The use of special stains in liver biopsy interpretation: Implications for the management of liver disease in Nigeria

Context: The evaluation of a liver biopsy requires the use of stains other than routine hematoxylin and eosin (H and E) to highlight many important features.Aims: Most Nigerian Histopathology Departments do not routinely perform special stains (personal communication by authors). This study aims to re‑evaluate a set of liver biopsies which has been diagnosed solely on H and E stains by performing a standard set of special stains on them.Settings and Design: This is a retrospective analysis.Materials and Methods: The formalin fixed paraffin embedded blocks of liver biopsies reported in two histopathology laboratories between 2008 and 2013 were retrieved. These were stained with H and E and the following standard special stains for liver tissue histology – Perl’s Prussian blue, reticulin, Sirius red, Shikata orcein, and periodic acid‑Schiff with diastase. The stained slides were re‑analyzed.Statistical Analysis Used: No formal statistical analysis was performed, but results are summarized and tabulated by summary statistics, where appropriate.Results: Seventy‑four liver biopsy paraffin blocks were received in the laboratories. Fifty‑three (71.6%) were suitable for analysis out of which 51 (68.9%) had their clinical details retrievable. In 29 cases (56.9%), Perl’s stain was positive for iron pigment within the hepatocytes with 17 (58.6%) of these being Grade 1, 7 (24.1%) Grade 2, and 5 (17.2%) Grade 3. Shikata orcein revealed hepatitis B viral surface antigen in 15 (29.4%) of the cases while copper‑associated protein was demonstrable in 6 (11.8%) of the cases. The discovery of stainable iron implies some degree of disturbance of iron metabolism, and a Grade 3 stainable iron requires investigation for genetic hemochromatosis. The demonstration of copper‑associated proteins suggests biliary disease in a noncirrhotic liver which also requires further investigation.Conclusion: This study confirms the need to routinely perform special stains in reporting liver biopsies to fully investigate and manage patients and their relatives.Keywords: Biliary disease, iron overload, liver biopsy, special stain

Idiopathic Pulmonary Calcification and Ossification in an Elderly Woman with a Missed Diagnosis of Subarachnoid Haemorrhage

This is a case of idiopathic pulmonary calcification and ossification in a 70 year old with long-standing diabetes and hypertension. Thirteen years prior to her demise, she was first noticed to have multiple calcific deposits in her lungs on a chest X-ray film. She had no risk factors for soft tissue calcification and ossification. Histology of tissue from autopsy showed intraparenchymal pulmonary calcification and ossification with marrow elements. Idiopathic pulmonary calcification and ossification is rare. At autopsy, she was also found to have had bilateral subarachnoid haemorrhage (SAH), a diagnosis missed during clinical evaluation. We highlight the pertinent details in our patient’s management that could have helped to prevent a missed diagnosis of SAH. Even though SAH occurs most commonly following head trauma, the more familiar medical use of SAH is for non-traumatic SAH occurring following a ruptured cerebral aneurysm. This patient had notable risk factors for cerebral aneurysm formation but an aneurysm was not identified at autopsy. The location of the blood high on the cerebral convexities further suggests a traumatic origin rather than a ruptured aneurysm. Heterotopic calcification and ossification (HO) is known to occur in the setting of severe neurologic disorders such as traumatic brain injury but the fact that the lung calcification in our patient predated the brain injury by over 10 years makes it unlikely for the HO to have been due to the brain trauma. Other organ pathologies found at autopsy include chromophobe renal cell carcinoma, renal papillary necrosis, lymphocytic thyroiditis, and seborrheic keratosis.Keywords: Idiopathic pulmonary calcification and ossification, traumatic subarachnoid haemorrhage

Surgical consideration for benign bone tumors

Background: The surgical management of symptomatic benign bone tumor has been described in various manners in medical literature. However, there are few published reports on the presentation and surgical management of benign bone tumors in black African patients.Objectives: To determine the pattern of presentation of benign bone tumors and evaluate the common indications for surgery in a Nigerian Orthopedic Center.Materials and Methods: This is a prospective study of 67 patients, surgically treated for benign bone tumors, over a three-year period, at the National Orthopedic Hospital, Lagos, Nigeria.Results: The common histological types include, osteochondroma, giant cell tumor, and the simple bone cyst. These tumors have varying anatomic locations, but are more commonly located around the knee joint. In this series, most of the patients have presented with an active or aggressive stage of the disease. The most common indication for surgery is painful swelling; other indications include a pathological fracture, restricted range of movement, and peripheral nerve compression. The surgical procedures performed are simple excision, curettage, and stabilization; and 1-stage and 2-stage wide resection with reconstruction. Patients with significant bone defects have autologous bone grafting or methylmethacrylate cement application. Further stabilization is achieved with intramedullary or compression plate and screw fixation. Amputation has only been necessary in one patient with a huge aneurysmal bone cyst. At the average follow-up period of 28.6 months, five patients showed recurrence. All were with a histological diagnosis of giant cell tumor.Conclusions: The mode of presentation of benign bone tumors in this group of black African patients is heterogenous, demanding various surgical options. Limb sparing is a largely feasible option, but the recurrence rate is particularly higher for giant cell tumors. Increase in the number of patients presenting with giant cell tumors raises the possibility of an increase in the incidence of this condition in the black African population. Larger multicenter studies in the black African population may shed more light on the actual incidence of giant cell tumors and other bone tumors in this group of patients

Trends in acute emergency room hypertension related deaths: An autopsy study

No Abstract

Immunophenotypical categarization of omental and liver metastatic tumours in Lagos, Nigeria

No Abstract

Childhood Renal Neoplasms in Lagos Nigera- A 28 Year Review

Out of 131 nephretomies received at the Morbid Anatomy Department of the Lagos University Teaching Hospital, there were 63 cases of childhood renal cancer representing 48% of total renal neoplasm seen over a period of 1970-1997. The ages range from 21/2 months - 11 years; over 75% of the cases were found under 5 years with only 3.2% occurring above 10 years. The male female ratio is 1:1. Of the cancers, there were 42 cases of classical nephroblastoma and 10 cases of the blastema type of nephroblastoma. We had 7 cases of purely sarcomatous nephroblastoma one of which is a rhabdomyosarcoma and the remaining 6 were undifferentiated sarcoma. There was one case of anaplastic carcinoma. Also seen was a case of mesoblastic nephroma in a 21/2 months male infant. In this study, neither benign neoplasm nor congenital tumour (angiomyolipoma) was encountered, in all cases, there was no age nor sex disparity. Most of the patients presented with abdominal mass with a unilaterally enlarged kidney, abdominal pain, haematuria and weight loss. All of them had nephrectomy as initial treatment followed by radiotherapy and chemotherapy. Nigerian Quarterly Journal of Hospital Medicine Vol. 9, No. 1 (1999) pp. 4-

Surgical Pathology of the Appendix in a Tropical Teaching Hospital

Acute appendicitis is the most common cause of acute surgical abdomen requiring emergency surgery both in developed and developing countries. Appendicectomies in patients presenting with clinically suspected acuteappendicitis show a diversity of pathologies. The aim of this study is to evaluate the frequency and types of pathologies seen in appendicectomy samples in Lagos. This is a retrospective histopathological review of slides and paraffin embedded blocks of all appendicectomies received from within and outside the Lagos University Teaching Hospital. The clinical data such as the age, sex and clinical summary were extracted from the request forms. A total of 299 cases of appendicectomies were received during the 8-year period representing 1.7% of all biopsies. There were 164 males and 135 females with M: F ratio of 1.2:1. The ages ranged between 2months and 70years with a mean of 24.2 (SD-12.9). One hundred and eighty-seven out of 266 cases removed for suspected acute appendicitis (70.3%) showed histological evidence of acute appendicitis, 57(30.5%) of which had perforated. Fourty-eight cases (19%) showed reactive lymphoid hyperplasia, 11(4%) had evidence of extra-appendiceal peritonitis. Negative appendicectomy was recorded in 27/ 266(10.2%) Unexpected pathologies such as granulomatous inflammation and neoplasticlesions were recorded in 6 cases (2%). In conclusion, diagnostic accuracy of appendicitis, perforation rate and negative appendicectomy rate in Lagos are comparable with what has been reported in other parts of the world. Other unexpected pathologies were present in 2% underscoring the need for routine histopathological examination of all appendiceal samples

Fibula head tumours

No Abstract.Nigerian Journal of Surgical Sciences Vol. 18 (1) 2008: pp. 54-5

Tuberculosis Revisited - a review of surgical biopsies and autopsy speciments (1992-1996)

Nigerian Quarterly Journal of Hospital Medicine Vol.10(2) 2000: 126-12