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 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 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 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 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 Distribution and characteristics of endometriotic lesions in South- Western Nigeria: A single institutional experience(Zambia Medical Association, 2019) Ajani, M. A.; Salami, A.; Nwanji, I. D.; Olusanya, A. A.; Fatunla, O. E.Background: Endometriosis poses a significant burden mainly to women of child bearing age. Historically, endometriosis was thought to be of low prevalence among African women. However, recent studies have documented an increased prevalence than previously thought. This study aimed to determine the distribution and characteristics of endometriotic lesions among Nigerian women . Methods: A retrospective study of all histologically diagnosed cases of endometriosis from the records of the Department of Pathology, University College Hospital, Ibadan from 1st January, 1997 to 31st October, 2018.The age of the women, location and distribution of the lesions were analysed. Results: A total of 85 cases of endometriosis were diagnosed histologically in the period under review. The mean age was 35 years with an age range of 18 to 52 years. The most commonly affected age groups were those between 30-39 years (47.1%) and 20-29 years (30.6%). The most commonly affected site was the ovary (58.8%) followed by the umbilicus (11.9%) and fallopian tubes (9.4%). Fourteen patients (28%) had bilateral ovarian involvement. Left sided ovarian lesions predominated (61.1% versus 38.9%). Eighteen (21.2%) patients had lesions at more than one site frequently involving both ovaries. Conclusion: Endometriosis affected mainly women of childbearing age with particular predilection for the ovaries. Endometriosis affecting the umbilicus is not uncommon among Nigerian women.Item Gender differential in inclination to donate brain for research among Nigerians: the IBADAN Brain Bank Project(Springer Nature, 2019) Akinyemi, R.; Ojagbemi, A.; Akinyemi, J.; Salami, A.; Olopade, F.; Farombi, T.; Nweke, M.; Uvere, E.; Aridegbe, M.; Balogun, J.; Ogbole, G.; Jegede, A.; Kalaria, R.; Ogunniyi, A.; Owolabi, M.; Arulogun, O.Background: Laboratory-based studies of neurological disease patterns and mechanisms are sparse in sub-Saharan Africa. However, availability of human brain tissue resource depends on willingness towards brain donation. This study evaluated the level of willingness among outpatient clinic attendees in a Nigerian teaching hospital. Methods: Under the auspices of the IBADAN Brain Bank Project, a 43—itemsemi-structured interviewer—administered questionnaire was designed to evaluate knowledge, attitude, and beliefs of individuals attending Neurology, Psychiatry and Geriatrics Outpatient clinics regarding willingness to donate brain for research. Association between participants characteristics and willingness towards brain donation was investigated using logistic regression models. Analysis was conducted using Stata SE version 12.0. Results: A total of 412 participants were interviewed. Their mean age was 46.3 (16.1) years. 229 (55.6%) were females and 92.5% had at least 6 years of formal education. Overall, 109 (26.7%) were willing to donate brains for research. In analyses adjusting for educational status, religion, ethnicity, marital status and family setting, male sex showed independent association with willingness towards brain donation OR (95% CI) 1.7 (1.08–2.69), p = 0.023. Participants suggested public engagement and education through mass media (including social media) and involvement of religious and community leaders as important interventions to improve awareness and willingness towards brain donation. Conclusion: The survey revealed low willingness among outpatient clinic attendees to donate brain for research, although men were more inclined to donate. It is imperative to institute public engagement and educational interventions in order to improve consent for brain donation for research.Item Central nervous system tumours in children in Ibadan, Nigeria: a histopathologic study(Pan African Medical Journal and African Field Epidemiology Network, 2016) Ogun, G. O.; Adeleye, A. O.; Babatunde, T. O.; Ogun, O. A.; Salami, A. A.; Brown, B. J.; Akang, EIntroduction: Contrary to some earlier teachings that central nervous system (CNS) tumours are uncommon in black children, these neoplasms are the fourth most common paediatric tumours in Ibadan. Our centre is the major referral centre for CNS tumours in Nigeria. The last major study of paediatric CNS neoplasms from Ibadan was in 1985. An update of the data on paediatric CNS neoplasms at our centre is presented. Methods: A retrospective review of all histologically diagnosed CNS tumours in children (0-14 years) from January 2001 to December 2010 from the database of the Department of Pathology, University College Hospital, Ibadan, Nigeria was done. The cases were classified using the 2007 WHO Classification of Tumours of the Central Nervous System and were also based on their supratentorial and infratentorial locations. Results: Seventy-seven tumours, 44 in males, were included in the study. Astrocytic tumour comprised 20 cases, embryonal tumours 15, ependymal tumours 15, germ cell tumours 6, sellar tumours (all craniopharyngiomas) 9 and other histological types- 12 cases. Thirty-seven were WHO Grade 1, eleven Grade 2, ten Grade 3 and nineteen Grade 4 neoplasms. Thirty-six cases were supratentorial and thirty-eight were infratentorial in location. The most common tumours in this series were pilocytic astrocytomas, medulloblastomas, craniopharyngiomas and ependymomas in that order. Conclusion: Childhood CNS tumours are being increasingly diagnosed in our centre. This is largely explained by the recent expansion of the available neurosurgical servicesItem 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.