Scholarly works in Pathology (Basic Med Sci)
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Item Immunohistochemical human epidermal growth factor receptor 2 (her2) expression pattern in gastric adenocarcinomas in a Nigerian tertiary hospital(West African College of Physicians and the West African College of Surgeons, 2024) Mashor, M. I.; Ezenkwa, U. S.; Ogun, G. O.; Ajani, M. A.; Ogunbiyi, J. O.BACKGROUND AND OBJECTIVE: The demonstration of HER2 in gastric adenocarcinoma (GA) tissues by immunohistochemistry assists in deciding whether targeted therapy would optimise the treatment of GA patients who are HER2 positive. However, this has not been extensively studied in our patients hence the need for this study. METHODS: Recipient tissue microarray blocks were constructed from donor archival formalin fixed paraffin embedded gastric tumour tissue from 80 patients seen over a period of 17 years in a retrospective descriptive study. Slides cut from these blocks were stained with anti human HER2 antibody by immunohistochemistry and scored using the trastuzumab in gastric adenocarcinomas (ToGA) trial criteria. Data on age, gender, site of lesion and histological subtype of the gastric adenocarcinomas were also retrieved and reviewed. RESULTS: Eighty cases (52 males and 28 females; male to female ratio of 1.9:1), 55.65 ±13.50 years (modal age group 60-69 years), were studied. Most tumours (91.2%) involved the distal parts (pylorus, antrum and body) with a few (8.8%) involving the proximal part (cardia and fundus) of the stomach. HER2 was overexpressed in a total of 6 (7.5%) cases only. Two of seven (28.6%) proximal tumours showed HER2 positivity whereas only 4 of 73 (5.5%) of the distal tumours showed HER2 positivity. CONCLUSION: We had only a slightly lower HER2 overexpression rate than in studies from many other parts of the world. The observed overexpression was significantly higher in proximal than distally located tumours suggesting that distal tumours are less likely to respond to Trastuzumab than proximal tumours. The known association of distal gastric tumours with Helicobacter pylori infection probably provides for a possible difference in the molecular aetiopathogenesis of GAs by site of occurrence. The exact mechanisms for proximal gastric carcinogenesis remain to be more clearly elucidated. More studies, including clinical trials with larger sample sizes, are recommended to elucidate this differential expression of HER2 in gastric adenocarcinoma.Item Diagnostic Utility of EMA, Vimentin and CD117 Immunohistochemical Markers in Subtyping Renal Cell Carcinoma in a Nigerian Tertiary Hospital: A 10-year Retrospective Study.(West African College of Physicians and the West African College of Surgeons, 2023) Nwadiokwu, O. O; Adegoke, M. A.; Ajani, C. A.; Okolo, B. L.; Awosusi, V. C.; Okebalama J. I.; Adegoke, O. O.; Ajani, M. A.; Okolo, C. A.; Awosusi, B. L.; Okebalama, V. C.BACKGROUND: Renal cell carcinoma is the most lethal urological cancer and contributes significantly to morbidity and mortality due to cancers of the urogenital tract. In routine diagnostic surgical pathology practice of renal tumours, immunohistochemistry is a helpful ancillary technique after routine H & E. The role of renal immunohistochemistry is explored in this study. MATERIALS AND METHODS: The paraffin-embedded tissue blocks of all the confirmed cases of renal cell carcinoma seen at the University College Hospital (UCH), Ibadan, during the 10-year study period of 2007 to 2016 were retrieved, sectioned and immunohistochemistry done using monoclonal antibodies for EMA, Vimentin and CD117 following standard protocols. Frequency statistics and chi-square were applied to data to determine proportions and associations using the Statistical Package for the Social Sciences (SPSS) version 23. RESULTS: A total of 48 cases of renal cell carcinoma were seen within the study period that met the inclusion criteria for the study. The age range of the patients was between 3 to 76 years with an average age of 44.17 years. The male-to-female ratio was 1:1.3. Fuhrman Grade 2 nuclei were predominant (43.75%) while Fuhrman Grade 4 nuclei had the lowest frequency (6.25%). EMAstaining patterns for the different histological patterns of RCC showed no statistically significant difference while Vimentin and CD117 staining patterns showed a statistically significant difference. There was no statistically significant difference observed between the staining patterns of all three markers and the nuclear grades of the cases of RCC. CONCLUSION: This study demonstrated the usefulness of Vimentin and CD117 in differentiating chromophobe variant of renal cell carcinoma from other subtypes while EMA showed variable expression across the various subtypes. WAJM 2023; 40(10); 1035 -1040.Item Clinicopathological pattern of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 over-expression of epithelial ovarian carcinomas in Nigeria(Makerere University, Medical School, 2023) Ajani, M. A.; Lawan, A.; Oke, T.; Khramtsova, G.; Nwanji, I.; Salami, A.; Awolude, O.; Ebili, H.; Onwukamuche, M. E.; Sveen, E.; Yoshimatsu, T.; Olopade, O. I.Background: Ovarian cancer is the leading cause of death from all gynaecological malignancies. Only few biomarkers of epi thelial ovarian cancer (EOC) prognosis have been studied so far among Nigerian patients. Objective: To determine the pattern of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) expression in patients with EOC seen in Nigeria Materials and Methods: This was a retrospective multicentre study of 102 cases of epithelial ovarian cancers. Relevant clinical information was obtained from hospital-based records in the 3 participating centres. Tissue microarrays were constructed using representative tumour tissue and the ER, PR and HER2 immunohistochemical staining was carried out at the University of Chicago, United States of America. Results: Serous carcinomas predominated (71% of cases). ER positivity was observed in 31.4%, PR positivity in 21.5% and HER2/neu in 16.7% of tumours. Fifty-two percent of tumours were triple negative. Serous tumours were significantly asso ciated with ER positivity (p=0.001). Mean patient age for EOC was 52.6 ± 13.1 years. There were no statistically significant associations between hormone receptor status and histological grade, FIGO staging or survival. Conclusion: Serous tumours were significantly associated with ER expression while non-serous tumours tended to be triple negative.Item One year of breast cancer in Ibadan, Southwestern Nigeria: a histopathological review(African Journal of Open Libraries, 2021) Jimoh, M. A.; Ajani, M. A.; Folorunso, S. A.; Fatunla, E. O.; Aruah, C. S.; Abdus-Salam, A. A.; Ogunbiyi, J. O.Background: Breast cancer is a major public health problem in most low- to medium-income countries of the world because of its high morbidity and mortality rate. Histopathological features are vital in risk assessment, selection of treatment and prognostication in breast cancer patients. This study aimed to assess the histopathological features of all breast cancer cases seen in a tertiary hospital in the year 2018. Methods: This is a retrospective review of all breast cancer cases histologically diagnosed and confirmed by three Pathologists at the University College Hospital (UCH), Ibadan over a one-year period from 1st January 2018 to 31st December, 2018. Results: A total of 236 breast cancer cases were seen during this period, 234 (99.2%) were females while only 2 (0.8%) were male. 163 (69.7%) patients were between the fourth and sixth decades of life, 65 (27.8%) patients were above sixth decade while 6 (2.5%) patients were below fourth decade. Invasive ductal carcinoma of No Special Type (NST) was the commonest histological subtype 212 (89.8%). Grade 1 cases were 25 (10.6%), Grade 2 129 (54.7%) and Grade 3 cases were 40 (16.9%) while 42 (17.8%) were not graded. Lymphovascular invasion observed in 98 (41.5%) of the cases. 54 (22.9%) had immunohistochemistry out of which 23 (43.4%) were triple negative while 8 (3.4%) were triple positive. Conclusion: Histopathological features suggesting aggressive disease was predominantly observed. Efforts should be made towards early diagnosis, adequate evaluation and prompt treatment. Cancer care should be fully incorporated in the National Health Insurance Scheme (NHIS).Item Histopathological patterns of skin adnexal tumours in Ibadan, South-west Nigeria(Wolters Kluwer - Medknow, 2022) Adegoke, O. O.; Ajani, M. A.Background: Skin adnexal tumours (SATs) are tumours that differentiate towards one or more of the adnexal structures of the skin. The aim of this study was to determine the incidence of SATs in Ibadan and to correlate them with age, sex and anatomic location. Methods: This is a 10-year retrospective study of all SATs in the Department of Pathology, University College Hospital, Ibadan. The clinicopathological data were obtained from the department’s records for the given period. Haematoxylin and eosin stained sections obtained from formalin fixed paraffin embedded tissue blocks were examined to confirm the diagnosis and special stains such as periodic acid Schiff staining done where necessary. Cases of SATs were further classified into benign and malignant tumours. Results: Twenty-seven cases of SATs were reviewed over the study period. Tumours from the sweat glands formed the largest group (55.6%) with trichoepithelioma being the most common subtype, followed by tumours with follicular differentiation (40.7%) and sebaceous tumours (3.7%). There was a slight female predominance with a male-to-female ratio 1:1.07. The highest number of tumours was seen in the fourth decade of life (23%). Benign tumours made up the majority of cases (85.2%). The most common location was the head and neck with 40.8% of cases. Conclusion: SATs are not uncommon among Nigerian patients. These tumours are mostly benign and are present commonly in the head and neck location.Item Whole-genome analysis of Nigerian patients with breast cancer reveals ethnic-driven somatic evolution and distinct genomic subtypes(Nature Research, 2021) Ansari-Pour, N.; Zheng, Y.; Yoshimatsu, T. F.; Sanni, A.; Ajani, M.; Reynier, J.-B.; Tapinos, A.; Pitt, J. J.; Dentro, S.; Woodard, A.; Rajagopal, P. S.; Fitzgerald, D.; Gruber, A. J.; Odetunde, A.; Popoola, A.; Falusi, A. G.; Babalola, C. P.; Ogundiran, T.; Ibrahim, N.; Barretina, J.; Van Loo, P.; Chen, M.; White, K. P.; Ojengbede, O.; Obafunwa, J.; Huo, D.; Wedge, D. C.; Olopade, O. I.Black women across the African diaspora experience more aggressive breast cancer with higher mortality rates than white women of European ancestry. Although inter-ethnic germline variation is known, differential somatic evolution has not been investigated in detail. Analysis of deep whole genomes of 97 breast cancers, with RNA-seq in a subset, from women in Nigeria in comparison with The Cancer Genome Atlas (n = 76) reveal a higher rate of genomic instability and increased intra-tumoral heterogeneity as well as a unique genomic subtype defined by early clonal GATA3 mutations with a 10.5-year younger age at diagnosis. We also find non-coding mutations in bona fide drivers (ZNF217 and SYPL1) and a previously unreported INDEL signature strongly associated with African ancestry proportion, under scoring the need to expand inclusion of diverse populations in biomedical research. Finally, we demonstrate that characterizing tumors for homologous recombination deficiency has significant clinical relevance in stratifying patients for potentially life-saving therapies.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 Malignant peripheral nerve sheath tumour in an unusual location of the urinary bladder: case report and review of literature(SpringerOpen, 2021) Ajani, M. A.; Awosusi, B. L.; Nwanji, I. D.Background: Malignant peripheral nerve sheath tumour (MPNST) is a rare malignant soft tissue neoplasm of ectomesenchymal origin. They usually arise from a major or minor peripheral nerve branch or its sheath and also from somatic soft tissues. The most common sites of origin include the extremities and trunk but can sometimes arise an unusual site resulting in the demise of the patient before any intervention. Case presentation: We report a case of 58-year-old male who presented with complaints of weight loss of a year duration, abdominal swelling of 10 months duration and easy fatigability of 3 weeks duration. Digital rectal examina tion revealed a huge frm mass 6 cm from the anal verge which was non-tender. Abdomino-pelvic ultrasound scan revealed an irregular heterogeneous mass in the posterior wall of the urinary bladder measuring 15.1cmx 14.0 cm with bilateral dilatation of the renal pelvi-calyceal system and ureters. His clinical condition continued to deteriorate while on hospital admission, and he died on the12th day of admission. Post-mortem examination showed a rough ovoid tumour mass frmly adherent to the posterior wall of the bladder with compression of both ureters. Histological and immunohistochemical analysis of the tumour revealed the diagnosis of a MPNST. The fnal anatomical diagnosis and cause of death was that of a malignant peripheral nerve sheath tumour of the urinary bladder with obstructive uropathy and severe sepsis. Conclusion: MPNST can arise at unusual sites other than its common location in the extremities and the existence of neurofbromatosis may not be present. High index of suspicion of MPNST should be raised in rapidly growing painless tumour in and around a nerve tissue. Prompt radio-imaging with biopsy and expert immunohistochemical analysis of lesions will lead to early diagnosis and intervention. Molecular targeted therapies following surgery for MPNST should be developed to improve prognosis and patient outcomes.Item Prevalence and review of pathological anatomy of gestational choriocarcinoma in Ibadan(Journal Gurus, 2022) Awosusi, B. L.; Ajani, M. A.; Adegoke, O. O.; Salami, A. A.; Okolo, C. A.Objectives: Gestational choriocarcinoma (GCC) is a highly malignant epithelial tumor arising from the trophoblast of any type of gestational event, most often a complete hydatidiform mole. Choriocarcinoma is the most aggressive form of gestational trophoblastic neoplasia owing to their rapid growth and metastatic potential. This study reviewed all cases of GCC seen at the University College Hospital Ibadan. Methods: This was a 20 year retrospective hospital-based study designed to review all histologically diagnosed cases of choriocarcinoma registered at the Department of Pathology, University College Hospital (UCH), Ibadan, Nigeria, from 1st January, 1997 to 31st December, 2016. Clinicopathological data was extracted from the departmental surgical day book, Ward register, Department of Medical Records and Cancer Registry. The data was analyzed using the Statistical Package for Social Sciences, version 22. The results were presented in tables, relative frequencies and group percentages. Results: One hundred and eighty three cases of gestational trophoblastic disease were histologically diagnosed within the study period out of which 36 cases were GCC accounting for 19.7%. 55.6% of all the cases were received as endometrial biopsies, 33.3% as hysterectomy specimens, 8.3% as cervical biopsies and 2.8 as an anterior vaginal wall mass. Choriocarcinoma occurred in the age range 20 to 50 years with majority of cases occurring in the third decade of life. Conclusion: Gestational choriocarcinoma is still the most common gestational trophoblastic neoplasia seen in our environment. Awareness of this tumour with a high index of suspicion is needed for an accurate diagnosis and patient management.