Scholarly works in Pathology (Basic Med Sci)
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Item Prevalence and Review of Pathological Anatomy of Gestational Choriocarcinoma in Ibadan(JournalGurus (on behalf of the Society of Gynaecology and Obstetrics of Nigeria), 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 due to its 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 were extracted from the departmental surgical day book, ward register, Department of Medical Records, and Cancer Registry. The data were analyzed using the Statistical Package for Social Sciences (SPSS), version 22. 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, of which 36 cases were GCC, accounting for 19.7%. Of all the cases, 55.6% 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 of 20 to 50 years, with the majority of cases occurring in the third decade of life. Conclusion: Gestational choriocarcinoma remains the most common form of gestational trophoblastic neoplasia in our environment. Awareness of this tumor, along with a high index of suspicion, is essential for accurate diagnosis and effective patient management.Item Histopathological analysis of male breast cancer in Southwestern Nigeria: A single-center retrospective study(Wolters Kluwer - Medknow, 2021) Ajani, M. A.; Odetola, S. S.; Awosusi, B. L.; Fatunla, E. O.; Salami, A. A.Background: Breast cancer in men is still an uncommon and largely understudied disease. It accounts for 1% of all breast cancers. The aim of this study was to review all the male breast cancer cases diagnosed at the tertiary medical institution in South West Nigeria over a 10‑year period and to compare the findings with other similar studies done in Nigeria and globally. Methods: We retrospectively reviewed all histologically diagnosed cases of male breast cancers in the Department of Pathology, Tertiary Medical Institution in South West Nigeria over a 10‑year period from January 1, 2009, to December 31, 2018. Clinicopathological parameters including patients’ age, laterality, and specific histological sub‑types were extracted from surgical day book and Cancer Registry of the Department. The data were analyzed using the IBM SPSS Statistics (version 22; IBM Corporation, Armonk, New York, USA). The results were subsequently presented in tables, relative frequencies, group percentages, and photomicrographs. Results: Forty‑two cases of male breast cancer were seen, accounting for 1.7% of all breast cancer cases. The age range was between 22 and 91 years with a mean age of 60.3 years, and a peak occurrence was in the 8th decade. The right breast was more affected than the left, accounting for 52% of the total number of cases seen. The most common histological sub‑type found was invasive ductal carcinoma, accounting for 88% of all the cases. Conclusion: Male breast cancer is relatively uncommon compared to female breast cancer. It is more common in the older age group, and invasive ductal carcinoma is still the most common histological subtype.Item Histopathological analysis of male breast cancer in Southwestern Nigeria: A single-center retrospective study(Wolters Kluwer - Medknow, 2021) Ajani, M. A.; Odetola, S. S.; Awosusi, B. L.; Fatunla, E. O.; Salami, A. A.Background: Breast cancer in men is still an uncommon and largely understudied disease. It accounts for 1% of all breast cancers. The aim of this study was to review all the male breast cancer cases diagnosed at the tertiary medical institution in South West Nigeria over a 10‑year period and to compare the findings with other similar studies done in Nigeria and globally. Methods: We retrospectively reviewed all histologically diagnosed cases of male breast cancers in the Department of Pathology, Tertiary Medical Institution in South West Nigeria over a 10‑year period from January 1, 2009, to December 31, 2018. Clinicopathological parameters including patients’ age, laterality, and specific histological sub‑types were extracted from surgical day book and Cancer Registry of the Department. The data were analyzed using the IBM SPSS Statistics (version 22; IBM Corporation, Armonk, New York, USA). The results were subsequently presented in tables, relative frequencies, group percentages, and photomicrographs. Results: Forty‑two cases of male breast cancer were seen, accounting for 1.7% of all breast cancer cases. The age range was between 22 and 91 years with a mean age of 60.3 years, and a peak occurrence was in the 8th decade. The right breast was more affected than the left, accounting for 52% of the total number of cases seen. The most common histological sub‑type found was invasive ductal carcinoma, accounting for 88% of all the cases. Conclusion: Male breast cancer is relatively uncommon compared to female breast cancer. It is more common in the older age group, and invasive ductal carcinoma is still the most common histological subtype.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 P57kip2 Immunohistochemical Marker as a Diagnostic tool for Cases of Hydatidiform Moles in a Tertiary Health Facility in Southwestern Nigeria(Wolters Kluwer - Medknow, 2020) Awosusi, B. L.; Ajani, M. A.; Adegoke, O. O.; Salami, A. A.; Okolo, C. A.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.Item Inflammatory pseudotumor: a 20‑year single institutional experience(Wolters Kluwer - Medknow, 2020) Ajani, M. A.; Fatunla, E. O.; Onakpoma, F. A.; Salami, A. A."Background: Inflammatory pseudotumor (IPT) is a relatively rare benign disease. The aim of the study was to demonstrate the demographic distribution, clinical presentation, and histomorphological characteristics of IPT while highlighting its associated diagnostic challenges. Materials and Methods: A retrospective cross‑sectional review of all the IPT diagnosed in our institution between January 1999 and December 2018 was conducted. The samples were received from within and outside the hospital facility. The demographic data, clinical history, and histologic reports were reviewed. Results: A total of 25 cases of histologically confirmed IPT were seen. Patients’ age ranges from 7 to 74 years with a mean age of 38.96 years and standard deviation ± 17.94 years. There was a bimodal peak occurrence in the third and fifth decades. Most of the patients were adults (23, 92%), whereas only 2 (8%) were children. There was a female preponderance with a male‑to‑female ratio of 1:2.6. The head and neck had the highest number of cases (44%), followed by the gastrointestinal tract (GIT) (40%). Eight (73%) of head and neck cases occurred in the orbit. The presenting complaints depended on the site of the lesion with pain and swelling being the commonest symptoms irrespective of the site of the lesions. Two cases of bilateral IPT were observed. Immunohistochemistry was used in a certain condition of diagnostic dilemma. Conclusion: This study showed a female preponderance of IPT with the head and neck and GIT being the most common location. It is important to rule out other differentials in the diagnosis of IPT."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 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.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.