PROGRAMMED CELL DEATH LIGAND 1 (PD-L1) EXPRESSION IN TRIPLE NEGATIVE BREAST CANCER CASES IN BENIN CITY.

Background: Triple-negative breast cancers (TNBC) have been particularly challenging to manage due to their lack of intrinsic cellular receptors, with the resultant relatively higher morbidity and mortality. Recently, the programmed cell death 1/programmed cell death ligand 1 (PD-1/PD- L1) immune checkpoint pathway has become the focus of immunotherapy, especially for TNBCs. This study aimed to determine the pattern of expression of PD-L1 in TNBC cases in Benin City. Methods: It was a 3-year retrospective study that involved the PD-L1 immunostaining of the TNBC cases that were diagnosed in the Department of Anatomical Pathology, University of Benin Teaching Hospital, Benin City, from January 1, 2017 to December 31, 2019. Result: Ninety-two cases of TNBC were tested for PD-L1 expression. Thirteen (14.1%) of the TNBC cases were PDL1 positive to varying degrees on tumour and immune cells. Diffuse tumoural PD-L1 staining was seen in 4 (30.8%) of the PD-L1 positive cases. PD-L1 expression was significantly associated with increasing age up to the fifth decade (p =0.030). All the PD-L1 positive TNBC were invasive breast carcinoma of no special type and mostly grade 2 tumours; however, there was no significant association between PD-L1 expression and histological subtype or grade. Conclusion: PD-L1 expression was shown to occur at a relatively low rate among TNBC cases in this environment and was significantly associated with increasing age. This study has shown that 14.1% (1 in 7) of our TNBC patients could benefit from immune checkpoint inhibitor therapy.

Autopsy-related work experience: An important factor affecting knowledge and attitudes of health personnel toward autopsy.

Background: Despite benefits, autopsy rates continue to fall globally. The effects of education, religion, and culture on autopsy rates are well documented. Aim: This study examines the knowledge and attitudes of health personnel, aiming to identify other factors affecting autopsy rates in our environment. Subjects and Methods: This is a cross-sectional non-intervention study using semi-structured questionnaires and Statistical Package for Social Sciences Version 21, for data collection and analysis. Results: Seventeen percent, 50%, and 33% of participants had good, fair, and poor knowledge about autopsies, respectively. Poor understanding of the legal framework governing autopsies accounted for significant gaps in knowledge. Knowledge grade differed significantly amongst the different professional groups (χ2 = 33.14; P value = 0.016). Eighty-two percent had good attitudes toward autopsy, though only 63% indicated approval. About 74% percent indicated willingness to consent to autopsies on relations, while 45.3% indicated willingness to consent to autopsy on self-remains. Autopsy-related work experience correlated strongly with both knowledge (χ2 = 22.34; P value = 0.004) and attitude (χ2 = 24.28; P value = 0.004) grades. Multinominal regression analysis showed autopsy-related work experience to be an independent determinant of willingness to consent to autopsy on self (P value = 0.023). Conclusion: Autopsy rates in Benin city and environs may reflect lack of knowledge or a misunderstanding of the laws guiding autopsy. Autopsy-related work experience is an important factor influencing knowledge and attitude of health personnel in this study. Its effect on autopsy request and acceptance rates should be further evaluated.

Central Nervous System Pathology in Children: A Single-Institution Experience in South-South Nigeria.

BACKGROUND: Neuropathology is fundamental to neurology, neurosurgery, and neuroscience practice in general. In parts of Nigeria and other sub-Saharan African countries, Neuropathology is just emerging, and more so Paediatric Neuropathology. Paediatric Neuropathology encompasses diseases of brain, spinal cord, nerves and muscle, affecting infants, children and adolescents, many of which are surgically managed or biopsied for diagnosis. AIM: To determine the pattern of neurosurgical lesions in children diagnosed in Benin-City, Nigeria. METHODS: A retrospective database study of biopsies from paediatric patients with neurosurgical lesions histologically evaluated at the Department of Pathology, University of Benin Teaching Hospital, Benin-City, Nigeria, between January 2007 and December 2020 was done. Demographic and clinical data were extracted from Departmental Records; histopathological diagnoses confirmed; and data analyzed using SPSS 20.0. RESULTS: A total of 178 biopsies reviewed. Ages ranged between 2 days and 16 years. Male: female ratio was 1.02:1. There were 87 spinal; 53 intracranial; 32 skull; and 9 scalp lesions. Commonest were Neural tube defects - 56.7% (mostly myelomeningoceles); Intracranial neoplasms - 20.22% (mostly pilocytic astrocytoma and embryonal tumors); Intracranial suppurative lesions -5.06% and dermoid/epidermoid cysts - 5.06%. CONCLUSION: Most Paediatric neuropathological conditions encountered in our environment can be managed with good outcomes if correctly and promptly diagnosed. There is a need to channel resources into prevention and prenatal diagnoses of NTDs; early diagnosis and management of brain tumors and other intracranial lesions; and better management of otorhinolaryngologic and intracranial infections in children. Neuropathology training and capacity development is also needed.

CONTEXTE: La neuropathologie est fondamentale pour la neurologie, neurochirurgie et de la pratique des neurosciences en général. Dans certaines régions du Nigeria et d'autres pays d'Afrique subsaharienne, la neuropathologie est tout juste émergente, et plus encore la neuropathologie pédiatrique. La neuropathologie p¼diatrique englobe les maladies du cerveau, de la moelle épinière, des nerfs et des muscles. nerfs et des muscles, qui touchent les nourrissons, les enfants et les adolescents. sont traitées chirurgicalement ou biopsiées pour le diagnostic. OBJECTIF: Déterminer le profil des lésions neurochirurgicales chez des enfants diagnostiqués dans la ville de Bénin, au Nigeria. MÉTHODES: Une étude rétrospective de la base de données des biopsies de patients pédiatriques présentant des lésions neurochirurgicales évaluées histologiquement au département de pathologie de l'hôpital universitaire de l'Université du Bénin, BeninCity, Nigeria, entre janvier 2007 et décembre 2020. a été réalisée. Les données démographiques et cliniques ont été extraites des dossiers du département ; les diagnostics histopathologiques ont été confirmés ; et Les données ont été analysées à l'aide du logiciel SPSS 20.0. RÉSULTATS: Un total de 178 biopsies ont été examinées. Les âges variaient entre 2 jours et 16 ans. Le rapport hommes/femmes était de 1,02:1. Il y avait 87 biopsies rachis, 53 intracrâniennes, 32 crâniennes et 9 lésions du cuir chevelu. Les plus fréquentes étaient. Anomalies du tube neural - 56,7 % (principalement des myéloméningocèles). intracrâniens - 20,22 % (principalement astrocytome pilocytique et tumeurs embryonnaires) tumeurs embryonnaires); lésions suppuratives intracrâniennes -5,06% et kystes dermoïdes/ kystes épidermoïdes -5,06 %. CONCLUSION: La plupart des conditions neuropathologiques pédiatriques rencontrées dans notre environnement peuvent être gérées avec de bons résultats si elles sont correctement et rapidement diagnostiquées. Il est nécessaire de canaliser ressources dans la prévention et le diagnostic prénatal des ATN, le diagnostic et la prise en charge diagnostic et la gestion précoces des tumeurs cérébrales et autres lésions intracrâniennes intracrâniennes; et une meilleure gestion des infections otorhinolaryngologiques et intracrâniennes chez les enfants. intracrâniennes chez l'enfant. La formation en neuropathologie et le sont également nécessaires. Mots-clés: Afrique, Tumeur cérébrale, Nigéria, Neuropathologie, Pédiatrie. Pathologie.

Clinico-pathological Profile of Head and Neck Tumours with Intracranial Extension.

BACKGROUND: Intracranial extensions of Head and Neck region tumours are a result of direct spread, into the brain and meninges, of tumours arising in the pharynx, paranasal sinuses, orbit, middle ear, scalp, skull and neck tissues. Presenting features may resemble those of an intracranial mass, or the contiguous structure of origin, or both. Delayed diagnosis is not uncommon when patients are not able to afford diagnostic imaging or when the possibility of an intracranial extension is not readily considered in the evaluation of patients with head and neck lesions. AIM: To highlight the important histologic entities in the head and neck region presenting as intracranial mass lesions. METHODS: This was a retrospective database study of tumours in the head and neck region with extension into the cranial cavity. RESULTS: We present 13 patients with intracranial extension of tumours from contiguous structures. There were 7 males and 6 females. Age ranged from 16 to 80 years. Mean age of the patients was 48.92 ± 19.13 years. Specific histologic entities included: nasopharyngeal carcinoma, olfactory neuroblastoma, squamous cell carcinoma, rhabdomyosarcoma and adenoid cystic carcinoma, amongst others CONCLUSION: Early and accurate diagnosis requires a raised awareness of tumours in the head and neck region; their likelihood to invade the cranial cavity; and a familiarity with the likely presentation. Multidisciplinary approach is needed when clinical and radiological features are suggestive of mass lesions breaching the skull and invading the brain from adjacent structures. Confirmation of clinical suspicion by histology is essential.

Skull Base Chordoma: A Case Presentation and Review of Literature.

Chordomas are rare, aggressive, bone cancers with notochordal differentiation, a marked predilection for the axial skeleton, and higher incidence in males. Approximately 30% of chordomas occur at the skull base where they make up 0.1-0.2% of all intracranial neoplasms, and 6-16% of skull base neoplasms. Skull base chordomas typically occur between 20 and 40 years of age. We report a case of skull base chordoma in a 35 year old man, who presented with a 10 year history of symptoms, and died before treatment could be instituted. Late presentation and delay in treatment are contributing factors in the demise of this patient. The need for a high index of suspicion, early imaging and prompt referral in patients with symptoms attributable to an intracranial tumor is emphasized.

The histopathological pattern of liver biopsies at the University of Benin Teaching Hospital.

OBJECTIVE: Microscopic examination of liver tissues remains an essential part in the diagnostic work-up of patients with liver diseases. The aim of this study is to determine the histopathological pattern of liver diseases at the University of Benin Teaching Hospital, Benin City, Nigeria. MATERIALS AND METHODS: This is a retrospective study of all cases of liver biopsies between January 2005 and December 2011. The appropriate data was obtained from the Surgical day book of the department of histopathology. The data was analyzed to reflect age, sex, and pathological diagnosis of the lesions. RESULTS: A total of 80 cases of liver biopsies were reported during the 7-year period. There were 50 males and 30 females with a male:female ratio of 1.7:1. The age ranged from 4 months to 69 years with a mean age of 38.4 ± 13.3 years. The highest incidence was in the 4 th decade. The three common histopathological diagnoses were inflammatory lesions, 63.8%; malignant neoplasms, 22.5%, and liver cirrhosis in 6.3% of cases. Other less common lesions were alcoholic liver disease and steatosis. This peak age incidence of chronic hepatitis precedes that of hepatocellular carcinoma by about two decades. CONCLUSION: The preponderance of chronic hepatitis, hepatocellular carcinoma, and liver cirrhosis in this study is similar to those already established in the African literature, with hepatitis B and/or C being the most incriminated risk factors due to their endemicity in our environment. Public enlightenment programs, widespread implementation of hepatitis B virus vaccination, and surveillance of individual at-risk are essential for the control of hepatitis infection and its late complications.

HISTOPATHOLOGICAL EVALUATION OF H. PYLORI ASSOCIATED GASTRIC LESIONS IN BENIN CITY, NIGERIA.

BACKGROUND: Endoscopic biopsy of the gastric mucosa allows early diagnosis, grading, staging and classification of gastric diseases. Helicobacter pylori, has been recognized as a major aetiologic factor for chronic gastritis, benign gastric ulcers and gastric adenocarcinoma and lymphoma. The loco-regional variability in the prevalence of Helicobacter pylori and associated diseases in Nigeria, emphasise the need for evaluation of subsets of a heterogeneous population like ours. OBJECTIVE: To determine the frequency of helicobacter pylori in gastric endoscopic biopsies and document the pathology of gastric lesions commonly associated with Helicobacter pylori infection. DESIGN: Retrospective descriptive study. SETTINGS: University of Benin Teaching Hospital (UBTH), and Biogenics Histopathology Laboratory (a private Histopathology Laboratory), both based in Benin City, Niger Delta region of Nigeria. SUBJECTS: Endoscopic gastric biopsies recorded in the surgical pathology register of the department from 2005-2009 were studied and relevant demographic and clinical information extracted from the registers, original request cards and patient case files. The clinical data and slides processed from paraffin embedded tissue blocks of endoscopic biopsies of gastric lesions seen from year 2005 to 2009 were studied, analyzed and statistically presented. RESULTS: Total number of specimens studied was 142. Chronic gastritis was present in 117(82.39%) specimens; 9(6.34%) were benign gastric ulcers; 3(2.11%) were gastric polyps; and 11(7.75%) were gastric malignancies. Helicobacter pylori, was demonstrated in 55.6% of all specimens. The peak age for Chronic Gastritis and Gastric Cancer is the 6th decade. Amongst patients with chronic gastritis, inflammatory activity was present in 65%; atrophy in 53%; and intestinal metaplasia in 16.6%. All gastric malignancies seen were intestinal type adenocarcinomas. CONCLUSION: The spectrum of lesions diagnosed in gastric endoscopic biopsy specimens in Benin, their frequency and associations are largely comparable to what has been described elsewhere in Nigeria and Africa.