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In Africa, epidemiological data on the effect of the HIV epidemic on the occurrence of lymphomas are scanty. The 1990s witnessed the alarming rates of HIV/AIDS in Nigeria. The prevalence of HIV/AIDS in Nigeria increased from 1.8% in 1991 to 4.4% in 2005. The aim of this study was to determine whether there have been any changes in the frequency and pattern of lymphomas in view of the HIV/AIDS epidemic in the country. This is a retrospective study of all lymphoma cases diagnosed during 1991-2005. The prevalence of lymphomas declined from 1.4% to 0.7% of surgical biopsies during 1991-2005. There was a decline in the proportion of high-grade non-Hodgkin lymphoma and Burkitt's lymphoma from 79.1% and 45.8% respectively to 21.1% and 13.6% respectively. There is a suggestion that the HIV/AIDS epidemic in the country may not have influenced the pattern of occurrence of both major histomorphological types of lymphoma in Ibadan. [ABSTRACT FROM AUTHOR]

Background and Objective: The demonstration of HER2 in gastric adenocarcinoma (GA) tissues by immunohistochemistry assists in deciding whether targeted therapy would optimise the treatment of GA patients who are HER2 positive. However, this has not been extensively studied in our patients hence the need for this study., Methods: Recipient tissue microarray blocks were constructed from donor archival formalin fixed paraffin embedded gastric tumour tissue from 80 patients seen over a period of 17 years in a retrospective descriptive study. Slides cut from these blocks were stained with antihuman HER2 antibody by immunohistochemistry and scored using the trastuzumab in gastric adenocarcinomas (ToGA) trial criteria. Data on age, gender, site of lesion and histological subtype of the gastric adenocarcinomas were also retrieved and reviewed., Results: Eighty cases (52 males and 28 females; male to female ratio of 1.9:1), 55.65 ±13.50 years (modal age group 60-69 years), were studied. Most tumours (91.2%) involved the distal parts (pylorus, antrum and body) with a few (8.8%) involving the proximal part (cardia and fundus) of the stomach. HER2 was overexpressed in a total of 6 (7.5%) cases only. Two of seven (28.6%) proximal tumours showed HER2 positivity whereas only 4 of 73 (5.5%) of the distal tumours showed HER2 positivity., Conclusion: We had only a slightly lower HER2 overexpression rate than in studies from many other parts of the world. The observed overexpression was significantly higher in proximal than distally located tumours suggesting that distal tumours are less likely to respond to Trastuzumab than proximal tumours. The known association of distal gastric tumours with Helicobacter pylori infection probably provides for a possible difference in the molecular aetiopathogenesis of GAs by site of occurrence. The exact mechanisms for proximal gastric carcinogenesis remain to be more clearly elucidated. More studies, including clinical trials with larger sample sizes, are recommended to elucidate this differential expression of HER2 in gastric adenocarcinoma., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Cutaneous larva migrans (CLM) results from hookworm larvae infestation, mainly Ancylostoma braziliense or Ancylostoma caninum. It is common in Sub-Saharan Africa, often acquired through soil contact, especially in sandy beaches, manifesting as serpiginous, erythematous and intensely pruritic tracts within the epidermis, and presenting with diverse clinical appearances. Diagnosis is mostly clinical; however, dermoscopy can enhance diagnostic accuracy and distinction from mimics. The current body of literature is deficient in its representation of dermoscopic data for CLM in Black patients. This study explores dermoscopy in nine dark-skinned patients with 16 CLM lesions. Distinctive serpiginous structureless areas displaying a range of colours, peripheral scales surrounding brown areas and brown dots were predominant features, whereas vascular characteristics were less evident. This article highlights the presence of distinct reaction patterns, including brown dots, scales, and accentuated, often disrupted brown reticular lines in addition to the characteristic winding tracts in darker skin., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: This study aimed to characterise epithelial cell adhesion molecule (EpCAM) expression patterns in colorectal carcinomas (CRC) from Nigerian patients, its association with E-cadherin and tumour characteristics, to forecast patient selection for anti-EpCAM therapy among whom no data existed previously., Methods: Tissue microarray blocks of formalin-fixed and paraffin-embedded CRC tissues, with their non-cancer margins of resection, were sectioned and stained with EpCAM and E-cadherin primary antibodies. Scoring for antibody staining was done semiquantitatively by combining staining proportion and intensity. The outcome was correlated with patient age, gender and tumour histological parameters with p ≤ 0.05 regarded as statistically significant., Results: Sixty-three carcinoma tissues had staining status for the two markers and were included in this study. Of these, 36 (57.1%) showed positive EpCAM expression (immunoscore ≥3) out of which 83% (30/36 positive cases) were overexpressed (combined immunoscore ≥4) while 12 (19%) tissues were positive for E-cadherin. Non-tumour margins of resection tissues showed less EpCAM positivity in 24% (6/25) of histospots. The difference in staining between tumour and non-tumour margin tissues with EpCAM was significant ( p < 0.001). Also, EpCAM overexpression was significantly associated with reduced E-cadherin ( p < 0.035) expression in tumour cells. Tumour extent within the gut wall was equal (50% each) for early and late pT stages among EpCAM overexpressing tumours but two-thirds (8/12) of cases expressing E-cadherin had later pT stage paradoxically, while distant metastasis was negligible among tumours bearing both markers. Also, tumours overexpressing EpCAM had significant association with tumour-associated lymphocytes ( p < 0.02 each)., Conclusion: CRC in this study preferentially overexpress EpCAM over E-cadherin whose strong cell-cell contact inhibitory role is weakened even when expressed, resulting in further local tumour spread. This, and the observed immune response, supports targeted therapy among eligible patients., Competing Interests: The authors declare that they have no conflict of interest to declare with regard to this study., (© the authors; licensee ecancermedicalscience.)

Introduction: Sub-Saharan Africa has a heavy burden of oral diseases and cancers. Also, there is a dearth of published records of oral pathology services in The Gambia. Therefore, this review aimed to determine the prevalence of biopsied oral and maxillofacial lesions in order to ascertain the uptake of oral histopathology services at the foremost tertiary institution in The Gambia., Materials and Methods: This was a retrospective study performed at the Pathology Department of Edward Francis Small Teaching Hospital. Reports of all oral and maxillofacial biopsies submitted for the period 2012 to 2021 were reviewed and data were extracted. Descriptive analysis was done using SPSS software, version 26., Results: Total number of biopsy reports was 158 representing 0.02% over the study period. The mean age of patients was 34.3 ± 19.7 years, the 3rd decade was the peak age of presentation and male-to-female ratio was 1:1.6. Majority (65/41.1%) of the cases were benign neoplastic lesions, and the mandible was the most (21/13.3%) common site of biopsy. Reactive lesions were the predominant (34/21.5%) group and squamous cell carcinoma had the highest (24/15.3%) number of lesions while odontogenic tumours constituted six cases only (3.8%)., Conclusion: The findings of this study showed low uptake of oral histopathology services while biopsied oral and maxillofacial lesions were prevalent in female patients in the third decade of life. Also, the mandible was the most affected site whereas benign neoplastic diagnoses were most common. However, this study recorded a higher proportion of malignancies than some previous studies., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of West African College of Surgeons.)

Background: Clinical and histopathologic observations have indicated that psoriasis is not rare in our population as previously thought. The initial rarity also led to paucity of studies on the disorder including histopathologic features in our practice setting. To date, there is no report on the histopathologic features of psoriasis indigenous to our practice environment., Objective: To evaluate the frequency of occurrence of the various histopathologic features of psoriasis in patients from this environment and identify any peculiarities that exist in black African patients., Methods: A cross-sectional study of patients diagnosed clinically with psoriasis at the University College Hospital, Ibadan between January 2015 and October 2016. After baseline sociodemographic data, all patients had baseline clinical examination and were offered skin biopsy after obtaining informed consent. The biopsy specimen was examined for histopathologic features of psoriasis after routine processing and staining using a pretested proforma with the frequencies of each diagnostic feature reported in percentages., Results: Forty-four patients with plaque psoriasis were analyzed. The mean age of the patients studied was 39.84 ± 20.97 years with a male to female ratio of which was almost equal. The most consistent epidermal changes in decreasing other of frequency were acanthosis, hypogranulosis, hyperkeratosis followed by elongation of rete ridges while dermal features were dermal infiltration by inflammatory cells, and dilatation of superficial dermal vessels. Munro's microabscesses were found in less than half of the patients biopsied. Some of the patients were found to have atypical changes., Conclusion: Histopathological features of psoriasis in the study is similar to what has been previously established universally but typical features such as Munro's micro abscesses and Kogoj's spongiform pustules are less frequently seen than expected. Atypical changes such as dermal melanophages and periadnexal infiltration by inflammatory cells may also be seen., (© Association of Resident Doctors, UCH, Ibadan.)

Background: Progressive improvement in the accuracy of profiling of hormone receptors in breast cancer provides the basis for targeted endocrine therapy, a major pillar of multimodal breast cancer treatment. However, the disparity in findings from comparatively smaller sample-sized studies in West Africa has led to somewhat conflicting conclusions and recommendations., Objectives: This study investigates the immunohistochemical (IHC) profile of breast cancer specimens for estrogen receptor (ER), progesterone receptor (PR), human epidermal receptor-2 (HER2)/neu, and Ki-67 in a tertiary hospital in Ibadan, Nigeria over 12 years., Materials and Methods: We reviewed 998 IHC reports, documented clinicopathologic parameters, computed patterns of biomarkers, and stratified them based on the American Society of Clinical Oncology/College of American Pathologists recommendations. Descriptive analysis including frequency, mean, and median were generated from the data extracted., Results: Out of the 998 cases, 975 (97.7%) were females and 23 (2.3%) were males. The mean age was 48.84 ± 11.99 years. Open biopsies were the most common types of specimens (320, 41.6%): lumpectomy and incisional biopsy of ulcerated, fungating or unresectable tumours. In those cases, 246 (32.0%) were samples of breast-conserving or ablative surgical extirpation (mastectomy/wide local excision/quadrantectomy), and 203 (26.4%) were obtained by core needle biopsies. Invasive ductal carcinoma was the most common histopathological type (673, 94.5%). The majority of graded tumours were intermediate grade (444, 53.5%). Four hundred and sixty-nine (48.4%) were ER positive, 414 (42.8%) were PR positive, and 180 (19.4%) were HER2/neu positive. Three hundred and thirty-four (34.0%) were triple-negative. Eighty-nine cases had Ki-67 staining done, and of these 61 (68.5%) had positive nuclear staining., Conclusion: Steroid hormone receptors and HER-2/neu proportions in our cohort are likely to be more representative than the widely varied figures hitherto reported in the sub-region. We advocate routine IHC analysis of breast cancer samples as a guide to personalized endocrine therapy., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of the West African College of Surgeons.)

Competing Interests: There are no conflicts of interest.

Background: Surgical resection margins (RM), axillary nodal involvement and lymph node ratio (LNR) determine loco-regional control (LRC) in breast cancer management. Late presentation precludes breast conservation therefore surgical option is usually mastectomy and adjuvant chemoradiation minimize loco-regional recurrence (LRR)., Objective: We investigated the prognostic role of lymph nodes positive for malignancy (pN), LNR and RM on LRR of breast cancer in a tertiary hospital in Ibadan, Nigeria., Methods: Longitudinal cohort study of 225 females with breast carcinoma managed and followed up for 5-years with end point of LRR or not. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with LRR. The receiver-operator curve was plotted to determine the proportion of metastatic lymph nodes which predicted LRR., Results: Ninety-nine percent had modified radical mastectomy and 163 (72.4%) had negative resection margins. A mean of 11 axillary lymph nodes were harvested at surgery. The age, positive resection margin and number of harvested nodes with malignant cells are associated with LRR. The overall 5-year LRR rate was 16%., Conclusion: LRR is dependent on lymph node involvement as well as and tumor aggressiveness., (© 2022 Ayandipo OO et al.)

Sickle cell anaemia (SCA) is a chronic haemolytic anaemia associated with vaso-occlusive painful crises which may affect several systems including the gastro-intestinal system, resulting in abdominal pain. The concurrence of inflammatory bowel disease and haemoglobinopathy is rare. No previously reported concurrent cases of both SCA and ulcerative colitis (UC) in sub-Saharan Africa were found in the literature. A 16-year-old girl with concurrent SCA and UC is presented. She was admitted to University College Hospital, Ibadan with a 1-year history of recurrent peri-umbilical pain and bloody stools. These symptoms were mainly attributed to SCA at the referring hospital, and she was managed for chronic tropical diarrhoea without a remarkable clinical response. This case illustrates the concurrent presentation of SCA and ulcerative colitis which led to the missed and delayed diagnosis of ulcerative colitis.

Background: Different reasons for autopsies include medico-legal causes, medical education and deducing the cause of death. An additional benefit is auditing with regards to patient care in the diagnosis and treatment of diseases. The main objective of this study was to determine the concordance between ante-mortem clinical diagnoses and post-mortem causes of death., Materials and Methods: From January 2009 to December 2015, Autopsy records at the Department of Pathology, University College Hospital, Ibadan were reviewed. Discrepancies between the clinical diagnoses and postmortem findings were categorised using Goldman criteria into major and minor classes. Goldman's criteria can be sub-categorised into five classes: Class I, Class II, Class III, Class IV and Class V. Classification of the cause of death categories was by the International Classification of Diseases, Version 10. The study was carried out with respect to the world medical association's Declaration of Helsinki (2013). Data analysis was carried out with the use of the Statistical Package for the Social Sciences (SPSS version 22)., Results: Five hundred and thirty-three cases were involved with a male-female ratio of 1.6. The most common postmortem causes of death were traumatic Injuries (20.6%), Circulatory system-related deaths (19.7%), infections (16.9%) and malignant neoplasms (9.4%). Only 298 (55.9%) of the cases showed a concordance between the post-mortem causes of death and the clinical diagnosis., Conclusion: The post-mortem autopsy is useful in the audit of current medical practice in our environment., Competing Interests: None

Background: Emerging data suggest a negative role of cyclooxygenase-2 (COX-2) in colorectal carcinomas (CRC). Investigating this in developing communities such as ours helps to contribute to existing understanding of these lesions., Methods and Findings: Formalin-fixed paraffin-embedded CRC colectomy tissues and their corresponding non-tumour margins of resected tissues were sectioned and stained with COX-2 antibody. Adenomatous polyp tissues from non-cancer bearing individuals were similarly processed for comparison. COX-2 expression was scored for percentage (< 5% = 0; 6%-25% = 1; 26%-50% = 2; 51%-75% = 3; 76%-100% = 4) and intensity (no staining = 0; yellow = 2; yellowish-brown = 3, brown = 4). Total immunoscore (percentage + intensity score) ≥ 2 was regarded as positive COX-2 expression. Outcome was statistically evaluated with clinicopathological data to determine COX-2 expression-associated and predictor variables. Ninety-five CRC cases and 27 matched non-tumour tissues as well as 31 adenomatous polyps met the inclusion criteria. Individuals with CRC had a mean age of 56.1 ± 12.6 years while those with adenomatous polyps had a median age of 65 years (range 43-88). COX-2 was differentially overexpressed in CRCs (69/95; 72.6%) and in adenomatous polyps (17/31; 54.8%) than in non-tumour tissues 5/27 (18.5%); p < 0.001). The difference in COX-2 expression between CRC and polyps was non-significant (p > 0.065). Tumour grade, advanced pT-stage, tumour-infiltrating lymphocytes, and dirty necrosis were also significantly associated with COX-2 expression (p < 0.035; 0.043, 0.035 and 0.004, respectively). Only dirty necrosis and Crohns-like lymphocytic aggregates predicted COX-2 expression (p < 0.05)., Conclusion: This study showed a progressive increase in COX-2 expression from normal to adenomatous polyp and CRC tissues, this being associated with poorer prognostic indicators. Although COX-2 appears early in CRC, it may play a secondary role in promoting tumour growth and invasiveness., Competing Interests: The authors have declared that no competing interests exist.

The objectives of this study were to describe the clinicopathologic features and treatment outcomes of childhood rhabdomyosarcoma in a resource-constrained setting. All cases of childhood rhabdomyosarcoma seen over a 10-year period (July 2006 to June 2016) at the University College Hospital, Ibadan, Nigeria were reviewed. Data were extracted from the database of the pediatric Hematology/Oncology Unit of the hospital and analyzed. Ethical approval was obtained from the Institutional Ethics Committee. Fifty children were seen comprising 30 men and 20 women with bimodal ages of 4 and 5 years. Median duration of illness was 16 weeks and the most common primary tumor site was the head-and-neck region in 27 (54%) of cases. The histologic subtypes were embryonal in 30 (60%), alveolar in 9 (18%), and not specified in 11 (22%). The Intergroup Rhabdomyosarcoma Study group TNM Pretreatment stages were stage I in 15 (30%), stage III in 17 (34%), and stage IV in 18 (36%). Treatment included chemotherapy, surgery, and radiotherapy and abandoned in 20 (40%) cases. Median survival was 45 weeks (95% confidence interval: 16.4-73.6) and 5 (10%) patients were alive and disease free, 4 years or more after diagnosis. Outcome of childhood rhabdomyosarcoma is poor and early diagnosis and improved access to treatment are recommended., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: WHO revealed that morbidity and mortality from non-communicable diseases (NCDs) are on the increase and NCDs accounted for approximately 29% of all deaths in Nigeria in 2016. This study was conducted to estimate the economic cost of selected NCDs-lung cancer, liver cancer and liver cirrhosis. These diseases are known to be associated with key modifiable health risk behaviours (smoking and alcohol use), which are prevalent in Nigeria and often commence during the adolescent years., Methods: Data were obtained between 2016 and 2017, from mortality records of patients managed for the selected diseases in the University College Hospital, a major referral centre in Nigeria. Information on costs of treatment, clinic visits, admission and transportation was obtained. Average costs of terminal in-patient care and transportation costs (in 2020 prices) were computed per patient. Costs were converted to the US dollar equivalent using the current official rate of US$1: ₦360.50., Results: Twenty-two (out of 90 cases recorded) could be retrieved and all the patients had been diagnosed in the terminal stages of the disease. The average direct costs were ₦510 152.62 (US$1415.13) for an average of 49.2 days of terminal care for lung cancer; ₦308 950.27 (US$857.00) and ₦238 121.83 (US$660.53) for an average of 16.6 and 21.7 days of terminal care for patients managed for liver cancer and liver cirrhosis, respectively., Conclusion: The economic costs of each of the diseases were very high. Findings emphasise the need for aggressive efforts to promote primary prevention, improve early diagnosis and provide affordable treatment in view of the fact that the monthly minimum wage is less than US$85.00 and treatment costs are borne out-of-pocket by the generality of the population in Nigeria., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Aim: To describe the pattern of paediatric Rhabdomyosarcomas (RMS) and Non-Rhabdomyosarcomas (NRMS) with emphasis on the indices that affect survival outcomes., Methods: We reviewed all patients with histologically confirmed RMS and NRMS in the Departments of Pathology and Paediatrics, University College Hospital (UCH), Ibadan, Nigeria; in children aged 0-14 years. The study period was January 1991 to December 2016. Information obtained included age, gender, morphology and site of the tumours. The tumour grade and pathologic/clinical staging of all patients were also obtained and verified by the clinical records. Tumour grading was carried out using the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) Sarcoma group grading system and staging was done using TNM. Follow up, survival information and final outcome were retrieved., Results: The 104 patients included in the study had almost equal male-to-female ratio, age ranged between 5 months and 14 years (median 8.2 years). Rhabdomyosarcoma had mean age of 5.6 (±3.8) years while that of NRMS was 9.2(±4.1) years. Overall, the modal age group was 5-9 years. Rhabdomyosarcoma was the commonest histological type (76%), undifferentiated sarcomas (6.7%), fibrosarcoma (3.8%) and 2.9% each for synovial sarcoma and dermatofibrosarcoma protuberans. The common primary sites were the head and neck (including the orbit) 49 (47.1%), and the abdominopelvic 26 (25%) regions. Majority (89%) had histologic grade 3 at presentation. Seventy per cent and 64% of patients with RMS and NRMS, respectively, had high stage tumour at presentation. Median survival for all patients with Rhabdomyosarcoma was 45 weeks with a 1-year survival of 43% and 2-year survival of 25%. Non-RMS (Dermatofibrosarcoma protuberans and Solitary fibrous tumours) had survival of over 4 year's duration., Conclusion: Majority of our patients presented at a late stage with histologic high grade which confers poor prognosis and reduced chances for good overall survival outcome., (© 2020 John Wiley & Sons Ltd.)

We report a case of Rosai-Dorfman disease in a 28-year-old Nigerian woman with a 7-year history of painless prominent bilateral neck swelling which waxed and waned over the years. She had two misdiagnosis hence appropriate therapy was not initiated over the years. She was eventually referred for independent opinion and was diagnosed correctly with review of the histology sections and with the use of CD45, S100, CD 68, CD 15, CD 20, synaptophysin and AE1/AE3 immunohistochemistry markers. Classic features on Haematoxylin and eosin stained sections and positivity of the lesional cells for S100 and CD68 were diagnostic of Rosai-Dorfman disease. She was subsequently placed on oral steroids with minimal objective reduction in the neck circumference from 57 to 46 cm. After two months, she was managed with three courses of chemotherapy (cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone) which resulted to a significant sustained reduction in her neck circumference to 36 cm. She has been on follow up for about a year without a recurrence., Competing Interests: The Authors declare that no competing interest exists

Background: Fine-needle aspiration cytology (FNAC) is widely employed as an initial investigative tool in the diagnosis of various lesions in the body, however, it is limited in the provision of precise architectural detail of lesions. This is said to be responsible for the wide variation in the documented usefulness and accuracy relative to histopathology. This study aimed to correlate cytopathological and histopathological examination (HPE) of head and neck lesions, and assess the usefulness and accuracy of FNAC in our center., Materials and Methods: This was a retrospective study that utilized historical data obtained from case notes and histopathology records of 91 patients that had both FNAC and HPE done for head and neck lesions in our center during the study. The FNAC results were correlated with that of the histopathological diagnosis to obtain the accuracy of the FNAC diagnosis. Diagnostic validity of FNAC in terms of sensitivity, specificity, and predictive value were also evaluated., Results: A total of 91 FNAC-HPE sample pairs were included. The Sensitivity and specificity for benign lesion was 95.4% and 42.3%, respectively, while for sensitivity and specificity for malignant lesion was 31.8% and 96.9%, respectively. The overall Sensitivity and specificity for cytology was 96.8% and 30.4%, respectively., Conclusion: FNAC appears to be a useful tool in the initial assessment of head and neck lesions in our center, however, the high rate of missed diagnosis especially as concerned malignancies has dire negative treatment implications. There is need to develop capacity for improved skill in making cytopathologic diagnoses among anatomical pathologists involved in the use of FNAC as diagnostic and screening tool., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Nigerian Medical Journal.)

The original version of this article unfortunately contained a mistake. In Table 2, the number 36 under "N" should be 96 and "Tumour size in cm (range)" should read "Tumour size in cm."

Purpose: To determine the pattern and significance of tumour budding among colorectal carcinoma (CRC) Nigerian patients using the 2016 International Tumour Budding Consensus Conference (ITBCC) guidelines., Methods: H&E-stained slides of resected CRC at the University College Hospital and a private laboratory, both in Ibadan, Nigeria, from January 2008 to December 2017 were reviewed. Patient age, gender, tumour size and location were obtained from the surgical pathology records. Tumours were graded and staged according to the 2010 WHO and the 2017 UICC protocols, respectively. Tumour budding was determined at × 20 objective lens magnification with a 20-mm eyepiece field number diameter. Descriptive, Mann-Whitney U and chi-square test statistics were applied using SPSS 20; p < 0.05 was considered significant., Results: Ninety-six cases were included in this study. Fifty-one (53.1%) showed tumour budding. Tumour bud count was low (0-4) in 66 (68.8%), intermediate (5-9) in 12 (12.5%) and high (≥ 10) in 18 (18.8%) tumours. Four tumours had pT1 stage, 35 pT2, 37 pT3 and 20 pT4. Forty-three (44.8%) tumours were lymph node-positive, and 10 (10.4%) had metastasis. Patients' age and tumour size distribution were similar in the tumour budding and non-budding groups (52.4 ± 17.1/58.5 ± 13.9 years and 6.6 ± 2.9/6.6 ± 2.8 cm, respectively). There was significant association between tumour budding and tumour grade (p < 0.008), pT stage (p < 0.000), lymphovascular permeation (p < 0.000), perineural invasion (p < 0.003) and nodal status (p < 0.034), but not with gender (p = 0.588), metastasis (p = 0.327) and TNM group-stage (p = 0.062)., Conclusion: Tumour budding frequency is high among our CRC patients and is associated with poorer prognostic factors.

Purpose: Gastrointestinal stromal tumours (GIST) are rare and studies on GIST in Nigeria are extremely uncommon. This study aims to achieve a comprehensive systematic review of the cases of this tumour in Nigerians., Methods: A systematic search of all available literature on GIST published from Nigeria between January 2000 and December 2018 was done and reviewed. Simple descriptive data on all the cases are presented., Results: The search yielded 15 publications but 13 publications with a total of 67 patients were analysed. The other two studies centred on imatinib therapy and overall survival, and molecular characteristics respectively and were therefore reviewed independently. Age at diagnosis ranged from 9 to 75 years, with mean age being in the 50s and 60s across most studies. There is no gender disparity. Anatomical location of primary tumours showed gastric location as the most frequent (61%) followed by large intestine accounting for 15%, the small intestine (9%) and other locations (15%). Tumour size ranged from 5-39.5 cm. Over 85% of patients had tumour size greater than 10 cm at presentation, hence fell into intermediate or high-risk group irrespective of location of tumour. The overall survival of a cohort of 27 patients that had imatinib therapy was 69.5% after 4 years of follow-up. KIT exon 11 mutations were the only mutations detected from a small cohort of 12 patients., Conclusions: Characteristics of GIST in Nigerians are fairly similar to other parts of the world. However, most of our patients present with large masses which are of poor prognostic characteristics.

Background: Dermatofibrosarcoma protuberance (DFSP) is the commonest, yet rare, dermal sarcoma globally. There are few reports in the literature of this neoplasm in Nigerians and indeed in sub-Saharan Africa. This study documents our institutional practice observation and compares it with those from other regions of the world., Methods and Materials: This study was a retrospective review of all cases of histologically diagnosed DFSP at the University College Hospital, Ibadan, Nigeria, spanning a period of 27 years (January 1989-December 2016). Data on patient age, gender, tumour location, size, tumour recurrence and metastasis status were obtained from clinical and surgical pathology archival files and records., Results: Sixty-nine cases of DFSP were recorded over the period reviewed with a male-female ratio of 1.6:1. The mean age of the study population was 39.6 years. The youngest patient was 5-year old, while the oldest was 86 years and the modal age group was the 4th decade. The trunk was the commonest anatomic tumour location. Recurrences were seen in seven cases with recurrence interval ranging from 6 to 240 months. The correlation between tumour size and age was non-significant ( r = -0.183; p = 0.182). There was fibrosarcoma-like transformation in three cases (4.3%) studied., Conclusion: Dermatofibrosarcoma protuberance is rare in our population and occurs more commonly in males and on the trunk. Recurrence can occur beyond the recommended follow-up period of 10 years., Competing Interests: None declared by the authors., (© the authors; licensee ecancermedicalscience.)

Introduction: Oncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. Even though axillary lymph nodal metastasis is a critical index of prognostication, establishing the impact of lymph node ratio (LNR) and adequate surgical margins on disease-specific survivorship would be key to achieving longer survival. This study examines the prognostic role of pN (lymph nodes positive for malignancy), LNR and resection margin on breast cancer survival in a tertiary hospital in Ibadan, Nigeria., Methods: We conducted a longitudinal cohort study of 225 patients with breast carcinoma, documented clinico-pathologic parameters and 5-year follow up outcomes - distant metastasis and survival. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with patients' survival. The receiver operating characteristic curve was plotted to determine the proportion of metastatic lymph nodes which predicted survival. The survival analysis was done using Kaplan-Meier method., Results: Sixty (26.7%) patients of the patients had positive resection margins, with the most common immuno-histochemical type being Lumina A. 110 (49%) patients had more than 10 axillary lymph nodes harvested. The mean age was 48.6 ± 11.8 years. Tumour size (p = 0.018), histological type ( p = 0.015), grade ( p = 0.006), resection margin ( p = 0.023), number of harvested nodes ( p < 0.01), number of metastatic nodes ( p < 0.001) and loco-regional recurrence ( p < 0.01) are associated with survival. The overall 5-year survival was 65.3%., Conclusion: Unfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients., Competing Interests: The authors declare that they have no competing interests., (© the authors; licensee ecancermedicalscience.)

Background: Lymphomas are a heterogeneous group of tumors of lymphoid tissue in which there is a malignant proliferation of cells of the lymphatic system. They are the most frequent nonepithelial malignancy in the head and neck region., Objectives: The aim of this study was to evaluate the histological pattern of the disease in the head and neck region and trends in presentation seen in our center., Materials and Methods: This was a retrospective study of cases of head and neck lymphoma (HNL) seen in the Pathology Department of the University College Hospital Ibadan, Nigeria over a period of 37 years (1981-2017). Information extracted from the records included the sociodemographics of the patients, tumor location, and histological type among others. Data were analyzed and results were presented as frequencies and percentages., Results: There were a total of 373 cases of histologically and/or cytologically diagnosed HNL seen during the study period (an average of 10 cases per year). The mean age of patients was 33.5 ± 21.9 years with male:female ratio of 1.6:1. Most HNL were non-Hodgkin's lymphomas (NHL), accounting for 91% of cases. Nodal disease was seen in 39% of cases. The bone (prominently, the jaws) predominated (25%) in extranodal lesions. Burkitt's lymphoma was the most common specific subtype of NHL, occurring in 25.5% of cases., Conclusion: There has been an apparent upward trend in the prevalence of HNL over the past four decades, although other parameters such as age and sex predilection appear unaffected. Factors responsible for this trend need to be interrogated and ascertained., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of the West African College of Surgeons.)

Introduction: nasopharyngeal carcinoma is relatively common in our environment. It is one of the most difficult malignancies to diagnose at an early stage. The aim of the study was to determine the clinical features, clinical disease stage of nasopharyngeal carcinoma at presentation and at diagnosis as well as the histologic types at the University College Hospital, Ibadan, Nigeria., Methods: this was a ten year retrospective study of all histologically confirmed nasopharyngeal carcinoma between January 2007 to December 2016 using clinical and pathology records and files., Results: there were 73 cases. The male: female ratio was 1.7. The age of patients ranged from 12 to 80 years with a mean age of 39 ± 16 years. The median age at diagnosis was 40 years. The peak age group of occurrence was 40-49 years. The most common symptoms were namely epistaxis in 67.1% of patients at presentation, neck mass/swelling (64.4%) and nasal mass/obstruction (63.0%). Majority (54.8%) of the patients presented late with stage 3 or 4 disease. Most (94.5%) of the tumours were of the non-keratinizing squamous cell carcinoma subtype. The keratinizing and basaloid variants accounted for 4.1% and 1.4% of the tumours respectively., Conclusion: vague, non-specific symptoms make patients present at late stages of the disease, making it almost impossible to attempt cure. The dominant histopathological type is non-keratinizing squamous cell carcinoma and resembles that seen in most parts of Nigeria and endemic areas of the world., Competing Interests: The authors declare no competing interests., (© Gabriel Olabiyi Ogun et al.)

Background: A high proportion of skin cancers in Nigeria occur in Individuals with oculocutaneous albinism (OCA). A reduction or absence of melanin, a skin pigment with photoprotective properties, makes them susceptible to skin malignancies such as squamous cell carcinomas (SCCs), basal cell carcinomas (BCCs) and rarely melanomas. Globally, BCCs are the commonest cutaneous malignancies among Caucasians and in fair-skinned Africans. This has been attributed to the greater effect of melanin in protecting against UV damage in the basal layer of the epidermis. Older retrospective studies on African albinos suggested that SCCs accounted for a higher prevalence of skin cancers in albinos, followed by BCCs. Melanoma has been consistently documented to be rare in all of these reports. Recent reports however noted BCCs to occur at an increasing frequency, suggesting a higher frequency than previously documented. These conflicting reports reflect the need to re-explore the pattern of cutaneous malignancies in albinos in order to reconcile the role of pigmentation, UV exposure and the variance between the frequencies of the different keratinocyte skin cancers among extreme skin phenotypes. This study explores the pattern of cutaneous malignancies seen in albinos in South East Nigeria., Objective: To determine the pattern of cutaneous malignancies among albinos in Anambra state, Nigeria., Materials and Methods: A cross-sectional study conducted in Anambra State, Nigeria. Ninety albinos from the Albino foundation Anambra state were recruited. Malignant dermatoses were characterized clinically and confirmed by histology. Fifty-eight lesions from 30 albinos were biopsied to determine the presence of malignancy., Results: Skin cancers were seen in 20.98% of all participants and in 18 (60%) of all the albinos who had skin biopsy. The SCC/BCC ratio was 1.0: 2.3. There was no cutaneous melanoma., Conclusion: Contrary to previous reports, it would appear that the pattern of cutaneous malignancies in albinos shows the same trend as that seen in Caucasians and fair-skinned Africans., Competing Interests: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript., (© the authors; licensee ecancermedicalscience.)

Introduction: 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 services.

Introduction: Postoperative venous thromboembolism (VTE) is a major surgical complication, fraught with high case fatality rate, to which neurosurgical patients are particularly prone. There is dearth of data on this problem in the neurosurgical literature from sub-Saharan Africa., Materials and Methods: A 6-year prospective descriptive study of postoperative VTE in a neurosurgeon's clinical practice in Nigeria is hereby presented. The clinical case of a fatal, postmortem-confirmed post craniotomy VTE also is annotated., Results: There were 10 cases of clinically diagnosed neurosurgical postoperative VTE, representing 2.4% of the surgical patients population. The cases were diagnosed from clinical impressions supplemented with laboratory investigations like the Doppler ultrasonography with B-mode imaging of the deep veins of the lower extremities, and chest computed tomographic angiography. Six of these 10 cases died, a case fatality rate of 60%. Meningiomas were the intracranial tumours operated on in 60% of the cases., Conclusions: Postoperative venous thromboembolism has a very high case fatality rate among these neurosurgical patients. There is need for continuing surveillance of this problem, as well as a heightened vigilance to prevent and treat it in our neurosurgical patient populations., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Non-neoplastic skin lesions constitute the majority of skin diseases. There is a paucity of histopathology studies of non-neoplastic skin diseases in Nigeria and the West Africa sub-region in general. This is because the dermato-pathology sub-specialty is poorly developed. Therefore, the main aim of this study is to determine the spectrum of histologically diagnosed non-neoplastic skin lesions in Ibadan, Nigeria., Methods: This is a retrospective study. All non-neoplastic skin lesions diagnosed in the Department of Pathology, University College Hospital, Ibadan over a five year period. (January 2006 to December 2010) was reviewed. The lesions were classified into eight groups according to the International Classification of Diseases (ICD)-10 of skin and subcutaneous disorders. The main classes include Dermatitis/Eczema, Papulosquamous disorders, Infectious disorders, Connective tissue diseases, Bullous disorders, Naevi/Developmental lesions, Granulomatous lesions, keratinizing disorders and other categories/Miscellaneous group., Results: A total of 209 non-neoplastic skin lesions comprised 1.3% of all surgical pathology specimen received within the study period. The modal age group was 20-29. The Dermatitis/Eczema group has the highest frequency of 87 cases representing 41.6% of cases, papulosquamous disorders 39 (18.7%), infectious disorders 37 (17.7%), bullous disorders 11 (5.3%) and connective tissue disorder 9 (4.3%). Chronic non-specific dermatitis was the commonest specific diagnosis comprising 60 cases (28.7%) of all the skin diseases. The other common specific skin lesions were lichen planus/lichenoid dermatitis 27(12.9% of 209 cases), verruca vulgaris 25 (12% of 209 cases)., Conclusion: The number of histologically diagnosed non-neoplastic skin lesions is relatively small. There is a very wide spectrum of non-neoplastic skin lesions diagnosed within this period. There is a need for a specific diagnosis considering the high frequency of chronic non-specific dermatitis.

Background: Cancer is an important cause of morbidity and mortality worldwide in children under 15 years of age, with the incidence and mortality rate varying from 40 to 155 per million children., Aim: To describe the pattern of childhood cancer in Ibadan, Nigeria., Objective: To compare the findings of this study with those of previous studies in Ibadan and internationally., Methods: A retrospective review of histologically and cytologically confirmed cases of cancer in children aged <15 years diagnosed at University College Hospital (UCH), Ibadan between January 1991 and December 2010 was undertaken. The cases were categorised using the International Classification of Childhood Cancer, third edition (ICCC-3)., Results: There were 625 cases comprising 360 (57·6%) males with a modal age of 3 years. The most common neoplasms were lymphomas (140, 22·4%), of which 90% were non-Hodgkin lymphomas, with Burkitt lymphoma constituting the majority of cases (73). Other common neoplasms were retinoblastomas (21%), soft tissue sarcomas (14·9%), leukaemias (10·2%) and CNS tumours (6·9%). Lymphomas, bone tumours, malignant hepatic tumours and other malignant epithelial neoplasms had the highest mean and modal ages, while retinoblastomas, neuroblastomas, germ cell tumours and renal tumours had the lowest mean and modal ages. During 1960-72 there were 1326 cases and during 1973-90 there were 1881 cases and the proportion of lymphomas was 58·9% and 45·4%, respectively. The present study demonstrated a marked decline in the number of cases and proportion of lymphomas (22·4%), particularly Burkitt lymphomas., Conclusion: During the last 20 years, there has been a decline in the number of cases of childhood cancer seen at UCH, Ibadan. This may be due to the establishment of additional specialist centres in the sub-region. Owing to a persistent decline in the frequency of Burkitt lymphoma, retinoblastoma is now the most common individual childhood cancer seen at Ibadan.

Background: Mesenchymal Gastrointestinal (GI) tumours are heterogenous group of tumours. Prior to 2005, immunohistochemistry (IHC) was not used in diagnostic pathology to characterize these tumours at our centre., Objectives: To subclassify mesenchymal tumours in the GI tract and related locations into Gastrointestinal stromal tumour (GIST) and non-GIST tumours using specific IHC antibody markers., Methods: Formalin Fixed Paraffin Embedded tumour tissue over the period 1991- 2004 were retrieved, from the files and records of the Department of Pathology, University College Hospital, Ibadan, Nigeria. Haematoxylin and Eosin slides of such cases were reviewed. The IHC expressions of c-Kit, CD 34, α-smooth muscle actin, desmin and S-100 were evaluated in these tumours., Results: Based on morphology and IHC staining pattern, 24 of the 46 cases were identified as GIST by c-kit positivity. Nine of the cases were smooth muscle tumours (4- leiomyoma and 5- leiomyosarcoma), 8 cases of undifferentiated sarcomas, 4 cases of desmoid and one case of inflammatory myofibroblastic tumour. For GISTs: The male:female ratio is 1.2. The age range of the patients was 11-75 years with a mean age of 55.1 years.Tumour size ranged from 7-32 cm with an average of 19.8cm and average mitotic count of 20 per 50 high power field. The location of the GIST tumours were as follow- stomach- 9 cases (37.5% of the 24 GIST cases), colon and rectum -6 (25%), Abdominal cavity (omentum/ mesentery)- 6 (25%), retroperitoneum-2(8.3%), small intestine-1 (4.2%)., Conclusion: The use of IHC in this study has helped to segregate and distinguish GI mesenchymal tumours into different sub-types, majority being Gastrointestinal stromal tumours.

Background: Adult colo-colonic intussusception is a rare abnormality and it may pose a diagnostic challenge., Objective: To report two cases of adult colo-colonic intussusception with benign lesion as the lead points., Methods: The Clinical records of the two patients containing the management details were retrieved and reviewed., Results: The 1st case was a 60 year old man presenting with a year history of recurrent left abdominal pain a two week history of fullness left upper and lower abdomen. Examination showed an 8cm by 6 cm mass in the left hypochondrium continuing with another 16cm by 8 cm mass spanning the left lumbar and left iliac fossa. Abdominal ultrasound scan showed a huge mixed echogenic mass in the central abdomen spanning the left hypochondriac, left lumber and suprapubic regions. He had exploratory laparotomy which revealed cob-cobonic intussusception involving the ascending colon up to sigmoid colon. He had subtotal colectomy done. The lead point was a hamartomatous polyp The 2nd case was a 35 year old man with a two month history of recurrent abdominal pain and haematochezia, a month history change in bowel habit and five day history of abdominal distension. Examination showed distended abdomen with generalised tenderness. There was a firm mass in the left hypochondrium extending to the left iliac fossa. Abdominal ultrasound scan confirm intussusception: Exploratory laparotomy showed perforation of transverse colon at the neck of cob-colonic intussusception involving the distal third of the transverse colon to the rectum. He had extended left hernicolectomy and Devine colostomy done. He died 36 h6urs post operation. The lead point was an inflammatory polyp., Conclusion: Adult colo-colonic intussusception is an uncommon disease which may not present in a typical feature of intussusception as occur in children thus posing diagnostic dilemma. High index of suspicion with radiological investigation will serve to aid rapid and accurate diagnosis.

Introduction: Fine-needle aspiration biopsy (FNAB) as a means of evaluation of palpable soft tissue lesions is poorly utilized in our environment despite the fact that it safe, cheap, quick and easy to perform., Methods: All cases of cases of palpable soft tissue lesions of the trunk and extremities where FNAB was used as the initial evaluation tool were reviewed. Furthermore, the records for corresponding cases that had open excision biopsy and ultimately had histologic diagnosis out of these cases were also retrieved and correlated with the final diagnosis from FNAB., Results: Out of 142 aspirates, only 107(75.3% of cases) fulfilled the inclusion criteria for the study. The age range was from 0-85 years (mean = 41.2 yrs.) with a roughly equal male:female ratio. The lesions were located in the trunk -56 cases, upper arm -7, forearm -1, hand -1, thigh -28, leg -7 and the foot-7. The FNAB was diagnosed as benign in 56 (52.3%) cases, malignant in 48 (44.8%) cases and suspicious of malignancy in 3(2.8%) cases. The cases were cytomorphologically classified into the following categories: Lipomatous (32 cases), epithelia (18), spindle cell (14), inflammatory (13) pleomorphic (11), small round (6), myxoid (5), epitheloid/ polygonal (1) and others (7). The sensitivity and specificity of diagnosed cases with FNAB as either benign or malignant when correlated with histology were 95% and 100% respectively., Conclusion: FNAB is a valuable tool in the initial evaluation of palpable soft tissue lesions especially in primary soft tissue neoplasms and clinically suspected metastatic carcinomas.

Unlabelled: Germ cell neoplasms which have the potentials of differentiating along somatic cell lines are regarded as teratomas. They are mature teratomas when tissues are fully differentiated and immature teratomas when primitive or immature tissue elements are present. In this retrospective study, we analyzed all the renal biopsies submitted to the Department of Pathology of the University College Hospital, Ibadan, South-West Nigeria over a thirty one year period (1981-2011). Over the period, a total of 119,986 specimens were received for histological assessment and only 1,027 (0.86%) represented kidney specimens which included all the trucut biopsies and nephrectomies. Two (0.19%) of the nephrectomy specimens from a one-year and a five-month old children were diagnosed as mature and immature cystic teratoma respectively. The sample from the one-year-old child was heavy (810 g), cystic and measured 17 x 10 x 10 cm. On microscopy, the tissues were predominantly mature neural tissue, mature skeletal muscle, cartilage and foci of normal kidney tissue while the sample from the five month old child was almost double the weight of the former (1600 g) and measured 18 x 14 x 9 cm. Cut sections revealed cystic and solid areas comprising bone, glial tissue, primitive neuroectodermal tissue, choroid plexus, immature cartilage, skeletal muscle, fat, intestinal tissue, breast structures,odontogenic and squamous epithelial tissues on microscopy., Conclusion: Cystic teratoma is a rare occurrence in kidneys.

Background: Leukaemias are haematological malignancies characterized by unregulated clonal proliferation of haematopoietic cells., Objective: To determine the pattern of childhood leukaemia in Ibadan., Methodology: This was a retrospective study of leukaemia cases diagnosed at the University College Hospital (UCH), Ibadan between January 1991 and December 2010 in children less than 15 years of age. Data obtained was subjected to statistical analysis using the Statistical Package for Social Sciences version 20., Results: There were 64 cases of childhood leukaemia, accounting for 10.2% of childhood cancers seen during this study period. The male to female ratio was 2:1 and modal age group was between 10 and 14 years. Thirty (46.9%) cases were acute lymphoblastic leukaemia (ALL), 22 (34.4%) were acute myelogenous leukaemia (AML) and 12 (18.8%) were unspecified acute leukaemias. There was no case of chronic myeloid or lymphocytic leukaemia., Conclusion: There has been a relative increase in the frequency of leukaemia cases at UCH, Ibadan, which may be largely explained by increased awareness and referrals. There is a need for further collaborative multicentre studies of childhood leukaemias in Nigeria and other developing countries and focused research on childhood leukaemias in order to unravel the aetiology.

Introduction: Sickle Cell Disease (SCD) has a high mortality rate in the environment where we practice. There is lack of contemporal autopsy studies describing causes of death among SCD patients at our centre., Methods: This is a retrospective study of SCD patients who died between January 1991 and December 2008 and that had autopsy examination to confirm the cause of death in a Nigerian teaching hospital. The clinical data, including the age, gender, Hb genotype, and the major autopsy findings and cause of death were obtained for each patient from the complete autopsy reports that included histopathological examination. Multiple causes of death were entertained., Results: A total of 52 autopsies were performed. The mean age at death was 21.3 years (range, 1-47 years) and a male/female ratio of 1.3:1. HbS+C patients lived longer than HbS patients (21.0 years Vs 24.0 years) and peak mortality was in the 2nd and 3rd decades of life. The commonest causes of death as a single entity or in combination included infections in 78% of cases, fatal thrombotic/embolic events (37%) making acute chest syndrome a leading cause of death. This was followed closely by anemia alone or in combination with acute sequestration crises in 31% of patients., Conclusion: Infections are the commonest causes of death in Nigerian SCD patients, efforts to reduce infection especially early in life through prophylaxis or vaccination will impact on the overall survival of these patients.

A healthy 40-year-old man, restrained in the front passenger seat, suffered visually disabling blunt ocular trauma following spontaneous release of the passenger side air-bag module, during vehicular deceleration, without an automobile crash. Though the driver-side airbag was also released, the driver was unharmed. The passenger suffered bilateral hyphema, bilateral vitreous hemorrhage and suspected posterior scleral rupture in the left eye and also had an eyebrow laceration, from impact with the dashboard panel covering the air-bag module, which was detached by the force of airbag deployment. This is the first reported case from West Africa and the first case in which part of the airbag module detached to cause additional trauma. This report adds to the growing burden of evidence world-wide, for a review of the safety aspects of the automobile airbag. This case clearly illustrates that although airbags reduce mortality, they carry a high risk of ocular morbidity, even with seat belt restraint.

We report a case of congenital immature teratoma of the orbit in a female neonate who presented on the second day of life. She was successfully managed by modified exenteration. The patient was lost to follow-up intermittently over a 24-month period without recurrence of the tumour. However the patient could not be traced again after 24 months of follow up. This happened despite concerted efforts to educate the parents. The possible implications of this and other social factors, in a challenging and resource limited setting, on the prognosis of the disease and cosmetic outcome are considered.

Abstract Kaposi's sarcoma (KS) in women with HIV infection is observed to have increased from recent studies. To understand the gender-related differences of AIDS-KS in Nigeria, we conducted a prospective study of the clinical, virologic, and immunologic features of newly diagnosed AIDS-KS patients. Prevalence was similar in both genders. There were differences in the distribution of the lesions and the CD4 count in women was significantly lower.

Solitary fibrous tumor (SFT) of the orbit, initially thought to be rare, is being increasingly documented in the medical literature. We here present the case of a 37-year-old Nigerian man who presented with left sided painless, vision-sparing proptosis. Cranial computed tomography scan showed a globular, left medial, orbital extraconal mass. The mass was excised, en bloc, via a medial orbitotomy procedure aided by left ethmoidectomy. Surgery was uncomplicated and histology of the excised tissue was reported as compatible with SFT. There was also a strong and diffuse immunostaining with CD 34. At 6-month follow-up, the left-sided proptosis has completely regressed. To the best of our knowledge, this is the second case of orbital SFT to be reported in an African.

Background: Salivary gland neoplasms constitute an important group of intraoral tumours, with their malignant histological types being the second most frequently diagnosed intraoral malignancy. The incidence as well as the anatomical distribution of this heterogeneous group of neoplasms varies from one racial group and geographical location to the other. However, studies from Africa on intraoral salivary gland neoplasms are relatively sparse in the medical literature., Objective: To report the frequency and anatomical distribution of the various histological types of minor salivary gland neoplasms diagnosed at the University College Hospital, Ibadan and to provide data for comparison with other epidemiological findings in different geographic locations., Methods: A retrospective study of intraoral salivary gland neoplasms diagnosed at the University Teaching Hospital, Ibadan between January I991- December 2007. Included in the study were charts of patients with minor salivary glands in the mouth. Information obtained about each patient included age, sex, tumour location and histological classification based on the 1991 WHO recommendations., Results: Of a total of 309 neoplasms of salivary gland origin, 92 were from the intra-oral minor salivary glands constituting 4.5% of head and neck neoplasm. There was no significant gender predilection. Fifty-seven (62%) cases were malignant, while 35 (38%) were benign. The most frequently diagnosed tumour was adenoid cystic carcinoma 35(38%), followed by pleomorphic adenoma 30(32.6%). About 73% of the salivary gland neoplasms affected the palate, followed by the buccal mucosa (16.3%). Patients with malignant neoplasms were about 10 years older than those with benign tumours (p=0.012)., Conclusion: A large proportion of intraoral salivary gland neoplasms are malignant, the most frequently affected site being the palate.

Background/aims: To retrospectively evaluate the clinicopathological features, treatment modalities and factors affecting prognosis in patients with both conjunctival intraepithelial and invasive squamous neoplasms., Method: Review and analysis of clinical and pathological records of all cases histologically diagnosed in the Department of Pathology, University College Hospital, Ibadan, Nigeria between January 1990 and December 2004., Results: There were a total of 46 cases in 45 patients (eight intraepithelial carcinomas, 37 invasive squamous cell carcinomas (SCC) and a single case of mucoepidermoid carcinoma in a 71-year-old man). The intraepithelial neoplasms occurred in patients aged between 20 and 90 years. Seven of these patients had actinic changes on histology. For invasive SCC, patients' ages ranged from 18 to 84 years with a mean age of 53 years. Male to female ratio was 1:1. The majority presented with an orbital mass and loss of vision. Twenty-two (60%) of the patients with invasive SCC had enucleation or exenteration as the primary modality of treatment with or without radiotherapy or chemotherapy. Altogether for intraepithelial and invasive squamous neoplasms, the duration of presenting complaints ranged from 1 month to 5 years with an average of 2 years. Human immunodeficiency virus (HIV) infection and smoking were not significantly associated with these cases but a significant number had outdoor occupation. Low socioeconomic status and inability to afford treatment was common among our patients., Conclusion: Patients with invasive SCC in Nigeria present late and have significant delay before having any form of treatment. This contributes to the poor outcome. Human papilloma virus (HPV) and actinic aetiology are possible strong causative agents in Nigerians.