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.

KRAS and BRAF mutations in Nigerian colorectal cancers.

PURPOSE: Activation of the KRAS oncogene is implicated in colorectal carcinogenesis and mutations have been reported in 30-50% of cases. BRAF mutation, though less common, is also reported and importantly associated with shorter progression-free interval. This study aims to determine the KRAS and BRAF mutation statuses of Nigerian colorectal cancers (CRC). METHODS: Mutation analysis was carried out on archival paraffin-embedded blocks of CRC tissues. KRAS codons 12, 13 and 61 and BRAF V600E were assessed by pyrosequencing after DNA extraction from 200 cases at the Leeds Institute of Molecular Medicine, St. James's University Hospital, UK. Mutation rates and the spectra were determined. RESULTS: Pyrosequencing was successful in 112 of 200 cases. KRAS mutation in codons 12 and 13 was demonstrated in 23 of 112 cases (21%); none in codon 61. BRAF mutation in codon 600 was demonstrated in 4.5%. CONCLUSION: This study shows that 21% of Nigerian CRC patients carry a KRAS mutation; half the rate in Caucasians; and that BRAF mutation also occurs in Nigerian CRC cancers.

Prostate diseases in Lagos, Nigeria: a histologic study with tPSA correlation.

OBJECTIVE: To present a 10year retrospective histologic study of prostate diseases in Lagos, Nigeria. The aim is to document the prevalence, histologic pattern, age distribution and PSA values of prostatic diseases. MATERIALS AND METHODS: The materials consisted of slides, paraffin embedded tissue blocks, patients case files and histology request forms of all prostatic biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1999 to 2008. Each sample represents a different patient. RESULTS: Prostatic biopsies comprised 3.6 % of all biopsies in LUTH. BPH was the commonest prostatic lesion and accounted for 70.9% of all cases. The age range was 40 to 94 years with a mean of 67 years and a peak age group at 60-69 years. Stromoglandular pattern was the most common histological type of BPH accounting for 72.2 %( 393) of the cases. Malignant tumours constituted 28.9% of all prostatic biopsies. Most (93.7%) of these malignancies were seen in trucut biopsies. Adenocarcinoma accounted for 99.1% of the total 222 malignant tumours. It showed an age range of 40 to 98 years, a mean age of 66 years and peak prevalence in the 60-69 year age group. Gleason score nine was the most frequent (16.8%) in occurrence. Most adenocarcinomas were poorly differentiated (40%). Incidental carcinoma was seen in 4.2% of prostatectomy samples. High grade PIN was seen in 19.1% of adenocarcinoma cases. The most common inflammatory lesion was chronic non-specific prostatitis accounting for 76.4% of all inflammatory lesions. Malignant and benign lesions were accountable for PSA levels of 1 to 49.9ng/ml while values of 50ng/ml and above were seen exclusively in malignant lesions. CONCLUSION: Prostatic lesions constitute a significant source of morbidity among adult males in Lagos. Adenocarcinoma is the commonest histologic subtype of prostatic cancer and most are of poorly differentiated variety. Elevated levels of tPSA in Nigerian males may be as a result prostate cancer, BPH or BPH with prostatitis. PSA should in our opinion be used as a component of a strategy integrating multiple diagnostic approaches for prostate cancer screening and not to be used alone in our environment.

Bladder cancer in Lagos: a 15 year histopathologic review.

OBJECTIVE: To present a 15 year retrospective pathologic study of bladder cancers. The aim is to document histologic pattern, prevalence, sex and age distribution of urinary bladder cancer. MATERIALS AND METHODS: The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all urinary bladder biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1991 to 2005. Each sample represents a different patient. The study did not include information regarding the clinical or pathological stage of the tumours. RESULTS: Bladder malignancies comprised 39 (72.2 %) cases of all bladder biopsies and 0.86% of all diagnosed cancers in LUTH. The malignant lesions of the bladder showed a male preponderance with a M:F ratio of 4.6:1. The age range was 4-75 years with a mean age of 51.37 years and peak at 61-70 years age group. Transitional cell carcinoma was the commonest histological type accounting for 61.5% with a male to female ratio of 5:1 and mean age of 59 years. Squamous cell carcinoma accounted for 20.5% with a M:F ratio of 3:1 and showed a mean age of 47 years. Adenocarcinoma, anaplastic carcinoma and embryonal rhabdomyosarcoma accounted for 5.1%, 5.1% and 7.8% of cases respectively. CONCLUSION: Bladder cancer is not common in Lagos. The histopathologic pattern, prevalence, sex and age distribution of bladder cancer are similar to previous reports from schistosomiasis non endemic regions of Nigeria, Africa and the rest of the world.

Immunophenotyping of gastrointestinal mesenchymal tumours in Lagos, Nigeria.

BACKGROUND: Gastrointestinal stromal tumour (GIST) represents only 1% of all malignant tumours of the gastrointestinal tract (GIT) but it is the most common gastro-intestinal mesenchymal tumour (GMT) with majority arising from the stomach and small intestine. OBJECTIVE: To determine the prevalence of GIST using immunophenotypic characteristics. METHODS: Materials were formalin fixed paraffin embedded blocks of GMT diagnosed in Lagos Nigeria between January 1995 and February 2007. Sections were stained with CD117, CD34, SMA, S100 and Desmin antibodies at the research Laboratory of The Leeds General Infirmary, United Kingdom following standard procedure. RESULTS: Thirty-two cases of GMT (aged 10 to 78 years with a mean age of 46 and M: F=1.3:1) were analyzed. GIST accounted for 13 (40.6%), smooth muscle tumours 7(22%), vascular three(9.3%), de-differentiated liposarcoma two (6.2%), and unclassified (3%) of the GMT cases. Immuno-staining was not done for six cases of lipoma (18.7%). GIST patients had a mean age of 45.4 years with a M: F of 1.6:1; 54% was located in the stomach. Histologically, spindle cell type predominated accounting for 46% followed by mixed (31%) and epithelioid types (23%). Only 30.7% the GIST were suspected before immuno-staining. CONCLUSION: Gastrointestinal stromal tumour is the most common gastro-intestinal mesenchymal tumour in Lagos with a male preponderance. The most common site is the stomach. The immunophenotypic characteristics are comparable with gastrointestinal stromal tumours reported from other parts of the world.

Malignant gastrointestinal tumours in south western Nigeria: a histopathologic analysis of 713 cases.

BACKGROUND: Malignant tumours of the gastro-intestinal tract are not as rare as previous studies suggest. Recent studies have indicated increasing incidence. OBJECTIVE: To document the pattern, age and sex distribution as well as histopathology characteristics of malignant tumours of the gastro-intestinal system in Lagos and Sagamu in Southwestern Nigeria. METHODS: The paraffin embedded blocks and slides as well as pathology reports of malignant tumours of the gastrointestinal (GIT) organs collected from five laboratories (Morbid Anatomy Departments of the Lagos University Teaching Hospital and Olabisi Onabanjo University Teaching Hospital in Sagamu, Ogun State as well as the three private histolopathology laboratories in Lagos State) were reviewed. The clinical data such as the age, sex, and clinical summary were extracted from the records. RESULTS: About 80% (578 cases) of all the 713 malignant GIT tumours were epithelial; sarcomas, carcinoid and non-Hodgkin's lymphoma being less common. The ages ranged from 4-96 yrs (mean of 48.9 years) with the peak in patients 60-69-year age group and M:F ratio of 1.35:1. Colorectal tumours topped the list with 402 cases (56%), followed by liver 105 (14.7%), stomach 85 (12%) and omental metastases 67 (9.4%). The oesophagus, pancreas, small intestine and gall bladder represented 18 (2.5%), 16 (2.2%), 12 (1.7%), and eight (1.1%) respectively. Colorectal cancers peaked in the 60-69 year age group, liver and stomach cancer occurred mostly between the 50-59 years age group. Over half of the colorectal adenocarcinomata were located in the ano-rectum with 93 (23%) occurring in those below 40 years of age. CONCLUSION: Colorectal cancer remains the commonest GIT tumour in the region. Molecular studies are imperative to identify the common subtypes of GIT tumours in order to ascertain their specific pathogenetic and prognostic features.

Idiopathic interstitial pneumonias in LUTH--A morphologic study of three cases.

OBJECTIVE: Idiopathic interstitial pneumonias are rarely diagnosed in our environment. However in in the year 2000 a group of new cases were histologically diagnosed in the Department of Morbid Anatomy of the Lagos University Teaching Hospital (LUTH). This study aims to review the clinical and morphologic features of the three cases or Idiopathic Interstitial Pneumonias seen at surgicals and autopsy over a 10 year period (March 1995 to March 2005) in LUTH; as well as discuss some clinicopathologic features of interstitial pneumonias. MATERIALS AND METHODS: A review of the cases seen at surgicals and autopsy from March 1995 to March 2005 was done by retrieving the relevant reports. Cases described with interstitial pneumonitis were re-evaluated and their respective paraffin blocks re-cut for special staining to better demonstrate the changes in morphology. RESULTS: A total of 3 cases were retrieved from the ten year period reviewed. Incidentally, all occurred in the year 2000. Their mean age was 57 years and the male to female ratio was 2:1. The 'Usual Interstitial Pneumonitis' pattern was more common. CONCLUSION: Interstitial pneumonias are rare in our environment; the apparent emergence of three cases in the year 2000 alone is a curiosity as a search over a ten year period (March 1995 to March 2005) yielded no other histologically convincing case. An increased index of clinical suspicion on the part of our clinicians and pathologists as well as collaborative research involving several specialists and Medical Institutions will be required to determine the true frequency of this disease in our environment and its peculiar clinicopathological features.

Histopathological study of liver diseases at the Lagos University Teaching Hospital, Nigeria (1989-2000).

OBJECTIVE: We present a retrospective histopathological study of 345 liver biopsies over a 12-year period. The study sought to record the frequencies of the range of histopathological changes observed in liver biopsy specimens. MATERIALS AND METHODS: the materials consisted of slides and paraffin embedded blocks of all liver biopsy specimens received from within and outside the hospital. The clinical data such as the age, sex, and clinical summary were extracted from the request forms. RESULTS: there were 222 males and 123 females; M: F=1.8:1; peak age incidence of 41-50 years. The three common histopathological diagnoses were hepatocellular carcinoma-33%, chronic hepatitis-17.7%, and liver cirrhosis-17.7%. Thirty per cent of hepatocellular carcinoma was post-cirrhotic. The peak age incidence of chronic hepatitis precedes that of liver cirrhosis and hepatocellular carcinoma by one decade. CONCLUSION: the common forms of liver disease diagnosed histologically are hepatocellular carcinoma, chronic hepatitis and liver cirrhosis. The age and sex distribution are similar to those already established in the African literature.

Medical audit of maternal deaths in the Lagos University Teaching Hospital, Nigeria.

OBJECTIVES: To determine the rate of autopsy certification of maternal deaths; evaluate concordance and/discordance rates between autopsy and clinical diagnoses of maternal deaths, and to compare these with findings from other parts of the world. DESIGN: Retrospective study. SETTING: The Lagos University Teaching Hospital (LUTH), Nigeria between January 1989 and December 1998. SUBJECTS: Women who died from pregnancy-related complications having been on admission in or having presented as emergencies to LUTH. RESULTS: In the study period, 445 maternal deaths were registered in the LUTH mortuary. Autopsies were performed on 371 of these, giving an autopsy rate of 83.37%. Only 230 cases were found suitable for evaluation of concordance and discordance. Two hundred and six of these (89.57%) had related clinical and autopsy diagnoses (concordance) while 24 (10.43%) had completely unrelated diagnoses (discordance). CONCLUSION: Adequate investigation of cause of death using the autopsy will assist in accurately determining the sequence of events that result in death and hence provide required statistics for the planning of appropriate interventions.

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

OBJECTIVE: We present a 13-years retrospective histological study of 444 thyroidectomies received between 1989 and 2001 at the Morbid Anatomy department of the Lagos University Teaching Hospital, Nigeria. The aim of the study is to update the available literature on the frequencies of the common thyroid lesions as well as compare with previous studies. MATERIALS AND METHODS: The materials for this study consist of slides and paraffin embedded blocks of all thyroidectomies received from within and outside the teaching hospital. The clinical data such as the age, sex, and clinical summary were extracted from the request forms. RESULTS: The male: female ratio is 1: 7. The most common entity was goiter (74%); most of which occurred in the age group 30-39 yrs. Thyroid adenomas (majority; follicular), constituted 10%. There were 29 cases of thyroid carcinoma accounting for 7% of all lesions and occurring more in females than males (17:12). Histologically, follicular carcinoma predominated (48.3%), followed by papillary carcinoma (34.5%) and medullary carcinoma (13.8%). Thyroiditis was uncommon (only 2%). CONCLUSION: Goiter, adenoma and carcinoma remain the commonest pathologic entities of the thyroid gland in Lagos. The age and sex incidences as well as the histological characteristics concur with reports from other parts of Africa and Nigeria. However, unlike many of the Nigerian series except the latest from Ibadan, 4 cases of medullary carcinoma were encountered in this study. The frequencies of toxic hyperplasia and thyroiditis are also lower than those recorded in previous studies. KEYWORDS: thyroidectomy, histopathology, thyroid lesions.

Mucocele of the appendix: pseudomyxoma peritonei and intracytoplasmic canaliculus-like structures.

A case of pseudomyxoma peritonei associated with mucocele of the appendix is reported. To date there is no general agreement as to whether this entity (pseudomyxoma) should be categorized as a malignant lesion. The presence of intracellular canaliculus-like structures adds support to those investigators who believe that pseudomyxoma peritonei reflects a form of malignant disease.

Effects of anti-protozoal drugs and histopathological studies on trypanosome species.

The trypanosomostatic and trypanosomicidal effects of four anti-protozoal drugs, namely halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine, on species of trypanosomes, viz. Trypanosoma brucei brucei (MBOS/NG/94/NITR) Bassa strain, T. congolense (MBOS/NG/93/NVRI) Zaria strain and T. brucei gambiense (MHOM/NG/92/NITR) Abraka strain, were investigated. In vitro and in vivo studies on these drugs vis-a-vis the parasites were carried out. The histopathological changes in organs and tissues of experimentally infected rats were also studied. Results from the in vitro studies indicated that halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine appeared to be effective trypanosomicidal agents against T. brucei brucei (Bassa strain), T. congolense (Zaria strain) and T. brucei gambiense (Abraka strain). The in vivo studies showed that these drugs were sub-curative by prolonging the survival period of the trypanosome-infected rats, but not necessarily curing the infection. Histopathological findings indicated inflammatory reactions characterised by infiltration to variable degrees in the majority of tissues, mostly in the lungs and liver. The most consistent lesions were interstitial pneumonia, multifocal necrosis and oedema. Pathological findings showed the T. brucei brucei and T. brucei gambiense strains studied to be both intravascular and extravascular parasites. These results suggest that halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine could be used as supportive, suppressive and/or synergistic/additive drugs in the treatment of African trypanosomiasis. Their effects on species of trypanosomes have been studied and are reported for the first time.

Childhood liver diseases in Jos, Nigeria: a retrospective histopathological study.

Forty eight needle biopsies of the liver, from children registered in the histopathological laboratory of Jos University Teaching Hospital (JUTH) were reviewed. Liver disease diagnosis was based on histopathological criteria without recourse to either clinical, biochemical or microbiological data. Hepatic Schistosomiasis (37.5%) and liver cirrhosis (25%) were the most frequently diagnosed lesions. There were only two cases of biliary cirrhosis secondary to biliary atrisia. Parasitic infestation of the liver was the most common cause of childhood hepatic dysfunction. Our results confirm the observations of workers in other tropical and subtropical regions, where infection is the commonest cause of childhood liver disease. This is in sharp contrast to the findings from European countries where neonatal hepatitis or biliary atresia are the most commonly diagnosed disorders. This retrospective study provides a good starting point for a prospective study, to determine the incidence and severity of childhood liver disease in Nigeria. This is a retrospective histopathological study aimed at establishing the pattern of liver disease in the paediatric age group in Jos. The indication for liver biopsy in all the cases was hepatosplenomegaly with or without biochemical abnormality.

Primary pulmonary carcinoma in Lagos, Nigeria: a clinicopathological study.

A retrospective clinicopathological study of bronchogenic carcinoma in patients admitted to Lagos University Teaching Hospital (LUTH) during a 17-year period (1975-1991) is presented. Out of the 148 cases, 88 were confirmed histopathologically and in the remaining 66 cases, diagnosis was based on a combination of clinical and radiological features. Epidermoid carcinoma was the commonest histopathological variant and the male/female ratio was 2:1. Sixty five percent of the patients admitted to being heavy smokers. The majority of patients presented with weight loss, chronic cough with chest pain and haemoptysis in that order. With an average of nine cases yearly, this study shows that this disease is still uncommon in Nigerians.

Colorectal neoplasms: a retrospective study.

A total of 254 cases of colorectal neoplasms were studied. A male predominance was noted with both benign and malignant neoplasms (M:F of 4.6:1 and 1.1:1 respectively). The peak incidence was in the fifth decade. The rectum was the commonest site for both benign and malignant neoplasms (75% and 63% respectively) followed by the sigmoid colon (11% and 16% respectively). Right-sided cancers presented commonly as fungating masses (74%) while left sided cancers were predominantly of the ulcerating/infiltrating pattern (81%). The commonest benign neoplasm was tubular adenoma (39%) while the commonest malignant neoplasm was adenocarcinoma (90%) followed by squamous cell carcinoma (4%). Advanced stage on presentation was noted with these cancers, especially the mucinous adenocarcinoma variant. This may be explained by the usual late presentation of patients to orthodox doctors in our environment.

Rising incidence of cerebral malaria in Lagos, Nigeria: a postmoterm study.

One hundred and forty seven cases of acute malaria were diagnosed at autopsy between 1988 and 1991 at the Lagos University Teaching Hospital (LUTH). In 67 (46.5%) cases death was attributed to cerebral malaria (CM). There was a gradual increase in the incidence of CM during the period under review. Both sexes were affected equally but more children than adults succumbed. The highest death rate was recorded in the age group 1-5 years with a peak in the 2nd and 3rd year. There were seven adults out of which one was intenerant white lady. Only one of the six adult Nigerians had travelled outside Africa and stayed away for about four years. The commonest presenting symptoms were: fever only, fever with convulsions and/or coma and fever with gastrointestinal symptoms such as vomiting and diarrhoea. The majority of the adults were comatose (five out of seven) without fever on admission. A review of the English literature on the diagnosis, pathogenesis and management of CM is also presented. The possible reasons of the rising incidence of CM in a holoendemic region such as Nigeria are discussed.

Sacrococcygeal teratomas in Lagos, Nigeria: relationship of age, sex, clinical type and histopathology to prognosis in 30 cases.

From 1973 to 1986, 30 cases of sacrococcygeal teratomas were seen at the Lagos University Teaching Hospital (LUTH). 67% of the tumours were benign and 33% malignant. There were 25 girls and 5 boys. Majority of the benign cases were operated before the age of 3 months and all had types I & II lesions. All the patients with malignant tumours had significant presacral and endopelvic components; some of these presented clinically with urinary retention, constipation, inability to walk and neurologic deficit. Our surgical experience is compared with the reports from other centres both within and outside Africa.

Morphological patterns of paediatric solid cancer in Lagos, Nigeria.

With successful implementation of the Expanded Programme on Immunisation (E.P.I.), many Nigerian children are protected against the common infections of childhood which claim their lives within the first decade of existence. Recent observations tend to show that paediatric cancer may start to play a significant role in childhood morbidity and mortality. Therefore, this study analyses 372 cases of paediatric solid malignant tumours received at the Department of Morbid Anatomy, Lagos University Teaching Hospital (L.U.T.H) from 1974 to 1988. Considering all the age groups together, the commonest malignant tumour is lymphoma (32.8%), of which Burkitt's lymphoma accounts for 19.6%. Retinoblastoma and Wilms' tumour represent second and third commonest solid cancers respectively. There is, however, slight variation in the different age groups. For example, in the age group 1-4 years, malignant lymphoma is an uncommon disease representing only 11.0% of all cancers whilst retinoblastoma (34.5%) and nephroblastoma (24.0%) together account for 58.6%. Epithelial cancer although rare in children, represents 12.6% in the 10-14 year age group. There is a higher incidence of this tumour when compared to the other age groups (less than 1 year, 1-4 years and 5-9 years). Intracranial neoplasia are uncommon, representing only 2.0%. The overall incidence of solid malignant tumours in children aged 0-14 years in Lagos is estimated to be 22 per million person years.

Unilateral macronodular adrenal hyperplasia as an unusual cause of Cushing's syndrome--a case study.

To appraise clinicians of the problems that may be encountered in the diagnosis and management of Cushing's syndrome, we present a case report of a 20-year old female, who was admitted with a recently developed central obesity, ammenorrhea hirsuitism, proximal myopathy and depression. She was found to have multiple striae, thin skin, elevated blood pressure glycosuria and hyperglycaemia. Morning and mid-night plasma cortisol concentrations revealed elevated levels, with a loss of diurnal variation. There was a failure of the normal suppressibility of cortisol secretion by low doses of dexamethasone, while a significant suppression of plasma cortisol concentration was observed with high doses of dexamethasone. There were no significant abnormalities observed in the pituitary fossa on skull radiograph and on the cranial computerised tomographic scan. After a period of stabilisation, she had a bilateral adrenalectomy done, with a histopathological finding of a left adrenal macronodular hyperplasia, while the right adrenal gland was small and friable. There was an uneventful post-operative period, with a gradual return to normality of most of the presenting complaints. The hyperglycaemia and hypertension got controlled without medications, while her menstrual cycles resumed within three months of bilateral adrenalectomy. This case report illustrates that an adrenal-dependent Cushing's syndrome may mimic a pituitary-dependent one, especially as regards the suppressibility of plasma cortisol secretion by high doses of dexamethasone.

Changes in blood chemistry and liver histopathology of rabbits during experimental tetanus toxicity.

Changes in blood chemistry, especially blood glucose, were studied in rabbits developing tetanus after injection of tetanus toxin. Blood glucose levels increased significantly above control values after the animals developed tetanus. The increase in glucose level paralleled the depletion of liver glycogen, detected by means of PAS staining. The observed changes were not affected by adrenergic receptor block or catecholamine depletion by reserpine, suggesting non-mediation of the sympathetic nervous system in the response. A direct action of the toxin on the liver, initiating glycogen depletion, is being postulated.