Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria.

INTRODUCTION: Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. METHODS: We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. RESULTS: A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC +), and 47 (19.7%) were HIV-positive (HIV +/ICC +). The HIV +/ICC + patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC + (P < 0.001). Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV +/ICC + diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC +. The HIV-/ICC + women had better OS compared to HIV +/ICC + participants (p = 0.018), with 12-month OS 84.1% (95%CI 75-90%) and 67.6% (95%CI 42-84%) respectively. CONCLUSION: ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.

Epidemiology and Survival outcomes of HIV-associated cervical cancer in Nigeria.

Introduction: Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. Methods: We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. Results: A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC+), and 47 (19.7%) were HIV-positive (HIV+/ICC+). The HIV+/ICC) patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC+) (P<0.001. Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV+/ICC+ diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC+. The HIV-/ICC+ women had better OS compared to HIV+/ICC+ participants (p=0.018), with 12-month OS 84.1% (95%CI: 75% - 90%) and 67.6% (95%CI: 42%-84%) respectively. Conclusion: ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.

Comparative Assessment of p16/Ki-67 Dual Staining Technology for cervical cancer screening in women living with HIV (COMPASS-DUST)-Study protocol.

The risk of progression of low-grade (CIN1) to high-grade cervical intraepithelial neoplasia (CIN2/3) is 3-5 times higher for women living with HIV (WLHIV) than for HIV-negative women. Evidence suggests that the current cervical cancer screening methods perform less effectively in WLHIV. An emerging screening method-p16/Ki-67 dual staining technology (DUST) is a safe and rapid assay that could be used to detect CIN2/3 with higher sensitivity and specificity. The study in this protocol will evaluate the performance of DUST in cervical cancer screening among WLHIV. We will conduct an intra-participant comparative study (Phase 1) to enrol n = 1,123 sexually active WLHIV aged 25-65 years at two accredited adult HIV treatment centres in Lagos, Nigeria to compare the performance of DUST to the currently used screening methods (Pap smear, hr-HPV DNA, or VIA testing) in detecting high-grade CIN and cancer (CIN2+). Subsequently, a prospective cohort study (Phase 2) will be conducted by enrolling all the WLHIV who are diagnosed as having low-grade CIN (CIN1) in Phase 1 for a 6-monthly follow-up for 2 years to detect the persistence and progression of CIN1 to CIN2+. The findings of this study may provide evidence of the existence of a better performance screening method for the primary and triage detection of CIN2+ in WLHIV. It may also demonstrate that this high-performance test can improve the long-term predictive accuracy of screening by extending the intervals between evaluations and thus decrease the overall cost and increase screening uptake and follow-up compliance in WLHIV.

Cervical Epithelial Abnormalities and Associated Factors among HIV-Infected Women in Lagos, Nigeria: A Cytology-Based Study.

INTRODUCTION: As it may not be feasible to provide cervical cancer screening services to all HIV-infected women in most resource-limited settings, there is a need to identify those who are most at risk. We determined the prevalence, patterns, and associated factors of cervical cytological abnormalities among HIV-infected women in Lagos, Nigeria. METHODS: This descriptive cross-sectional study was conducted among HIV-infected women at the adult HIV treatment and colposcopy clinics of a university teaching hospital in Lagos, Nigeria, between October 2018 and December 2019. A cervical sample was collected from each woman to detect cervical cytological abnormalities. RESULTS: Of the 593 enrolled women, cervical cytological abnormalities were present in 40 (6.7%). Most (37.5%) of the women with cytological abnormalities had atypical squamous cells of undetermined significance. Age at coitarche (<20 vs. ≥20 years: adjusted odds ratio, 2.42; 95% confidence interval, 1.21-4.83, p = 0.01) was the only factor that was independently associated with cervical epithelial abnormalities. CONCLUSION: The prevalence of cervical cytological abnormalities in our study is lower than most previous reports in Africa. Sexual debut at an early age was significantly associated with cytological abnormalities. It is necessary to confirm the findings of this study through a well-designed and adequately powered longitudinal study.

Histopathological report of colorectal carcinoma resections: A 5-year audit in Lagos.

BACKGROUND: Complete and accurate pathology reporting of colorectal carcinoma (CRC) resection specimen is critical to clinical management of individual patients. The study aims to audit colorectal cancer histopathology reporting in Lagos between 2011 and 2015 before the adoption of the Society for Gastroenterology and Hepatology in Nigeria pro forma in 2016. MATERIALS AND METHODS: All resected CRC cases were identified from the Histopathology record of our Department and that of a private Laboratory in Lagos over a 5-year from 2011 to 2015. The dataset as contained in the pro forma was extracted from the reports and analysed using SPSS version 16 software. RESULTS: A total of 92 colorectal resections were received during the 5-year period consisting of 90 colonic and 2 rectal tumours. Data inclusiveness on tumour differentiation, extent of primary tumour, total lymph node and lymph node involvement were 96.7%, 91.3%, 83.7% and 92.4%, respectively. Tumour perforation, level of venous involvement and distant metastasis were reported in 73.9%, 21.7% and 96.7% respectively. The circumferential resection margin (CRM) in the 2 rectal tumours had 100% inclusiveness. Tumour node metastasis staging was complete in 87% of cases while Dukes staging was documented in 8.7% of the reports. CONCLUSION: None of the data items was 100% complete except the CRM for rectal carcinoma. Free text reporting results in incomplete data resulting in improper staging, especially the lymph node status. This highlights the need for pro forma reporting to ensure and maintain consistent reporting of important parameters required for proper staging and management of patients with colorectal cancer.

Prevalence of HBsAg, knowledge, and vaccination practice against viral hepatitis B infection among doctors and nurses in a secondary health care facility in Lagos state, South-western Nigeria.

INTRODUCTION: Hepatitis B Virus, a highly infectious blood-borne virus poses a major threat to public health globally due to its high prevalence rate and grave consequence in causing liver cirrhosis and hepatocelullar carcinoma, the third cause of cancer death worldwide. The aim is determine the prevalence of HBsAg, knowledge, and vaccination practices against viral hepatitis B infection among doctors and nurses in a health care facility. METHODS: Study design was a descriptive cross-sectional study among all the doctors and nurses in the health care facility. Data was collected using pre-tested, structured, self-administered questionnaire and blood samples were taken from respondents and tested using commercial enzyme-linked immunosorbent assay (ELIZA) test kit to determine prevalence of hepatitis B surface antigen after informed consent. Ethical approval was obtained from Health Research and Ethics Committee of the Lagos University Teaching Hospital. Responses of the respondents to the knowledge and vaccination practices against viral hepatitis B infection were scored and graded as poor (<50%), fair (50-74%) and good (≥75%). The study was carried out in January, 2014. RESULTS: A total of 134 out of the 143 recruited respondents participated in the study. Prevalence of HBsAg was 1.5%. Among the respondents, 56.7% had good knowledge and 94.8% reported poor practice of vaccination against viral hepatitis B infection. Mean knowledge and vaccination practices scores (%) were 72.54+7.60 and 29.44+14.37 respectively. Only 29% of the respondents did post vaccination testing for anti HBsAg. CONCLUSION: Prevalence of HBsAg was low. Knowledge of viral hepatitis B was fair, and practice of post hepatitis B vaccination testing was poor. It is therefore recommended that the state ministry of health should organise further health education programme, institute compulsory occupational hepatitis B vaccination programme and post vaccination anti-HBS testing to ensure adequate antibody level in this adult population.

Undifferentiated spindle-cell carcinoma of the gallbladder: a report of a case, an immunohistochemistry profile, and a review of the literature.

Undifferentiated spindle-cell carcinoma is a rare gallbladder cancer with a worse or similar prognosis to the generally dismal outcome seen in most gallbladder cancer patients. We reported a case of SpCC, stage IV disease that was initially diagnosed as undifferentiated pleomorphic sarcoma, but deeper sections revealed few clusters of epithelioid clear cells. Although the tumour showed biphasic appearances on haematoxylin and eosin, it exhibited poor protein expression with most sarcoma markers being negative except for focal vimentin positivity. The CEA and CK7 were positive only in the epithelioid clear cell clusters while CD 68 positive was also focally positive in the spindle-cell component. The poor tumour differentiation coupled with advanced stage at presentation was partly responsible for the disease progression and patients' death one year after surgery. Early diagnosis and surgical intervention with better understanding of this tumour biology may offer improved prognosis and survival in this rare cancer.

Heterotopic ossification in a colorectal carcinoma.

A 48 years old man presented with subacute intestinal obstruction resulting from an intraluminal colorectal mass. He underwent partial colectomy. Histological diagnosis of mucinous adenocarcinoma with focal areas of heterotopic ossification was made. Although the presence of heterotopic ossification has no known prognostic implication in colorectal carcinoma, however, it is important that both radiologist and pathologist be aware of this phenomenon as distinct from carcinosarcoma that has poorer prognosis. From the available literature reviewed and to the best of our knowledge, this is the first reported case of mucinous colorectal carcinoma with heterotopic ossification in Saudi Arabia.

Awareness and knowledge of ocular cancers in a resource-limited economy.

AIMS: To determine awareness and knowledge of ocular cancers in a resource-limited setting. MATERIAL AND METHODS: A descriptive cross-sectional survey (2009) of 1,887 Nigerians using interviewer-administered questionnaire. RESULTS: Respondents were 55.6% males, and mean age was 30 years, SD 9.5. Most respondents (77.8%) had at least secondary education. Fewer respondents were aware of eye cancers (57.1%) compared to cancers in general (73.7%) (P<.001). Despite the male preponderance there were no associations between gender and awareness of ocular cancers (P=0.07) and cancers in general (P=0.85). However, education was associated with awareness of ocular cancers (P<.001) and cancers in general (P<.001). Ocular cancers were thought to be caused by corrosives 33.2%, trauma 21.4%, witchcraft 18.6%, genetic transmission 15.7%, sunlight 8.0%, radiations 2.5% and infections 0.6% (n = 883). Of 280 respondents, 41.1% based their knowledge of patients having ocular cancers on sources other than hospital diagnosis. Of 148 respondents, 16.2% were related to 'patients' they knew had ocular cancers. There were 202 respondents who indicated challenges to accessing orthodox medical eye care services by ocular cancer patients as high cost 55.5%, long waiting period 23.3%, long distance 15.4% and poor attitude of health workers 5.9%. CONCLUSION: Awareness of ocular cancers compared to other cancers is low. Misconceptions on the causes of ocular cancers exist. Public ocular cancers health education can enhance awareness. The need to address barriers to accessing eye care is underscored.

Hypertension, erythrocyturia and proteinuria in childhood non-Hodgkin's lymphoma.

AIM: The objectives were to determine the prevalence and outcome of hypertension, significant microerythrocyturia and proteinuria among children with acute renal failure (ARF) due to Burkitt-type non-Hodgkin's lymphoma (BNHL). METHODS: A retrospective analysis of clinical and laboratory data of children with BNHL/ARF was undertaken. RESULTS: Nine of 23 (39.13%) BHNL/ARF children aged 5-14 years were found to have significant microerythrocyturia and proteinuria as urinary markers of glomerulonephritis (GN). Eight of nine were hypertensive with hypertensive encephalopathy (HTE) in three, and congestive heart failure (CCF)/pulmonary oedema in six. Three of nine patients (33.3%) died from these complications; two from CCF and one from a combination of CCF and HTE. A fourth death was due to uraemia. Treatments with cytotoxic drugs and anti-tumour lysis syndrome therapy resulted in normotension, improved clinical outcome and normalisation of laboratory features of ARF and GN in all five (55.6%) survivors. CONCLUSION: We conclude that all the children with BNHL/ARF had enlarged kidneys and evidence of glomerular disease. The mechanism of the glomerular disease is unclear. It is associated with a high mortality rate.

Autopsy diagnosis of endemic burkitt lymphoma as the primary etiology of acute renal failure in children.

Two cases of Burkitt lymphoma are reported who presented atypically with acute renal failure and significant proteinuria as initial features of the lymphoma. The cases underscore the need for high index of suspicion for Burkitt lymphoma in any child with rapidly enlarging kidneys and acute renal failure of obscured origin in parts of the world where Burkitt lymphoma is endemic.