Diagnostic Utility of EMA, Vimentin and CD117 Immunohistochemical Markers in Subtyping Renal Cell Carcinoma in a Nigerian Tertiary Hospital: A 10-year Retrospective Study

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.

Direct regulation of the cardiac ryanodine receptor (RyR2) by O-GlcNAcylation

BACKGROUND

O-GlcNAcylation is the enzymatic addition of a sugar, O-linked β-N-Acetylglucosamine, to the serine and threonine residues of proteins, and is abundant in diabetic conditions. We have previously shown that O-GlcNAcylation can trigger arrhythmias by indirectly increasing pathological Ca2+ leak through the cardiac ryanodine receptor (RyR2) via Ca2+/calmodulin-dependent kinase II (CaMKII). However, RyR2 is well known to be directly regulated by other forms of serine and threonine modification, therefore, this study aimed to determine whether RyR2 is directly modified by O-GlcNAcylation and if this also alters the function of RyR2 and Ca2+ leak.

METHODS

O-GlcNAcylation of RyR2 in diabetic human and animal hearts was determined using western blotting. O-GlcNAcylation of RyR2 was pharmacologically controlled and the propensity for Ca2+ leak was determined using single cell imaging. The site of O-GlcNAcylation within RyR2 was determined using site-directed mutagenesis of RyR2.

RESULTS

We found that RyR2 is modified by O-GlcNAcylation in human, animal and HEK293 cell models. Under hyperglycaemic conditions O-GlcNAcylation was associated with an increase in Ca2+ leak through RyR2 which persisted after CaMKII inhibition. Conversion of serine-2808 to alanine prevented an O-GlcNAcylation induced increase in Ca2+ leak.

CONCLUSIONS

These data suggest that the function of RyR2 can be directly regulated by O-GlcNAcylation and requires the presence of serine-2808.

Outcome and surgical management of symptomatic renal angiomyolipoma in Ibadan, Nigeria, Sub-Saharan Africa

BACKGROUND

Renal angiomyolipoma is the commonest benign solid kidney neoplasm though rare in clinical practice. The advent of radiological imaging techniques, refinement in surgical approach and techniques and availability of mammalian target of rapamycin have improved the outcome in these cohort of patients.

AIM

To report our experience with the surgical management of renal angiomyolipoma in the sub-Saharan Africa.

PATIENTS AND METHODS

This was a retrospective review of the records in the operating theatre book of urology division of patients who underwent radical nephrectomy over a 7-year-period (January 2013 to December 2019). The histologically confirmed renal angiomyolipoma information were retrieved from the records in the Department of Pathology. The clinical data were obtained from the patients' case files by identifying the patient with their registration number and not their names. The clinical features, investigations done, treatment offered, and the outcome of management were recorded in an SPSS version 20. The data was analyzed using statistics of central tendency and percentage.

RESULTS

Only 3 females with symptomatic renal angiomyolipoma were managed. This represented 4.9% of 61 patients with solid renal masses managed in the study period. The mean age was 51.2 (ranged 40-70) years. The mean tumor size was 18.9 cm. All the patients underwent radical nephrectomy. The pre- and postoperative urea and creatinine remained normal. The median follow-up period was 21 (16.5-30) months and were asymptomatic.

CONCLUSION

The incidence of renal angiomyolipoma among solid renal masses is 4.9% in our environment. Open radical nephrectomy is still the preferred method of treatment with satisfactory outcome.

Protein O-GlcNAcylation in the heart

O-GlcNAcylation is a ubiquitous post-translational modification that is extremely labile and plays a significant role in physiology, including the heart. Sustained activation of cardiac O-GlcNAcylation is frequently associated with alterations in cellular metabolism, leading to detrimental effects on cardiovascular function. This is particularly true during conditions such as diabetes, hypertension, cardiac remodelling, heart failure and arrhythmogenesis. Paradoxically, transient elevation of cardiac protein O-GlcNAcylation can also exert beneficial effects in the heart. There is compelling evidence to suggest that a complex interaction between O-GlcNAcylation and phosphorylation also exists in the heart. Beyond direct functional consequences on cardiomyocytes, O-GlcNAcylation also acts indirectly by altering the function of transcription factors that affect downstream signalling. This review focuses on the potential cardioprotective role of protein O-GlcNAcylation during ischaemia-reperfusion injury, the deleterious consequences of chronically elevated O-GlcNAc levels, the interplay between O-GlcNAcylation and phosphorylation in the cardiomyocytes and the effects of O-GlcNAcylation on other major non-myocyte cell types in the heart.

Correlative imaging using super-resolution fluorescence microscopy and soft X-ray tomography at cryogenic temperatures provides a new way to assess virosome solutions for vaccine development

Active virosomes (AVs) are derivatives of viruses, broadly similar to ‘parent’ pathogens, with an outer envelope that contains a bespoke genome coding for four to five viral proteins capable of eliciting an antigenic response. AVs are essentially novel vaccine formulations that present on their surface selected viral proteins as antigens. Once administered, they elicit an initial ‘anti‐viral’ immune response. AVs are also internalised by host cells where their cargo viral genes are used to express viral antigen(s) intracellularly. These can then be transported to the host cell surface resulting in a second wave of antigen exposure and a more potent immuno‐stimulation. A new 3D correlative microscopy approach is used here to provide a robust analytical method for characterisation of Zika‐ and Chikungunya‐derivatised AV populations including vesicle size distribution and variations in antigen loading. Manufactured batches were compared to assess the extent and nature of batch‐to‐batch variations. We also show preliminary results that verify antigen expression on the surface of host cells. We present here a reliable and efficient high‐resolution 3D imaging regime that allows the evaluation of the microstructure and biochemistry of novel vaccine formulations such as AVs.

Cryo-Structured Illumination Microscopic Data Collection from Cryogenically Preserved Cells

Three-dimensional (3D) structured illumination microscopy (SIM) allows imaging of fluorescently labelled cellular structures at higher resolution than conventional fluorescence microscopy. This super-resolution (SR) technique enables visualization of molecular processes in whole cells and has the potential to be used in conjunction with electron microscopy and X-ray tomography to correlate structural and functional information. A SIM microscope for cryogenically preserved samples (cryoSIM) has recently been commissioned at the correlative cryo-imaging beamline B24 at the UK synchrotron. It was designed specifically for 3D imaging of biological samples at cryogenic temperatures in a manner compatible with subsequent imaging of the same samples by X-ray microscopy methods such as cryo-soft X-ray tomography. This video article provides detailed methods and protocols for successful imaging using the cryoSIM. In addition to instructions on the operation of the cryoSIM microscope, recommendations have been included regarding the choice of samples, fluorophores, and parameter settings. The protocol is demonstrated in U2OS cell samples whose mitochondria and tubulin have been fluorescently labelled.

Sample preparation strategies for efficient correlation of 3D SIM and soft X-ray tomography data at cryogenic temperatures

3D correlative microscopy methods have revolutionized biomedical research, allowing the acquisition of multidimensional information to gain an in-depth understanding of biological systems. With the advent of relevant cryo-preservation methods, correlative imaging of cryogenically preserved samples has led to nanometer resolution imaging (2-50 nm) under harsh imaging regimes such as electron and soft X-ray tomography. These methods have now been combined with conventional and super-resolution fluorescence imaging at cryogenic temperatures to augment information content from a given sample, resulting in the immediate requirement for protocols that facilitate hassle-free, unambiguous cross-correlation between microscopes. We present here sample preparation strategies and a direct comparison of different working fiducialization regimes that facilitate 3D correlation of cryo-structured illumination microscopy and cryo-soft X-ray tomography. Our protocol has been tested at two synchrotron beamlines (B24 at Diamond Light Source in the UK and BL09 Mistral at ALBA in Spain) and has led to the development of a decision aid that facilitates experimental design with the strategic use of markers based on project requirements. This protocol takes between 1.5 h and 3.5 d to complete, depending on the cell populations used (adherent cells may require several days to grow on sample carriers).

The Transgender Phenomenon and its Effect on the Practice of Anatomic Pathology: A Futuristic Perspective

Introduction of the 'Transgender Phenomenon' "Dave King and Richard Ekins are the leading world sociologists in the field of transgender research. They have put together a brilliant synthesis of history, case studies, ideas and positions as they have emerged over the past thirty years, and bring together a rich and grounded account of this field, providing a state of the art of critical concepts and ideas in this field further during the twenty first century."¹ Based on two decades of fieldwork, life history work, qualitative analysis, archival work and contact with several thousand cross-dressers and sex-changers around the world, these researchers have distinguished a number of contemporary Transgendering 'stories'. 'The assignment of an individual as being of the male or female sex is most often based on the phenotypic appearance of the external genitalia at birth, which is largely determined by the chromosomal type (most commonly 46,XX or 46,XY). Gender identity, however, is an individual's perceived or experienced gender, which may or may not be the same as one's sex assigned at birth. The concept of gender identity includes gradations of masculinity to femininity and maleness to femaleness, as well as identification of some individuals as having nonbinary gender, which means being essentially neither male nor female, or a combination of both. Gender nonconformity is behavioral variation in gender expression (e.g., clothing, mannerisms, accessories, and hairstyles) from cultural and societal norms expected for that gender. Sexual orientation is defined as the physical and emotional attraction of an individual to same-sex people (lesbian or gay; homosexual), both same-sex and opposite-sex people (bisexual), or opposite-sex people (heterosexual).² Transgender is an all-inclusive term that may include all individuals whose gender identity or expression does not align with their assigned birth sex and/or those whose gender identity is outside of the binary male/female classification'.².

3D Correlative Cryo-Structured Illumination Fluorescence and Soft X-ray Microscopy Elucidates Reovirus Intracellular Release Pathway

Imaging of biological matter across resolution scales entails the challenge of preserving the direct and unambiguous correlation of subject features from the macroscopic to the microscopic level. Here, we present a correlative imaging platform developed specifically for imaging cells in 3D under cryogenic conditions by using X-rays and visible light. Rapid cryo-preservation of biological specimens is the current gold standard in sample preparation for ultrastructural analysis in X-ray imaging. However, cryogenic fluorescence localization methods are, in their majority, diffraction-limited and fail to deliver matching resolution. We addressed this technological gap by developing an integrated, user-friendly platform for 3D correlative imaging of cells in vitreous ice by using super-resolution structured illumination microscopy in conjunction with soft X-ray tomography. The power of this approach is demonstrated by studying the process of reovirus release from intracellular vesicles during the early stages of infection and identifying intracellular virus-induced structures.

ENDOSCOPIC ASSISTED, TRANSFONTANELLE EXCISION OF A LARGE THIRD VENTRICULAR ATYPICAL CHOROID PLEXUS PAPILLOMA IN AN INFANT

Choroid plexus papillomas are rare benign tumours, which are found in both adult and paediatric age groups. The 'atypical' histological subclass is rarer still. The commonest site of occurrence is in the lateral ventricles; rare locations are the cerebellopontine angle and the third ventricle. The goal of care is a gross total excision of the tumour. The histologic subtype determines further adjuvant care given to the patient. The outcome of the care of these patients depends on the histological grade, extent of surgical resection adjuvant care. We present a case of a 12 week-old infant with obstructive hydrocephalus, secondary to a third ventricular atypical choroid plexus papilloma. He had a 'two-staged' resection of the choroid plexus papilloma, using an endoscopic access via the right Kocher's point in the right anterior fontanelle, in the same position as that proposed for access in endoscopic third ventriculostomy because of the observed sutural diastasis. Histology confirmed an atypical choroid plexus papilloma. He made progressive recovery post-surgery but unfortunately there has been default with follow-up clinic visits.

CERVICAL LYMPHADENOPATHY IN IBADAN, NIGERIA

AIM

To determine the pattern and causes of lymph node enlargement of cervical region in Ibadan, Nigeria.

MATERIALS AND METHODS

A 10-year (2003-2012) retrospective study was conducted on all head and neck lymph node biopsies received at the Department of Pathology, University College Hospital, Ibadan, Nigeria.

RESULTS

A total of 101 lymph node biopsies of cervical region were received within this period of study. 59.4% cases were seen in Males. Second decade of life has the highest number of cases (22.8%) followed by 3^rd decade (17.8%). The common cause of cervical lymphadenopathy include non - specific hyperplasia, tumour metastasis and Non Hodgkin's lymphoma seen in 27 (26.7%), 22 (21.8%) and 20 (19.8%) respectively. Granulomatous and Hodgkin's Lymphoma constitute 17 (16.8%) and 11 (10.9%) respectively. The granulomatous causes were all due to tuberculosis. A single case of Rosai-Dorfman disease was seen in a male in the 3^rd decade of life.

CONCLUSION

This study shows that metastatic tumours, Hodgkins lymphoma and Non Hodgkins lymphoma constituting 52.4% of all cases of cervical lymphadenopathy are common in this environment therefore highlighting the need for early and proper evaluation of patients.

MORPHOLOGICAL PATTERN OF ENDOMETRIAL BIOPSIES IN SOUTHWESTERN NIGERIA

BACKGROUND

Endometrium remains the most sensitive indicator of ovarian function and endometrial biopsy is one of the diagnostic procedures in endometrial pathology. The current study was carried out to examine the morphological pattern of endometrial biopsies in Ibadan, South-western Nigeria and compare the results with similar studies.

METHOD

A retrospective study was undertaken to review all cases of endometrial biopsies received in the Department of Pathology, University College Hospital, Ibadan between January 1999 and December 2008. The patients' data were retrieved from the surgical pathology daybooks and Histology Request forms. The neoplastic lesions were classified according to 2003 World Health Organization classification for endometrial neoplasms.

RESULTS

A total of 2,444 cases of endometrial biopsies were received during the 10-year study period. The functional endometrial changes were the most common histopathological diagnostic category, accounting for 53.8% (1035) of cases. Other pathological diagnoses included endometritis (7.8%), simple endometrial hyperplasia (5.8%), partial hydatidiform mole (2.3%), complete hydatidiform mole (2.1%) and malignant neoplastic lesions (3.9%). Infertility was the most common (57%) indication for endometrial biopsies followed by uterine bleeding (33%) while the least common clinical indication were the menstrual disorders (10%).

CONCLUSION

The functional endometrial changes account for the highest morphological patterns while malignant lesions account for the least pattern of the endometrial biopsies evaluated for etiological basis of infertility, uterine bleeding and menstrual disorders in Ibadan. Infertility was the commonest indication for endometrial biopsies while the least common clinical indication was menstrual disorders.

HEXANE EXTRACT OF Dacryodes edulis FRUITS POSSESSES ANTI-DIABETIC AND HYPOLIPIDAEMIC POTENTIALS IN ALLOXAN DIABETES OF RATS

BACKGROUND

The fruit extract of Dacryodes edulis (D. edulis), the African pear or plum, a tree indigenous to the humid tropics has been used for managing wounds, skin diseases, sickle cell anaemia, dysentery and fever in some African nations. In South Eastern Nigeria, 'herbal doctors' include its marshed fruit in decoctions administered to diabetic patients. However no scientific substantiation of their claim and use exist in literature. Hence, the need to evaluate the antidiabetic and hypolipidaemic activity of hexane extracts of D. edulis fruit in alloxanised animal model.

MATERIALS AND METHODS

Sub-toxic doses between 400 and 1600mg/kg were orally administered sub-chronically to alloxan-induced diabetic rats for 15 days and compared to glibenclamide (2.5mg/kg). The glycaemia levels, body weights, lipid profile, blood urea, creatinine and liver enzyme levels were measured. Basic histology of the pancreatic tissue was also performed to examine the effects on the pancreas as possible mechanistic lead.

RESULTS

Oral acute dosing of D. edulis hexane extract decreased blood glucose levels, while sub-chronic treatment of the extract down-regulated significantly hyperglycaemia, total cholesterol, triglycerides, LDL-C, ALT and ALP levels. However, the HDL-C levels increased significantly. Histopathological examination of the pancreatic tissues after sub-chronic treatment showed that glibenclamide and the highest dose of the extract 1600mg/kg restored the afore-damaged pancreatic β-cell architecture.

CONCLUSION

Our findings portend that D. edulis hexane fruit extract possesses hypoglycaemic and hypolipidaemic activities as well as restoration of the pancreatic architecture without any obvious untoward hepatic damages, suggesting that its use in the management of the diabetes may be valid. List of Non-standard abbreviations:D. edulis = dacryode edulis, DEnH = Dacryodes edulis n-hexane fruit extract, B.wt. = Body weight, Per os = Oral administration, NC = normal control, DC =Diabetic control, SC = Standard control, LDL-C = low density lipoprotein cholesterol, HDL-C = High density lipoprotein cholesterol, TG = Triglyceride, TC = Total cholesterol.

Primary ovarian pregnancy mimicking abdominal pregnancy

The objectives of this study were to emphasise that ectopic pregnancy (EP) can occasionally occur in rare sites such as the ovary, and to show that it may be difficult making the diagnosis clinically and radiologically. It also highlighted the benefit of early surgical intervention in reducing mortality and morbidity from this condition. The case was a 31-year-old nulliparous woman who presented with amenorrhoea of 20 weeks and a 2-month history of lower abdominal pain. Radiological studies suggested abdominal pregnancy coexisting with uterine fibroids for which she had an exploratory laparotomy, which revealed a primary right ovarian pregnancy necessitating the performance of right ovariectomy. Locating the sites of EP may still pose a diagnostic challenge. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be confirmed at surgery.

Survival of ovarian cancer patients in Ibadan: clinical and pathological factors

This retrospective cross-sectional study evaluated the applicability of the universal grading system in a selected patient population and compared the results with the FIGO staging. A total of 49 patients who met the inclusion criteria, were studied. The slides were independently examined by two pathologists, using Silverberg's parameters. The prognostic value of their findings was analysed using Kaplan-Meier graphs. Papillary subtype and abnormal nuclear features were the most frequent histological pattern and a younger age was associated with improved survival. The longest surviving patient (250 weeks) had the lowest mitotic activity, predominantly glandular architecture and little or no nuclear pleomorphism, the reverse is the case for the shortest-term survivor (120 weeks). The universal grading system is useful and comparable with the FIGO staging. The two systems are complementary.

CT-guided percutaneous transthoracic lung biopsy: first experience in Ibadan, Nigeria

Percutaneous lung biopsy had been described in the nineteenth century by Leyden, but image- guided needle chest biopsy only gained widespread acceptance in the 1970s. Currently, tissue sampling of a thoracic lesion is indicated when the diagnosis cannot be obtained by the non-invasive techniques and cytological diagnosis will modify the stage of the disease or influence the therapeutic strategy. Cytology obtained by small-gauge needle aspiration biopsy confirms the nature of the lesion in 80 - 95% of cases and carry a low incidence of major complications. The purpose of this report was to provide information on our first experience with CT-guided biopsy and show that with some innovativeness much can be achieve with limited resources and good team work. We performed a CT of the thorax using appropriately placed improvised metal markers, which determined the optimal cutaneous entry point. We then re-checked the location of the lesion scanning intermittently at 5mm slice thickness; we marked the entry point with a pen and cleaned the surface with methylated spirit. A local anaesthetic was subcutaneously injected around marked area. We used a 21G aspiration needle to obtain cytology sample then 18G Trucut biopsy needle to obtain histology specimen. The length of the needle was chosen based on predetermined distance of the target lesion from the skin estimated from the CT images. Our patient was a 51-year-old Nigerian female with a peripherally located nodule in the posterior aspect of the right lung. She had CT-guided biopsy of the nodule. The procedure was well tolerated with no complication of pneumothorax. The histology report provided the basis for treatment regimen. Our experience indicates that percutaneous transthoracic CT-guided needle biopsy is feasible and a safe procedure in our hospital for evaluation of undetermined lung lesions.

Renal cell carcinoma in Ibadan: a 5-year clinicopathologic review

BACKGROUND

To review all the cases of the patients with renal cell carcinoma seen during the study period and to determine the pattern of presentation, number of operable cases, histological types and outcome of treatment.

MATERIALS AND METHODS

The data of the patients with renal cell carcinoma was retrieved from the Urology division audit book, theatre record books and case files from the health records department and pathology register in the department of pathology. The parameters studied were age, gender, pattern of presentation, number of patients who had surgery, histology types and the outcome of treatment.

RESULTS

In total, there were 69 patients with renal cell carcinoma that accounted for 59.5% of all renal masses seen. The male to female ratio was 1:1. Their age ranged from 16 to 88 with a mean of 48 years and median of 50 years. The main clinical feature was loin swelling (100%) and others were loin pain (29%), hematuria (18.8%), weight loss (4%) and paraneoplastic syndrome (anaemia without haematuria) was seen in 2.9%. Ten percent of the cases had the classical triad of hematuria, loin pain and loin swelling. All cases were unilateral disease and 15 (21.7%) had metastasis at presentation. The pre-operative tests were abdominal ultrasound (94%), intravenous urography (45%) and CT-Scan (11.6%). Twenty eight patients (40.6%) had surgery of which 5 were unresectable. 37 of the patients (53.6%) were subsequently lost to follow-up. The 28 operative specimens were histologically confirmed and 85.7% were clear cell carcinoma. The 23 patients whose tumours were resected have remained symptom free, some up to 5 years. However the five patients with unresectable tumours died between 3 to 6 months of exploratory surgery.

CONCLUSION

The patients with resectable tumour could remain disease free for a significant period afterwards despite late presentation. However, there is a high loss to follow-up rate.

Diagnostic value of lipids, total antioxidants, and trace metals in benign prostate hyperplasia and prostate cancer

BACKGROUND

Considerable overlap exists in the value of total prostate specific antigen (tPSA) in both prostate cancer (Pca) and benign prostate hyperplasia (BPH). Developing an effective biochemical screening test that will complement PSA assay could reduce the associated cost of care and give timely attention to prostate cancer patients even when they are still asymptomatic is therefore desirable. This work was therefore an attempt to evaluate the possible roles of lipids, antioxidants, and trace metals in breaking the diagnostic tie between Pca and BPH.

MATERIALS AND METHODS

Anthropometric characteristics, total prostate specific antigen (tPSA), serum lipids (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), Vit. E, total antioxidant status (TAS), and trace metals (Se, Cu, Fe, Zn, and Mn) were determined in 40 patients with histopathological diagnosis of BPH and Pca. Forty age matched control subjects were also recruited from the same community. Informed consent was obtained from all the participants in the study. A P-value < 0.05 was considered significant.

RESULTS

There were significant variations in the weight, hip circumference, and body mass index (BMI) across the group but the post hoc test did not show any difference between patients with prostate cancer and BPH. Among the biochemical parameters studied, only the total cholesterol and triglyceride differed significantly between patients with BPH and prostate cancer patients. Cut-offs from ROC for BPH and prostate cancer at 88.9 sensitivity and 66.7% specificity (95% CI) were 88.5 mg and 161 mg/dl for triglycerides and cholesterol respectively. Furthermore there were no significant variations in the mean levels of copper and tPSA, Vit E, and LDL cholesterol among the study subjects and the controls.

CONCLUSION

Prior to prostate biopsy, serum lipid (especially, fasting triglycerides, total cholesterol) could help in early discrimination of patients with BPH from prostate cancer in adjunct to total PSA and other management protocol for diagnosis of prostate cancer. The use of trace metal or antioxidants may have limited advantages. Further studies in this regard will be very desirable to see if this pattern of triglyceride and total cholesterol values in BPH and Pca are sustainable.

Outcome of one hundred and forty-nine consecutive breast biopsies in Ibadan, Nigeria

OBJECTIVE

To study the outcomes of one hundred and forty nine consecutive breast biopsies in both male and female patients in one arm of the general surgery division of the department of surgery, university college hospital Ibadan.

METHODOLOGY

A retrospective study of the case files and histopathology reports of 149 patients who had biopsies of the breast from May 1996 to September 2004.

RESULTS

The study showed that below the age of 30 years, there was no malignancy detected in 85 breast biopsies, however as the age increased it was seen that less than one out of four biopsies were malignant when the patients were aged between 31 and 40 years, rising to one out of four biopsies for the 41-50 and 51-60 age-groups. The 61-70 yielded roughly one out of three whilst two out of three breast biopsies were malignant in the 71-80 age-groups.

CONCLUSIONS

Majority of breast lumps are benign and women have a probability of one chance in 10 that their biopsies may be malignant. However under 30 years this is unlikely. Above the age of 40 years the chance of malignancy rises to a one in four which will strongly support screening methods for women above 40 years. For record purposes, fibroadenoma is still the most common breast lesion in women under 30 years and invasive ductal carcinoma is the most common histopathological type of breast cancer in Ibadan, Nigeria.

Preventable trauma deaths in Ibadan: a comparison of revised trauma score and panel review

BACKGROUND

The proportion of preventable trauma-related deaths may be a reflection of the quality of trauma care in a health institution.

OBJECTIVE

To classify mortality in trauma patients in the emergency room and to determine the proportion of preventable trauma related mortality in a teaching hospital.

METHODS

The records of patients who died in the emergency room following trauma from January 1996 to December 2005 were reviewed. Data extracted from the patients' records included the demographics, the mechanism of injury; and the duration of injury prior to presentation. The Probability of Survival (Ps) was calculated for each patient using the Revised Trauma Score (RTS). The RTS includes three physiologic parameters namely the Glasgow Coma Score [GCS], systolic blood pressure and respiratory rate which were recorded soon after the patient' presentation at the emergency department.

RESULTS

There were 286 patients who died following trauma from January 1996 to December 2006. There was a male: female ratio of 3.4:1. Eighty-one percent were preventable deaths based on the revised trauma score while the panel review considered approximately 22% as preventable. Fifty-nine percent or 168 of the patients arrived in the hospital within six hours of sustaining injury.

CONCLUSION

Despite access to emergency care within the first six hours (golden hours) the overall survival of our trauma patients is poor. The severity of the injuries, inadequate resuscitation, and missed injuries by medical personal are some of the factors associated with poor outcome of trauma care.

End-stage renal disease in Nigeria: an overview of the epidemiology and the pathogenetic mechanisms

There is paucity of information on the magnitude of the burden of renal disease in our environment. Obtaining accurate data is hampered by the poor socioeconomic status of most patients with lack of access to specialized care in tertiary institutions, where most of the data is generated. The incidence of chronic renal failure (CRF) and end-stage renal disease (ESRD) in any specified area is known to be influenced by the prevalence of specific disease entities resulting in CRF. Hypertension, glomerulonephritis (GN), sickle cell disease, quartan malaria nephropathy, urinary tract schistosomiasis and other parasite-related forms of chronic GN are known to contribute significantly to the incidence of CRF in Nigeria. As is the situation in other parts of the world, diabetic nephropathy appears to be of increasing importance in the causation of ESRD in Nigeria. Even though the underlying cause of renal disease can often not be treated, extensive studies in experimental animals and preliminary studies in humans suggest that progression in chronic renal disease may largely be due to secondary factors, attention to which may be important in the prevention and/or control of renal disease.

Recurrent nasal polyp and pansinus mucopyocele associated with bilateral blindness: a case report

A 39 year old female with 24-month history of recurrent mucoid rhinorhea associated with progressive bilateral nasal blockage, headache, anosmia and bilateral impaired vision is reported. There was a past history of sinus surgery. The neuro-ophthalmic examination revealed left non-axial proptosis and visual acuity of nil light perception in both eyes at 3 meters. CT scan of the paranasal sinuses and brain showed markedly expanded left frontal sinus with sclerotic walls and expanded mixed density lesion in all the sinuses. She had surgery via trans-nasal, external and skull base approaches for effective clearance of the polypoidal masses and drainage of the sinus mucopyocele. Histological examination confirmed chronic inflammatory polyp. She remains stable to date although visual impairment and anosmia remained persistent. Patients with nasal polyposis require frequent follow-up even after surgical treatment for the early detection and management of complications to avoid consequences such as visual loss.

Intussusception and volvulus secondary to jejunal adenocarcinoma in an adult Nigerian male: a case report

A 31 year-old Nigerian man with jejuno-jejunal intussusception with the lead point being an adenocarcinoma complicated by small intestinal volvulus is presented. The subtle clinical features of an underlying small bowel malignancy were masked by the overwhelming clinical and radiological features of intussusception. rare case is reported to remind clinicians to have an increased index of suspicion of malignancy in patients who present with the usual features of chronic anemia, weight loss and loss of appetite with an intra-abdominal mass. The presentation of acute intestinal obstruction, with mesenteric vein thrombosis probably due to intussusception or volvulus should not however lower the suspicion. Histological evaluation of surgical biopsies is of immense importance.

Pattern of tuberculous lymphadenitis diagnosed by fine needle aspiration cytology at the University College Hospital, Ibadan, Nigeria

Nigeria currently carries a high burden of tuberculosis, with an associated increasing incidence of extrapulmonary tuberculosis, with the lymph node being one of the most frequently affected sites. This 10 year (1996-2005) retrospective study was carried out to determine the prevalence of tuberculous lymphadenitis in patients at the Fine Needle Aspiration Cytology Clinic of the Department of Pathology, University College Hospital, lbadan, Nigeria. In all, a total of 1,120 lymph node aspirates were examined, out of which 285 (25.45%) were reported as tuberculous lymphadenitis. One hundred and forty-eight (51.9%) were males while 137 (48.1%) were females. The age group of 10-19 years had the highest prevalence of 80 (28.1%), followed by those of 0-9 years with 75 (26.3%) and 20-29 years with 62 (21.8%). The cervical lymph nodes were the most affected sites (63.9%) followed by the supraclavicular (7.7%); submandibular (5.6%); the least affected sites being the clavicular and axillary nodes. The study concludes that tuberculous lymphadenitis is a common clinical presentation in Ibadan and it usually affects children, adolescents and young adults; with the cervical group of lymph nodes being the most commonly affected site.

Correlation of cervical cytology and visual inspection with acetic acid in HIV-positive women

The prevalence of squamous intraepithelial lesion is higher among human immunodeficiency virus (HIV)-positive women. These lesions when they occur in these patients are also more difficult to treat. A total of 205 consenting HIV-seropositive women were recruited. A cervical cytology (Pap smear) was taken, followed by visual inspection with freshly prepared 5% acetic acid and cervical biopsy taken from the squamocolumnar junction as the reference for diagnosis to avoid verification bias. The sensitivity of VIA was 76.0% (95% CI 52.0-91.0); specificity 83.0% (95% CI 77.0-88.0); positive predictive value 34.0% (95% CI 21.0-49.0). The sensitivity of cervical cytology (Pap smear) was 57.0% (95% CI 34.0-77.0), specificity of 95.0% (95% CI 90.0-97.0), and positive predictive value of 55.0% (95% CI 33.0-75.0). In HIV-seropositive women, the sensitivity of VIA is 76.0%, making it a useful screening test for preinvasive lesion of the cervix in low resource settings.

Primary malignant bone tumours in Ibadan, Nigeria: an update

Bone tumours are relatively rare compared to tumours of other sites. The frequency of primary malignant bone tumours is low in our environment, as was observed in an earlier study. The aim of this study is to update the information available on the pattern of primary malignant bone tumours at the University College Hospital (UCH), Ibadan, Nigeria. The medical records of 49 patients with malignant bone tumours documented in the Cancer Registry of UCH, Ibadan between January 2001 and September 2007 were reviewed retrospectively. The results were then added to those of the previous study published in 2002. This brought the number of cases of primary malignant bone tumours to 163 from January 1977 to September 2007. Primary malignant bone tumours represented 0.53% of the 30462 cases of cancer seen in the hospital in the period studied. The male female ratio was 1.5:1. About 44% of the tumours occurred among patients less than 20 years of age. Osteogenic sarcoma was the commonest malignant bone tumour. Important changes recorded in the seven years since the last review from this centre include; a rise in the prevalence rate of primary malignant bone tumours (49 new cases in the last seven years as compared to 114 cases over 23 years), the male-female ratio of Osteogenic sarcoma showed a decline (1.5:1 as compared to 1.6:1), and there was an increase in the prevalence of primary malignant bone tumours in the 0-9 years and > 60 years age groups. The significance of these findings will need to be determined by further studies.