FACULTY OF BASIC MEDICAL SCIENCES
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Item Prevalence and Review of Pathological Anatomy of Gestational Choriocarcinoma in Ibadan(JournalGurus (on behalf of the Society of Gynaecology and Obstetrics of Nigeria), 2022) Awosusi, B. L.; Ajani, M. A.; Adegoke, O. O.; Salami, A. A.; Okolo, C. A.Objectives: Gestational choriocarcinoma (GCC) is a highly malignant epithelial tumor arising from the trophoblast of any type of gestational event, most often a complete hydatidiform mole. Choriocarcinoma is the most aggressive form of gestational trophoblastic neoplasia due to its rapid growth and metastatic potential. This study reviewed all cases of GCC seen at the University College Hospital, Ibadan. Methods: This was a 20-year retrospective hospital-based study designed to review all histologically diagnosed cases of choriocarcinoma registered at the Department of Pathology, University College Hospital (UCH), Ibadan, Nigeria, from 1st January 1997 to 31st December 2016. Clinicopathological data were extracted from the departmental surgical day book, ward register, Department of Medical Records, and Cancer Registry. The data were analyzed using the Statistical Package for Social Sciences (SPSS), version 22. Results were presented in tables, relative frequencies, and group percentages. Results: One hundred and eighty-three cases of gestational trophoblastic disease were histologically diagnosed within the study period, of which 36 cases were GCC, accounting for 19.7%. Of all the cases, 55.6% were received as endometrial biopsies, 33.3% as hysterectomy specimens, 8.3% as cervical biopsies, and 2.8% as an anterior vaginal wall mass. Choriocarcinoma occurred in the age range of 20 to 50 years, with the majority of cases occurring in the third decade of life. Conclusion: Gestational choriocarcinoma remains the most common form of gestational trophoblastic neoplasia in our environment. Awareness of this tumor, along with a high index of suspicion, is essential for accurate diagnosis and effective patient management.Item Bilateral Ganglionic Haemorrhagic Stroke Complicating Suspected Meningococcaemia: A Case Report(Association of Resident Doctors, University College Hospital, Ibadan, Nigeria, 2020) Omenai, S. A.; Okonkwo, O. O.; Salami, A. A.; Labaeka, A. A.; Okolo, C. A.Haemorrhagic stroke in pyogenic meningitis is a rare complication, accounting for about 2% of all complications. It often results from disseminated intravascular coagulation, a complication of bacterial meningitis, and portends a poor prognosis. A superimposed intracranial haemorrhage, although extremely rare, is associated with a high mortality rate. We report a child who had haemorrhagic stroke during the acute phase of bacterial meningitis. The diagnosis was made during post-mortem examination. It was discovered that she had suffered haemorrhagic necrosis of both basal ganglion nuclei. Early imaging is advised in meningitis patients presenting with altered levels of consciousness to detect cerebrovascular complications. Introduction Meningitis is a severe infection of the leptomeninges caused by viruses, bacteria, parasites, or fungi. Mortality rates are as low as 2% in infants and children and as high as 20–30% in neonates and adults. Cerebral vasculopathy is a complication of bacterial meningitis, with ischaemic stroke being much more common than haemorrhagic stroke, usually occurring during the acute phase of meningitis. Bacterial meningitis remains a leading cause of mortality from infectious disease globally, and the neurologic complications associated with this disease are a major contributor to mortality. In the paediatric age group, meningitis usually develops after encapsulated bacteria colonising the nasopharynx are disseminated into the blood and breach the blood–brain barrier, colonising the leptomeninges where they rapidly multiply. The body’s immune system mounts a response against the microbes. Studies in rabbits with C3 deficiency have demonstrated the importance of the complement system in meningitis. Genetic deficiencies in early response cytokines such as TNF-α, IL-1β, and IL-6 predispose individuals to central nervous system infections that may run a fulminant course. Cerebral vasculopathy in bacterial meningitis can occur from infection by organisms such as Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and Staphylococcus aureus. Haemorrhagic stroke from bacterial meningitis is rare. Various pathophysiological mechanisms have been proposed, including focal hyperperfusion from loss of cerebral autoregulation, disseminated intravascular coagulation (DIC), localized vasculitis, and microaneurysm formation. This complication confers a worse prognosis on meningitis, with higher morbidity and mortality. Early diagnosis of cerebrovascular events complicating meningitis allows for prompt surgical intervention to improve prognosis. We report the case of a nine-year-old female child who presented and died within 24 hours of presentation from bilateral basal ganglia haemorrhages due to acute bacterial meningitis. Case Report A nine-year-old female was seen in the paediatric clinic with a history of fever, sore throat, non-productive cough, vomiting, and generalized body weakness. She was a known asthmatic. She was nebulized and placed on antibiotics and antimalarials. Her condition deteriorated later in the night. She was brought into the children’s emergency unit with a six-hour history of fever and lack of response to calls for two hours. She was admitted into the intensive care unit and managed as a case of meningitis. On presentation, she was acutely ill, anicteric, and not cyanosed. There was tachycardia, with a blood pressure of 90/60 mmHg. She was tachypnoeic and dyspnoeic, with crepitations in the lower lung zones. The Glasgow Coma Score (GCS) was 13, the neck was supple, and Kernig’s and Brudzinski’s signs were negative. Pupils were 3 mm bilaterally and reacted briskly to light. Muscle tone and reflexes were normal, with no facioparesis. Laboratory tests revealed thrombocytopenia (platelet count 85,000/mm³), elevated INR (3.5), and deranged prothrombin time (41 seconds). Blood culture did not yield growth. Her GCS dropped to 6 within two hours of admission; she had two episodes of tonic convulsions and went into refractory shock despite intravenous boluses and adequate inotropic support. Nasogastric aspirate was bloody, and blood stains were seen in her perineum. She desaturated with SpO₂ of 65% while on 100% oxygen. Her GCS further dropped to 3 within fourteen hours of admission. She was managed with intravenous antibiotics, fluids, steroids, and antimalarials. Cranial imaging was not performed prior to death. She spent a total of seventeen hours on admission before demise. Although there was no growth on blood culture and a lumbar puncture was deferred, she was managed as a possible case of meningococcaemia. At autopsy, there was linear ecchymosis on the arm and ecchymosis on the right ventricular wall. Mesenteric and splenic haematoma with haemorrhagic gastropathy were noted. The lungs were markedly congested, showing features of diffuse alveolar damage with microthrombi. Histology of the kidneys showed extensive tubular necrosis, and both adrenal glands showed haemorrhagic infarctions. The brain was heavy, weighing 1600 g (normal 1150–1250 g), with greyish-white exudates over the convexities of the parietal lobes and superior cerebellar hemispheres; there was no frank pus. Coronal sections of the cerebral hemispheres showed bilateral basal ganglia haemorrhages affecting both lenticular nuclei and sparing the caudate. Histology revealed haemorrhagic infarction of the basal ganglia with associated microthrombi. The patient had no features of hypertension, and the vessels showed only mild fatty streaks of the abdominal aorta.Item P57kip2 Immunohistochemical Marker as a Diagnostic tool for Cases of Hydatidiform Moles in a Tertiary Health Facility in Southwestern Nigeria(Wolters Kluwer - Medknow, 2020) Awosusi, B. L.; Ajani, M. A.; Adegoke, O. O.; Salami, A. A.; Okolo, C. A.Background: Hydatidiform mole (HM) is the most common gestational trophoblastic disease. P57kip2 has been reported to be helpful in differentiating between partial and complete HMs. Objectives: The study aims to evaluate the P57kip2 immunohistochemical (IHC) marker as a useful ancillary investigation to differentiate complete hydatidiform mole (CHM) from partial hydatidiform mole (PHM). Materials and Methods: A retrospective study of all histologically diagnosed HM cases over a 20 year period was undertaken. Clinicopathological parameters were extracted from the surgical day book and medical record archives. Archival haematoxylin‑.and eosin‑stained slides and formalin‑fixed paraffin‑embedded tissue blocks of all cases of HM diagnosed within the study period were retrieved and reviewed. Cases of HM were reclassified using the P57kip2 IHC marker. The data obtained were analysed using the SPSS version 23. Results: One hundred cases of HMs were studied. CHM accounted for 68%, while PHM accounted for the remaining 32%. The incidence of HM was 2.98 cases per 1000 deliveries. The ratio of CHM to PHM was found to be 2.1:1. Seventy‑two per cent of the cases were diagnosed in the first trimester, while the remaining 28% were diagnosed in the second trimester of pregnancy. Based on the P57kip2 IHC staining pattern, HM cases were finally reclassified into 68 cases of CHM and 32 cases of PHM. The age range for all the HM cases was 18–50 years with the majority of the cases seen in the third and fourth decades of life. Conclusion: P57kip2 could be useful as an ancillary investigation in confirming the diagnosis of CHM and differentiating it from PHM, particularly in difficult and challenging cases.Item Childhood ovarian neoplasms in Ibadan,South‑western Nigeria(Wolters Kluwer – Medknow, 2016) Ajani, M. A.; Aramide, K. O.; Ajani, T. A.; Salami, A. A.; Okolo, C. A.Background: Childhood ovarian neoplasms are very rare. Little information is available on the relative pattern and frequency of these tumors in Nigerian children. Earlier study done in Ibadan involved ovarian neoplasms in children and adolescents. The aim of this study is to review cases of ovarian neoplasms in children <15 years over a 22½ year period. Materials and Methods: This was a retrospective study. Twenty‑four cases of childhood ovarian neoplasms were seen in patients <15 years of age. These cases were classified using the current World Health Organization histological classification of ovarian tumors. Results: Childhood ovarian neoplasms accounted for 2.8% of all cases of ovarian tumors seen in this period. Fourteen (58.3%) cases of childhood ovarian neoplasms were benign, and 10 (41.7%) were malignant. Mature cystic teratoma occurring in 13 (54.2%) was the most common childhood ovarian neoplasm and was most prevalent between 10 and 14 years of age. Burkitt lymphoma was the most common 4 (40%) malignant childhood ovarian tumor and prevalent between 5 and 14 years of age. Conclusion: Mature cystic teratoma remains the single most common childhood ovarian neoplasm, and Burkitt’s lymphoma is the most malignant childhood ovarian tumor in Ibadan, South‑western Nigeria.Item Prevalence and review of pathological anatomy of gestational choriocarcinoma in Ibadan(Journal Gurus, 2022) Awosusi, B. L.; Ajani, M. A.; Adegoke, O. O.; Salami, A. A.; Okolo, C. A.Objectives: Gestational choriocarcinoma (GCC) is a highly malignant epithelial tumor arising from the trophoblast of any type of gestational event, most often a complete hydatidiform mole. Choriocarcinoma is the most aggressive form of gestational trophoblastic neoplasia owing to their rapid growth and metastatic potential. This study reviewed all cases of GCC seen at the University College Hospital Ibadan. Methods: This was a 20 year retrospective hospital-based study designed to review all histologically diagnosed cases of choriocarcinoma registered at the Department of Pathology, University College Hospital (UCH), Ibadan, Nigeria, from 1st January, 1997 to 31st December, 2016. Clinicopathological data was extracted from the departmental surgical day book, Ward register, Department of Medical Records and Cancer Registry. The data was analyzed using the Statistical Package for Social Sciences, version 22. The results were presented in tables, relative frequencies and group percentages. Results: One hundred and eighty three cases of gestational trophoblastic disease were histologically diagnosed within the study period out of which 36 cases were GCC accounting for 19.7%. 55.6% of all the cases were received as endometrial biopsies, 33.3% as hysterectomy specimens, 8.3% as cervical biopsies and 2.8 as an anterior vaginal wall mass. Choriocarcinoma occurred in the age range 20 to 50 years with majority of cases occurring in the third decade of life. Conclusion: Gestational choriocarcinoma is still the most common gestational trophoblastic neoplasia seen in our environment. Awareness of this tumour with a high index of suspicion is needed for an accurate diagnosis and patient management.Item P57kip2 immunohistochemical marker as a diagnostic tool for cases of hydatidiform moles in a tertiary health facility in southwestern Nigeria(National Postgraduate Medical Journal, 2020) Awosusi, B. L.; Ajani, M. A.; Adegoke, O. O.; Salami, A. A.; Okolo, C. A.Background: Hydatidiform mole (HM) is the most common gestational trophoblastic disease. P57kip2 has been reported to be helpful in differentiating between partial and complete HMs. Objectives: The study aims to evaluate the P57kip2 immunohistochemical (IHC) marker as a useful ancillary investigation to differentiate complete hydatidiform mole (CHM) from partial hydatidiform mole (PHM). Materials andMethods: Aretrospective study of all histologically diagnosed HM cases over a 20 year period was undertaken. Clinicopathological parameters were extracted from the surgical day book and medical record archives. Archival haematoxylin- and eosin-stained slides and formalin fixed paraffin embedded tissue blocks of all cases of HM diagnosed within the study period were retrieved and reviewed. Cases of HM were reclassified using the P57kip2 IHC marker. The data obtained were analysed using the SPSS version 23. Results: One hundred cases of HMs were studied. CHM accounted for 68%, while PHM accounted for the remaining 32%. The incidence of HM was 2.98 cases per 1000 deliveries. The ratio of CHM to PHM was found to be 2.1:1. Seventy two per cent of the cases were diagnosed in the first trimester, while the remaining 28% were diagnosed in the second trimester of pregnancy. Based on the P57kip2 IHC staining pattern, HM cases were finally reclassified into 68 cases of CHM and 32 cases of PHM. The age range for all the HM cases was 18–50 years with the majority of the cases seen in the third and fourth decades of life. Conclusion: P57kip2 could be useful as an ancillary investigation in confirming the diagnosis of CHM and differentiating it from PHM, particularly in difficult and challenging cases.Item Childhood ovarian neoplasms in Ibadan, South‑western Nigeria.(Wolters Kluwer - Medknow, 2016) Ajani, M. A.; Aramide, K. O.; Ajani, T. A.; Salami, A. A.; Okolo, C. A.Childhood ovarian neoplasms are very rare. Little information is available on the relative pattern and frequency of these tumors in Nigerian children. Earlier study done in Ibadan involved ovarian neoplasms in children and adolescents. The aim of this study is to review cases of ovarian neoplasms in childrenMaterials and Methods: This was a retrospective study. Twenty four cases of childhood ovarian neoplasms were seen in patientsResults: Childhood ovarian neoplasms accounted for 2.8% of all cases of ovarian tumors seen in this period. Fourteen (58.3%) cases of childhood ovarian neoplasms were benign, and 10 (41.7%) were malignant. Mature cystic teratoma occurring in 13 (54.2%) was the most common childhood ovarian neoplasm and was most prevalent between 10 and 14 years of age. Burkitt lymphoma was the most common 4 (40%) malignant childhood ovarian tumor and prevalent between 5 and 14 years of age. Conclusion: Mature cystic teratoma remains the single most common childhood ovarian neoplasms, and Burkitt’s lymphoma is the most malignant childhood ovarian tumor in Ibadan, South western Nigeria.