Adult Squamous Cell Carcinoma of The Scrotum in HIV Positive Patients in Nigeria

Squamous cell carcinoma of the scrotum (SCCS) is rare, particularly in West Africa. It usually affects males older than 60 years. Although it was the first cancer to be linked to environmental factors, the mechanism of action of these risk factors is still not completely understood. We reporton 4 men who presented with SCCS at our centre during a 20-month period. Three patients were relatively younger (mean age 43 years) and tested positive for human immunodeficiency virus (HIV) infection. They had no history of exposure to any known risk factor for SCCS. Thus, it seems that SCCS may occur in younger men who have HIV infection.Key Words:   Squamous cell carcinoma, scrotum, HI

Autopsy study of prostatic weight and lesions in LUTH: a 12 month prospective study

Background: Diseases of the prostate are common among adult Nigerians with some, clinically asymptomatic during life.Objective: The study is to determine the prostatic weight and document the histopathologic patterns, frequency, and age distribution of clinically asymptomatic prostatic lesions seen at autopsy in LUTH, Lagos, Nigeria over a 12 month period (January to December 2009).Methods: Consisted of hospital case files and prostate glands harvested en bloc from all autopsies in men aged 20 years and above who died of other causes other than clinically diagnosed prostate disease in LUTH within the study period. After en block removal, the prostate glands were fixed in formalin, weighed, sectioned at 3-5mm intervals, processed and embedded in paraffin. Whole mount serial sections were stained with H& E and examined.Results: Only 145 prostate glands were suitable for histological evaluation. There was an increasing prostatic weight with age. The distribution of identified prostatic lesions showed 75(51.7%) having no histological diagnosis. Acute and chronic prostatitis accounted for 2 (2.9%) each, benign prostatic hyperplasia alone, 52 (74.2%) while benign prostatic hyperplasia (BPH) associated with chronic prostatitis accounted for 7 (10%). Latent prostate cancer was found in 7 (10%) of the cases.Conclusion: Prostate weight increased with age. Acute prostatitis was found to be commoner in the younger age groups, particularly below 50 years while chronic prostatitis was seen more in the older men and was largely associated with BPH. BPH was found to be the commonest lesion. Latent carcinoma showed a prevalence of 10%, which is significant and in keeping with similar studies done elsewhere.Keywords: BPH, Prostate cancer, prostatiti

Glomus tumours of the Hand in Lagos, Nigeria

Background: Glomus tumours of the hand are uncommon intriguing tumours which cause significant morbidity. Few reports have documented the epidemiology and presentation in the West African subregion. The aim of this review is to identify the common baseline demographics, the presentation, evaluation, diagnosis and treatment outcome of glomus tumours of the hand in Lagos, Nigeria Methods: A 10 year retrospective review of the records of all patients seen with histopathologically diagnosed glomus tumor of the hand at the Lagos University teaching hospital was carried out noting the biodata, demographics, method of presentation and treatment of this condition. Results: 11 patients were seen over the study period .There were nine females and 2 males seen. The mean age of the patients was 41 years. The symptoms had been on for between 3 and 40 months .All patients seen had a positive Love test. Only one patient had associated bony erosion. All had complete excision with no recurrence at 6 months Conclusion: Glomus tumor of the hand is an uncommon tumour often occurring in adult women. Clinical test (Love “test”) will correctly identify the diagnosis. Surgical treatment was curative in all our cases. High index of suspicion is needed to make earlier diagnosis

Morphological Pattern of Childhood Solid Tumours in Lagos University Teaching Hospital.

Background: There is a wide variation in the incidence of childhood tumors world wide. The relative incidence of childhood tumors in developing countries is increasing and might add significantly to the high childhood morbidity and mortality caused by infectious diseases. There is need to determine the incidence of childhood cancer in different centers of the country and contribute to the National cancer register Objective: The aim of this study is to determine the burden and patterns of childhood tumour in our environment. Methods: A retrospective review of histologically diagnosed cases of childhood tumours seen from January 2000 to 2007 from the records of the department of Morbid Anatomy of the Lagos University Teaching Hospital (LUTH), Nigeria was carried out. All the cases were analyzed for age and gender distribution as well as histological types Results: Malignant tumours constituted 30.50% of the tumours of which retinoblastoma is the most common. The most common benign tumour was fibroadenoma accounting for 36.2% of all benign tumours. The female to male ratio for malignant and benign tumours are 1:1 and 1:1.3 respectively. The peak age incidence was 11 – 15 years for benign and 1 – 5 for malignant tumours. . Conclusion: The study showed decrease in the annual incidence of childhood tumours in Lagos. There was however no difference in the pattern when compared with other centers in Nigeria and in other African countries.Keywords: Morphology, Pattern, Childhood, Solid tumour

Comparative Efficacy of Bromelain and Ascorbic Acid in the Healing of Acute Crush Achilles tendon Injury: A Preliminary Study

Background: Ascorbic acid (AA) has been reported to stimulate tenocyte proliferation and increase collagen synthesis in healing tendons. Bromelain, an enzyme from the pineapple plant has also been suggested to augment tendon healing though it has been reported to be associated with blood clotting and gastrointestinal disturbances.Objective: This study compared the effects of Bromelain and Ascorbic acid (AA) on tenocyte proliferation and oxidative stress level in the early stage of healing in a crush injury to the Achilles tendon of Sprague-Dawley rats.Methods: Twenty four male rats all had induced crush injury to the left Achilles tendon and were divided randomly into three groups. Group 1; no treatment, Group 2; oral Bromelain and Group 3; AA. Bromelain was given at a dosage of 7mg/kg body weight and Ascorbic acid at a dosage of 1.4mg/kg body weight daily over the first 14 days post-injury. On the 15th day post injury, the animals were sacrificed and the tendons excised and processed for histological studies and Malondialdehyde (MDA) assay.Results: Results showed a significant proliferation of tenocytes in the Bromelain treated group compared with the control and AA groups (p<0.05). There was however no significant difference in the MDA level among the three groups (p>0.05). The bromelain and AA treated tendons groups had better organized bundles of collagen fibres with few tenocytes indicating an advanced healing response compared with the control group.Conclusion: Based on this study, both Bromelain and AA are capable of augmenting the healing of acute tendon injuries. However, because of the documented effects of Bromelain on blood clotting and GIT disturbances, AA may be a better option to consider in the management of acute tendon injuries.Keywords: Bromelain, Tenocyte proliferation, Tendon injury, Ascorbic acid, MD

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

Adult renal cell carcinoma in Lagos: Experience and challenges at the Lagos University Teaching Hospital

Introduction: Renal cell carcinoma (RCC), regarded as the most lethal of all urological tumors, is relatively uncommon. Recent reports from developed countries indicate a rising incidence, most likely from the increasing availability of imaging services leading to an increase in incidental diagnosis of early stage tumors, with consequently better prognosis. However, literature on RCC in sub-Saharan Africa is relatively sparse. Objectives: To determine the prevalence, presentation, pattern and outcome of RCC at the Lagos University Teaching Hospital. Methods: Information extracted from the records of 64 adult patients with RCC seen in our institution between January 2000 and December 2010 included the age and sex of the patient, clinical features, investigations, tumor stage, treatment, outcome of management and follow-up. Results: The mean patient age was 41.8 years (range 20–75 years) with a male:female ratio of 1:1.7. Flank mass, flank pain and hematuria were present in 90.6%, 86% and 40.6% of patients, respectively, while 36% of patients had the classical triad of loin pain, loin mass and hematuria. Only 1 patient (1.6%) had an incidental diagnosis. TNM tumor stages T3 and T4 accounted for 93.7% of patients, while the clear cell type accounted for 60% of histologically examined cases. Forty-five patients (70.3%) had surgical intervention. Of the T2 patients available for follow-up, 50% were alive at 48 months, while all inoperable T4 and M1 patients available for follow-up were dead within 1 year. Conclusion: RCC in our environment is characterized by a younger age at presentation, a female predominance and clinical presentation at an advanced clinical stage

The role of the percentage free PSA in the diagnosis of prostate cancer in Blacks: Findings in indigenous West African men using TRUS guided biopsy

Introduction: In Western and Asian literature, the measurement of percentage free prostate specific antigen (%fPSA) has been known to enhance the predictive role of total prostate specific antigen (tPSA) in early prostate cancer (Ca-P) detection. Relationship between the tPSA and Ca-P are known to be influenced by race. To the best of our knowledge, the relationship between %fPSA and Ca-P has not been studied in sub-Saharan Africa using current established biopsy protocol. Objective: To evaluate the usefulness of %fPSA in indigenous West African men and determine the appropriate cut-off values that may be used as indication for prostate biopsy in men with tPSA of 4–10 ng/ml. Subjects and methods: A total 169 consecutive patients with tPSA of 4–10 ng/ml with non-suspicious findings on digital rectal examination (DRE) had a transrectal ultrasound (TRUS) guided 10-core prostate biopsy. The technique of PSA analysis was the Access hybritech assay technique using the Beckman's Access autoimmuno analyser. The rates of prostate cancer in different %fPSA ranges were evaluated. Receiver operating characteristic curve (ROC) was used to evaluate the efficiency of %fPSA in the diagnosis of prostate cancer. Results: A reduction %fPSA was associated with a higher detection rate of Ca-P. There was a 62% prevalence of Ca-P with %fPSA ≤ 10% while there was a zero prevalence in patients with fPSA above 20%. At a %fPSA cut off of 20% the sensitivity and specificity were 100% and 45%, respectively. Using the ROC curve, the area under the curve (AUC) was 0.76 while the ROC decision plot showed that a %fPSA cut off 15% was associated with the highest ability to discriminate between benign and malignant diseases. Conclusion: The %fPSA is an effective discriminating tool in determining the need for prostate biopsy in indigenous West African men with PSA 4–10 ng/ml. A cut off of 15% was associated with the highest performance

Clinicopathological and molecular significance of Sumolyation marker (ubiquitin conjugating enzyme 9 (UBC9)) expression in breast cancer of black women

The majority of breast cancers (BC) in Nigerian women are triple negative and show breast cancer-associated gene 1 (BRCA1) deficiency as well as the basal like phenotype, with a high mortality rate. In contrast to the well-defined predictive factors for the hormonal therapy, there is a paucity of information on the BRCA1 deficiency breast tumor biology, particularly among African women. BRCA1 Sumoylation (UBC9) has been speculated to be involved in the ER transcription activity, BRCA1 deficiency and triple negative BC. We therefore hypothesized that UBC9, a SUMOylation marker, may have contributed to the aggressive nature of BRCA1 tumor phenotype observed in Nigerian women.This study investigated the immunoprofiles of UBC9 in tissue microarray (TMA) of 199 Nigerian women and correlated their protein expression with clinical outcome, pathological responses and the expression of other biomarkers to demonstrate the functional significance in Nigerian women.The protein expression of UBC9, as compared with other biomarkers, showed an inverse correlation with steroid hormones (ER, progesterone (PgR)), BRCA1, p27, p21 and MDM4, and a positive correlation with triple negative, basal cytokeratins (CK14 and CK5/6), epidermal growth factor receptor (EGFR), basal-like breast cancer phenotype, p53, phosphoinositide-3-kinases (PI3KCA), placental cadherin, (P-cadherin) and BRCA1 regulators (metastasis tumor antigen-1 (MTA1). Survival analysis showed that those tumors positive for UBC9 expression had a significantly poorer breast cancer-specific survival (BCSS) as compared with those showing negative expression. UBC9 remained an independent predictor of outcome for BCSS.This study demonstrates that UBC9 appears to play an important role in the tumor biology of Nigerian women. Therefore, a novel UBC9 targeted therapy in black women with BC could enhance a better patient outcome