Yawale Iliyasu

Oncologic Care and Pathology Resources in Africa: Survey and Recommendations

The connection of a clinician who identifies a patient with signs and symptoms of malignancy to an oncologist who has the tools to treat a patients cancer requires a diagnostic pathology laboratory to receive, process, and diagnose the tumor. Without an accurate classification, nothing is known of diagnosis, prognosis, or treatment by the clinical team, and most important, the patient is left scared, confused, and without hope. The vast majority of deaths from malignancies occur in sub-Saharan Africa primarily as a result of lack of public awareness of cancer and how it is diagnosed and treated in the setting of a severe lack of resources (physical and personnel) to actually diagnose tumors. To correct this massive health disparity, a plan of action is required across the continent of Africa to bring diagnostic medicine into the modern era and connect patients with the care they desperately need. We performed a survey of resources in Africa for tissue diagnosis of cancer and asked quantitative questions about tools, personnel, and utilization. We identified a strong correlation between pathology staffing and capacity to provide pathology services. On the basis of this survey and through a congress of concerned pathologists, we propose strategies that will catapult the continent into an era of high-quality pathology services with resultant improvement in cancer outcomes.

Histopathological study of soft tissue sarcomas seen in a teaching hospital in Kano, Nigeria

Background and Objective: Malignant soft tissue tumours account for less than 1% of overall human burden of malignant tumours. Increasing incidences of these tumours have been noted worldwide. This study aims to determine the pattern of soft tissue sarcomas seen in a teaching hospital. Materials and Methods: The study comprised of all cases of soft tissue sarcoma diagnosed over a 10-year review from 1 January 1999-31 December 2008. Results: A total of 264 cases of soft tissue sarcomas were reviewed; 162 males and 102 females with a male to female ratio of 1.6:1. The age range was between 3 months and 89 years with a mean age of 39.0 years. Kaposi sarcoma was the predominant histological type with 56 cases (21.2%). This was followed by rhabdomyosarcoma with 54 (20.5%) cases, dermatofibrosarcoma with 52 (19.7%) cases and liposarcoma with 32 (12.0%) cases. The most common site of affectation was the lower limb with 73 (27.7%) cases, followed by the trunk with 66 (25.0%) cases, head and neck with 45 (17.0%) cases and upper limb with 35 (13.3%) cases. Two hundred and eight cases satisfied the criteria for grading, out of which 34.1% were classified in grade I, 32.2% in grade II and 33.7% in grade III. Conclusion: Soft tissue sarcomas accounted for 8.8% of malignant tumours seen over the review period and Kaposi sarcoma was the predominant histological subtype commonly affecting young adults in our centre.

Histopathological review of breast tumors in Kano, Northern Nigeria

Context: Breast tumors are common worldwide, and various reports suggest an increasing incidence in Nigeria, which necessitates an urgent need to differentiate benign from malignant tumors. Aims: To classify, grade and to determine the changing pattern, frequency, age and sex distribution of breast tumors seen in a tertiary hospital. Materials and Methods: This was a 10-year retrospective study of all breast tumors diagnosed at the Pathology Department of a Teaching Hospital from 1 January 2001 to 31 December 2010. Results: A total of 1,566 breast tumors were diagnosed during the study period, of which 1035 (66.1%) were benign, and 531 (33.9%) were malignant. Fibroadenoma was the commonest benign breast tumor followed by fibrocystic change, and they accounted for 47.1% and 25.4% of benign breast tumors respectively. Out of the 531 malignant cases reviewed; 496 (93.4%) were females, and 35 (6.6%) were males with a female to male:ratio of 14.2:1.0. The age range of malignant cases was between 21 and 79 years with a mean age of 42.0 years. Invasive ductal carcinoma was the predominant histological type with 316 cases (59.5%). This was followed by medullary carcinoma with 61 (11.5%) cases, invasive lobular carcinoma and invasive papillary carcinoma each with 37 (6.9%) cases. Three hundred and ninety-eight cases satisfied the criteria for grading, out of which 237 (59.5%) cases were classified in Grade 1, 133 (33.4%) cases in Grade 2 and 28 (7.1%) cases in Grade 2. Conclusions: Breast tumors are quite common which are mostly benign and are seen in both sexes with a striking female preponderance. The findings are generally similar to most previous studies from Nigeria, Africa and western world with minimal variations.

EPSTEIN –BARR VIRUS ASSOCIATION WITH MALIGNANT LYMPHOMA SUBGROUPS IN ZARIA, NIGERIA

Epstein-Barr virus (EBV) is said to infect more than 90% of humans worldwide with latent infection for life. A recognized carcinogen, EBV is linked to malignant lymphoma (ML) subtypes of Burkitt′s lymphoma, plasmablastic lymphoma, diffuse large cell lymphoma and Hodgkin′s lymphoma. We report the association of EBV with ML in a segment of our patient population. Paraffin blocks from the archives of Ahmadu Bello University Teaching Hospital Zaria were used to construct tissue microarray. Sections were stained using 30 monoclonal antibodies for common non-Hodgkin′s lymphoma/Hodgkin′s lymphoma antigen. Chromogenic in situ hybridization for EBV-encoded RNA was done. Fewer associations of ML with EBV (54-5%) were found than reported elsewhere in Africa.

An analysis of dietary fiber and fecal fiber components including pH in rural Africans with colorectal cancer

Background/Aims Colorectal cancer (CRC) is now a major public health problem with heavy morbidity and mortality in rural Africans despite the lingering dietary fiber-rich foodstuffs consumption. Studies have shown that increased intake of dietary fiber which contribute to low fecal pH and also influences the activity of intestinal microbiota, is associated with a lowered risk for CRC. However, whether or not the apparent high dietary fiber consumption by Africans do not longer protects against CRC risk is unknown. This study evaluated dietary fiber intake, fecal fiber components and pH levels in CRC patients. Methods Thirty-five subjects (CRC=21, control=14), mean age 45 years were recruited for the study. A truncated food frequency questionnaire and modified Goering and Van Soest procedures were used. Results We found that all subjects consumed variety of dietary fiber-rich foodstuffs. There is slight preponderance in consumption of dietary fiber by the control group than the CRC patients. We also found a significant difference in the mean fecal neutral detergent fiber, acid detergent fiber, hemicellulose, cellulose and lignin contents from the CRC patients compared to the controls (P<0.05). The CRC patients had significantly more fecal pH level than the matched apparently healthy controls (P=0.017). Conclusions The identified differences in the fecal fiber components and stool pH levels between the 2 groups may relate to CRC incidence and mortality in rural Africans. There is crucial need for more hypothesis-driven research with adequate funding on the cumulative preventive role of dietary fiber-rich foodstuffs against colorectal cancer in rural Africans “today.”

Nasopharyngeal carcinoma at the Ahmadu Bello University Teaching Hospital, Zaria: A 22-year histopathological review (1992–2013)

Background: Nasopharyngeal carcinoma (NPC) is uncommon cancer with unique geographical variations and strong association with Epstein–Barr Virus. The increasing incidence of NPC in Nigeria in recent years has reinforced the need for more studies to be done. This study aims to determine the frequency, age, and sex distribution as well as the histopathological patterns of NPC seen over a period of 22 years, from 1992 to 2013. Materials and Method: It was a retrospective study of all NPCs diagnosed in the Department of Pathology, Ahmadu Bello University Teaching Hospital from January 1st 1992 to December 31st, 2013. The request forms, histopathology reports, slides, and paraffin-embedded tissue blocks of all histologically diagnosed NPCs within the study period were retrieved and examined. The age, sex and site/nature of the biopsy were extracted. Histopathological diagnosis was in accordance to the 2005 World Health Organization classification. Results: NPC showed a frequency of 0.3% (112 cases) with a significant rise in incidence in the last decade. There was a male preponderance with M: F of 3.5:1. The age range was 6–91 years, mode 40 years, mean age 42.4 years, and peak age of incidence 40–49 years (18.8%). Histologically, nonkeratinizing carcinoma (NKC) was the most common (94.6%) followed by keratinizing squamous cell carcinoma (KSCC, 4.5%) and a single case of basaloid squamous cell carcinomas (bscc, 0.9%). Undifferentiated subtypes made up 79.4% of NKC, 12.7% differentiated and 7.9% mixed. In addition, 44.4% were of Regaud type growth pattern, 34.9% Schmincke type, and 20.6% were mixed. The nasopharynx was the most common site of surgical biopsy (57.1%) followed by the nasal cavity (17.9%) and cervical lymph node (11.6%). Conclusions: NPC showed a recent increase in frequency, a male preponderance and a unimodal age pattern that peaked in the 5th decade with an overall mean age of 42.4 years. NKC over KSCC and a solitary case of BSCC was seen. A significant number of biopsies were from sites outside the nasopharynx, suggestive of advanced disease with poor prognosis.

From Access to Collaboration: Four African Pathologists Profile Their Use of the Internet and Social Media

The shared practice of pathology via the Internet holds great potential for pathologists in sub-Saharan Africa (SSA) and their global partners. Application of the Internet is constrained by issues of bandwidth, cost, and power. The penetration of mobile telephony and the arrival of smartphones have changed the use of Internet and social media in Africa and therefore the work of the 4 African pathologists featured in this article. As pathology in SSA struggles for visibility and usefulness, the Internet and its electronic applications provide a critical infrastructure as well as a podium for pathologists across the continent.

Training the Next Generation of African Pathologists

Quality patient care requires correct and timely evidence-based diagnoses. Pathology and laboratory medicine training varies significantly across the continent, but is inadequate to serve the needs of the population. This article summarizes the current state of pathology workforce and training in sub-Saharan Africa; discusses challenges to recruitment and retention; and outlines the necessary elements for training and sustaining a robust workforce in pathology and laboratory medicine. The authors provide several case studies of institutions around the continent that include expansion of existing programs, a de novo program, South-South collaborations, and skill building for the existing workforce.

Abstract B27: Assessment of chemotherapeutic responses to neoadjuvant FOLFOX and Aspirin on BIRC7 in colorectal adenocarcinoma cells induced in Albino rats

Chemotherapeutic resistance is a problem in the management of malignant tumors especially colorectal adenocarcinoma. Overexpression of Baculoviral IAP repeat-containing protein-7 (BIRC7) was previously reported by this study group to limit the cytotoxic efficacy of neoadjuvant folinic acid, 5-fluorouracil and oxaliplatin (FOLFOX) chemotherapy regimen on human colorectal cancer cells in-vivo. And a significant inhibitory effect of Aspirin on the BIRC7 protein in p53 mutant SW480 colon cancer cells in-vitro was also found. Our aim now is to access the efficacy of the addition of Aspirin to neoadjuvant FOLFOX-chemotherapy on colorectal cancer cells in-vivo using the N-methyl-N-nitrosourea (NMU) carcinogen-induced model on albino rats per rectum. A total of 180 male Albino rats whose weight falls between 110-150g will be used. They will be grouped into 18 sets of 10 rats each and a three staged study will be performed. Namely, assessment of health parameters before the cancer induction, assessments on confirmation of cancer induction and assessments after chemotherapeutic intervention. The chemotherapeutic intervention will be further subdivided into mono, bi or tri therapy in various combinations with and without the addition of the Aspirin. The addition of Aspirin to the chemotherapy regimen will be further divided into concurrent and sequential addition. NMU will be administered at a dose of 2 mg/kg intra rectally every other day until the development of colorectal cancer which, will be confirmed by barium enema and histological analysis. Aspirin will be administered at a dose of 25 mg/kg or 12.5 mg/kg. Folinic acid will be administered at a dose of 7 mg/kg or 3.5 mg/kg intraperitoneally (i.p). Oxaliplatin will be dministered at a dose of 3 mg/kg or 1.5 mg/kg i.p. And 5-FU will be administered at a dose of 50 mg/kg or 25 mg/kg i.p. The animals9 hemogram and other pertinent investigations will be done ultimately including culling for histological assessment of tumors. The tumors will be processed for HE May 16-19, 2016; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(1_Suppl):Abstract nr B27.

Abstract 4918: Is Livin a protagonist of mucinous adenocarcinoma histology in colorectal cancer

The mechanism of cancer resistance to chemotherapy regimen remains uncertain. Colorectal mucinous adenocarcinoma is one of the distinct histological subtypes of the disease implicated in chemotherapeutic resistance associated with nodal and peritoneal metastases and worse disease-free survival as an index of poor prognosis. One of the important acquired capabilities used by the cancer cells to resist anticancer therapies is evasion of apoptosis possibly via inhibitor of apoptosis proteins for which Livin is one. This protein contains baculoviral IAP repeat domains in addition to a RING finger, a protein-protein motif important for binding and inhibition of active caspases that interfere with intrinsic and/or extrinsic pathway and the ensuing blockade of apoptosis. Thus, understanding the molecular events on how cancer cells of mucinous histology evade apoptotic death may provide a novel paradigm for a molecular targeted therapy in the management of colorectal mucinous adenocarcinoma. In this study, the expression pattern and prognostic value of IAP family protein, Livin, in colorectal cancer patients with mucinous histology pre and post-chemotherapy regimen was investigated. Tissue sections from advanced stage colorectal cancer patients who were treated or untreated with neo-adjuvant FOLFOX chemotherapy before curative resection were included in this study. The tissue sections were grouped according to colorectal adenocarcinomas showing mucinous histology and non-mucinous component. Histological study including Haematoxylin and Eosin, and immunohistochemistry for Anti-Livin and DNA mismatched repair proteins were carried out. Immunofluorescence study was performed to clarify the expression pattern of the protein using Anti-Livin antibody. Protein expression quantification study was also used. Results show significant cytoplasmic localisation and expression of Livin protein in the colorectal cancer cells. The Livin protein expression was found to be increased by more than a one-fold post-chemotherapy treatment when compared with pre-chemotherapy treated patients with mucinous histology of colorectal cancer. Younger patients were found to have a greater probability of colorectal mucinous adenocarcinoma diagnosis and worse prognosis. Our findings show that Livin-induced inhibition of apoptosis activity can be a target for novel approaches to treatment and prevention of chemotherapy associated drug resistance in mucinous histology colorectal cancer since Livin overexpression has been associated with metastases and worse disease-free survival. More study is needed Citation Format: Mohammed Faruk, Abdulmumini Hassan Rafindadi, Sani Ibrahim, Surajo Mohammed Aminu, Surajo Mohammed Aminu, Ahmed Adamu, Ahmed Adamu, Yawale Iliyasu, Adamu Abdullahi, Mohammed Sani Shehu, Abdullahi Mohammed, John Idoko, Abdullahi Jibril Randawa, Abdullahi Jibril Randawa, Atara Ntekim, Saad Aliyu Ahmed, Aishatu Suleiman Maude, Almustapha Aliyu Liman, Abubakar Sani, Khalid Zahir Shah, Yahaya Ukwenya, Yahaya Ukwenya, Cheh Augustine Awasum, Kasimu Umar Adoke, James Olowu Enemari, James Olowu Enemari, James Olowu Enemari, Andrew Jonathan Nok. Is Livin a protagonist of mucinous adenocarcinoma histology in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4918. doi:10.1158/1538-7445.AM2017-4918