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   Table of Contents - Current issue
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July-December 2020
Volume 11 | Issue 2
Page Nos. 101-199

Online since Thursday, December 31, 2020

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ORIGINAL ARTICLES  

Histopathologic analysis of endometrial biopsies in a Northern Nigerian Teaching Hospital Highly accessed article p. 101
Murtala Abubakar, Balarabe Kabir, Almustapha Aliyu Liman, Sani Muhammed Shehu, Bilkisu Lawal Kankia, Anisa Yahya, Zainab Adamu Ali
DOI:10.4103/atp.atp_29_20  
Background: Endometrial biopsy is a reliable means of evaluating the physiologic and pathologic states of the endometrium. The aim of this study was to examine the histopathological pattern of endometrial biopsies as seen in Zaria, Nigeria and to compare the results with similar studies elsewhere. Method: A retrospective analysis was carried out based on the records of the Department of Pathology, Ahmadu Bello University Teaching Hospital, Shika, Zaria between January 2014 and December 2018. The neoplastic lesions were classified according to 2014 World Health Organization classification for endometrial neoplasms. Results: A total of 1518 endometrial tissue samples were analysed. Pregnancy related conditions (41.76%) and functional endometrial changes (27.24%) were the most common morphologic diagnostic category seen. Endometrial hyperplasia (7.13%) was the most common pathologic lesion diagnosed. Of the malignant endometrial tumours, endometrial carcinoma is the most common with 29 cases (58% of all malignant endometrial lesions). One Hundred and Nine cases (7.2%) of the total cases reviewed were found to be inadequate for histopathologic evaluation. Conclusion: Retained product of conception was the most common morphologic entity seen in endometrial biopsy in Zaria. The proportion of endometrial samples that are inadequate for histopathologic evaluation is high. There is a need, therefore, for retraining of staff and standardization of biopsy procedures.
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Seroprevalence and factors associated with risk of human brucellosis among febrile patients attending health-care facilities in Bauchi, North-Eastern Nigeria Highly accessed article p. 107
Hafiz Halilu, Fatima J Giwa, Saad A Ahmed, Mu'awiyyah B Sufiyan, Amina I Mohammed
DOI:10.4103/atp.atp_39_20  
Background: Brucellosis is a neglected underdiagnosed zoonotic disease of worldwide distribution with varying symptoms similar to those occurring in other febrile illnesses. A recent screening survey conducted among butchers in Bauchi state reported a high prevalence of human brucellosis; however, its burden among patients with other febrile illnesses is unknown. We determine the seroprevalence and factors associated with risk of brucellosis among febrile patients attending health-care facilities (HCFs) in Bauchi metropolis, North-Eastern Nigeria. Methodology: We conducted a hospital-based descriptive cross-sectional study of 382 participants using a multistage sampling technique. Brucella antibodies were detected using Rose Bengal plate test, and a questionnaire was used to identify risk factors associated with human brucellosis. Data analyses were conducted using Epi Info version 7.0. Bivariate and multivariate analyses were conducted at P = 0.05. Results: Fifty-seven (14.9%) of the 382 febrile patients tested had Brucella antibodies. Males: female ratio was 1.1:1, and the mean age was 29.9 (standard deviation 12.03). Age, sex, occupational status, keeping animals, having ever milked an animal, handling animals during birth, and consuming unpasteurized milk or meat were found to be significantly associated with brucellosis on bivariate analysis. Conclusions: Up to 14.9% of the febrile patients attending HCFs in Bauchi metropolis had Brucella antibodies. Age, occupational status, consuming unpasteurized milk or meat, handling animals during birth, and lack of awareness on zoonosis remained independent predictors for brucellosis. Therefore, conducting routine serological screening tests for Brucella antibodies in all febrile patients presenting to HCFs will assist in its diagnosis and proper management.
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Breast lesions in a district hospital: Demographic and histopathologic characteristics p. 113
Kevin Nwabueze Ezike, Solomon Raphael, Ijeoma Ahunna Okwudire-Ejeh, Damian Ikechukwu Okonkwo
DOI:10.4103/atp.atp_23_20  
Background and Aim: Breast cancer is increasingly the most common malignancy among Nigerian women. This study documents the demographic and histopathologic characteristics of breast lesions in a district hospital over a 5-year period. Patients and Methods: Data were collated from patients' request forms and duplicate copies of histology reports of all cases seen under the study period. Results: Breast lesions represented 13% of all histologically diagnosed lesions during the period of the study. Almost 98.6% of these breast specimens were received from females, with a female-to-male ratio of 58.9:1.0. The overall age range of the patients seen was from 10 to 96 years, with a mean of 33.3 ± 13.1 years at the time of presentation. There were 37 (4.4%) nonneoplastic breast lesions, 547 (65.3%) benign breast neoplasms (BBNs), and 254 (30.3%) malignant breast neoplasms (MBNs). The peak age incidence of MBNs was seen in the fifth decade (33.1%). The most common BBN was fibroadenoma (54.5%), followed by fibrocystic change (29.3%). The most common MBN was invasive ductal carcinoma (84.3%), followed by lobular and mucinous carcinoma, each accounting for 4.3%. About 77.1% of the breast carcinomas were Grade II. Conclusion: Breast lesions are common in our setting, strikingly more common in females, predominantly benign in nature with fibroadenoma which peaks in the 20–29 years age group being the most common variety. Invasive ductal carcinoma is the most common malignancy, affecting more women in their 40s with one of every three cases seen in women before their 40th birthday.
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Indications and diagnostic utility of bone marrow aspiration cytology: A 12-year experience at a tertiary health center in Gombe, Northeastern Nigeria p. 119
Saleh Yuguda, Ahmed Iya Girei, Kasim Mohammed Pindiga, Rufai Abdu Dachi, Aliyu Ibrahim Lawan, Yusuf Mohammed Abdullahi
DOI:10.4103/atp.atp_15_20  
Background: Bone marrow aspiration (BMA) cytology is very important in the diagnosis and management of a wide range of both hematological and nonhematological disorders. It has several indications ranging from the evaluation of cytopenias to staging and assessment of remission in the course of management. Aim: The aim of the study was to determine the indications and diagnostic utility of BMA cytology at the Federal Teaching Hospital, Gombe, Gombe State, Nigeria. Methodology: A retrospective review of BMA cytology records performed at the department of Haematology and Blood Transfusion of the Federal Teaching Hospital, Gombe, over a 12-year period from January 1, 2006, to December 31, 2017. Results: A total of 596 BMAs were performed over the study period. The age ranges were from 2 months to 88 years, with a median age of 36 years. Majority of the patients were males (61%). The most common indication for the bone marrow examination was for the evaluation of recurrent anemia 32.2%, followed by presumptive diagnosis of leukemia 27.7%. Normal marrow finding constituted 4.7%, while the diagnosis was inconclusive in 4.2% of the cases. The most frequently diagnosed diseases are the nutritional deficiency anemia together accounting for about one-third of the cases (megaloblastic anemia 20.3%, combined deficiency anemia 9.9%, and iron deficiency anemia 2.5%) and leukemia. Conclusion: Anemia and leukemia are the most common indication for BMA, and nutritional deficiency anemia is the major BMA diagnosis in Gombe, Northeastern Nigeria.
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Adherence to glivec (imatinib mesylate) therapy amongst patients with chronic myeloid leukaemia in Nigeria p. 123
Charles Erhinyodavwe Origbo, Rahman A Bolarinwa, Anthony A Oyekunle, Temitope O Afolabi, Benedict Nwogoh, Muheez A Durosinmi
DOI:10.4103/atp.atp_4_20  
Background: Adherence to Imatinib (Glivec®) is of critical importance in achieving optimal treatment outcomes in patients with chronic myeloid leukemia (CML). Objective: This study aims to investigate adherence to therapy and factors that could influence patient adherence to Glivec®. Methods: This is a prospective cohort study conducted at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. Seventy consenting newly diagnosed CML patients in the chronic phase were counseled on adherence to therapy and administered 400 mg/day dose of Glivec. Six months after commencement, they were evaluated for adherence using two structured self-administered questionnaires. The first one to evaluate adherence (Morisky Medication Adherence Scale) and the other was administered to identify factors known to influence adherence to therapy. Data were analyzed using SPSS version 21.0 Statistical package (2012, IBM Corp, Armonk, NY, USA.). Results: The study participants had a mean age of 38.4 ± 12.7 years. The male-to-female (male:female) ratio was 1.7:1. Thirty-three (47.1%) of the patients were classified as adherent. Family support was significantly associated with adherence (P = 0.012). The distance of >200 km away from the point of drug collection, OAUTHC, Ile-Ife was significantly associated with nonadherence to Glivec therapy (P = 0.008). Conclusion: This study found that adherence in patients on Glivec® therapy was <50%. Distance of >200 km and family support were significant determinants of adherence in this study.
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Overexpression of human epidermal growth factor receptor 2 protein in urothelial carcinoma of the urinary bladder in Ibadan: A single-institutional experience p. 128
Ebenezer O Fatunla, Mustapha A Ajani, Francis A Onakpoma, Augustine O Takure, Clement A Okolo
DOI:10.4103/atp.atp_31_20  
Background: Overexpression of human epidermal growth factor receptor 2 (HER-2) protein has been shown to have both prognostic and therapeutic values in several malignancies including urothelial carcinoma of urinary bladder (UCB). Aims: This study aimed to determine HER-2 protein overexpression and evaluate its correlation with clinico-pathological parameters in UCB. Materials and Methods: This was a descriptive-analytical study involving the immunohistochemical review of all histologically diagnosed urinary bladder malignancy in the Department of Pathology, University College Hospital, Ibadan, between January 2002 and December 2016. Urinary bladder malignancies whose tissue blocks could not be found and/or demographic data were not available were excluded. Immunohistochemistry analysis was done using rabbit anti-HER-2 antibody (Biocare) and American Society of Clinical Oncology/College of American Pathologists guidelines established for breast cancer were used for HER-2 status scoring. The statistical analysis was carried out usingthe Statistical Package for the Social Sciences, version 22 (SPSS Inc, Chicago, Illinois, USA). Results: HER-2 overexpression was found in four (6.3%) cases. All the HER-2-positive cases were males. One (2.9%) of the 35 high-grade UCB showed positive HER-2 overexpression, whereas three (10.7%) of the 28 low-grade tumor were positive for HER-2 protein overexpression.There was no statistically significant association between HER-2 protein overexpression and histological grades of UCB and muscle invasion by the tumor. Conclusion: Our study demonstrated the low percentage of HER-2 overexpression in UCB with no significant association with tumor grades and muscle invasion. Larger samples involving multiple centers can provide more robust information and further evaluate HER-2 overexpression in urothelial carcinoma in our environment.
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Antimicrobial activity of garlic (Allium sativum ) on selected uropathogens from cases of urinary tract infection p. 133
Okunye Olufemi Lionel, Idowu Philip Adegboyega, Adeleke O Ezekiel, Babalola Caroline Olufunke
DOI:10.4103/atp.atp_9_20  
Introduction: The etiologic agents of urinary tract infection (UTI) occur among both the Gram-positive and Gram-negative bacteria including those that exhibit resistance to commonly used standard antibiotics. Both the male and female individuals can be prone to developing UTI. Garlic (Allium sativum) has been associated with antibacterial activity, though with scanty reports on uropathogens. This study was, therefore, carried out to determine the antibacterial efficacy of aqueous and methanol extracts of garlic (A. sativum)in vitro against six uropathogens (Escherichia coli , Staphylococcus saprophyticus, Pseudomonas aeruginosa, Proteus spp., Klebsiella spp., and Serratia marcescens ) and a reference strain, E. coli ATCC-25922 . Materials and Methods: The bacterial isolates were collected from the Routine Microbiology Laboratory, University College Hospital, Ibadan, and were authenticated by Gram staining and some conventional biochemical tests. The isolates were then subjected to antimicrobial susceptibility testing against both the aqueous and methanol extracts of garlic. Phytochemical screening was also carried out on the plant. Results: Both aqueous and methanol extracts had maximum zones of growth inhibitions of 22 mm at 200 mg/mL and 25 mm at 200 mg/mL against E. coli, followed by P. aeruginosa with zones of growth inhibitions of 21 mm and 25 mm at the same concentration. Proteus spp., exhibited the lowest zones of growth inhibition of 16mm at 200mg/mL.and 10mm at 25mg/mL to methanol and aqueous extracts respectively. The minimum inhibitory concentrations MICs and MBCs of the aqueous and ethanol extracts of garlic varied for each organism. Escherichia coli had the MICs' of 100mg/mL and MBC of 220mg/mL while the MIC and MBC of the aqueous extract on the Proteus spp. are 100mg/mL and 320mg/mL respectively. The MBCs recorded were relatively higher in comparison to the MIC values. Conclusion: These findings showed that garlic could be of therapeutic use in the management of bacterial mediated UTI.
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Analysis of argyrophilic nucleolar organizer region score and epithelial dysplasia in common odontogenic cysts seen in a university teaching hospital p. 139
Oluseyi Folake Ajayi, Oladunni M Ogundana, Moses T Kolade, Onatolu Odukoya
DOI:10.4103/atp.atp_14_20  
Aim: Carcinomatous transformation in odontogenic cysts (OC) lining may be more common than is generally appreciated. Thus, the aim of this study is to predict the potential for neoplastic transformation in the epithelial lining of OC using argyrophilic nucleolar organizer region (AgNOR) scores and degree of epithelial dysplasia. Subjects and Methods: A retrospective clinicopathological study was undertaken on OC histologically diagnosed over a 40-year period in a university teaching hospital in Southwestern Nigeria. Paraffin blocks of selected cases were retrieved and sectioned for hematoxylin and eosin and AgNOR stain. Evaluation of epithelial dysplasia was done using the WHO 2005 protocol. Estimation of atypical features and AgNOR scoring were done using modified and established protocols. Epi info and GraphPad InStat software packages were employed to manage the ensuing data. Results: The commonly observed OC was odontogenic keratocyst (OKC), which accounted for 44.5%, radicular cyst (RC) (24.2%), calcifying odontogenic cyst (COC) (12.7%), and dentigerous cyst (DC) (11.5%). Nuclear pleomorphism was the most common atypical feature and was present in 50% each of DC and COC, 42% of OKC, and 36% of RC. Drop-shaped rete pegs were rarely observed. A significant association was observed between the presence of moderate dysplasia and histologic type of OC (P = 0.022). Mean AgNOR scores per 100 cells was OKC (137.38 ± 35.82), RC (132.04 ± 34.22), COC and DC (119.00 ± 10.93) and (96.91 ± 38.88) respectively. This was not statistically significant (P = 0.218). Conclusions: As moderate epithelial dysplasia was more significantly associated with OKC than other cysts, it is concluded that the potential for malignant transformation is higher in OKC than other histologically categorized types of cysts.
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Evaluation of lipid profile pattern among apparently healthy students of Niger Delta University p. 146
Benedicta Erere Kasia, Victoria Y Nyondia, Promise O Oseajeh, Prohp The Prophet
DOI:10.4103/atp.atp_17_20  
Background: Dyslipidemia constitutes a high risk of cardiovascular disease. Aim: This study was designed to evaluate the lipid profile pattern of apparently healthy students of Niger Delta University to detect any possible abnormality. Setting and Design: This was a cross-sectional descriptive study. Materials and Methods: A total of 102 apparently healthy students were studied. A convenient sampling technique was employed for willing participants. The studied group constituted 55 males and 47 females aged within 20–40 years. Relevant demographic data were obtained by a one-on-one interview with the participants. A blood specimen was collected for measurements of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) by standard assay methods. The data obtained were analyzed using SPSS 22.0, and the student t -test was performed at P < 0.05 for comparison of means. Results: The mean plasma TC and LDL-c values for males were significantly lower than females values of 3.865 ± 0.675 mmol/L versus 4.251 ± 0.851 mmol/L and 2.38 ± 0.49 versus 2.64 ± 0.64 with P = 0.012 and 0.023, respectively. Similarly, the mean plasma HDL-c and TGs for males were lower than female values of 1.126 ± 0.190 mmol/L versus 1.194 ± 0.224 mmol/L and 0.77 ± 0.20 versus 0.82 ± 0.27 with P = 0.099 and 0.27, respectively which were not statistically significant. The age group of 24–27 years constituted the highest mean values and the age group of 28–40 years constituted the least mean values for all the studied parameters. These values, however, did not differ statistically. Most of the participants had significantly within low-normal reference range values. Conclusion: These findings revealed within normal lipid profiles for most subjects.
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Peritrabecular clefting in differentiating ossifying fibroma from fibrous dysplasia of the jaws p. 151
Adetokunbo B Olawuyi, Olajumoke A Effiom, Sunday Omilabu, Onatolu Odukoya
DOI:10.4103/atp.atp_16_20  
Context: Fibrous dysplasia (FD) and ossifying fibroma (OF) are the most prevalent fibro-osseous lesions in Nigerians and present with overlapping clinical, radiological, and microscopic features, resulting in diagnostic challenges for the pathologist and surgeon. Aims: The objectives of this study were to differentiate between FD and OF using clinical features, radiographic features, growth rate, and microscopic method to evaluate the prevalence of peritrabecular clefting. Settings and Design: Random sampling was used to select the sample size of 30 for each lesion from cases diagnosed from 1994 to 2014 in the oral biopsy service of Lagos University Teaching Hospital. Subjects and Methods: Hematoxylin and Eosin sections were prepared from retrieved blocks of FD and OF which had been blinded. Each section was divided into four quadrants, largest vertical and horizontal dimensions of cleft surrounding five trabeculae in each quadrant were measured with ocular grid and multiplied to project an estimation of area of each cleft. Data retrieved on clinical and radiographic information were statistically compared to differentiate between the lesions. Statistical Analysis Used: Statistical Package for the Social Sciences for Windows (version 16.0, Chicago, IL, USA) was used. Results: In the study, 77% of FD had clefts, none was seen in OF. This difference was statistically significant P = 0.001. Ill-defined radiographic borders occurred in 60% of FD, well-defined borders occurred in 81% of OF. In lesions with mixed radiolucency and radiopacity, an association was established between border definition and type of lesion. P = 0.02122. Conclusions: Peritrabecular clefting was observed in 77% of FD, while this feature was not observed in OF and could therefore serve as a reliable parameter to differentiate the lesions.
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Nephroprotective effect of Citrus sinensis L. on mercury exposed wistar rats p. 157
Washima Seth Amber, Sunday Abraham Musa, Sohnap James Sambo, Abel Nosereme Agbon
DOI:10.4103/atp.atp_42_20  
Context: Exposure to all forms of mercury has toxic effect on several biosystems. Disruption in structural, biochemical, and physiological renal integrity results in nephrotoxicity. Citrus sinensis L (sweet orange) has medicinal benefits for diverse ailments. Aim: This study evaluated the nephroprotective effect of ethanol fruit peel extract of C. sinensis (EPCS) against mercuric chloride (HgCl2)-triggered nephrotoxicity in Wistar rats. Materials and Methods: Twenty-five Wistar rats (150–180 g) were separated into five Groups (I-V, n = 5): Group I received normal saline (1 ml/kg); Group II received HgCl2 (5 mg/kg); Group III received reference drug, silymarin (100 mg/kg) +HgCl2(5 mg/kg); Group IV received EPCS (750 mg/kg) +HgCl2 (5 mg/kg); and Group V received EPCS (1250 mg/kg) +HgCl2 (5 mg/kg). Treatments were for 14 days. Nephroprotective effect was evaluated using the biochemical assay for renal function, histological, and histochemical assessments using H and E and periodic acid Schiff (PAS) stains and quantification of PAS staining intensity using Imagej® NIH, US. Statistical Analysis Used: One-way analysis of variance with Tukey post hoc test. Results: The results revealed remarkable (P < 0.05) alterations in renal functional biomarkers, especially urea, creatinine, and Na + in HgCl2-treated group compared to the controls. However, EPCS treatment ameliorated alterations comparable to the silymarin and control groups. Histological and histochemical examinations revealed severe distortions in renal histoarchitecture such as shrunken glomerulus and Bowman-space dilatation for the rats exposed to HgCl2 compared to controls. However, EPCS treatment ameliorated distortions by the preservation of renal histoarchitecture comparable to the silymarin and control groups. No remarkable difference for PAS staining intensity relative to controls. Conclusion: EPCS possesses potential nephroprotective effect against mercuric chloride-induced toxicity in Wistar rats.
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Clinicoepidemiological profile and morphological spectrum of intracranial tumors seen in a tertiary health-care facility: A 6-year retrospective study p. 166
Sunday Sokunle Soyemi, Francis Adedayo Faduyile, Daniel Ayodele Sanni, Alban Ikenna Mgbehoma, Olufemi E Idowu, John Oladapo Obafunwa
DOI:10.4103/atp.atp_40_20  
Introduction: Brain tumors are a diverse group of primary central nervous system (CNS) tumors and each tumor has a distinctive biology, treatment, and prognosis. The increase in the number of neurosurgeons and availability of newer diagnostic imaging techniques in our center, prompted this study, which was aimed at identifying the epidemiological pattern and the morphological spectrum of all intracranial tumors in this center and compare our findings with previous results from this institution and other centers. Materials and Methods: A retrospective study of cases of all intracranial tumors was conducted from January 2013 to December 2018. All slides were then reviewed by at least two pathologists. The age, sex, diagnosis using the World Health Organization grading, and the histological subtypes were recorded and then analyzed using the SPSS. Results: Altogether 113 intracranial tumors were identified out of 13,651 samples reported over a 6-year period representing 0.82% of all surgical biopsies. The mean age was 45 ± 23.6 years with ages ranging from 1 year to 85 years. Males accounted for 47.8%, whereas females represented 51.3% with a male-to-female ratio of 1–1.1. Intracranial tumors were most common in the 41–50 years of age group. Supratentorial tumors accounted for 75.2%. Headache, loss of vision, seizure, and paresis were the common presentations accounting for 39.8%, 31.9%, 27.4%, and 19.4%, respectively. Meningiomas were the most common tumors representing 47.8%. Grade I tumors were predominant. Conclusion: Supratentorial tumors were predominant and meningiomas accounted for the majority. Headache, loss of vision, and seizure were common presentations.
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Aqueous beetroot juice extract improves renal function and some biochemical parameters in carbon tetrachloride-induced toxicity in sprague dawley rats p. 171
Fidelis Ehidiamen Olumese, Henrietta Ayodele Oboh
DOI:10.4103/atp.atp_38_20  
Background: The ability of plant extracts to improve toxicity in the kidney is gaining attention. This may be due to the untoward effects and high cost of orthodox drugs used for the management of kidney disease, therefore, the use of aqueous beetroot juice as a potential ameliorative agent was evaluated. Materials and Methods: Group 1 received 2 ml/kg distilled water (normal control); Group II received 2 ml/kg olive oil; Group III received 2 ml/kg carbon tetrachloride (CCl4) in olive oil 48 hourly (negative control); Group IV received 2 ml/kg CCl4 in olive oil and 250 mg/kg of beetroot/day; Group V received 2 ml/kg CCl4 in olive oil and 500 mg/kg of beetroot/day; and Group VI received 2 ml/kg CCl4 in olive oil and 100 mg/kg silymarin/day (positive control) for 14 days. Animals were euthanized, and blood was collected for the evaluation of electrolytes, urea, and creatinine, whereas the kidney tissue was assessed for histopathological changes. Results: There was a significant (P < 0.05) decrease in the level of K + in the group of rats administered 250 mg and 500 mg/kg of aqueous beetroot extract, when compared to negative control. The levels of Na + were reduced in the treated groups when compared to normal control. There were no significant changes in Cl − levels in all the group of animals. The urea levels decreased in the groups treated with extract or silymarin, and a similar trend of creatinine was observed in the groups administered beetroot extract. However, creatinine concentration was significantly (P < 0.05) increased in the group of rats administered only silymarin when compared to other groups. Histopathological evaluation revealed that the tubular necrosis observed in the kidney was ameliorated after beetroot juice administration. Conclusion: Beetroot juice showed nephroprotective effects against CCl4-induced renal toxicity.
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Bladder diseases: A histopathological study p. 176
Babatunde M Duduyemi, William G Ayibor, Roland Azorliade, Foster Safo, Ebenezer Owusu
DOI:10.4103/atp.atp_33_20  
Background: There is a dearth of publications on the histopathological findings from the bladder specimen in this country. Knowledge of the profile of histological findings from bladder biopsies will help reveal the most common lesions, the demographical distribution as well as the association of clinical symptoms with various conditions and interventions to be made. Methodology: This was a retrospective, histopathological study conducted over a period of 10 years. Demographics of the patient were abstracted, and slides were reviewed to establish the diagnoses on bladder biopsies. Results: There were 180 cases of bladder lesions studied. Males accounted for 86 (47.78%), and females recorded 94 (52.22%) of the cases. The modal age group is 50–59, with 42 cases. The mean age is 54.14 ± 18.62. Inflammatory (nonneoplastic) lesions accounted for 53 (29.44%) and neoplastic lesions accounted for 127 (70.56%), of which benign lesions (squamous papilloma) were 13 (10.24%) whereas malignant cases were 114 (89.76%). Urothelial carcinoma of the bladder was the most common bladder malignancy (57%) and squamous cell carcinoma (35.96%). Lymphoma, rhabdomyosarcoma, carcinoma in situ, and adenocarcinoma were relatively rare. Most of the tumors were high grade. Conclusion: Bladder diseases are more common in females in our center, and most of the neoplastic lesions are high-grade carcinomas.
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Breast cysts with masses versus breast masses with cysts: Sonographic sub-types of complex breast cysts with pathologic correlations p. 180
Olarinoye - Akorede Sefiya Adebanke, Aliyu Halima, Lawal Suleiman, Bello Nafisa, Mohammed Halima Mono
DOI:10.4103/atp.atp_21_20  
Background: Cystic lesions of the breast are generally classified as simple, complicated or complex. A complex breast cyst is however defined as a lesion which contains both cystic (anechoic) and solid (echogenic) components. There is a need to understand the sonographic criteria and differential diagnoses of complex cysts which have varying risks of malignancy, as against simple or complicated cysts which are typically benign. Objectives: To examine the sonographic subdivisions of complex breast cysts, correlating with histopathological diagnosis as seen in Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: A 5-year retrospective review of 106 women who had complex breast cysts diagnosed on high resolution ultrasound (Mindray DC- 8, 2013; transducer frequency 7.5–12 MHz). The lesions were categorized as: Type 1 (cysts with thick wall or septa), Type 2 (cysts with a small mural nodule), Type 3 (cystic and solid lesion with >50% cystic component), Type 4 (cystic and solid lesion with >50% solid component). The final diagnosis was either by short term ultrasound follow-up, Ultrasound-guided fine needle aspiration cytology/core biopsy or excision biopsy. Results: Out of a total of 248 patients with breast cysts, 106 women had complex cysts. 27 (25.4%) patients had cysts with either thick wall or septa or both; 11 (10.4%) had a small intra-mural nodule; 14 (13.2%) had solid-cystic mass with >50% cystic component and 54 (50.9%) had solid-cystic mass with >50% solid component. Overall 66% were benign while 34% were malignant. The commonest pathology to present as a complex breast cyst was invasive ductal carcinoma not otherwise specified. Conclusion: Complex cysts are associated with varying risks of malignancy. Also, a certain pathology could exhibit sonographic features of any of the subdivisions (Type 1-4). Therefore, meticulous attention should be paid to other associated imaging findings as well as detailed history and thorough clinical examination.
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CASE REPORTS Top

Tubal schistosomiasis: A not so rare cause of ectopic gestation p. 186
Aminatu Makarfi Umar, Usman Danjuma Zubairu, Afolabi Korede Koledade, Yusuf Salisu Abeku, Modupeola Omotara Samaila, Oladapo Sunday Shittu
DOI:10.4103/atp.atp_36_20  
Schistosomiasis, a neglected Tropical disease affects over 220 million people worldwide and is endemic in Nigeria. Reproductive difficulties are some of the consequences of chronic infestation with Schistosoma spp particularly S. haematobium. We present the case of a 20 year old nullipara who was managed for ectopic pregnancy on a background of a previous first trimester miscarriage. Intraoperatively, she was found to have bilateral tubal pathology, histology of which turned out to be schistosoma granuloma.
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Extranodal sinonasal rosai-dorfman disease in a Nigerian woman: A case report and review of literature p. 189
Abdulrazak Ajiya, Emmanuel Sara Kolo, Iliyasu Yunusa Shuaibu
DOI:10.4103/atp.atp_37_20  
Rosai Dorfman disease (RDD) also referred to as sinus histiocytosis with massive lymphadenopathy is a rare non-neoplastic lymphoproliferative disease with unknown etiology and pathogenesis first described by Rosai and Dorfman in 1969. It is characterized by histiocytic proliferation of lymphatic sinuses, which primarily involves the lymph nodes, but has an extranodal tendency. Frequently encountered extranodal sites in the head-and-neck region is paranasal sinuses and nasal cavity, orbit, parotid gland, and middle ear. We present a case of RDD occurring in the nasal cavity of a 28-year-old female from Nigeria. RDD should be considered a differential diagnosis in any patient with benign sinonasal mass especially arising from the nasal septum with massive cervical lymphadenopathy.
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Challenges of managing childhood cancers in resource-constrained settings: A case of sarcoma botryoides in a 3-year-old girl p. 193
Yakubu Abubakar, Jamilu Abdullahi Faruk, Hafsat Rufa'i Ahmad, Dauda E Suleiman
DOI:10.4103/atp.atp_19_20  
Sarcoma botryoides is a rare histological variant of rhabdomyosarcoma (RMS) found in the mucosal lining of body cavities of the bladder, vagina, nasopharynx, and biliary tract. Vaginal RMS typically affects young girls below 2 years of age but has also been reported in adolescents. Most patients present late when the tumor has already caused significant regional effects and complications. The management of such children usually poses numerous challenges in a resource-poor setting. A 3-year-old girl presented with a 1-year history of a progressive mass protruding through the vaginal introitus, associated with bleeding, progressive weight loss of 6 months, and abdominal swelling of 3 months duration. After 6 weeks of hospital stay, a diagnosis of sarcoma botryoides was made, and chemotherapy was commenced 2 weeks following the diagnosis. Delays were encountered due to financial constraints, laboratory stock-outs, and hesitance in accepting treatment by the parents. She completed one cycle of chemotherapy, comprising vincristine, actinomycin, and cyclophosphamide, with demonstrable reduction in the tumor sizes. Unfortunately, her management was complicated by severe measles infection acquired during admission; and she succumbed to the illness. Treatment of childhood cancers is bedevilled by the multiple levels of delays, and a host of co-morbidities that combine to produce an undesirable outcome. There is a need for a highly coordinated multidisciplinary approach that is hinged on a strong support for infection prevention and treatment access, in addition to good nutrition, adequate supply of blood, and blood products.
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Orbital mesenchymal chondrosarcoma: Report of a rare tumor in a Nigerian girl p. 196
Kazeem Olatunde O. Ibrahim, Grace Feyisayo Adepoju, Joshua Folusho A. Owoeye, Abdurafiu Ayinde Abdulmajeed, Olaleke Oluwasegun Folaranmi, Mutairu Abiodun Taiwo
DOI:10.4103/atp.atp_20_20  
The orbit (eye socket) is one of the rare extraskeletal sites of mesenchymal chondrosarcoma (MC). This is a report of the clinical presentation, the results of radiological and histopathological investigations, as well as the treatment outcome of a case of orbital MC in an 11-year-old Nigerian girl who presented with right eye protrusion and worsening vision. Examination of the right eye revealed lagophthalmos with marked proptosis of the globe. Right eye modified exenteration was done due to progressive proptosis, pain, and no perception to light. Histology revealed a biphasic neoplasm that is composed of well-formed hyaline cartilage and sheets of undifferentiated mesenchymal cells with a diagnosis of MC. She had four courses of cytotoxic chemotherapy, and was initially clinically stable on follow-up, but had a recurrence due to noncompletion of chemotherapy and radiotherapy. Orbital MC should be considered among young females who present with progressive proptosis, with or without pain, and worsening visual impairment.
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