The practice of hepatocellular cancer surveillance in Nigeria

Background: Hepatocellular cancer is a disease of global and public health importance due to the widespread distribution of risk factors and associated high case fatality. Hepatocellular Cancer (HCC) in Sub-Saharan Africa is commonly seen among the younger age groups (<45 years) who present mostly in the terminal stage, when the disease is not amenable to any curative therapy. Hepatocellular Carcinoma surveillance employs the use of simple, cheap and readily available investigations, to detect early curable cancer in individuals with risk factors for HCC.Objectives:The aim of this study is to assess the practice of hepatocellular cancer screening among physicians.Methodolgy:This is a nationwide online survey carried out among physicians who care for patients with HCC. A questionnaire was sent out via a web link to all consenting doctors in Nigeria. The responses were collated in a cloud-based application and data was analysed using Epi-info version 20.Results:Atotal of 218 respondents, 142 were males (65.1 %) with a mean age of 37.6 ± 5.7 years. The modal age group was 31-40 years 153 (69.5%). The main factors considered as a hindrance to surveillance were; the cost of the tests (57.7%), failure of return of patients (50.5%) and not being aware of a surveillance program (45.2 %). The majority of the respondents were Gastroenterologists and Family Physicians. 54% of the gastroenterologists and 64% of the family physicians have never offered HCC surveillance to their patients.Conclusion:This survey highlights a knowledge gap in HCC surveillance among physicians. There is a need to make HCCsurveillance a daily routine among patients at risk by all physicians. Keywords: Surveillance, Hepatocellular Carcinoma, HBV, HCV, Cancer screening

Cystic poorly differentiated nephroblastoma: A case report and review of literature

Background: Cystic poorly differentiated nephroblastoma (CPDN) is a rare variant of nephroblastoma which follows a benign clinical course. Case diagnosis/treatment: In this report, we document a case of CPDN in a 2 year old boy who presented with recurrent gross painless hematuria and progressive abdominal distension. Abdominal ultrasound showed a multicystic lesion and CT scan features of Stage III Wilms tumour. Nephrectomy was done after two cycles of chemotherapy according to the SIOP Nephroblastoma therapeutic protocols. Histology showed blastemal cells in the wall of only one of the cysts, with no solid expansile nodules. The patient had to have five more cycles of chemotherapy and also radiotherapy for residual tumour. Conclusions: Surgery is curative in Stage I CPDN and adjuvant therapy is not required. Adequate sampling is critical to ensure accurate diagnosis and appropriate management. We suggest that a minimum of 2–3 tissue sections should be taken per centimetre of tumour diameter. Related entities including cystic nephroma, cystic Wilms tumour and completely necrotic nephroblastoma are discussed in the differential diagnosis

Female malignant breast lesions: the Lagos University Teaching Hospital experience (1999–2013)

Background: Breast cancer is the most common cancer in women worldwide and its incidence has been on the increase. Nigeria is no exception to this trend.Objectives: The aim of this study is to review malignant breast lesions seen in the Lagos University Teaching Hospital over a 15yr period (1999-2013) with a view to determining the variety of histopathologic types seen, as well as to determine the molecular characteristics of a smaller cohort of these lesions with immunohistochemistry using a panel of 5 antibodies on tissue microarray.Methods: The histopathology reports of breast lesions seen in the Anatomic and Molecular Pathology department of LUTH between 1999 and 2013 were retrieved, reviewed and analysed to determine the frequency of malignant breast lesions seen over the past 15yrs. Representative tumour slides and paraffin blocks of a smaller cohort of 115 consecutive cases seen in the last three years of the study were retrieved, reviewed and jointly scored by a Nigerian pathologist (AOD) and a UK specialist breast pathologist (AM) following the RCPath guidelines. Representative tumour areas were selected on the slides and marked on the corresponding paraffin block for tissue microarray (TMA) construction. TMA sections were stained for ER, PR, HER2, CK5 and E-cadherin.Results: A total of 4450 breast biopsies were studied; 22.3% of these neoplasms were malignant; 97.9% of all malignant breast lesions were epithelial in origin. Invasive ductal carcinoma of no specific type (IDC, NST) was the predominant histologic type accounting for 86.6%. Ductal carcinoma in situ (DCIS) and lobular carcinoma were seen in 3.2% and 1.5% respectively. A mixed ductal and lobular pattern was seen in 1.4%. Mucoepidermoid carcinoma, carcinoid tumour, and papillary carcinoma were rarely recorded, accounting for 0.1%, 0.2% and 0.4% respectively. In the smaller cohort of 115 breast cancer cases with immunopheno typing carried out , immunohistochemical staining revealed 24.4% oestrogen receptor (ER) positivity, 13.9% progesterone receptor (PR) positivity and 5.2%, human epidermal growth factor receptor-2 (HER2) positivity (score of 3+), 4.3% were equivocal ( 2+). Thirty-five percent of tumours were triple negative breast cancers (TNBC)and 52.5% of these were CK5 positive suggesting a basaloid phenotype.Conclusion: Malignant breast lesions, form about a quarter of all breast lesions seen in our laboratory, Majority (86.6%) are IDC, NST. A relatively high proportion (35%) of the immunophenotyped cohort consisted of TNBCs and about half of these had a basal phenotype (CK5+). More markers of the basal phenotype will be required to make a definitive statement on the proportion of TNBCs that have a basal phenotype.Keywords: Breast cancer, histopathologic pattern, immunohistochemistry, basal phenotyp

A review of breast cancer pathology reports in Nigeria

Background: Diagnosis and treatment of cancer rely heavily on imaging, histopathology and molecular information. Incomplete or missing tumour information can hinder the delivery of high-quality care in oncology practice, especially in resource-limited countries. To evaluate the completeness of histopathology reporting in a real-world setting and identify areas for future cancer care delivery research efforts, we retrospectively analysed reports from patients diagnosed with breast cancer who received care at a high-volume oncology department at a hospital in Lagos, Nigeria. Methods: Demographic, institutional and histopathology characteristics were retrospectively obtained from 1,001 patient records from 2007 to 2016. Completeness was defined as reporting five tumour features (tumour histology, tumour grade, laterality, oestrogen receptor (ER) or progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2)) for biopsy specimens and seven tumour features (tumour size, tumour histology, tumour grade, laterality, ER/PR, HER2 and lymph node involvement) for surgical specimens. Results: The mean age of patients was 48.6 -11.7 years with a predominantly female population (99.3%). A majority of pathologic reports were produced after 2011, and two-thirds of the reports originated from centres or labs within Lagos, Nigeria (67.7%). Most reports documented primary site (98.0%) and specimen type (85.0%) while other characteristics were less often recorded. This led to substantial variation in reporting between biopsy (13.4%) and surgical (6.1%) specimens for an overall low pathology report completeness <10%. Conclusion: The majority of patient records analysed lacked complete documentation of breast cancer histopathological characteristics commonly used in oncology practice. Our study highlights a need to identify and address the contributing factors for incomplete histopathological reporting in Nigeria and will guide future clinical programmatic developments. Copyright:Scopu

Comparative studies of genotoxicity and anti-plasmodial activities of stem and leaf extracts of Alstonia boonei (De Wild) in malaria-infected mice

Drug resistance in malaria infection is a serious public health challenge. Thus, scientific search for alternative treatment measures among the local medicinal plants is exigent. We therefore investigated the anti-plasmodial efficacy and genotoxicity of the methanolic leaf and stem extracts of Alstonia plant at varying concentration (200 mg/kg, 400 mg/kg and 600 mg/kg) in mice infected with chloroquine sensitive Plasmodium berghei. The phytochemical screening of the extract revealed that leaf sample contained significantly higher secondary metabolites, except saponins (p&lt;0.05). Anti-plasmodial activities of the two extracts were duration and dose- dependent. Stem bark extract showed higher curative potential with inhibition rate of 56.71% at 400 mg/kg whereas, leaf extract was efficient at 600mg/kg with 52.15% inhibition rate. Stem bark extract at 400 mg/kg improved the enzymatic activities of the mice; it lowered serum ALT (6.88±4.42) and increased liver ALT (41.07±5.56). Similarly, 400 mg/kg leaf extract showed highest AST (70.65±4.00) and ALT (44.65±7.83) activities in the kidney and liver respectively. Analysis of genotoxicity revealed that micronucleus and abnormal (binucleated, notched and blebbed) were prevalent among the experimental mice which increased significantly (p&lt;0.05) at all concentrations except at 600mg/kg leaf extract. Therefore, this present study indicates that both leaf and stem bark extracts of A. boonei possess anti-plasmodial activity and are less genotoxic when compared with standard drug.Keywords: Genotoxicity; Plasmodium berghei; metabolites; micronucleus; blebbed; standard dru