Scholarly works in Pathology (Basic Med Sci)
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Item Bilateral Ganglionic Haemorrhagic Stroke Complicating Suspected Meningococcaemia: A Case Report(Association of Resident Doctors, University College Hospital, Ibadan, Nigeria, 2020) Omenai, S. A.; Okonkwo, O. O.; Salami, A. A.; Labaeka, A. A.; Okolo, C. A.Haemorrhagic stroke in pyogenic meningitis is a rare complication, accounting for about 2% of all complications. It often results from disseminated intravascular coagulation, a complication of bacterial meningitis, and portends a poor prognosis. A superimposed intracranial haemorrhage, although extremely rare, is associated with a high mortality rate. We report a child who had haemorrhagic stroke during the acute phase of bacterial meningitis. The diagnosis was made during post-mortem examination. It was discovered that she had suffered haemorrhagic necrosis of both basal ganglion nuclei. Early imaging is advised in meningitis patients presenting with altered levels of consciousness to detect cerebrovascular complications. Introduction Meningitis is a severe infection of the leptomeninges caused by viruses, bacteria, parasites, or fungi. Mortality rates are as low as 2% in infants and children and as high as 20–30% in neonates and adults. Cerebral vasculopathy is a complication of bacterial meningitis, with ischaemic stroke being much more common than haemorrhagic stroke, usually occurring during the acute phase of meningitis. Bacterial meningitis remains a leading cause of mortality from infectious disease globally, and the neurologic complications associated with this disease are a major contributor to mortality. In the paediatric age group, meningitis usually develops after encapsulated bacteria colonising the nasopharynx are disseminated into the blood and breach the blood–brain barrier, colonising the leptomeninges where they rapidly multiply. The body’s immune system mounts a response against the microbes. Studies in rabbits with C3 deficiency have demonstrated the importance of the complement system in meningitis. Genetic deficiencies in early response cytokines such as TNF-α, IL-1β, and IL-6 predispose individuals to central nervous system infections that may run a fulminant course. Cerebral vasculopathy in bacterial meningitis can occur from infection by organisms such as Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and Staphylococcus aureus. Haemorrhagic stroke from bacterial meningitis is rare. Various pathophysiological mechanisms have been proposed, including focal hyperperfusion from loss of cerebral autoregulation, disseminated intravascular coagulation (DIC), localized vasculitis, and microaneurysm formation. This complication confers a worse prognosis on meningitis, with higher morbidity and mortality. Early diagnosis of cerebrovascular events complicating meningitis allows for prompt surgical intervention to improve prognosis. We report the case of a nine-year-old female child who presented and died within 24 hours of presentation from bilateral basal ganglia haemorrhages due to acute bacterial meningitis. Case Report A nine-year-old female was seen in the paediatric clinic with a history of fever, sore throat, non-productive cough, vomiting, and generalized body weakness. She was a known asthmatic. She was nebulized and placed on antibiotics and antimalarials. Her condition deteriorated later in the night. She was brought into the children’s emergency unit with a six-hour history of fever and lack of response to calls for two hours. She was admitted into the intensive care unit and managed as a case of meningitis. On presentation, she was acutely ill, anicteric, and not cyanosed. There was tachycardia, with a blood pressure of 90/60 mmHg. She was tachypnoeic and dyspnoeic, with crepitations in the lower lung zones. The Glasgow Coma Score (GCS) was 13, the neck was supple, and Kernig’s and Brudzinski’s signs were negative. Pupils were 3 mm bilaterally and reacted briskly to light. Muscle tone and reflexes were normal, with no facioparesis. Laboratory tests revealed thrombocytopenia (platelet count 85,000/mm³), elevated INR (3.5), and deranged prothrombin time (41 seconds). Blood culture did not yield growth. Her GCS dropped to 6 within two hours of admission; she had two episodes of tonic convulsions and went into refractory shock despite intravenous boluses and adequate inotropic support. Nasogastric aspirate was bloody, and blood stains were seen in her perineum. She desaturated with SpO₂ of 65% while on 100% oxygen. Her GCS further dropped to 3 within fourteen hours of admission. She was managed with intravenous antibiotics, fluids, steroids, and antimalarials. Cranial imaging was not performed prior to death. She spent a total of seventeen hours on admission before demise. Although there was no growth on blood culture and a lumbar puncture was deferred, she was managed as a possible case of meningococcaemia. At autopsy, there was linear ecchymosis on the arm and ecchymosis on the right ventricular wall. Mesenteric and splenic haematoma with haemorrhagic gastropathy were noted. The lungs were markedly congested, showing features of diffuse alveolar damage with microthrombi. Histology of the kidneys showed extensive tubular necrosis, and both adrenal glands showed haemorrhagic infarctions. The brain was heavy, weighing 1600 g (normal 1150–1250 g), with greyish-white exudates over the convexities of the parietal lobes and superior cerebellar hemispheres; there was no frank pus. Coronal sections of the cerebral hemispheres showed bilateral basal ganglia haemorrhages affecting both lenticular nuclei and sparing the caudate. Histology revealed haemorrhagic infarction of the basal ganglia with associated microthrombi. The patient had no features of hypertension, and the vessels showed only mild fatty streaks of the abdominal aorta.Item Histopathological Profile of Childhood Thyroid Carcinoma in Ibadan, Southwestern Nigeria(University of Malawi, College of Medicine, in collaboration with the Medical Association of Malawi., 2020) Ajani, M. A.; Omenai, S. A.; Nwadiokwu, J. I.; Salami, A. A.Background Thyroid carcinoma is a common endocrine malignancy. It is, however, rare in childhood and often occurs as a result of radiation exposure or inherited genetic mutations. Most childhood thyroid carcinomas are well differentiated. There are very few epidemiological studies of this disease in Nigeria, and our study aimed to determine the frequency in a subset of our population. The study aimed to determine the prevalence and histopathological characteristics of childhood thyroid carcinoma in our environment. Methods This was a retrospective review of histopathologically diagnosed thyroid carcinoma in children less than 18 years of age in the Department of Pathology, University College Hospital, Ibadan, over a 40-year period. Histopathological diagnosis, age, sex, and other relevant clinical information were extracted from the hospital records and surgical pathology records of the department. All cases of patients under 18 years old had their slides re-examined and reclassified by two pathologists according to the World Health Organization histopathological classification of thyroid tumours. Results There were 25 cases of thyroid carcinomas seen in children within the study period. Papillary thyroid carcinoma was the most common, accounting for 80% of the cases. Follicular carcinoma accounted for 12%, and medullary and anaplastic carcinoma accounted for 4% each. The mean age at presentation was 13 years. There was a female preponderance, with females accounting for 60% of cases. Tumours with distant metastasis made up 20% of the cases. Conclusion Childhood thyroid carcinomas are rare in our environment, with a minority of cases presenting with metastases.Item Histopathological characteristics of gynaecomastia in Southwestern Nigeria: A review from a tertiary hospital(Wolters Kluwer - Medknow, 2020) Ajani, M. A.; Salami, A. A.; Awosusi, B. L.; Omenai, S. A.; Iyapo, O.; Odetola, S. S.Background: Gynaecomastia is a benign proliferation of the glandular tissue of the male breast. It is thought to be present in at least a third of men in the course of their lifetime. This study aims to review the histomorphological characteristics of gynaecomastia seen at the department of Pathology, University College Hospital (UCH), Ibadan, over 10 years period. Methods: A hospital-based retrospective study was undertaken to review the histopathology reports of all gynaecomastia cases diagnosed at the Department of Pathology, UCH Ibadan, over a 10‑year period from 01 January, 2009 to 31 December, 2018. Patient’s biodata, histological diagnosis and clinical details were extracted from the surgical day books and laboratory request forms. The data were analysed for the frequency distribution using the SPSS software version 22. Results: Gynaecomastia accounts for 2.5% of all breast biopsies received within the study period and accounted for 68.1% of all benign breast lesions seen in males. The left breast was the most affected with 48.8% of the cases, whereas 17.2% of the cases were bilateral. The age range of patients with gynaecomastia seen in this study is between 12 and 80 years with a mean age of 43.36 years. The most common histopathological subtype seen in this study is the florid type gynaecomastia. Conclusion: Gynaecomastia is the most common diagnosis from male breast biopsies. The left breast is the most commonly affected breast. The florid type gynaecomastia is the main histopathological variant seen in this study.Item Histopathological characteristics of gynaecomastia in Southwestern Nigeria: A review from a tertiary hospital(Wolters Kluwer - Medknow, 2020) Ajani, M. A.; Salami, A. A.; Awosusi, B. L.; Omenai, S. A.; Iyapo, O.; Odetola, S. S.Background: Gynaecomastia is a benign proliferation of the glandular tissue of the male breast. It is thought to be present in at least a third of men in the course of their lifetime. This study aims to review the histomorphological characteristics of gynaecomastia seen at the department of Pathology, University College Hospital (UCH), Ibadan, over 10 years period. Methods: A hospital-based retrospective study was undertaken to review the histopathology reports of all gynaecomastia cases diagnosed at the Department of Pathology, UCH Ibadan, over a 10‑year period from 01 January, 2009 to 31 December, 2018. Patient’s biodata, histological diagnosis and clinical details were extracted from the surgical day books and laboratory request forms. The data were analysed for the frequency distribution using the SPSS software version 22. Results: Gynaecomastia accounts for 2.5% of all breast biopsies received within the study period and accounted for 68.1% of all benign breast lesions seen in males. The left breast was the most affected with 48.8% of the cases, whereas 17.2% of the cases were bilateral. The age range of patients with gynaecomastia seen in this study is between 12 and 80 years with a mean age of 43.36 years. The most common histopathological subtype seen in this study is the florid type gynaecomastia. Conclusion: Gynaecomastia is the most common diagnosis from male breast biopsies. The left breast is the most commonly affected breast. The florid type gynaecomastia is the main histopathological variant seen in this study.Item Patterns of inflammatory lesions of the appendix in a Nigerian Tertiary Health Facility(African Journal of Open Libraries, 2021) Ajani, M. A.; Awosusi, B. L.; Omenai, S. A.; Adegoke, O. O.; Ajani, T. A.Background: Appendicitis is most common between the ages of 10 and 20 years, although all ages can be affected. Acute appendicitis is the most common cause of acute surgical abdomen worldwide and its incidence varies with geographical location. The aim of this study was to review all the inflammatory lesions of the surgically removed appendix in University College Hospital, Ibadan, Nigeria and to describe the histopathological patterns of these lesions. Methods: This study was a retrospective review of all appendectomy specimens submitted to the Department of Pathology, University College Hospital, Ibadan, Nigeria from January 2009 to December 2018. Patients’ biodata, clinical parameters, and histological diagnoses were extracted from departmental surgical day books. The data were analyzed using IBM SPSS Statistics (version 23; IBM Corporation, Armonk, New York) and expressed as frequency distribution. Results: A total of 1071 appendectomy specimens were received in our laboratory during the 10-year study period, accounting for 3% of all specimens received. There were 1062 cases of inflammatory lesions, accounting for 99.2% of the cases. There was a male preponderance with male to female ratio of 1.2:1. The age was from 1 to 83 years. The most common histological diagnosis was acute suppurative appendicitis with peritonitis accounting for 47.6% of all the cases. Conclusion: The findings in our study supports the fact that acute suppurative appendicitis is the most common inflammatory disease of the appendix which is consistent with other similar studies that have been done in our environment and in the developed world.Item Histomorphological assessment of non-neoplastic renal diseases at autopsy: an institutional experience in Southwestern Nigeria(The College of Medicine and the Medical Association of Malawi., 2021) Omenai, S. A.; Ajani, M. A.; Nwadiokwu, J. I.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.Item Histopathological profile of childhood thyroid carcinoma in Ibadan, Southwestern Nigeria(The National Postgraduate Medical College of Nigeria, 2020) Omenai, S. A.; Ezenkwa, U. S.; Ajani, M. A.Objectives: Diabetes mellitus (DM) is a global health problem with associated high morbidity and mortality. This study was a retrospective review of post mortem examination findings of hospitalised patients with DM for causes of death. Materials and Methods: A retrospective, cross sectional autopsy review of all the patients with DM in our hospital between January 2008 and December 2017 was conducted. The causes of death were classified into cardiovascular, cerebrovascular, acute diabetic emergencies, infection, cancers and unnatural deaths. The demographic data and clinicopathological parameters were extracted, and the data were analysed using the SPSS software version 23. Results: A total of 1092 cases of autopsy were done within the study period, of which 91 cases were on patients with diabetes accounting for 8.3%. Infections with sepsis were the major cause of death, accounting for 51.6% followed by cardiovascular diseases(16.5%), cancers(14.3%), acute diabetic emergencies (6.6%) and cerebrovascular accidents (6.6%), with renal complications and road traffic accidents accounting for 2.2% each. Patients’ age ranged from 31 to 84 years, with a modal age of 57 years. There was a male predominance with a male to female ratio of 1.5:1. Systemic hypertension co morbidity was statistically significantly more common in patients aged 60 and above (P = 0.035). The most common lesion observed in the kidneys was benign nephrosclerosis (43.2%). Conclusions: This study suggests that majority of our patients with diabetes mellitus die from infections with attendant sepsis. Older patients appear to have co morbid systemic hypertension. Patient education on infection prevention and prompt treatment might be life saving.Item Histopathological profile of childhood thyroid carcinoma in Ibadan, Southwestern Nigeria(Medical Association of Malawi, 2020) Ajani, M. A.; Omenai, S. A.; Nwadiokwu, J. I.; Salami, A. A.Background Thyroid carcinoma is a common endocrine malignancy. It is however rare in childhood and often occurs as a result of radiation exposure or inherited genetic mutations. Most childhood thyroid carcinomas are well differentiated. There are very few epidemiological studies of this disease in Nigeria and our study aimed to determine the frequency in a subset of our population. The study aimed to determine the prevalence and histopathological characteristics of childhood thyroid carcinoma in our environment. Methods This was a retrospective review of histopathologically diagnosed thyroid carcinoma in children less than 18 years of age in the Department of Pathology, University College Hospital, Ibadan over a 40-year period. Histopathological diagnosis, age, sex and other relevant clinical information were extracted from the hospital records and surgical pathology records of the department. All cases of patients under18 years old had their slides re-examined and reclassified by two pathologists according to the World Health Organization histopathological classification of thyroid tumours. Results There were 25 cases of thyroid carcinomas seen in children within the study period. Papillary thyroid carcinoma was the most common, accounting for 80% of the cases. Follicular carcinoma accounted for 12%, and medullary and anaplastic carcinoma accounted for 4% each. The mean age at presentation was 13 years. There was a female preponderance with females accounting for 60% of cases. Tumours with distant metastasis made up 20% of the cases. Conclusion Childhood thyroid carcinomas are rare in our environment, with a minority of cases presenting with metastases.Item Histopathological characteristics of gynaecomastia in Southwestern Nigeria: A review from a tertiary hospital(Wolters Kluwer - Medknow, 2020) Ajani, M. A.; Salami, A. A.; Awosusi, B. L.; Omenai, S. A.; Iyapo, O.; Odetola, S. S.Background: Gynaecomastia is a benign proliferation of the glandular tissue of the male breast. It is thought to be present in at least a third of men in the course of their lifetime. This study aims to review the histomorphological characteristics of gynaecomastia seen at the department of Pathology, University College Hospital (UCH), Ibadan, over 10 years period. Methods: A hospital-based retrospective study was undertaken to review the histopathology reports of all gynaecomastia cases diagnosed at the Department of Pathology, UCH Ibadan, over a 10-year period from 01 January, 2009 to 31 December, 2018. Patient’s biodata, histological diagnosis and clinical details were extracted from the surgical day books and laboratory request forms. The data were analysed for the frequency distribution using the SPSS software version 22. Results: Gynaecomastia accounts for 2.5% of all breast biopsies received within the study period and accounted for 68.1% of all benign breast lesions seen in males. The left breast was the most affected with 48.8% of the cases, whereas 17.2% of the cases were bilateral. The age range of patients with gynaecomastia seen in this study is between 12 and 80 years with a mean age of 43.36 years. The most common histopathological subtype seen in this study is the florid type gynaecomastia. Conclusion: Gynaecomastia is the most common diagnosis from male breast biopsies. The left breast is the most commonly affected breast. The florid type gynaecomastia is the main histopathological variant seen in this study.