Immunohistochemical characterisation and histopathology of astrocytic neoplasms at a tertiary Nigerian hospital.

AIM: To describe histological features and pattern of expression of selected markers including epithelial growth factor receptor (EGFR), mutant p53 and mutant isocitrate dehydrogenase-1 (IDH-1R132H) among astrocytic neoplasms at the University College Hospital, Ibadan, Nigeria. DESIGN: A retrospective cross-sectional study involving histologically diagnosed Central Nervous System (CNS) neoplasms between January 2004 and December 2015. Haematoxylin and Eosin Slides of 81 cases of astrocytomas were retrieved, re-cut and reviewed. Ethical clearance was obtained from the ethical board of the hospital. Immunohistochemistry using the Biotin-Streptavidin system was performed with IDH-1 R132H, p53 and EGFR mouse monoclonal antibodies (MOABs) specific against all the cases of astrocytomas under review. All cases were graded and classified using the World Health Organisation (WHO) Classification of Central Nervous System tumours (2016). Membranous and cytoplasmic staining of EGFR and IDH-1R132H mouse monoclonal antibodies, respectively, were regarded as positive while nuclear staining of p53 mouse monoclonal antibody was regarded as positive. The data obtained were analysed with the level of statistical significance set at P < .05. RESULTS: Males constituted a majority of cases, 50 (61.7%). Male-Female ratio was 1.6:1. Mean age was 30.6 years. Tumours were of a higher WHO grade with increasing age, albeit glioblastoma cases tended to present at younger ages. The higher WHO grades were more likely to be located supratentorially. Glioblastomas accounted for most of the diagnosis 39 (48.1%), followed by pilocytic astrocytomas at 23 (28.4%). There was a low positive cytoplasmic expression of IDH-1 with only three (3.7%) being positive, eight (9.9%) showed a positive nuclear expression for mutant p53 while 17 (21%) showed membranous positivity for EGFR expression. CONCLUSION: There are similar epidemiological trends between our cohort of patients and as described in most instances worldwide. Optimal stratification for astrocytomas can be achieved using a combination of IDH-1/EGFR immunohistochemistry.

P57kip2 immunohistochemical marker as a diagnostic tool for cases of hydatidiform moles in a tertiary health facility in Southwestern Nigeria.

BACKGROUND: Hydatidiform mole (HM) is the most common gestational trophoblastic disease. P57kip2 has been reported to be helpful in differentiating between partial and complete HMs. OBJECTIVES: The study aims to evaluate the P57kip2 immunohistochemical (IHC) marker as a useful ancillary investigation to differentiate complete hydatidiform mole (CHM) from partial hydatidiform mole (PHM). MATERIALS AND METHODS: A retrospective study of all histologically diagnosed HM cases over a 20 year period was undertaken. Clinicopathological parameters were extracted from the surgical day book and medical record archives. Archival haematoxylin- and eosin-stained slides and formalin-fixed paraffin-embedded tissue blocks of all cases of HM diagnosed within the study period were retrieved and reviewed. Cases of HM were reclassified using the P57kip2 IHC marker. The data obtained were analysed using the SPSS version 23. RESULTS: One hundred cases of HMs were studied. CHM accounted for 68%, while PHM accounted for the remaining 32%. The incidence of HM was 2.98 cases per 1000 deliveries. The ratio of CHM to PHM was found to be 2.1:1. Seventy-two per cent of the cases were diagnosed in the first trimester, while the remaining 28% were diagnosed in the second trimester of pregnancy. Based on the P57kip2 IHC staining pattern, HM cases were finally reclassified into 68 cases of CHM and 32 cases of PHM. The age range for all the HM cases was 18-50 years with the majority of the cases seen in the third and fourth decades of life. CONCLUSION: P57kip2 could be useful as an ancillary investigation in confirming the diagnosis of CHM and differentiating it from PHM, particularly in difficult and challenging cases.

Trends in the histopathology of childhood nephrotic syndrome in Ibadan Nigeria: preponderance of idiopathic focal segmental glomerulosclerosis.

BACKGROUND: Reports on the histopathology of childhood nephrotic syndrome (NS) had emanated from our Centre since the 1960s and by the late 1980s and early 1990s, a change was observed and reported. Taking into consideration the worldwide changing trend in the histopathology of the NS and our Unit policy change in the indications for renal biopsy, a change was envisaged. We therefore evaluated the current histologic pattern of childhood NS in Ibadan with the view to highlighting any variations from the past and comparing the findings with regional and global trends. METHODOLOGY: We reviewed our database and analyzed the renal biopsy findings in patients who were biopsied before treatment was administered between 1997 and 2001 and those with mostly idiopathic steroid resistant NS (SRNS) and secondary NS, managed between 2006 and 2013. A comparative analysis of the findings from the present study was carried out with two previous reports from our Unit in the 1970s and early 1990s and also with reports from other Centres. RESULTS: A total of 78 patients had successful biopsies done during the study period in children aged between 2 ½ and 16 years. In both pre-treatment biopsy era (1997-2001) and post-treatment biopsy era (2006-2013), focal segmental glomerulosclerosis (FSGS) predominated. 75 % of the patients had idiopathic NS and among the patients that had idiopathic steroid resistant NS, FSGS was the most common followed by MPGN. For secondary NS, MCD was the most common but could be the early stages of either membranous nephropathy (MN) or FSGS. Chronic pyelonephritis and chronic interstitial nephritis occurred in 25 % of the study population but they were more prevalent in secondary nephrotic syndrome. CONCLUSION: FSGS is the most common histopathology in children requiring renal biopsy in Ibadan presently. FSGS is also the most common histopathology in idiopathic SRNS, which is in keeping with reports from most parts of the world. There has been a transition from the preponderance of Quartan Malarial Nephropathy (QMN) in the 1960s to MPGN in the 1980s to FSGS presently. This has great implications with regards to searching for new aetiologic factors, providing more efficacious treatment modalities and ensuring facilities for immunofluorescence, electron microscopic and genetic studies.

Intrarenal teratoma: report of two cases seen in a 31-year retrospective study at the University College Hospital, Ibadan.

UNLABELLED: Germ cell neoplasms which have the potentials of differentiating along somatic cell lines are regarded as teratomas. They are mature teratomas when tissues are fully differentiated and immature teratomas when primitive or immature tissue elements are present. In this retrospective study, we analyzed all the renal biopsies submitted to the Department of Pathology of the University College Hospital, Ibadan, South-West Nigeria over a thirty one year period (1981-2011). Over the period, a total of 119,986 specimens were received for histological assessment and only 1,027 (0.86%) represented kidney specimens which included all the trucut biopsies and nephrectomies. Two (0.19%) of the nephrectomy specimens from a one-year and a five-month old children were diagnosed as mature and immature cystic teratoma respectively. The sample from the one-year-old child was heavy (810 g), cystic and measured 17 x 10 x 10 cm. On microscopy, the tissues were predominantly mature neural tissue, mature skeletal muscle, cartilage and foci of normal kidney tissue while the sample from the five month old child was almost double the weight of the former (1600 g) and measured 18 x 14 x 9 cm. Cut sections revealed cystic and solid areas comprising bone, glial tissue, primitive neuroectodermal tissue, choroid plexus, immature cartilage, skeletal muscle, fat, intestinal tissue, breast structures,odontogenic and squamous epithelial tissues on microscopy. CONCLUSION: Cystic teratoma is a rare occurrence in kidneys.

Knowledge of the human papilloma virus vaccines, and opinions of gynaecologists on its implementation in Nigeria.

The objective of this study was to determine the knowledge and perception of Nigerian Obstetricians and Gynaecologists towards human papilloma virus vaccine use in Nigeria. A cross sectional study was conducted amongst participants that attended the 42nd Society of Gynaecology and Obstetrics of Nigeria. The findings revealed that 44.5% knew the correct HPV vaccine schedule. Regarding implementation in Nigeria, 87.4% suggested its incorporation into the national immunization program and about a third agreed that it should be a precondition for school enrolment. Regression analysis showed that senior residents were more likely to have adequate knowledge of the vaccine compared to junior residents (AOR 7.181 95% CI OR = 1.792 - 28.782). We conclude that the knowledge of eligibility and schedule is poor. It is recommended that adequate information should be provided to this group of health workers because of their strategic position in its implementation in Nigeria.

EGFR and HER2 expression in cervical cancer patients in Ibadan, Nigeria.

Cervical cancer is a leading cause of cancer-related deaths in developing countries, including Nigeria where it is the second most common female malignancy. Studies from elsewhere have demonstrated the relationship between epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) and advanced cervical cancer. However, we are not aware of such studies in Nigerian patients. The main objective of the study was to determine the prevalence of EGFR or HER1 and HER2 protein expression in cervical cancers and to determine their impact on overall survival. Clinical data and formalin-embedded tissue blocks of 124 patients who presented in the Radiation Oncology Department, University College Hospital (UCH), from 2006 to 2015 and had their histological diagnosis at the Pathology Department, UCH were retrieved and analysed for EGFR and HER2 expression using immunohistochemistry. EGFR expression was analysed using the immunoreactivity score by Remmele and Stegner. HER2 was analysed using the Hercep® test kit guidelines. Survival analysis was done using Kaplan-Meier and Cox regression analysis. Missing data were reported as missing, not documented. EGFR (immunoreactivity score > 4) was overexpressed in 26.6% of the 124 cervical tissue samples tested. Most patients whose samples were positive for EGFR were young, had squamous cell carcinoma and advanced diseases. HER2 was overexpressed in two samples (1.6%). The 5-year overall survival rate of the patients was 28.3%. The 5-year survival rate of patients who were EGFR positive was 9.5% and 34.1% for those who were EGFR negative. Screening for EGFR should be considered in cervical cancer patients. HER2 was overexpressed in two cervical tissue samples in this study and may be of poor interest as a potential target in the management of cervical cancer patients. Large prospective multi-institutional studies should be considered to further explore the relationship between EGFR and survival in cervical cancer patients.

Cerebral pleomorphic xanthoastrocytoma associated with NF1: an updated review with a rare atypical case from Africa.

The occurrence of cerebral pleomorphic xanthoastrocytoma (PXA) in individuals with neurofibromatosis type 1 (NF1) is very rare. We present a 10-year-old Nigerian boy with NF1 who was found to harbor a thalamic-lateral ventricular solid mass lesion whose histologic and immunohistochemical findings were in keeping with PXA. We also carried out an updated review of the PXA-NF1 literature and found only eight previous reports of this clinical disease association. These reports have been limited to only certain regions of the world, with none yet reported from Africa, South America, Australia, and Eastern Europe. As far as we know, this might be the first such report from Africa. The case we present, in addition, demonstrated some other unique clinical, radiological, and histopathologic characteristics which have been highlighted in this review.

Programme death ligand 1 expressions as a surrogate for determining immunotherapy in cervical carcinoma patients.

BACKGROUND: The programme death ligand1 and its receptor (PD-1/PD-L1) interaction is a target for blockage by immunotherapy that uses the body's own immune system. Some studies show that PD-L1 expressing tumours are also more aggressive with poor prognosis. This study evaluated the immunohistochemical expression of PD-L1 in uterine cervical carcinomas. Women with cervical cancer would benefit from its use as a marker in therapy and prognosis. METHODS: Hospital-based cross-sectional retrospective study was conducted. The study materials included 183 archived formalin fixed and paraffin embedded (FFPE) tissue blocks with histological diagnosis of cervical carcinoma diagnosed in our facility within a five-year period (January 2012 and December 2016) that met the study criteria. Data were extracted from records in the Department and immunohistochemistry was done using polyclonal antibodies to PD-L1 (GTX104763, Genetex). Obtained data were analysed using SPSS version 23. P < 0.05 was considered significant. RESULTS: A hundred and eighty-three cases of cervical cancer were studied. PD-L1 was positive in 57.4% of all cases. The diffuse pattern of staining was the major pattern accounting for 88.5% of positive cases. Poorly differentiated cervical carcinomas are less likely to express PD-L1. Within the histologic types, the squamous cell carcinomas expressed PD-L1 in 58.7%, and 50% of adenocarcinomas were positive. PD-L1 was not expressed in all cases of adenoid cystic carcinomas and basaloid squamous cell carcinomas. CONCLUSION: A significant population of cervical carcinoma expresses PD-L1 by immunohistochemistry. PD-L1 prevalence is lower amongst the poorly differentiated cancers compared to other grades.

Histomorphological assessment of non-neoplastic renal diseases at autopsy: an institutional experience in Southwestern Nigeria.

Background: Autopsy remains an invaluable resource for medical education and establishing diagnosis of diseases that were missed prior to death. Many patients on admission in hospitals suffer kidney diseases that may contribute to their morbidity and/or mortality. The kidneys from autopsies provide opportunity to diagnose and understand some of these non-neoplastic renal lesions. This study aimed to present the frequency of non-neoplastic renal diseases at autopsy. Methods: We conducted a five-year retrospective review of post-mortem records of deceased who had autopsy. Data such as age, sex, cause of death, and kidney lesions were extracted from the post-mortem records and clinical details were gotten from the clinical summaries in the autopsy reports. The kidneys were examined for pathological findings that were then classified into glomerular, tubulointerstitial (tubulointerstitial nephritis and other tubular lesions such as tubular necrosis, casts and fibrosis) and vascular lesions. Results: A total of seventy (70) cases met the inclusion criteria with 91.4% having significant non-neoplastic renal lesions. The mean age of the deceased was 57.7years (18years - 91years). Males accounted for 65.7% of the cases. Glomerular lesions were seen in 84.3% of the cases, tubulointerstitial nephritis in 41.6% of cases, vascular lesions were seen in 30% of the cases and other tubular lesions (such as stones, casts and tubular necrosis) were seen in 52.9% of the cases. Cardiovascular diseases and infections were the major causes of death in these patients, accounting for 40% and 27% respectively. Renal diseases were attributed to immediate cause of death in 10% of the cases. Conclusion: The kidney at autopsy provides a valuable renal pathology educational tool, as a wide range of medical renal lesions can be seen from kidneys examined at post mortem.

Management of symptomatic vertebral haemangioma in a resource challenged environment.

INTRODUCTION: Vertebral haemangiomas are benign lesions and often asymptomatic. They are more common in the thoracic spine where they may become symptomatic with varying presentations. CASE REPORTS: We present two teenage girls who presented with progressive, nontraumatic paraparesis with no background history of chronic cough or underlying medical illness. DISCUSSION: The radiologic investigations were suggestive of vertebral haemangiomas of the thoracic spine. They had surgery: transthoracic approach with corpectomy and fusion with iliac crest autograft. The posterior stabilisation in the first patient was with Rush nails and circlage wire and only circlage wire in the second patient. The first patient's post-operative recovery was complicated by graft extrusion necessitating re-opening thoracotomy and graft replacement. They are, however, both ambulant at discharge and have remained so 13 and 15 months post-surgery. CONCLUSION: We have presented two cases with rewarding outcomes in the face of 'adaptive' instrumentation due to limited resources.

Histopathology of Head and Neck Lymphomas in Ibadan.

Background: Lymphomas are a heterogeneous group of tumors of lymphoid tissue in which there is a malignant proliferation of cells of the lymphatic system. They are the most frequent nonepithelial malignancy in the head and neck region. Objectives: The aim of this study was to evaluate the histological pattern of the disease in the head and neck region and trends in presentation seen in our center. Materials and Methods: This was a retrospective study of cases of head and neck lymphoma (HNL) seen in the Pathology Department of the University College Hospital Ibadan, Nigeria over a period of 37 years (1981-2017). Information extracted from the records included the sociodemographics of the patients, tumor location, and histological type among others. Data were analyzed and results were presented as frequencies and percentages. Results: There were a total of 373 cases of histologically and/or cytologically diagnosed HNL seen during the study period (an average of 10 cases per year). The mean age of patients was 33.5 ± 21.9 years with male:female ratio of 1.6:1. Most HNL were non-Hodgkin's lymphomas (NHL), accounting for 91% of cases. Nodal disease was seen in 39% of cases. The bone (prominently, the jaws) predominated (25%) in extranodal lesions. Burkitt's lymphoma was the most common specific subtype of NHL, occurring in 25.5% of cases. Conclusion: There has been an apparent upward trend in the prevalence of HNL over the past four decades, although other parameters such as age and sex predilection appear unaffected. Factors responsible for this trend need to be interrogated and ascertained.

Correction to: Pattern and Significance of Tumour Budding in Colorectal Carcinomas Using ITBCC Guidelines: a Low Resource Setting Practice Observation.

The original version of this article unfortunately contained a mistake. In Table 2, the number 36 under "N" should be 96 and "Tumour size in cm (range)" should read "Tumour size in cm."

Pattern and Significance of Tumour Budding in Colorectal Carcinomas Using ITBCC Guidelines: a Low Resource Setting Practice Observation.

PURPOSE: To determine the pattern and significance of tumour budding among colorectal carcinoma (CRC) Nigerian patients using the 2016 International Tumour Budding Consensus Conference (ITBCC) guidelines. METHODS: H&E-stained slides of resected CRC at the University College Hospital and a private laboratory, both in Ibadan, Nigeria, from January 2008 to December 2017 were reviewed. Patient age, gender, tumour size and location were obtained from the surgical pathology records. Tumours were graded and staged according to the 2010 WHO and the 2017 UICC protocols, respectively. Tumour budding was determined at × 20 objective lens magnification with a 20-mm eyepiece field number diameter. Descriptive, Mann-Whitney U and chi-square test statistics were applied using SPSS 20; p < 0.05 was considered significant. RESULTS: Ninety-six cases were included in this study. Fifty-one (53.1%) showed tumour budding. Tumour bud count was low (0-4) in 66 (68.8%), intermediate (5-9) in 12 (12.5%) and high (≥ 10) in 18 (18.8%) tumours. Four tumours had pT1 stage, 35 pT2, 37 pT3 and 20 pT4. Forty-three (44.8%) tumours were lymph node-positive, and 10 (10.4%) had metastasis. Patients' age and tumour size distribution were similar in the tumour budding and non-budding groups (52.4 ± 17.1/58.5 ± 13.9 years and 6.6 ± 2.9/6.6 ± 2.8 cm, respectively). There was significant association between tumour budding and tumour grade (p < 0.008), pT stage (p < 0.000), lymphovascular permeation (p < 0.000), perineural invasion (p < 0.003) and nodal status (p < 0.034), but not with gender (p = 0.588), metastasis (p = 0.327) and TNM group-stage (p = 0.062). CONCLUSION: Tumour budding frequency is high among our CRC patients and is associated with poorer prognostic factors.

Unintentional injury outcomes secondary to pedestrian traffic crashes: a descriptive analysis from a major medical center.

INTRODUCTION: An environment in which traffic regulations are not strictly enforced often is characterized by carnage from motor vehicular crashes resulting in severe injuries with unacceptably high mortality. The descriptive demographics and injury characteristics of pedestrian road crash victims presenting to a tertiary medical center in southwestern Nigeria are presented in order to provide baseline epidemiology as a first step in determining areas of potential mitigation for care of unintentional injuries. METHODS: Consecutive pedestrian road traffic crash patients treated in the Accident and Emergency Department of a tertiary hospital were prospectively reviewed from March 2007 to February 2008 to determine baseline demographics and clinical outcomes. RESULTS: A total of 184 patients with a mean value of the ages of 31.4 years were studied; 27% of the patients were <11 years of age. The male to female ratio was 1.6:1. Fifty-four percent of the victims were struck by automobiles and 29% were struck by motorcycles. Sixty-five percent were struck while crossing common thoroughfares. Head injury was sustained in 61% of patients. The mortality rate was 31.0% (n = 57). The clinical course leading to death showed 22.8% of the patients who died initially experienced hemorrhagic shock, 17.5% suffered a severe head injury, and 17.5% suffered aspiration. Autopsy confirmed brainstem herniation in 28.1% of the patients who died. The average interval between injury and death was 5.5 +/-13.6 days (range: 0-77 days). In this setting, three out of every ten patients experiencing pedestrian vehicular trauma will die before leaving the hospital. The elderly are most at risk, with two-thirds of victims dying from injuries sustained. CONCLUSIONS: This raises serious questions about the prehospital- and hospital-based emergency services for vehicular road crash victims in this environment, and confirms the World Health Organization findings that Africa has the highest rate overall for unintentional injury deaths. A system-wide program must be put in place that addresses proven prevention measures across all sectors of the community.

Kidney disease in hepatitis B surface antigen-positive children: experience from a centre in south-west Nigeria and a review of the Nigerian literature.

BACKGROUND: Kidney disease is an important extra-hepatic manifestation of hepatitis B virus (HBV) infection. However, there is paucity of recent literature on kidney disease in children and adolescents with HBV infection from several parts of sub-Saharan Africa including Nigeria. OBJECTIVE: To review the pattern of kidney disease in hepatitis B surface antigen (HBsAg)-positive children and adolescents seen at a tertiary hospital in south-west Nigeria. METHODS: A retrospective study was undertaken of HBsAg-seropositive children with kidney disease managed at University College Hospital, Ibadan, from January 2004 to December 2015. Patients were identified from the paediatric nephrology unit admissions and the renal histology registers. RESULTS: 24 children and adolescents were studied, 17 of whom were male (70.8%), and the median age was 10.0 years (range 3-15). Ten (41.7%) had nephrotic syndrome, five (20.8%) had non-nephrotic glomerulonephritis, five (20.8%) were in end-stage renal disease (ESRD), including a patient with posterior urethral valves, and four had acute kidney injury secondary to acute tubular necrosis. Renal histology was available for 10 patients: nine had nephrotic syndrome associated with minimal change disease in six, focal segmental glomerulosclerosis in two and one had membanoproliferative glomerulonephritis. The patient with non-nephrotic glomerulonephritis had diffuse global sclerosis. CONCLUSION: The pattern of kidney disease in HBV-positive children demonstrated a predominance of nephrotic syndrome, followed by non-nephrotic glomerulonephritis, ESRD and acute kidney injury. Better diagnostic facilities and treatment are required. Prevention of HBV infection by universal childhood immunisation is the ultimate goal.

Microsatellite Instability Is Common in Colorectal Cancer in Native Nigerians.

BACKGROUND: Colorectal cancer (CRC) is the fifth most common cancer in Africa, with significant differences in incidence, biology and clinical behavior from other populations. MATERIALS AND METHODS: We studied prevalence and clinicopathological features of microsatellite instability (MSI) and young onset CRC in 83 archival samples from the University of Ibadan, Nigeria. RESULTS: Nigerian cases of CRC were MSI-high in 43% and MSI-high CRC had significantly lower histological heterogeneity than microsatellite-stable CRC (20% vs. 55% respectively, p=0.046). Presence of signet ring cell differentiation (10-50% of tumor) was significantly higher in younger patients with CRC (<50 years) (odds ratio(OR)=5.93, 95% confidence interval(CI)=1.17-29.95, p=0.038). Poor differentiation (34%), invasive growth (96%), and high prevalence of mucinous (10%) and signet ring cell adenocarcinomas (4%) were among distinct features of Nigerian patients with CRC. CONCLUSION: MSI-high CRC is more common in West Africa and more detailed molecular and genetic analysis is warranted as CRC incidence and mortality continue to increase in the Sub-Saharan Africa.

Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report.

INTRODUCTION: Intracranial tuberculomas are a rare complication of tuberculosis occurring through hematogenous spread from an extracranial source, most often of pulmonary origin. Testicular tuberculosis with only intracranial spread is an even rarer finding and to the best of our knowledge, has not been reported in the literature. Clinical suspicion or recognition and prompt diagnosis are important because early treatment can prevent patient deterioration and lead to clinical improvement. CASE PRESENTATION: We present the case of a 51-year-old African man with testicular tuberculosis and multiple intracranial tuberculomas who was initially managed for testicular cancer with intracranial metastasis. He had undergone left radical orchidectomy, but subsequently developed hemiparesis and lost consciousness. Following histopathological confirmation of the postoperative sample as chronic granulomatous infection due to tuberculosis, he sustained significant clinical improvement with antituberculous therapy, recovered fully and was discharged at two weeks post-treatment. CONCLUSION: The clinical presentation of intracranial tuberculomas from an extracranial source is protean, and delayed diagnosis could have devastating consequences. The need to have a high index of suspicion is important, since neuroimaging features may not be pathognomonic.

Nasal septal lobular capillary haemangioma in West Africa sub-region: a case report.

INTRODUCTION: Lobular capillary haemangioma is a rare vascular lesion of the nose. It is the aim of this communication to highlight the importance of considering this lesion as an important differential diagnosis of bleeding lesion in the nasal cavity. CASE PRESENTATION: A case report of a 41-year-old female who presented with an obstructive, bleeding, pedunculated left nasal mass arising from the nasal septum in the anterior nasal cavity. An initial diagnosis of squamous papilloma was made and she had excision of the mass done under local anaesthesia. Tissue histology revealed lobular capillary haemangioma. The patient has been followed up for over 15 months and is still free of the lesion. CONCLUSION: To the best of our knowledge, this is the first report in the literature of lobular capillary haemangioma in the nasal septum in West Africa. The case is reported due to the rarity of this lesion in our environment.

Amyloid angiopathy of the floor of the mouth: a case report and review of the literature.

Amyloidosis is a rare disease characterised by the deposition of insoluble extracellular fibrillar proteins in various tissues of the body. The pattern of manifestation is organ dependent and also on whether the disease is localised or systemic, primary or secondary.Though the disease is usually fatal with a 5-year survival rate of 20%, there is still paucity of literature on this disease entity worldwide. Diagnosis has remained mostly at autopsy.A case of amyloid angiopathy involving the submandibular gland and floor of the mouth with an associated fatal bleed is reported. The purpose of this case report is to reiterate the importance of a high index of suspicion in the approach to the management of head and neck swellings.

Knowledge dissemination and evaluation in a cervical cancer screening implementation program in Nigeria.

OBJECTIVES: Our goals were to train health professionals in Nigeria using the text, "Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers", and then evaluate the knowledge dissemination process using a pre- and post-test assessment. The manual was developed by the ACCP, WHO, IARC, PATH, Engender Health, JHPIEGO, and PAHO with funding from the Gates Foundation. It is an inclusive guide to implementation and maintenance of screen-and-treat cervical cancer prevention clinics and is ideally suited for programs operating in the developing world. METHODS: Training took place at a conference in Ibadan, Nigeria. Participants included teams of physicians, nurses, bioengineers, data managers, and administrators who met in joint and parallel sessions to "train the trainers". This meeting was designed to provide both training and equipment to personnel to be involved in the implementation of a cervical cancer control initiative in Nigeria. A 36 item pre-test was administered prior to a group study sessions. A slide presentation summarized salient points before the post-test was given. The results were entered into an MS Excel spreadsheet for descriptive statistics about (1) the participants, (2) the test, (3) an examination of profession, years of work experience, years of education, and gender as predictors of two outcomes (low pre-test score and large difference between pre- and post-tests) and (4) overall performance on the exam. RESULTS: There were 70 participants and trainers, of which 53 took the exam. Most of the examinees were physicians. Some participants did not fill out the post-test, leaving their tests inevaluable. A closer look at the test revealed eight questions that were confusing and nine that were too easy. All participant subgroups performed better on the post-test than the pre-test; the improvements were statistically significant. While profession impacted the results, profession was not statistically significant. Years of work experience, years of education, and gender did not affect test results. CONCLUSIONS: While the study suffers from a small sample size, a few ambiguous questions, and the need for pilot testing the instrument prior to the meeting, the report evaluates the manual very favorably. The authors showed a significant gain in knowledge. The manual gives "the big picture" and does so with clarity. The text and supplementary material outline the work that needs to proceed in an organized program, and the material was easily understandable in Nigeria. Future evaluations could benefit from more participants and varied learning structures.