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Item Programme death ligand 1 expressions as a surrogate for determining immunotherapy in cervical carcinoma patients(Public Library of Science (PLOS), 2022) Omenai, S. A.; Ajani, M. A.; Okolo, C. A.Background The programme death ligand1 and its receptor (PD-1/PD-L1) interaction is a target for block age by immunotherapy that uses the body’s own immune system. Some studies show that PD-L1 expressing tumours are also more aggressive with poor prognosis. This study evalu ated the immunohistochemical expression of PD-L1 in uterine cervical carcinomas. Women with cervical cancer would benefit from its use as a marker in therapy and prognosis. Methods Hospital-based cross-sectional retrospective study was conducted. The study materials included 183 archived formalin fixed and paraffin embedded (FFPE) tissue blocks with histo logical diagnosis of cervical carcinoma diagnosed in our facility within a five-year period (January 2012 and December 2016) that met the study criteria. Data were extracted from records in the Department and immunohistochemistry was done using polyclonal antibodies to PD-L1 (GTX104763, Genetex). Obtained data were analysed using SPSS version 23. P < 0.05 was considered significant. Results A hundred and eighty-three cases of cervical cancer were studied. PD-L1 was positive in 57.4% of all cases. The diffuse pattern of staining was the major pattern accounting for 88.5% of positive cases. Poorly differentiated cervical carcinomas are less likely to express PD-L1. Within the histologic types, the squamous cell carcinomas expressed PD-L1 in 58.7%, and 50% of adenocarcinomas were positive. PD-L1 was not expressed in all cases of adenoid cystic carcinomas and basaloid squamous cell carcinomas. Conclusion A significant population of cervical carcinoma expresses PD-L1 by immunohistochemistry. PD L1 prevalence is lower amongst the poorly differentiated cancers compared to other grades.Item Colonic polyps in Nigerians, a change in trends: A retrospective single‑center clinicopathological study(Wolters Kluwer - Medknow, 2022) Adegoke, O. O.; Ajani, M. A.; Nwanji, I. D.Background: Adenomatous polyps in the colon are recognized precursors of colorectal carcinoma; however, the low incidence of these polyps in sub Saharan Africans has led many to believe that the pathway of colorectal cancer may differ in this region. The objective of this study was aimed to determine the change in trends of colonic polyps in Nigeria. Methods: This was a 10 year retrospective review of all colonic polyp specimens received at the Department of Pathology in our hospital utilizing the histopathology request cards and hematoxylin and eosin stained slides. The data were analyzed using the IBM SPSS Statistics (version 23; IBM Corporation, Armonk, New York, USA). Results: A total of 131 cases were reviewed. The age of patients ranged from 5 to 86 years with a mean age of 55 years. The male to female ratio was 1.6:1. The mean age was 59.4 years. Of the 131 cases reviewed, 62 patients had adenomatous polyps, 49 had inflammatory polyps while 20 others included juvenile polyps, hyperplastic polyps, and hamartomatous polyps. Conclusion: Adenomatous polyps are increasingly being seen among Africans in the sub Sahara region and perhaps they are not as rare as it was once thought provided the facilities for the diagnosis are available. They may yet play a more important role than has been ascribed to them in the pathogenesis of colorectal carcinomas in Africans.Item Metastatic prostate cancer presenting as a rapidly increasing gluteal muscle mass at an intramuscular injection site(Remedy Publications LLC., 2022-02) Olapade-Olaopa, O. E.; Adebayo, A. S.; Osobu, E.; Ajani, M.; Ogunlayi, S.; Magbagbeola, O. A.; Farinre, O. M.; Ogunbiyi, O. J.; Ogunlade, S. O.Prostate cancer is the second commonest male cancer globally. However, diagnosis may be delayed or missed due to atypical presentations such as metastases to unusual sites. The axial skeleton, lymph nodes, and viscera are the common sites for prostate cancer metastasis with skeletal muscles being uncommonly affected, and until now there has been no report of metastasis to the gluteal muscles from the disease. We present the case of a 78-year-old man with no lower urinary tract symptoms who presented with a 2-year history of a right supra-gluteal mass at the site of an intramuscular injection hematoma/abscess that rapidly increased in size 5 months prior to presentation and an abnormal gait. CT and MRI scans were suggestive of a malignant mass (possibly a rhabdomyosarcoma) and enlarged multinodular prostate with bilateral lymphadenopathy. A biopsy of the gluteal mass confirmed metastatic adenocarcinoma with the colon or the prostate being possible primaries. His serum PSA was markedly elevated (3441 ng/ml) but his other tumor markers were normal. Prostate biopsies confirmed a Gleason 4+3=7 prostate cancer and ADT was commenced. He responded well and remains in good health 15 months into his treatment with a marked reduction in the size of his gluteal mass and a restoration of a normal gait. His serum PSA and Testosterone are presently 2.4 ng/ml and 0.3 mmol/L respectively.Item Human epidermal growth factor receptor 2 overexpression in endometrial carcinomas at a tertiary center in sub-Saharan Africa(Faculty of pathology, national postgraduate medical college of Nigeria, 2022) Odetola, S. S.; Ajani, M. A.; Nwanji, I. D.; Salami, A. A.; Okolo, C. A.Background: Endometrial cancer is the third most common gynecological malignancy, following cervical and ovarian malignancies. Prognosis among the women of African origin is, however, worse as they tend to have high grade tumors and late presentation. Close to 50% of high grade endometrial cancers show human epidermal growth factor receptor 2 (HER2) overexpression and may thus benefit from targeted treatment. Aims: This study aimed to determine the overexpression status of HER2 protein among the cases of endometrial carcinoma. Materials and Methods: All cases of histologically diagnosed endometrial carcinoma from January 2007 to December 2016 were retrieved from the files and records of department of pathology in our hospital. Cases were classified and graded according to the World Health Organization (2014 version) classification of endometrial carcinoma followed by immunohistochemical staining for HER2 overexpression. Results: There were a total of 51 cases of endometrial carcinoma that met the inclusion criteria during the study. The mean age of patients was 63 years. As a group, nonendometrioid carcinomas predominated (55%). The majority (70%) of cases showed high grade histological morphology. Positive Her2/Neu expression was seen in 11 cases (22%) of endometrial carcinoma. There was no statistically significant association between hormone expression status and age, histological variant, or grade. Conclusion: Endometrial carcinomas among Nigerian women are predominantly nonendometroid and high grade. HER2 overexpression was seen in a fifth of cases. Future studies should explore the response of targeted therapy among Nigerian patients showing HER2 overexpression.Item Histopathology turnaround time of surgical biopsies in a Nigerian tertiary health-care facility(Wolters Kluwer - Medknow, 2021) Ajani, M. A.; Adegoke, O. O.; Nwanji, I. D.; Nwadiokwu, J. I.Background: Turnaround time (TAT) analysis is finding increasing relevance in clinical laboratories due to its relevance in the quality of care of patients. TAT involves all the various processes that occur within the laboratory. Aims: The aim of this study was to analyze the histopathology TAT of surgical biopsies at the Department of Pathology, University College Hospital (UCH), Ibadan. Materials and Methods: This was a retrospective analysis of 1085 samples received at the Department of Pathology, UCH, Ibadan, from January to April 2020. Samples were categorized into small, intermediate, and large sizes. Average duration spent in the grossing room, processing, reporting, and result verification was calculated, and the total TAT was determined from the summation of the duration of these processes. Results: The mean TAT for all samples was 22 days(±10 days). Reception grossing, histological processing, reporting, and transcription accounted for an average of 1.5 (7%), 5.9 (27%), 9.1 (41%), and 5.6 (25%) days and percentage of TAT, respectively. There was no significant difference in the mean TATs for small , intermediate-, and large-sized samples. Conclusion: We identified reporting time as the largest contributor to TAT. Other areas of delay were noted at tissue processing and result verification. Adoption of new technology and staff orientation may help to reduce the observed TAT.Item A histomorphological pattern of gallbladder lesions in a tertiary hospital in Southwestern Nigeria: a retrospective descriptive study(Rwanda Biomedical Centre (RBC), 2021) Ajani, M. A.; Onakpoma, F. A.; Fatunla, E. O.; Adegoke, O. O.; Salami, A. A.BACKGROUND: The gallbladder is one of the most common specimens encountered in the surgical pathology laboratory, and gallstone related diseases are among the most common medical problems requiring surgical intervention. This study's objective was to determine the histomorphological patterns and frequency of gall bladder lesions from cholecystectomy specimens received in our institution for over twenty years. METHODS: We carried out a retrospective review of all cholecystectomy specimens received at the pathology department for 20 years from January 1999 to December 2018. The specimens were obtained from within and outside the hospital facility. The demographic data, clinical details, and histological diagnosis were retrieved from the departmental records and were analyzed with SPSS version 23. RESULTS: A total of 211 cholecystectomy specimens were received during the study period. Patients’ age ranged from 14 to 84 years, with a mean age of 47.6 ± 0.899 years. There was a female preponderance with male to female ratio of 43:168 (1:3.9). Surgery for gallbladder disease was most commonly performed in the age range of 41-50 years. Out of the 211 specimens, 153 (72.5%) had calculi and 58 (27.5%) were acalculous. Chronic calculous cholecystitis was the most common histopathological diagnosis (65.4%). Others were chronic acalculous cholecystitis (18.0%), acute on chronic acalculous cholecystitis (2.4%), adenocarcinoma (3.3%), metastatic adenocarcinoma (0.1%), adenocarcinoma with chronic calculous cholecystitis (0.5%), klatskin tumour (0.5%), and normal gallbladders (1.9%). CONCLUSION: This study revealed that the commonest indication for cholecystectomy in our hospital was gall stone disease. Malignancy of the gallbladder is uncommon in our center.Item Histopathological analysis of male breast cancer in Southwestern Nigeria: A single center retrospective study(Wolters Kluwer - Medknow, 2021) Ajani, M. A.; Odetola, S. S.; Awosusi, B. L.; Fatunla, E. O.; Salami, A. A.Background: Breast cancer in men is still an uncommon and largely understudied disease. It accounts for 1% of all breast cancers. The aim of this study was to review all the male breast cancer cases diagnosed at the tertiary medical institution in South West Nigeria over a 10 year period and to compare the findings with other similar studies done in Nigeria and globally. Methods: We retrospectively reviewed all histologically diagnosed cases of male breast cancers in the Department of Pathology, Tertiary Medical Institution in South West Nigeria over a 10 year period from January 1, 2009, to December 31, 2018. Clinicopathological parameters including patients’ age, laterality, and specific histological sub types were extracted from surgical day book and Cancer Registry of the Department. The data were analyzed using the IBM SPSS Statistics (version 22; IBM Corporation, Armonk, New York, USA). The results were subsequently presented in tables, relative frequencies, group percentages, and photomicrographs. Results: Forty two cases of male breast cancer were seen accounting for 1.7% of all breast cancer cases. The age range was between 22 and 91 years with a mean age of 60.3 years, and a peak occurrence was in the 8th decade. The right breast was more affected than the left accounting for 52% of the total number of cases seen. The most common histological sub type found was invasive ductal carcinoma accounting for 88% of all the cases. Conclusion: Male breast cancer is relatively uncommon compared to female breast cancer. It is more common in the older age group, and invasive ductal carcinoma is still the most common histological subtype.Item Histopathology of head and neck lymphomas in Ibadan(Medknow, 2020) Ajani, M. A.; Nwanji, I. D.; Olaniran, F. O.; Ogun, G. O.; Okolo, C. A.; Akinmoladun, V. I.Background: Lymphomas are a heterogeneous group of tumors of lymphoid tissue in which there is a malignant proliferation of cells of the lymphatic system. They are the most frequent nonepithelial malignancy in the head and neck region. Objectives: The aim of this study was to evaluate the histological pattern of the disease in the head and neck region and trends in presentation seen in our center Materials and Methods: This was a retrospective study of cases of head and neck lymphoma (HNL) seen in the Pathology Department of the University College Hospital Ibadan, Nigeria over a period of 37 years (1981–2017). Information extracted from the records included the sociodemographics of the patients, tumor location, and histological type among others. Data were analyzed and results were presented as frequencies and percentages. Results: There were a total of 373 cases of histologically and/or cytologically diagnosed HNL seen during the study period (an average of 10 cases per year). The mean age of patients was 33.5±21.9 years with male:female ratio of 1.6:1. Most HNL were non-Hodgkin’s lymphomas (NHL), accounting for 91% of cases. Nodal disease was seen in 39% of cases. The bone (prominently, the jaws) predominated (25%) in extranodal lesions. Burkitt’s lymphoma was the most common specific subtype of NHL, occurring in 25.5% of cases. Conclusion: There has been an apparent upward trend in the prevalence of HNL over the past four decades, although other parameters such as age and sex predilection appear unaffected. Factors responsible for this trend need to be interrogated and ascertained.Item Inflammatory pseudotumor: a 20‑Year single institutional experience(Wolters Kluwer - Medknow, 2020) Ajani, M. A.; Fatunla, E. O.; Onakpoma, F. A.; Salami, A. A.Background: Inflammatory pseudotumor (IPT) is a relatively rare benign disease. The aim of the study was to demonstrate the demographic distribution, clinical presentation, and histomorphological characteristics of IPT while highlighting its associated diagnostic challenges. Materials and Methods: A retrospective cross sectional review of all the IPT diagnosed in our institution between January 1999 and December 2018 was conducted. The samples were received from within and outside the hospital facility. The demographic data, clinical history, and histologic reports were reviewed. Results: A total of 25 cases of histologically confirmed IPT were seen. Patients’ age ranges from 7 to 74 years with a mean age of 38.96 years and standard deviation ± 17.94 years. There was a bimodal peak occurrence in the third and fifth decades. Most of the patients were adults (23, 92%), whereas only 2 (8%) were children. There was a female preponderance with a male to female ratio of 1:2.6. The head and neck had the highest number of cases (44%), followed by the gastrointestinal tract (GIT) (40%). Eight (73%) of head and neck cases occurred in the orbit. The presenting complaints depended on the site of the lesion with pain and swelling being the commonest symptoms irrespective of the site of the lesions. Two cases of bilateral IPT were observed. Immunohistochemistry was used in a certain condition of diagnostic dilemma. Conclusion: This study showed a female preponderance of IPT with the head and neck and GIT being the most common location. It is important to rule out other differentials in the diagnosis of IPT.Item Premalignant and malignant lesions of the esophagus: a single institutional experience(Medical and Dental Consultants Association of Nigeria, University of Abuja Teaching Hospital, 2020) Ajani, M. A.; Adegoke, O. O.; Nwanji, I. D.; Omenai, S. A.; Akande, K. O.Background: Esophageal malignancy is a highly aggressive tumor with a poor prognosis. A number of lesions occurring in the esophagus are associated with a high risk of malignant transformation. While the patterns of esophageal cancers have been documented in a number of African countries, there is a limited data on the Nigerian situation. This study was aimed at reviewing the histological patterns of premalignant and malignant lesions of the esophagus. Methods: This was a 10 year retrospective study of histologically confirmed premalignant and malignant lesions of the esophagus seen at the University College Hospital, Ibadan, between January 2009 and December 2018. Data retrieved from the departmental records were analyzed using the SPSS computer software version 20.0. Results: There were 45 cases diagnosed with premalignant lesions and 32 cases diagnosed with malignant lesions out of the 363 biopsies during the study period. The most common premalignant lesion was Barret’s esophagus (68.9%). Premalignant lesions were more common in males (64.4%). The mean age for patients with a diagnosis of premalignant lesions was 55 years. The mean age at the diagnosis for esophageal cancer was 61.5 years. Squamous cell carcinoma was the predominant histological subtype seen (65.6%) with adenocarcinomas accounting for the remainder of cases (35.4%). Conclusion: Squamous cell carcinoma is the most common malignancy of the esophagus in our study. Adenocarcinomas of the esophagus were not as rare as documented in previous African studies. This finding may imply a changing pattern in esophageal malignancies in tandem with the pattern in Western countries.