Expression of Ki 67 in Malignant and Premalignant Cervical Lesions in Nigerian Women

Background: Cervical cancer, though preceded by treatable premalignant lesions, ranks second among all cancers in Nigerian women. The proliferative marker ‘Ki-67’ is useful immunohistochemically to enhance the diagnosis of cervical dysplastic lesions, reducing inter-and intra-observer variability. This study is aimed at evaluating the role of Ki-67 expression in cervical dysplastic lesions as a diagnostic and prognostic tool.Methodology: We applied Ki-67 immunohistochemical staining on 142 cervical biopsies from the archives of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi in Anambra state, a federal teaching hospital. Ki-67stains nuclei of proliferating cells, and was expressed as Ki-67 scores and labeling index (LI). LI was calculated as the number of positive cells per 100 dysplastic cervical epithelial cells while Ki-67 score was given based on levels of positive staining per third of epithelial thickness. The data analysis was done using the IBM SPSS Statistics (Statistical Product and Service Solutions) software version 20.0, and the result presented with tables where relevant.Results: LI and Ki-67 score increased with increasing dysplasia. There was disagreement between IHC (immunohistochemistry) enhanced and morphologic diagnosis in 9 (6.33%) cases. Ki-67 IHC significantly enhanced the diagnosis of CIN (Cervical intraepithelial neoplasm) and carcinomas (x2 =0.001, P<0.05). Both premalignant and malignant cervical lesions were more common in fifth and sixth decades.Conclusion: Ki-67 IHC is a veritable diagnostic and prognostic marker, reducing inter-and intra-observer variability in the diagnosis of cervical dysplastic lesions

Gossypiboma Mimicking Intra-abdominal Tumour

Gossypiboma is a rare, preventable and under-reported pseudo-tumour complication following surgery. It has serious medicolegal consequences. It poses a diagnostic dilemma due to non-specific clinical and radiologic features. We therefore report a case of gossypiboma in a 31-year old woman following a midnight emergency caesarean operation, to highlight the risk in our environment, the implications and the need for a high index of suspicion in postsurgical patients

Histopathological Profile of Primary Ovarian Lesions in Nnewi, Nigeria: A 5 Year Retrospective Study

Background: This is the first base line research on different primary ovarian lesions in Histopathology department, Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi since the institution of the hospital.Objectives: To determine the different patterns of ovarian lesions in relation to age and histopathological features and compare these patterns with local and international studies. The study will also highlight the most common histologic variants in our environment and make recommendations depending on the outcome of the research.Methodology: The pathology report forms of all the gynaecological lesions in histopathology department NAUTH, Nnewi, were studied. The processed tissue and the slides stained with regular histochemical stain (Haematoxylin and Eosin) technique in this 5-year study period were reviewed by the researchers using multi-headed microscope (CARL ZEISS®).Results: Of the 130 cases that were analysed, 91 (70.0%)cases were neoplastic while 39(30.0%) cases were non-neoplastic lesions. Benign neoplasms were the most common neoplasm and accounted for 56.0% (51 cases) followed by invasive malignant neoplasms with 31.9% (29 cases) while borderline and indeterminate tumours, were 3.3% (3 cases) and 8.8% (8 cases). respectively. Among the benign neoplastic lesions, mature cystic teratoma was the most common tumour (no= 22, 16.9%) with the patients’ mean age of 33.1 ±SD 13.0, followed by serous cystadenoma (no=15, 11.5%) with a mean age of 33.4 ±SD 12.9. However, high grade papillary serous cystadenocarcinomas (no=13, 9.8%) were the highest recorded invasive malignant lesions with a mean age of 49.8 ± SD 15.9) followed by choriocarcinoma (no.=5, 3.8%) with a mean age of 35.3 ±SD 9.7. Immature teratoma and mucinous cystadenocarcinoma were 4 (3.1%)cases each with mean ages of 20.8 ± SD 13.9 and 55.3 ± SD 14.3, respectively. Malignant germ cell tumours; immature teratoma and choriocarcinoma, formed only 28.1% of all germ cell tumours. Of the non-neoplastic lesions, corpus luteum cyst and follicular cyst were the most common with 11 cases (8.5%) and 10 cases (7.7%), respectively.Conclusion: Ovarian neoplasia are quite diverse, and in our environment, benign lesions of the ovary were far more common than malignant cases and tend to occur at the reproductive age group. Surface –epithelial neoplasms were more common than germ-cell tumours with a ratio of 1.4:1. Majority of invasive malignant cases were high grade serous cystadenocarcinoma. Keywords: Corpus luteum cyst, Follicular cyst, Teratoma, Cyst adenoma, Borderline tumour, Serous cystadenocarcinom

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa