Tropical Pathology

Histopathologic analysis of endometrial biopsies in a Northern Nigerian Teaching Hospital Murtala Abubakar, Balarabe Kabir, Almustapha Aliyu Liman, Sani Muhammed Shehu, Bilkisu Lawal Kankia, Anisa Yahya, Zainab Adamu Ali Annals of Tropical Pathology 2020 11(2):101-106 Background: Endometrial biopsy is a reliable means of evaluating the physiologic and pathologic states of the endometrium. The aim of this study was to examine the histopathological pattern of endometrial biopsies as seen in Zaria, Nigeria and to compare the results with similar studies elsewhere. Method: A retrospective analysis was carried out based on the records of the Department of Pathology, Ahmadu Bello University Teaching Hospital, Shika, Zaria between January 2014 and December 2018. The neoplastic lesions were classified according to 2014 World Health Organization classification for endometrial neoplasms. Results: A total of 1518 endometrial tissue samples were analysed. Pregnancy related conditions (41.76%) and functional endometrial changes (27.24%) were the most common morphologic diagnostic category seen. Endometrial hyperplasia (7.13%) was the most common pathologic lesion diagnosed. Of the malignant endometrial tumours, endometrial carcinoma is the most common with 29 cases (58% of all malignant endometrial lesions). One Hundred and Nine cases (7.2%) of the total cases reviewed were found to be inadequate for histopathologic evaluation. Conclusion: Retained product of conception was the most common morphologic entity seen in endometrial biopsy in Zaria. The proportion of endometrial samples that are inadequate for histopathologic evaluation is high. There is a need, therefore, for retraining of staff and standardization of biopsy procedures.

Seroprevalence and factors associated with risk of human brucellosis among febrile patients attending health-care facilities in Bauchi, North-Eastern Nigeria Hafiz Halilu, Fatima J Giwa, Saad A Ahmed, Mu'awiyyah B Sufiyan, Amina I Mohammed Annals of Tropical Pathology 2020 11(2):107-112 Background: Brucellosis is a neglected underdiagnosed zoonotic disease of worldwide distribution with varying symptoms similar to those occurring in other febrile illnesses. A recent screening survey conducted among butchers in Bauchi state reported a high prevalence of human brucellosis; however, its burden among patients with other febrile illnesses is unknown. We determine the seroprevalence and factors associated with risk of brucellosis among febrile patients attending health-care facilities (HCFs) in Bauchi metropolis, North-Eastern Nigeria. Methodology: We conducted a hospital-based descriptive cross-sectional study of 382 participants using a multistage sampling technique. Brucella antibodies were detected using Rose Bengal plate test, and a questionnaire was used to identify risk factors associated with human brucellosis. Data analyses were conducted using Epi Info version 7.0. Bivariate and multivariate analyses were conducted at P = 0.05. Results: Fifty-seven (14.9%) of the 382 febrile patients tested had Brucella antibodies. Males: female ratio was 1.1:1, and the mean age was 29.9 (standard deviation ± 12.03). Age, sex, occupational status, keeping animals, having ever milked an animal, handling animals during birth, and consuming unpasteurized milk or meat were found to be significantly associated with brucellosis on bivariate analysis. Conclusions: Up to 14.9% of the febrile patients attending HCFs in Bauchi metropolis had Brucella antibodies. Age, occupational status, consuming unpasteurized milk or meat, handling animals during birth, and lack of awareness on zoonosis remained independent predictors for brucellosis. Therefore, conducting routine serological screening tests for Brucella antibodies in all febrile patients presenting to HCFs will assist in its diagnosis and proper management.

Breast lesions in a district hospital: Demographic and histopathologic characteristics Kevin Nwabueze Ezike, Solomon Raphael, Ijeoma Ahunna Okwudire-Ejeh, Damian Ikechukwu Okonkwo Annals of Tropical Pathology 2020 11(2):113-118 Background and Aim: Breast cancer is increasingly the most common malignancy among Nigerian women. This study documents the demographic and histopathologic characteristics of breast lesions in a district hospital over a 5-year period. Patients and Methods: Data were collated from patients' request forms and duplicate copies of histology reports of all cases seen under the study period. Results: Breast lesions represented 13% of all histologically diagnosed lesions during the period of the study. Almost 98.6% of these breast specimens were received from females, with a female-to-male ratio of 58.9:1.0. The overall age range of the patients seen was from 10 to 96 years, with a mean of 33.3 ± 13.1 years at the time of presentation. There were 37 (4.4%) nonneoplastic breast lesions, 547 (65.3%) benign breast neoplasms (BBNs), and 254 (30.3%) malignant breast neoplasms (MBNs). The peak age incidence of MBNs was seen in the fifth decade (33.1%). The most common BBN was fibroadenoma (54.5%), followed by fibrocystic change (29.3%). The most common MBN was invasive ductal carcinoma (84.3%), followed by lobular and mucinous carcinoma, each accounting for 4.3%. About 77.1% of the breast carcinomas were Grade II. Conclusion: Breast lesions are common in our setting, strikingly more common in females, predominantly benign in nature with fibroadenoma which peaks in the 20–29 years age group being the most common variety. Invasive ductal carcinoma is the most common malignancy, affecting more women in their 40s with one of every three cases seen in women before their 40th birthday.

Indications and diagnostic utility of bone marrow aspiration cytology: A 12-year experience at a tertiary health center in Gombe, Northeastern Nigeria Saleh Yuguda, Ahmed Iya Girei, Kasim Mohammed Pindiga, Rufai Abdu Dachi, Aliyu Ibrahim Lawan, Yusuf Mohammed Abdullahi Annals of Tropical Pathology 2020 11(2):119-122 Background: Bone marrow aspiration (BMA) cytology is very important in the diagnosis and management of a wide range of both hematological and nonhematological disorders. It has several indications ranging from the evaluation of cytopenias to staging and assessment of remission in the course of management. Aim: The aim of the study was to determine the indications and diagnostic utility of BMA cytology at the Federal Teaching Hospital, Gombe, Gombe State, Nigeria. Methodology: A retrospective review of BMA cytology records performed at the department of Haematology and Blood Transfusion of the Federal Teaching Hospital, Gombe, over a 12-year period from January 1, 2006, to December 31, 2017. Results: A total of 596 BMAs were performed over the study period. The age ranges were from 2 months to 88 years, with a median age of 36 years. Majority of the patients were males (61%). The most common indication for the bone marrow examination was for the evaluation of recurrent anemia 32.2%, followed by presumptive diagnosis of leukemia 27.7%. Normal marrow finding constituted 4.7%, while the diagnosis was inconclusive in 4.2% of the cases. The most frequently diagnosed diseases are the nutritional deficiency anemia together accounting for about one-third of the cases (megaloblastic anemia 20.3%, combined deficiency anemia 9.9%, and iron deficiency anemia 2.5%) and leukemia. Conclusion: Anemia and leukemia are the most common indication for BMA, and nutritional deficiency anemia is the major BMA diagnosis in Gombe, Northeastern Nigeria.

Adherence to glivec (imatinib mesylate) therapy amongst patients with chronic myeloid leukaemia in Nigeria Charles Erhinyodavwe Origbo, Rahman A Bolarinwa, Anthony A Oyekunle, Temitope O Afolabi, Benedict Nwogoh, Muheez A Durosinmi Annals of Tropical Pathology 2020 11(2):123-127 Background: Adherence to Imatinib (Glivec®) is of critical importance in achieving optimal treatment outcomes in patients with chronic myeloid leukemia (CML). Objective: This study aims to investigate adherence to therapy and factors that could influence patient adherence to Glivec®. Methods: This is a prospective cohort study conducted at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. Seventy consenting newly diagnosed CML patients in the chronic phase were counseled on adherence to therapy and administered 400 mg/day dose of Glivec. Six months after commencement, they were evaluated for adherence using two structured self-administered questionnaires. The first one to evaluate adherence (Morisky Medication Adherence Scale) and the other was administered to identify factors known to influence adherence to therapy. Data were analyzed using SPSS version 21.0 Statistical package (2012, IBM Corp, Armonk, NY, USA.). Results: The study participants had a mean age of 38.4 ± 12.7 years. The male-to-female (male:female) ratio was 1.7:1. Thirty-three (47.1%) of the patients were classified as adherent. Family support was significantly associated with adherence (P = 0.012). The distance of >200 km away from the point of drug collection, OAUTHC, Ile-Ife was significantly associated with nonadherence to Glivec therapy (P = 0.008). Conclusion: This study found that adherence in patients on Glivec® therapy was <50%. Distance of >200 km and family support were significant determinants of adherence in this study.

Overexpression of human epidermal growth factor receptor 2 protein in urothelial carcinoma of the urinary bladder in Ibadan: A single-institutional experience Ebenezer O Fatunla, Mustapha A Ajani, Francis A Onakpoma, Augustine O Takure, Clement A Okolo Annals of Tropical Pathology 2020 11(2):128-132 Background: Overexpression of human epidermal growth factor receptor 2 (HER-2) protein has been shown to have both prognostic and therapeutic values in several malignancies including urothelial carcinoma of urinary bladder (UCB). Aims: This study aimed to determine HER-2 protein overexpression and evaluate its correlation with clinico-pathological parameters in UCB. Materials and Methods: This was a descriptive-analytical study involving the immunohistochemical review of all histologically diagnosed urinary bladder malignancy in the Department of Pathology, University College Hospital, Ibadan, between January 2002 and December 2016. Urinary bladder malignancies whose tissue blocks could not be found and/or demographic data were not available were excluded. Immunohistochemistry analysis was done using rabbit anti-HER-2 antibody (Biocare) and American Society of Clinical Oncology/College of American Pathologists guidelines established for breast cancer were used for HER-2 status scoring. The statistical analysis was carried out usingthe Statistical Package for the Social Sciences, version 22 (SPSS Inc, Chicago, Illinois, USA). Results: HER-2 overexpression was found in four (6.3%) cases. All the HER-2-positive cases were males. One (2.9%) of the 35 high-grade UCB showed positive HER-2 overexpression, whereas three (10.7%) of the 28 low-grade tumor were positive for HER-2 protein overexpression.There was no statistically significant association between HER-2 protein overexpression and histological grades of UCB and muscle invasion by the tumor. Conclusion: Our study demonstrated the low percentage of HER-2 overexpression in UCB with no significant association with tumor grades and muscle invasion. Larger samples involving multiple centers can provide more robust information and further evaluate HER-2 overexpression in urothelial carcinoma in our environment.

Antimicrobial activity of garlic (Allium sativum ) on selected uropathogens from cases of urinary tract infection Okunye Olufemi Lionel, Idowu Philip Adegboyega, Adeleke O Ezekiel, Babalola Caroline Olufunke Annals of Tropical Pathology 2020 11(2):133-138 Introduction: The etiologic agents of urinary tract infection (UTI) occur among both the Gram-positive and Gram-negative bacteria including those that exhibit resistance to commonly used standard antibiotics. Both the male and female individuals can be prone to developing UTI. Garlic (Allium sativum) has been associated with antibacterial activity, though with scanty reports on uropathogens. This study was, therefore, carried out to determine the antibacterial efficacy of aqueous and methanol extracts of garlic (A. sativum)in vitro against six uropathogens (Escherichia coli , Staphylococcus saprophyticus, Pseudomonas aeruginosa, Proteus spp., Klebsiella spp., and Serratia marcescens ) and a reference strain, E. coli ATCC-25922 . Materials and Methods: The bacterial isolates were collected from the Routine Microbiology Laboratory, University College Hospital, Ibadan, and were authenticated by Gram staining and some conventional biochemical tests. The isolates were then subjected to antimicrobial susceptibility testing against both the aqueous and methanol extracts of garlic. Phytochemical screening was also carried out on the plant. Results: Both aqueous and methanol extracts had maximum zones of growth inhibitions of 22 mm at 200 mg/mL and 25 mm at 200 mg/mL against E. coli, followed by P. aeruginosa with zones of growth inhibitions of 21 mm and 25 mm at the same concentration. Proteus spp., exhibited the lowest zones of growth inhibition of 16mm at 200mg/mL.and 10mm at 25mg/mL to methanol and aqueous extracts respectively. The minimum inhibitory concentrations MICs and MBCs of the aqueous and ethanol extracts of garlic varied for each organism. Escherichia coli had the MICs' of 100mg/mL and MBC of 220mg/mL while the MIC and MBC of the aqueous extract on the Proteus spp. are 100mg/mL and 320mg/mL respectively. The MBCs recorded were relatively higher in comparison to the MIC values. Conclusion: These findings showed that garlic could be of therapeutic use in the management of bacterial mediated UTI.

Analysis of argyrophilic nucleolar organizer region score and epithelial dysplasia in common odontogenic cysts seen in a university teaching hospital Oluseyi Folake Ajayi, Oladunni M Ogundana, Moses T Kolade, Onatolu Odukoya Annals of Tropical Pathology 2020 11(2):139-145 Aim: Carcinomatous transformation in odontogenic cysts (OC) lining may be more common than is generally appreciated. Thus, the aim of this study is to predict the potential for neoplastic transformation in the epithelial lining of OC using argyrophilic nucleolar organizer region (AgNOR) scores and degree of epithelial dysplasia. Subjects and Methods: A retrospective clinicopathological study was undertaken on OC histologically diagnosed over a 40-year period in a university teaching hospital in Southwestern Nigeria. Paraffin blocks of selected cases were retrieved and sectioned for hematoxylin and eosin and AgNOR stain. Evaluation of epithelial dysplasia was done using the WHO 2005 protocol. Estimation of atypical features and AgNOR scoring were done using modified and established protocols. Epi info and GraphPad InStat software packages were employed to manage the ensuing data. Results: The commonly observed OC was odontogenic keratocyst (OKC), which accounted for 44.5%, radicular cyst (RC) (24.2%), calcifying odontogenic cyst (COC) (12.7%), and dentigerous cyst (DC) (11.5%). Nuclear pleomorphism was the most common atypical feature and was present in 50% each of DC and COC, 42% of OKC, and 36% of RC. Drop-shaped rete pegs were rarely observed. A significant association was observed between the presence of moderate dysplasia and histologic type of OC (P = 0.022). Mean AgNOR scores per 100 cells was OKC (137.38 ± 35.82), RC (132.04 ± 34.22), COC and DC (119.00 ± 10.93) and (96.91 ± 38.88) respectively. This was not statistically significant (P = 0.218). Conclusions: As moderate epithelial dysplasia was more significantly associated with OKC than other cysts, it is concluded that the potential for malignant transformation is higher in OKC than other histologically categorized types of cysts.

Evaluation of lipid profile pattern among apparently healthy students of Niger Delta University Benedicta Erere Kasia, Victoria Y Nyondia, Promise O Oseajeh, Prohp The Prophet Annals of Tropical Pathology 2020 11(2):146-150 Background: Dyslipidemia constitutes a high risk of cardiovascular disease. Aim: This study was designed to evaluate the lipid profile pattern of apparently healthy students of Niger Delta University to detect any possible abnormality. Setting and Design: This was a cross-sectional descriptive study. Materials and Methods: A total of 102 apparently healthy students were studied. A convenient sampling technique was employed for willing participants. The studied group constituted 55 males and 47 females aged within 20–40 years. Relevant demographic data were obtained by a one-on-one interview with the participants. A blood specimen was collected for measurements of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) by standard assay methods. The data obtained were analyzed using SPSS 22.0, and the student t -test was performed at P < 0.05 for comparison of means. Results: The mean plasma TC and LDL-c values for males were significantly lower than females values of 3.865 ± 0.675 mmol/L versus 4.251 ± 0.851 mmol/L and 2.38 ± 0.49 versus 2.64 ± 0.64 with P = 0.012 and 0.023, respectively. Similarly, the mean plasma HDL-c and TGs for males were lower than female values of 1.126 ± 0.190 mmol/L versus 1.194 ± 0.224 mmol/L and 0.77 ± 0.20 versus 0.82 ± 0.27 with P = 0.099 and 0.27, respectively which were not statistically significant. The age group of 24–27 years constituted the highest mean values and the age group of 28–40 years constituted the least mean values for all the studied parameters. These values, however, did not differ statistically. Most of the participants had significantly within low-normal reference range values. Conclusion: These findings revealed within normal lipid profiles for most subjects.

Peritrabecular clefting in differentiating ossifying fibroma from fibrous dysplasia of the jaws Adetokunbo B Olawuyi, Olajumoke A Effiom, Sunday Omilabu, Onatolu Odukoya Annals of Tropical Pathology 2020 11(2):151-156 Context: Fibrous dysplasia (FD) and ossifying fibroma (OF) are the most prevalent fibro-osseous lesions in Nigerians and present with overlapping clinical, radiological, and microscopic features, resulting in diagnostic challenges for the pathologist and surgeon. Aims: The objectives of this study were to differentiate between FD and OF using clinical features, radiographic features, growth rate, and microscopic method to evaluate the prevalence of peritrabecular clefting. Settings and Design: Random sampling was used to select the sample size of 30 for each lesion from cases diagnosed from 1994 to 2014 in the oral biopsy service of Lagos University Teaching Hospital. Subjects and Methods: Hematoxylin and Eosin sections were prepared from retrieved blocks of FD and OF which had been blinded. Each section was divided into four quadrants, largest vertical and horizontal dimensions of cleft surrounding five trabeculae in each quadrant were measured with ocular grid and multiplied to project an estimation of area of each cleft. Data retrieved on clinical and radiographic information were statistically compared to differentiate between the lesions. Statistical Analysis Used: Statistical Package for the Social Sciences for Windows (version 16.0, Chicago, IL, USA) was used. Results: In the study, 77% of FD had clefts, none was seen in OF. This difference was statistically significant P = 0.001. Ill-defined radiographic borders occurred in 60% of FD, well-defined borders occurred in 81% of OF. In lesions with mixed radiolucency and radiopacity, an association was established between border definition and type of lesion. P = 0.02122. Conclusions: Peritrabecular clefting was observed in 77% of FD, while this feature was not observed in OF and could therefore serve as a reliable parameter to differentiate the lesions.

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