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.

Advanced carcinoma of the prostate presenting as a supraclavicular mass: case report.

Advanced carcinoma of the prostate presenting initially with supraclavicular lymphadenopathy is uncommon. These are 2 cases of advanced prostate cancer that presented initially with persistent painless left supraclavicular mass. Both patients had elevated prostate specific antigen (PSA) level. This as well as histological finding of metastatic adenocarcinoma following biopsy of the neck masses necessitated referral to the urologists. Urological review revealed enlarged hard nodular prostate and transrectal prostate biopsy findings in keeping with high grade adenocarcinoma in both cases. The patients had initial clinical and biochemical response to androgen deprivation therapy with resolution of neck masses within 4-8 weeks of treatment. The authors advocate that men presenting with persistent supraclavicular masses should have a digital rectal examination (DRE) and a PSA test as part of their initial assessment.

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.

Period of onset and lack of clinical manifestation of hepatotoxicity after commencing highly active antiretroviral therapy.

AIM: The period of onset of hepatotoxicity varies between cohorts as do their clinical manifestations. Clinical manifestations of hepatotoxicity that have been previously reported include fatal portal hypertension, dress syndrome, and lipodystrophy syndrome. The aim of this study was to determine the period of onset and clinical manifestation of hepatotoxicity after commencing HAART. MATERIALS AND METHODS: This study was carried out on patients with HIV on HAART attending infectious disease clinic, gastroenterology clinic or admitted into the medical wards of University of Benin Teaching Hospital. Patients with HIV but not on HAART were used as controls. A clinical evaluation and relevant laboratory investigations were done. Hepatotoxicity was defined using a standardized toxicity grade scale. RESULTS: A total of 84 cases and 42 controls were studied. The mean ages were 35.2 ± 9.9 years and 35.5 ± 9.0 years for the cases and the controls respectively. Over 70% of the study population and controls were females. The overall incidence of hepatotoxicity was 17.85% and severe hepatotoxicity occurred in 10.71% of the patients. Over 80% of liver enzyme elevations occurred within 3 months, most of which were asymptomatic. CONCLUSION: This study shows that over 80% of enzyme elevations occurred within 3 months and were mostly asymptomatic. There is a need for regular monitoring of liver function tests at short intervals in HIV patients starting HAART since most of the cases of hepatotoxicity found in this study occurred early and were asymptomatic.

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.

Cysticercosis in the anterior chamber: a case report.

Cysticercosisis a public health problem and its occurrence in the anterior chamber of the eye israre. It occurs following ingestion of poorly cooked infested meat of pigs, sheep and dogs etc. Clinical evaluation and investigations were done to determine the cause of defective vision in a 45 year old female patient. A cyst was removed surgically from the anterior chamber by visco expression followed by a course of medication. The cyst was taken for histopathological examination. Investigations revealed mild eosinophilia on blood examination and an erythrocyte sedimentation rate of 95 mm/hr. Histology showed a cystic lesion with a thin fibrocollagenous wall and a hyalinised scolex within the lumen.A high index of suspicion is required for appropriate diagnosis and subsequent management of patients with anterior chamber cysticercosis.

CAUSES OF SUDDEN NATURAL DEATH: A MEDICO-LEGAL AUTOPSY STUDY OF MEDICAL CASES IN AN AFRICAN REFERRAL CENTRE.

OBJECTIVE: To evaluate and characterise the causes of sudden natural deaths (SNDs) that occurred in medical cases in an African referral centre. DESIGN: A descriptive retrospective study. SETTING: University of Benin Teaching Hospital, between January 2005 and December 2011. SUBJECTS: Autopsy reports of 626 cases that were referred to the coroner. RESULTS: A total of 626 cases of SNDswere identified representing 30.3% of all autopsies performed within the period. There were 390 (62.3%) males and 236 (37.7%) females with a M:F ratio of 1.7:1. The age range of the cases was 19-105 years with a mean age of 51 ± 17 years. The modal age group was 40-49 years which accounted for 19.8% of the cases, and most of the cases (56.8%) were seen in the 30-59 year age groups. In majority of cases (39.3%), the cause of death was related to the cardio-vascular system-principally death due to complications of hypertension which was seen in 88.2% of the cardio-vascular system diseases. Immune/infectious diseases (mainly AIDS), gastro-intestinal/hepatic lesions and respiratory diseases were seen in 15.2, 14.1 and 12.5% of cases respectively. SNDs due to malignant neoplasms were not a common finding as they occurred in 5.1% of cases. CONCLUSION: This study shows that with the increasing, modernisation of our lifestyle and dietary habits, cardio-vascular system diseases-particularly complications of hypertension have become the leading cause of sudden natural death in our environment.

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.

Neck masses in children: etiopathology in a tertiary center.

BACKGROUND: Neck masses are common in children; they could present diagnostic challenges, and some may be malignant. This study determines the etiology, histopathology, and outcome of treatment in a Nigerian tertiary center. MATERIALS AND METHODS: This is a three-year retrospective study of children managed with neck masses at the University of Benin Teaching Hospital between January 2007 and December 2009. The biodata, side distribution of the masses, clinical conditions of the children at presentation, methods of biopsy, histopathology results, definitive treatment options, follow-up, and outcome were analyzed. RESULTS: A total of 35 children who were aged between one month and 16 years (mean, 8.1 ± 2.6 years) with a male : female ratio of 1.9 : 1 (23 males to 12 females) were managed with 26 (74.3%) acquired and nine (25.7%) congenital neck masses. The masses were located in the anterior triangle in 14 (40%) cases, right side of the neck in 12 (34.3%), and left side of the neck in seven (20%), with two (5.7%) bilateral/confluent. Twelve (34.3%) cases were enlarged lymph nodes; five (41.7%) of them due to malignant lesions. Except for the neck mass, 16 (45.7%) of the children enjoyed clinically stable health on presentation. Twenty (57.1%) acquired tumors were malignant compared with 15 (42.9%) mainly congenital tumors which were benign. Four malignant tumors (11.4%) were rare in anterior triangle. Hodgkin's lymphoma, 9 (25.7%), and thyroglossal duct cyst, 5 (14.3%), were most common malignant and nonmalignant masses, respectively. Surgical excision was curative in 12 (34.3%) cases, but others required additional chemo and/or radiotherapy, with two (5.7%) mortality recorded due to late referral of children with Hodgkin's lymphoma. CONCLUSIONS: Many neck masses in otherwise healthy children in our setting were malignant. We advocate early surgical consultation and thorough histopathologic analysis of neck masses in children in our subregion.