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.

Frequency of distribution of oestrogen and progesterone receptors positivities in breast cancer cases in Benin-City, Nigeria.

AIMS AND OBJECTIVES: The aim of this study is to determine the prevalence of oestrogen and progesterone receptors positivities among histologically diagnosed breast cancer cases at the University of Benin Teaching Hospital, Benin City, Nigeria. MATERIALS AND METHODS: Cases of breast carcinomas in the records of the Department of Histopathology, University of Benin Teaching Hospital, between 2003 and 2007 constitute the materials used for this study. Immunohistochemical staining was done using representative paraffin-embedded blocks (H&E slides assessment) and stained with oestrogen and progesterone antibodies manufactured by Dako Denmark (AS Denmark). RESULTS: A total of 135 cases were studied. The female to male ratio was 44:1 with an overall mean age of 48.3±13 years. Invasive ductal carcinoma, NOS (not otherwise specified) was the most common histological type (81.5%). Eighty per cent of cases were categorised as grades 2 and 3 tumours. The steroid hormone receptor positivity was 17%. Oestrogen and Progesterone receptor positivity were 14.1% and 9.6% respectively. There was a statistically significant association between hormone receptor status and the grade of tumour (?2 = 6.37, df = 2, p = 0.04). CONCLUSION: This study shows a relatively low steroid hormone receptor positivity of breast cancer in Benin. This finding portends a poor prognostic effect and it is consequently recommended that steroid hormone receptor status be determined before hormonal treatment in these patients. There is the need to determine the immunohistochemical patterns of breast cancer in other centres that treat breast cancer patients.

Immunohistochemical detection of Her-2/neu overexpression in breast carcinoma in Nigerians: a 5-year retrospective study.

OBJECTIVE: To determine the pattern of Her-2/neu status among breast carcinoma in the University of Benin Teaching Hospital, Benin City, Nigeria. MATERIALS AND METHODS: Immunohistochemical staining for Her-2/neu was performed on 10% formalin-fixed, paraffin-embedded primary carcinoma of the breast from 83 patients, between 2003 and 2007 using anti-Her-2/neu rabbit polyclonal antibody (DakoCytomation, CA, USA) and reactivity detected by an avidin-biotin immunoperoxidase method. The clinicopathologic parameters analyzed were patients' age, histological types, and tumor grade. The Her-2/neu Dako scoring system was used. RESULTS: During the 5-year period, 83 histologically confirmed cases of invasive breast carcinoma were assessed for Her-2/neu status. These included 67 (80.7%) cases of invasive ductal carcinoma, nine cases of invasive lobular carcinoma (10.8%), three cases of medullary carcinoma (3.6%), two cases of papillary carcinoma (2.4%), and a case each of mucinous and clear cell carcinoma (1.2%). Mean age of patients was 48.9 ± 13.6 years with an age range of 25 to 83 years. Only nine (10.8%) cases showed immunopositivity for Her-2/neu. Seven of these were cases of invasive ductal carcinoma, while two were invasive lobular carcinoma. Tumors were predominantly high grade with grade III, II, and I accounting for 42, 28, and 13 cases, respectively. There was no significant correlation between patient age, the various histological types, tumor grade, and Her-2/neu positivity. CONCLUSIONS: This study indicates that Her-2/neu may not be useful in defining the prognosis of breast cancer in this environment. Nevertheless, it highlights the need for routine immunostaining for Her-2/neu before institution of trastuzumab (Herceptin) therapy.

Benign breast lesions in an African population: A 25-year histopathological review of 1864 cases.

OBJECTIVE: The objective of this study was to delineate the prevalence and characterize the histologic pattern of benign breast diseases (BBDs) in the University of Benin Teaching Hospital, Benin City, Nigeria. MATERIALS AND METHODS: A 25-year-old (1985-2009) retrospective study of all patients presenting with BBD. RESULTS: During the 25-year-old study period, 1864 cases of BBD constituting 72.4% of all breast lesions were seen. The female to male ratio was 28.6:1. An increasing incidence of BBDs was observed. The overall mean age for BBD was 27.5 years, SD±11.3 with an age range of 9-84 years and a peak age occurrence in the third decade. The single most common lesion was fibroadenoma accounting for 43.1% of cases, followed by fibrocystic change (23.8%) with mean ages of 22.3 years and 30.2 years, respectively. Both lesions had a peak occurrence in the third decade. Other major lesions encountered were sclerosing adenosis (7.3%), atypical ductal hyperplasia (3.6%), and blunt duct adenosis (2.3%). Gynecomastia (2.1%) was the predominant lesion in males. Inflammatory lesions constituted 8.1% of cases while stromal and skin lesions accounted for 1.1% and 0.9% of cases respectively. CONCLUSION: BBDs constituted 70% of breast lumps and were mostly fibroadenoma and fibrocystic change. BBDs occurred predominantly in young females with a peak in the third decade. Though premalignant lesions of atypical hyperplasia were less common, biopsy of all BBDs should be done to exclude these lesions and routine mammographic screening of at risk individuals instituted to increase their detection.

Hodgkin lymphoma: clinicopathologic features in Benin City, Nigeria and update on its biology and classification.

OBJECTIVE: To review the age incidence, common pathohistologic subtypes, and anatomical nodal sites of lymph nodes involvement for histology. MATERIALS AND METHODS: A 25 (May 1985-June 2010) years retrospective study of all patients who had lymph node biopsy. SETTING: Department of Pathology and Haematology, University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: Of 821 lymph node biopsies encountered, 56 (6.8%) cases biopsied were for Hodgkin lymphoma (HL). There was a bimodal peak incidence of age interval of 11-15 years and 21-25 years and the relationship between the age and sex distribution was statistically significant (P = 0.03). The overall median age was 23 years with a mean age of 25.6 ± 2.0 (SEM). Pathological re-appraisal of these 56 cases in the study indicates that mixed cellularity HL constituting 36 cases (64.3%) was the predominant subtype. This was followed by lymphocyte depleted HL with a total of 11 cases (19.6%). The major site of lymph node involvement where biopsy was taken for histological diagnosis was the cervical group of lymph nodes constituting 78.6%. Staging classification of the disease indicates low frequency of early stage disease (I-II) with 19 cases (33.9%) and high frequency of late stage (III-IV) with 37 cases (66.1%). CONCLUSION: Patients are predominantly males, children and young adults presenting with cervical lymphadenopathy at late stage of the disease, and a dominance of mixed cellularity and lymphocyte depleted histological subtypes were observed.

Clinicopathological study of male breast cancer in Nigerians and a review of the literature.

BACKGROUND: Breast cancer is rare in men, accounting for approximately 1% of all cases of breast carcinoma. OBJECTIVE: To evaluate the incidence, presentation, histopathological types, management and outcome of male patients with breast cancer treated at the University of Benin Teaching Hospital, Benin City, Nigeria. METHODS: A 20 year (1987-2006) retrospective study of all male patients with breast cancer was done. Clinic demographic data regarding age, sex, clinical information, treatment and follow up were obtained from request cards and case files. Slides were retrieved from the archives of the Department of Pathology and reviewed. RESULTS: Sixteen cases of male breast cancer were encountered. This comprised 18.4% of the breast lesions in males and 2.8% of all breast cancers seen in the Department during the 20 year study period. The ages of patients ranged from 35-90 years with a mean age of 64.4 years. Delay in patient presentation to physician ranged from 14-49 months. Clinically, patients presented mostly with a self-detected lump (87.5%), or ulceration (68.8%), nipple discharge (43.8%) and nipple bleeding (25.0%). Unilaterality was observed in 87.5% of cases were while 12.5% of cases were bilateral (metachronous). Invasive ductal carcinoma (81.25%) was the predominant histological type of cancer. Stage IV disease was most commonly encountered (43.8%). Eleven (68.8%) patients had modified radical mastectomy. Only 31.3% patients came for follow-up, for a median duration of 10 months. CONCLUSION: Male breast cancer is rare and patients present late with advanced disease. Education needs to be intensified to increase awareness of the disease.

Diagnostic accuracy of fine needle aspiration cytology of palpable breast masses in Benin City, Nigeria.

BACKGROUND: Beast cancer is the commonest malignancy afflicting women. It accounts for 18.4% of all female cancers worldwide. OBJECTIVE: To determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) of palpable breast masses at a Nigerian University Teaching Hospital.. METHODS: Fine Needle Aspiration Cytology was done on all consecutive cases of palpable breast masses referred from the surgical outpatient clinic of the University of Benin Teaching Hospital between January 2005 and March 2006. Comparison was made with subsequent histological diagnoses in order to ascertain the diagnostic accuracy of the procedure. RESULTS: One hundred and three fine needle aspirates of breast masses were performed during the study period. Subsequent biopsies were done on 43 of these cases yielding a biopsy rate of 41.8%. The absolute and complete sensitivities of this study were 84.6% and 97.4% respectively. The full specificity was 64% while the specificity for biopsy cases was 75%. The positive predictive value for malignancies was 100% with a false positive rate of 0%; however the false negative rate was 2.6% with a suspicious rate of 9.7%. The inadequacy rate was 19.4%. CONCLUSION: These results show that FNAC of palpable breast masses in UBTH is an accurate procedure with results comparable to those from other centres and well above the minimum standards recommended internationally. It is, therefore, recommended that FNAC be done on all palpable breast masses.

Histopathological Study of Thyroid Cancer in a Nigerian Tertiary Hospital

Background: Thyroid cancers are rare but are reported as the most common endocrine malignancies. There is a regional variation in the incidence. Aim: To evaluate the incidence and histological pattern of thyroid cancer with respect to age and sex. Methods: A 20-year (1986-2005) retrospective study of thyroid neoplasms at the University of Benin Teaching Hospital; Benin City. Nigeria. Results: A total of 46 malignant tumours were diagnosed constituting 8.6of all thyroid lesions and 1.3of the malignant tumours seen during the period of study. Thyroid cancer was more prevalent in females with a female to male ratio of 1.9:1. Papillary carcinoma (47.8) was the most common histological type of thyroid cancer; followed by follicular carcinoma (30.4); anaplastic carcinoma (13.0); and Medullary carcinoma (8.7); in order of frequency. While papillary carcinoma was the most common histological type of thyroid cancer in females; follicular carcinoma was the predominant form of thyroid cancer in males. Papillary carcinoma was most prevalent in the third decade of life while follicular carcinoma was more frequent after the fourth decade of life. Anaplastic carcinoma occurred in the 6th decade. Conclusion: There is need for an increased level of awareness of the disease and the provision of cancer registries

A 20-Year Clinicopathological Analysis of Tuberculous Mastitis in Nigerians

Background: Tuberculosis is a global problem with high incidence in endemic areas such as Nigeria. A resurgence of tuberculosis attributed to an increase in the incidence of AIDS was observed in many countries in the last decade. A corresponding increase in the incidence of extrapulmonary tuberculosis including tuberculous mastitis was also documented in tuberculous endemic areas Aim: To present the experience of tuberculous mastitis from the Department of Pathology; University of Benin Teaching Hospital; Benin City; Nigeria. 1987 to 2006. Methods: A retrospective study of cases of tuberculosis of the breast from 1987 to 2006 as found in the records of the Pathology Department was done. Results: Twenty-four cases of tuberculosis of breast were seen during the 20 year period of study. All patients were females. They presented with a lump; mostly in the right breast (70.8). All cases were histologically confirmed. Five (20.8) patients were lactating at the time of presentation. Only 3 (12.5) of the 24 cases were suspected clinically as tuberculous mastitis. There was co-existing fibrocystic disease; fibroadenoma and carcinoma in 3 (12.5); 2 (8.3); and 1 (4.2) patient respectively. All patients had satisfactory results on antituberculosis treatment. Co-existing fibroadenoma and carcinoma were treated by excision biopsy and simple mastectomy respectively. Conclusion: Although the incidence of the tuberculous mastitis is low; it is often misdiagnosed. There is need for a high index of suspicion in making the diagnosis in young women with breast lumps in whom malignancy has been excluded

Intracystic papillary carcinoma of the breast in a Nigerian male: case report.

Intracystic papillary non invasive breast carcinoma is an extremely rare form of intraductal carcinoma constituting 5% of male breast cancer. The latter accounts for only 1% of all breast cancers. Until now, no case has been documented in an African male. This tumour was found in an 86 year-old male. It appeared benign on physical examination. Fine needle aspiration cytology was inaccurate. However, excisional biopsy in the form of total mastectomy with axillary clearance served to diagnose as well as treat the disease. This may be the first case of intracystic papillary carcinoma of the breast in the Nigerian male.

Management of Pregnancy Associated Breast Cancer

Background: The peak age incidence for breast cancer in developing countries is 35-45 years; which is part of the reproductive years of our women. As women defer child- bearing on account of education and careers; the incidence of pregnancy associated breast cancer is expected to increase. Aim: This study presents 4 cases of pregnancy associated breast cancer (PABC) to illustrate the challenges and dilemma in the management of these patients. Methods: The clinical features; stage of presentation of the disease; treatment and outcome of treatment of 4 patients with PABC are reviewed. Results: There were live births of normal babies by all 4 patients; but 100mortality as all the 4 patients with PABC died within 18 months of delivery from metastatic breast cancer. Conclusion: Seventy to 80of non-pregnant patients present with advanced breast cancer. PABC as illustrated by these 4 cases presented at worse stages of the advanced cancer. The late stage at diagnosis of PABC and the desire by the patients to have normal live birth at term have worsened prognosis for the PABC patients in our environment. Recommendation: Multidisciplinary team approach by midwives; obstetricians; surgeons and counselors using BSE; CBE and screening at ante-natal clinics for early detection and diagnosis. Counselors to assist patients take decision in the best interest of patient and unborn baby to reduce morbidity and mortality

Pneumothorax in a 16-year-old Nigerian Male with Asthma

Background: Asthma is a commonly occurring disease but the combination of asthma with pneumothorax is not as common. Aim : To outline the diagnostic features and management of this disorder. Case Report : A 16-year-old male student presented with history of marked dyspnoea; tachycardia and chest findings of bilateral polyphonic rhonchi. Drugs which are used for acute severe asthma were administered. The response was not satisfactory . A chest radiograph showed left pneumothorax. A chest tube was inserted and connected to an under-water seal drainage. Conclusion : A detailed history and physical examination aided by a chest radiograph are important in patients who present with acute severe asthma to rule out possible complications; such as pneumothorax

Pneumothorax in a 16-year-old Nigerian male with asthma

Background: Asthma is a commonly occurring disease but the combination of asthma with pneumothorax is not as common. Aim: To outline the diagnostic features and management of this disorder. Case Report: A 16-year-old male student presented with history of marked dyspnoea; tachycardia and chest findings of bilateral polyphonic rhonchi. Drugs which are used for acute severe asthma were administered. The response was not satisfactory . A chest radiograph showed left pneumothorax. A chest tube was inserted and connected to an under- water seal drainage. Conclusion: A detailed history and physical examination aided by a chest radiograph are important in patients who present with acute severe asthma to rule out possible complications; such as pneumothorax

Blader tumors in Benin city : a 15 year histopathological study

A 15 year (1988 - 2002) retrospective study was undertaken to determine the frequency and histological pattern of bladder neoplasms seen in the University of Benin Teaching Hospital; Benin City; Nigeria. Forty-five cases were diagnosed. Males predominated constituting 35 (77.8) cases; giving a M:F ratio of 3.5:1 with ages ranging from 1.5 - 75 years. Malignant neoplasms (40 cases) accounted for 88.9of the bladder tumours and 1.85of all malignant neoplasms seen during the study period. Contrary to most reports; the malignant neoplasms were predominantly transitional cell carcinoma constituting 27(67.2) cases; with peak in the 7th and 8th decades; mean age of 61 years (SD + 13.3) and an age range of 33 - 75 years. Squamous cell carcinoma (SqCC) was relatively rare accounting for 15malignant tumours. SqCC patients had a lower mean age 42 years (SD + 27.5) with ages ranging from 11 - 64 years. None of the SqCC cases showed evidence of schistosoma ova. Rhabdomyosarcoma; fibrosarcoma; non Hodgkin's lymphoma and metastatic tumours constituted 7.5; 2.5; 2.5and 5of the malignant tumours respectively. The benign tumours were all squamous papillomas comprising 5(11.1) cases. Haematuria screening for individuals in high risk occupation; and provision of pipe borne water were recommended

Bladder Tumors in Benin City : a 15 Year Histopathological Study

A 15 year (1988 - 2002) retrospective study was undertaken to determine the frequency and histological pattern of bladder neoplasms seen in the University of Benin Teaching Hospital; Benin City; Nigeria. Forty-five cases were diagnosed. Males predominated constituting 35 (77.8) cases; giving a M:F ratio of 3.5:1 with ages ranging from 1.5 - 75 years. Malignant neoplasms (40 cases) accounted for 88.9 of the bladder tumours and 1.85 of all malignant neoplasms seen during the study period. Contrary to most reports; the malignant neoplasms were predominantly transitional cell carcinoma constituting 27(67.2) cases; with peak in the 7th and 8th decades; mean age of 61 years (SD + 13.3) and an age range of 33 - 75 years. Squamous cell carcinoma (SqCC) was relatively rare accounting for 15 malignant tumours. SqCC patients had a lower mean age 42 years (SD + 27.5) with ages ranging from 11 - 64 years. None of the SqCC cases showed evidence of schistosoma ova. Rhabdomyosarcoma; fibrosarcoma; non Hodgkin's lymphoma and metastatic tumours constituted 7.5; 2.5; 2.5 and 5 of the malignant tumours respectively. The benign tumours were all squamous papillomas comprising 5(11.1) cases. Haematuria screening for individuals in high risk occupation; and provision of pipe borne water were recommended

Pharyngeal lipoma with cartilaginous metaplasia (chondrolipoma): a case report and literature review.

The relative rarity of pharyngeal lipomas and paucity of clinical manifestations in the early stages of tumour growth conspire to task the diagnostic acumen of the clinician. A high index of suspicion and meticulous examination are essential in order to arrive at the diagnosis, which may be achieved pre-operatively by computerized axial tomography, revealing a mass lesion with a characteristic low attenuation value. A case of pharyngeal chondrolipoma in a 25-year-old male is reported. It is suggested that this conceptually intriguing and rarely encountered lesion can be explained on the basis of neoplastic transformation of the second to fourth pharyngeal cleft mesenchymal rests displaying both adipose and cartilaginous differentiation. Alternatively, the cartilage could represent vestigial remnants of non-neoplastic pharyngeal cleft tissue entrapped within a primarily lipomatous neoplasm. Slow growth may occur over a period of several years, prior to overt clinical manifestation.