KIT-positive (CD117+) gastrointestinal stromal tumours (GISTs) patients treated with imatinib mesylate. METHODS: Between July 2003 and December 2012, consenting patients with advanced c-kit-positive GISTs were enrolled to receive imatinib mesylate therapy at a dose of 400mg - 800mg daily, supplied gratis by Novartis Pharma (Basel, Switzerland) under its GIPAP initiative. Disease severity was based on tumour site, size and mitotic index at diagnosis. Clinical features together with drug toxicity, haematological and biochemical parameters were monitored. Overall survival (OS) reviewed at 12 months intervals over 5 years was computed using Kaplan-Meier RESULTS: There were 27 patients in all (17 males and 10 females with a median age of 52 years (range 26 - 83). Twenty three patients, 15 males and 8 females that have been followed up for at least 6 months were evaluated, aged 26-83 years (median = 56). There were 17 (73.9%) gastric tumours and 6 extragastric including 3 cases of peritoneum and 1 each of small gut, colon and rectum. At diagnosis, 21 (91.3%) cases were high risk, and 1 each fell into the intermediate and low risks, respectively. Ten patients (43.4%) including 5 with metastases presented with unresectable lesions. Five patients (21.7%) had complete tumour resection, 5 (3 with metastases) had partial resections and 3 others with non-bulky, nonmetastatic diseases underwent no surgery. Imatinib was used as the primary therapy for all patients, except the 5 patients that underwent complete tumour resection. Nine (39.1%) patients were lost to disease progression with a median survival of 16.7 +/- 10.7 (+/- SE) (95% CI = 0-37.6) months. The overall survival at 2 years for all patients was 71.9%, which dropped to 65.9% at 4 years. CONCLUSIONS: Although a small number of GISTs, imatinib induced an extended remission in patients with advanced disease, most of whom would have been dead within a few months of diagnosis.

Gastric precancerous lesions among Nigerians with chronic gastritis.

AIMS AND OBJECTIVES: To investigate the frequency of precancerous lesions in H. pylori gastritis in Nigerians MATERIALS AND METHODS: Previously, the slides of all endoscopic gastroduodenal biopsies seen at the Pathology Department of Obafemi Awolowo University Teaching Hospital, Ile-Ife between 1994 and 2003 were reviewed and published. The current review examined interplay of intestinal metaplasia, glandular atrophy and epithelial dysplasia with H.pylori. The H.pylori, intestinal metaplasia and glandular atrophy were graded based on updated Sydney classification scheme while Vienna classification was used for dysplasia. RESULTS: Out of 1036 biopsies seen during the study period, 135 (13%) had associated precancerous lesions. Intestinal metaplasia was the commonest (9.2%), followed by severe atrophic gastritis (4.3%) and low grade dysplasia (0.7%) occurring either alone or in various combinations. Most of these lesions were seen in patients above 40 years of age and over 80% were H.pylori positive. CONCLUSION: Frequency of precancerous lesions is low among Nigerians with H.pylori gastritis. Intestinal metaplasia was the commonest lesion and was mostly type I with relatively low risk for gastric cancer development. The relatively high prevalence H.pylori infection among these cases could have resulted from repeated infection and most were localised to the corpus relative to the antral region where the precancerous lesions were seen.

Colorectal carcinoma in children and young adults in Ilorin, Nigeria.

BACKGROUND: Colorectal carcinoma is thought to be rare among children and young adults among whom presentation is usually at a late stage with poor prognosis. OBJECTIVE: To review the demography, clinical presentation, morphology, and pathological stage of cases of colorectal carcinomas diagnosed in the children and adults. METHODS: This was a retrospective review of cases of histologically diagnosed colorectal carcinoma of patients aged 40 years and below, between 1979 and 2008, using the request cards and hematoxylin and eosin stained slides. RESULTS: Seventy-six (31.5%) of all cases of colorectal carcinoma were seen in patients aged 40 years and below. The mean age at presentation was 31 years and the youngest aged 16 years. The male : female ratio was 1.6 : 1. The dominant clinical presentations were bloody diarrhea and rectal bleeding. Fifty-one (67.1%) cases were localized to the rectum, nine (16.1%) cases in the sigmoid colon, and eight (10.5%) cases in the caecum. Adenocarcinoma was the most common histological variant. Mucin-producing tumours were seen in 25 (32.9%) cases. Almost all the patients presented at advanced pathological stage. CONCLUSION: Colorectal carcinoma is not rare among young Nigerians and it should be suspected when young patients present with chronic bloody diarrhoea. Digital rectal examination should be encouraged as part of clinical examination in this age group too since a large percentage of colorectal carcinomas is within the reach of the examining finger.

Morphology of colorectal carcinoma among Nigerians: a 30-year review.

BACKGROUND: The incidence of colorectal carcinoma has been on the increase in the developing countries, including Nigeria, as a result of change in diet and adoption of western lifestyle. OBJECTIVES: The aim of this review is to highlight the prevalence, age and sex distribution, anatomical location, and morphological characteristics of colorectal carcinomas in Ilorin, Nigeria. MATERIALS AND METHODS: This is a retrospective study of all cases of histologically diagnosed colorectal carcinoma in the University of Ilorin Teaching Hospital, Ilorin, Nigeria, over a 30-year period (January 1979-December 2008), using the departmental record and histological slides of the cases. RESULT: A total of 241 cases of colorectal carcinoma were reported, 144 cases (60%) in males and 96 cases (40%) in females with a male: female ratio of 1.5:1. The peak age of occurrence for males was between 51 and 60 years, while that of the females was between 41 and 50 years. The malignancy was found in the rectum in 60.2% of the cases, while the least affected site is the descending colon (1.2%). The exophytic occluding masses were found in 82.2% of the cases, and the most common histological type is adenocarcinoma (77.2%) with well-, moderately, and poorly differentiated forms constituting 52.3%, 32.8%, and 14.9% respectively. Of the 241 cases that were seen over the last 30 years, 93 cases (38.6%) were seen in the last 5 years. CONCLUSION: Colorectal carcinoma is no longer a rare disease in Nigeria. The surge in the incidence reported in the last 5 years in this center calls for a pragmatic action in its control, with emphasize on colonoscopic screening for those with family history, and possibly making digital rectal examination a mandatory aspect of clinical examination, because most colorectal carcinomas are within the reach of examining finger.

Pathological characterization of colorectal polyps in Ilorin, Nigeria.

Colorectal polyps especially the adenomas are recognized precursors of colorectal carcinoma. Identification and removal of such polyps before malignant transformation could reduce the burden of colorectal carcinoma. To document the demography and the histopathological types ofcolorectal polyps received by the Department of Pathology of University of Ilorin Teaching Hospital over a period of thirty years. This is a retrospective review of all cases ofcolorectal polyps that were received, processed and had histological diagnosis in our centre between 1979 and 2008 using the request cards and hematoxylin and eosin stained slides. Forty-four cases of colorectal polyps were reviewed constituting 6.7 percent of all colorectal biopsies/resections received in the same period. The male to female ratio was 2.1:1. Seventeen (38.6%) were adenomas, 9 (20.5%) were juvenile polyps, 8 (18.2%) were inflammatory polyps, 4 cases were lipomatous polyps, 3 were leiomatous polyps, and one each of lymphoid polyp, hamartomatous polyp and neurofibromatous polyp. Of the adenomas, 11 (58.8%) were tubular, 5 (29.4%) were villous, 1 (5.9%) was tubulovillous, and one was a villous adenoma with a focus of malignant transformation. Adenomatous polyp is the commonest pathological type ofcolorectal polyps in our centre. This study therefore sets out to review the age and sex distribution, location and morphological characteristics of all cases of colorectal polyps in our centre over the study period.

Histomorphology of Helicobacter pylori-associated chronic gastritis in Ilorin.

The presence or absence of Helicobacter pylori in gastric biopsies is of significant therapeutic implication. The aim of the study was to review gastric biopsies taken from dyspeptic patients in the University of Ilorin Teaching Hospital for H. pylori mucosa positivity and other parameters of chronic gastritis. Fifty-seven chronic gastritis cases were evaluated using the updated Sydney classification scheme. There were 27 males and 30 females with a mean age of 48.8 +/- 15.6 years. Chronic mononuclear inflammatory infiltrates ranging from mild, moderate to marked was seen in 15 (26.3%), 29 (50.9%) and 13 (22.8%) cases respectively. H. pylori was positive in 28 cases (49.1%) while the rest were H. pylori negative. Neutrophil activity was observed in 39 cases (68.4%). Non-atrophic gastritis was seen in 39 cases (68.4%) while atrophic gastritis ranging from mild to moderate changes was seen in 18 cases (31.6%). Intestinal metaplasia was found in 5 cases (8.8%) and it comprised of type I (3 cases) and type II (2 cases). H. pylori was the main aetiological agent responsible for chronic gastritis, commonly found in the antral mucosal biopsies and the majority presented with mild-moderate chronic inflammatory changes.

Clinico-pathological pattern of nasopharyngeal carcinoma in Ilorin, Nigeria.

BACKGROUND: Nasopharyngeal carcinoma is an uncommon tumour in Nigeria but the burden of the disease in terms of morbidity and mortality is very high. AIM: The aim of the study was to document the clinic-pathological characteristics of nasopharyngeal carcinoma in Ilorin, North central Nigeria. MATERIALS AND METHODS: This was a retrospective review of all patients seen in ENT department, University of Ilorin Teaching Hospital with the diagnosis of nasopharyngeal carcinoma between January 1 st 1999 and December 31st,2008. The patient's biodata, clinical presentation and histopathological findings are presented. The histopathological diagnosis was in accordance with the 1991 WHO classification. RESULTS: A total of 30 patients with histologically confirmed nasopharyngeal carcinoma seen during the study period accounted for 2% of the total cancers recorded in Ilorin cancer registry. There were 20 males and 10 females with a mean age of 48.7 ± 15.9 years. The commonest presenting complaint was cervical lymphadenopathy in 96.7% of patients followed by epistaxis (66.7%) and hearing loss (66.7%). Identifiable risk factors included regular intake of ungutted salted smoked fish (76.7%) and tobacco use (23.3%) with some having both risk factors. Histologically, undifferentiated carcinoma was the commonest (70%) followed by well-differentiated keratinizing squamous cell carcinoma (20%) and differentiated nonkeratinizing squamous cell carcinoma (10%). CONCLUSION: Undifferentiated carcinoma was the commonest type of nasopharyngeal carcinoma reported from this study especially among males in the 4th and 5th decades of life. Identifiable risk factors included consumption of ungutted salted smoked fish with tobaccon usage. diagnosis with effective referral system and easy access to radiotherapy would improve the survival outcome in patients with the disease.

Gastroduodenitis and Helicobacter pylori in Nigerians: histopathological assessment of endoscopic biopsies.

OBJECTIVE: Morphologic changes seen in the endoscopic biopsies are dynamic and could be predictive of more important sequelae of chronic H. pylori gastritis such as gastric carcinoma and lymphoma. The objective of the study was to review the biopsy appearances of endoscopic gastroduodenal biopsies using the updated Sydney System of classification in order to throw some light on the biology of gastroduodenitis. METHODS: A retrospective review of all endoscopic gastroduodenal biopsies received in the department of Morbid Anatomy of Obafemi Awolowo University Teaching Hospitals Complex between 1994 and 2003 was undertaken. Grading of the chronicity, activity, atrophy, H. pylori density and metaplasia were done using the updated Sydney System of classification and grading. RESULTS: A total of 1047 gastric and 47 duodenal biopsies from 1047 patients were reviewed. There was evidence of significant chronic gastritis in 98.1% of the gastric biopsies and in 78.0% of these, H. pylori was the main identifiable aetiological agent. Marked atrophic changes and intestinal metaplasia that are known to predispose to gastric malignances were seen in 4.9% and 9.3% of our cases respectively. Chronic duodenitis was seen in 83% of the duodenal biopsies and in 29.6%, H. pylori was seen on a background of gastric metaplasia. CONCLUSION: The prevalence of H. pylori was high and it was the single most important aetiological factor responsible for the biopsy changes associated with chronic gastroduodenitis.

Immunohistochemical Analysis of BRAF (V600E) Mutation and P16 Expression in Malignant Melanoma in Lagos, Nigeria: A 10-Year Retrospective Study.

BACKGROUND: In Blacks, malignant melanoma (MM) is associated with greater morbidity and mortality compared to Caucasians. MMs with BRAF V600E mutation as well as those with loss of p16 protein expression are associated with aggressive behavior and worse prognosis. OBJECTIVES: We determined BRAF (V600E) mutation status and loss of p16 expression in MM cases in Lagos, Nigeria, and correlated these with histopathologic parameters and patients' age. METHODS: Forty-five cases of MM received between January 2005 and December 2014 in the Anatomic and Molecular Pathology Department of Lagos University Teaching Hospital were subjected to immunohistochemical studies to determine BRAF V600E mutation and p16 protein expression. These included cutaneous (n=37), musosal (n=3), and ocular MM (n=2) as well as lymph node metastatases (n=3). RESULTS: BRAF (V600E) mutations were detected in 5/45 (11%) while 31/45 (69%) of the cases had loss of p16 expression. No statistically significant association was found between the BRAF (V600E) mutation, loss of p16 expression, and histologic parameters such as histologic variant, Clark level, Breslow thickness, and ulceration. CONCLUSION: BRAF (V600E) mutation was detected only in a small proportion of cases while loss of p16 expression occurred in most cases which also had high Clark level, high Breslow thickness, and ulceration.

Eosinophilic colitis presenting as a right iliac fossa mass--a case report.

BACKGROUND: Eosinophilic colitis is an inflammatory condition characterized by infiltration of the colonic wall by eosinophils with submucosal oedema. Involvement of caecum, appendix, ascending colon and the omentum by the inflammatory process could mimic a right iliac fossa neoplasm. OBJECTIVE: To highlight the diagnostic challenges posed by eosinophilic colitis and the import of histopathological diagnosis in the treatment of such a patient. METHODS: A47-year old perimenopausal woman presented to hospital with a 6-month history of intermittent lower abdominal pain. Besides clinical evaluation, an abdominal ultrasonography and full blood count were carried out. She subsequently had exploratory laparatomy. RESULTS: The lower abdominal pain was intermittent but not associated with vomiting or diarrhea. There was a tender right iliac mass extending to the suprapubic region. The ultrasound revealed a right-sided tubo-ovarian mass. At surgery, the mass was found to be a complex of caecum, ascending colon, appendix and the omentum. Histological diagnosis of the resected mass was eosinophilic colitis with peritonitis. She was placed on steroid therapy following a course of antihelminthics with sustained clinical improvement six months after surgery. CONCLUSION: Eosinophilic colitis is rare and could mimic a right iliac neoplasm if it is right-sided. Histopathological diagnosis of all specimens removed at surgery particularly in a peripheral district hospital is very important in patient's management.

Leiomyosarcoma of the uterus: a clinicopathological report of two cases and review of literature.

Leiomyosarcomas of the uterus are highly malignant tumours that are rare and represent slightly over 1% of all uterine malignancies. The clinical presentation is fairly constant and includes abnormal vaginal bleeding, pains or both. Only two cases (0.6%) out of 337 uterine malignancies seen over a period of 15 years in Ile-Ife had histological diagnosis of leiomyosarcoma. Both patients were postmenopausal, aged 49 years and presented in advanced disease stage. Two months after surgery, one of the patients died from disease progression while the other defaulted while on chemotherapy. Leiomyosarcoma of the uterus though rare in our environment, when it occurs, presents with advanced stage of the disease. Poor compliance coupled with high cost of treatment portends poor prognosis thus making it rapidly fatal.

Schistosomiasis presenting as acute appendicitis.

BACKGROUND: Schistosomiasis is a chronic granulomatous inflammation that affects many systems in the body including the gastrointestinal tract. This study was carried out by reviewing all cases of schistosomal appendicitis, and documents any association with acute appendicitis. OBJECTIVE: To review all cases of schistosomal appendicitis and document any possible asspciation with acute appendicitis. DESIGN: A retrospective study. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, 1991 to 2004. SUBJECTS: Eight hundred and forty three specimen of appendicectomy were reviewed. Thirty five of them were diagnosed as schistosomal appendicitis. RESULTS: The involvement of the vermiform appendix by schistosomiasis found in 35/843 (4.2%) cases of all the appendicectomy specimen received in our histopathology laboratory between 1991 and 2004 shows that 23 of the cases (65.7%) had histologically proven acute appendicitis while the remaining 12 cases (34.3%) were schistosomiasis without active inflammation. The appendiceal wall oviposition is associated with submucosal fibrosis, narrowing of the lumen and subsequent acute suppurative inflammation in 17 cases while there were active granulomas with tissue eosinophilia in six cases. CONCLUSION: This finding has demonstrated that though the frequency of appendix involvement is low considering the endemicity of schistosomiasis in our environment, however acute appendicitis may be caused by schistosomiasis.

Pulmonary alveolar microlithiasis--a case report.

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown aetiology. It is characterized by the presence of calcific concretions (calcospherites) inside the alveoli. We present a case of a 22 year old sickle cell anaemia patient with an incidental finding of PAM. This report is to highlight the fact that though rare, PAM is not entirely unheard of in this environment and should be kept in mind as a cause of diffuse opacities of the lungs.