Background: The names that have been used for asystem offering histopathology, cytopathology, andautopsy services vary and include anatomicpathology, histopathology, morbid anatomy, andpathology. In 2016, we recommended the label'Anatomic Pathology' as the most appropriate name.This study aims to review the impact of ouradvocacy on the nomenclature of the discipline ofanatomic pathology government tertiaryinstitutions across Nigeria from 2016 to 2024. Methodology: In June 2024, we collated the namesgiven to the pathology departments that undertakethe services of histology, cytology, and autopsy aswas done in 2016. The data was analysed using theIBM SPSS (International Business MachinesCorporation, Statistical Product and ServiceSolutions) version 2022. The data obtained in 2024was compared with that of 2016 using chi squaretest. Results: Histopathology was the terminology usedby the highest number of institutions in both 2016(13; 40.6%) and 2024 (31; 50.0%). The mostimproved nomenclature was Anatomic Pathology,growing from 5(15.6%) to 19(30.6%) institutionsrespectively in 2016 and 2024. Anatomic Pathologywas the least favoured nomenclature in 2016 and thesecond most favoured in 2024. There was howeverno statistical significance of this change in the use ofthis terminology across geopolitical regions(anatomic pathology p = 0.734, histopathology p =0.503, morbid anatomy p = 0.545, and pathology p =0.686) or the years under study (p = 0.078). Conclusion: The advocacy for the use of 'AnatomicPathology' as the proper term for the laboratoriesoffering cytopathology, histopathology, and autopsyis a step in the right direction. This designation inaddition to being representative offers an expansionroom for accommodating the ever-dynamic field ofsurgical pathology in tandem with advancements inthe modern era.

Background:Cervical cancer is an important contributor to morbidity and mortality in low Human Development Index (HDI) countries where organized cervical cancer screening is often lacking. There is a paucity of data on the prevalence of cervical precancerous lesions in Bauchi, Nigeria. Methodology:This cross-sectional study was carried out in selected hospitals in the 3 senatorial zones of Bauchi State. Sociodemographic and reproductive data were collected using a data collection tool, and cervical smears were collected and stained using a manual liquid-based cytology (LBC) method. Results:Out of 458 women who underwent screening, 410 (89.5%) of the participants had a negative smear. Low-grade squamous intraepithelial lesions (LSIL) and Atypical squamous cells of undetermined significance (ASC-US) were the most common diagnostic categories of abnormal smears, together accounting for 78.9% of abnormal pap smear results. The chances of developing cervical precancerous lesions were higher in women <35 years (p<0.05). There was no statistically significant association between precancerous lesions and age at sexual debut or marital status (p>0.05). Conclusion:There is a need to implement organized state-wide screening programmes within the state to improve detection rates of cervical pre-cancerous lesions and eventually a reduction in cervical cancer mortality and morbidity statistics in the country.

BackgroundHaematological malignancies (HMs) are primary cancers of the blood and blood-forming organs. They are heterogeneous and of diverse clinical features, treatment protocols and prognoses. They constitute a significant source of cancer-related morbidity and mortality. Northeastern Nigeria, being the region in the country with the worst literacy rate and poverty indices, is also battling with the burden of these diseases with the limited health facilities to adequately diagnose and treat these ailments. There is paucity of a comprehensive data on HMs in the region, so this study aims to report on the multi-centre burden of the common HMs in the region and to discuss their patterns of distribution and management challenges.Materials and methodsThis was a 5-year retrospective study where records of cases of HMs diagnosed in the four health facilities [viz., Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi; Federal Teaching Hospital (FTH), Gombe; Modibbo Adama University Teaching Hospital (MAUTH), Yola; and Federal Medical Centre (FMC), Azare] were collected from 1 January 2018 to 31 December 2022. Data on the age, gender, diagnosis and subtypes of some malignancies were also obtained and analysed using the SPSS Version 23.0 statistical software.ResultsA total of 493 cases of HMs, which constituted 8.2% of all cancers, were diagnosed during the period under review. Paediatric HMs constituted 42.0% (207/493) of the HMs. Non-Hodgkin lymphoma (NHL) constituted the majority of the HMs at 115/490 (23.5%), while multiple myeloma (MM) was the least at 38/493 (7.7%). An average cost of 5,000 to 10,000 United States dollars is required to manage an HM in Nigeria. Late presentation of patients, non-availability and inadequate number of personnel, inability to pay for investigations and/or treatments due to financial constraints, and limited facilities for tests such as flow cytometry, immunohistochemistry, cytogenetic and molecular genetic analyses were the challenges identified in the institutions in Northeastern Nigeria that manage cancer patients.ConclusionHaematological malignancies are common in our environment, and there are limited facilities and expertise to accurately diagnose and treat them in the region and Nigeria in general.

Background: There are relatively few studies in Nigeria, and indeed, sub-Saharan Africa that have documented the relative frequencies and histomorphological patterns of endo-metrial carcinoma. This study aimed to determine the relative frequencies and clinic-epidemiological characteristics of endometrial carcinoma and its histological variants in Kano, North-Western, Nigeria. Method: A 10-year retrospective study of all endometrial carcinoma cases in the Depart-ment of Pathology, Aminu Kano Teaching Hospital, Kano. All relevant information was retrieved and data was analysed using Statistical Package for Social Sciences version 22. Results: Endometrial carcinoma showed an increment in prevalence from 0.5% of all gyn-aecologic admission in 2008 to 1.0% in 2017. Type I endometrial carcinoma, specifically endometrioid adenocarcinoma accounted for 80% of cases, while endometrial serous carcinoma was the most common type II endometrial carcinoma representing 20% of cases. Over 75% of endometrial carcinomas occurred in postmenopausal women with a mean age of 59 years. Conclusion: There is a rise in the prevalence of endometrial carcinoma and endometrioid adenocarcinoma is the most common histologic type.

IntroductionSub-Saharan Africa (SSA) is plagued by myriads of diseases, mostly infectious; but cancer disease burden is rising among non-communicable diseases. Nigeria has a high burden of cancer, however its remote underserved culturally-conserved populations have been understudied, a gap this study sought to fill.MethodsThis was a cross-sectional multi-institutional descriptive study of histologically diagnosed cancers over a four-year period (January 2019-December 2022) archived in the Departments of Pathology and Cancer Registries of six tertiary hospitals in the northeast of Nigeria. Data obtained included age at diagnosis, gender, tumor site and available cancer care infrastructure. Population data of the study region and its demographics was obtained from the National Population Commission and used to calculate incident rates for the population studied.ResultsA total of 4,681 incident cancer cases from 2,770 females and 1,911 males were identified. The median age at diagnosis for females was 45 years (range 1–95yrs), and 56 years (range 1–99yrs) for males. Observed age-specific incidence rates (ASR) increased steadily for both genders reaching peaks in the age group 80 years and above with the highest ASR seen among males (321/100,000 persons) compared to females (215.5/100,000 persons). Breast, cervical, prostatic, colorectal and skin cancers were the five most common incident cancers. In females, breast, cervical, skin, ovarian and colorectal cancers were the top five malignancies; while prostate, haematolymphoid, skin, colorectal and urinary bladder cancers predominated in men.ConclusionRemote SSA communities are witnessing rising cancer disease burden. Proactive control programs inclusive of advocacy, vaccination, screening, and improved diagnostics are needed.

Introduction. The identification of mitotic figures is essential for the diagnosis, grading, and classification of various different tumors. Despite its importance, there is a paucity of literature reporting the consistency in interpreting mitotic figures among pathologists. This study leverages publicly accessible datasets and social media to recruit an international group of pathologists to score an image database of more than 1000 mitotic figures collectively. Materials and Methods. Pathologists were instructed to randomly select a digital slide from The Cancer Genome Atlas (TCGA) datasets and annotate 10-20 mitotic figures within a 2 mm2 area. The first 1010 submitted mitotic figures were used to create an image dataset, with each figure transformed into an individual tile at 40x magnification. The dataset was redistributed to all pathologists to review and determine whether each tile constituted a mitotic figure. Results. Overall pathologists had a median agreement rate of 80.2% (range 42.0%-95.7%). Individual mitotic figure tiles had a median agreement rate of 87.1% and a fair inter-rater agreement across all tiles (kappa = 0.284). Mitotic figures in prometaphase had lower percentage agreement rates compared to other phases of mitosis. Conclusion. This dataset stands as the largest international consensus study for mitotic figures to date and can be utilized as a training set for future studies. The agreement range reflects a spectrum of criteria that pathologists use to decide what constitutes a mitotic figure, which may have potential implications in tumor diagnostics and clinical management.

Neuroblastoma is a childhood malignancy with protean clinical manifestations. One rare presentation is multiple cutaneous nodules, especially in infants. We present a case of multiple cutaneous nodules as the initial presentation in an infant with metastatic neuroblastoma. The patient received chemotherapy with good response and is alive and well 5 years post diagnosis.

Papillary thyroid carcinoma (PTC) mostly occurs within the thyroid gland (entopic site), with its occurrence within an ectopic thyroid tissue being rare comprising less than 1% of all thyroid cancers. The coexistence of PTC in entopic and ectopic sites is even rarer, and differentiating ectopic PTC from a metastatic cervical lymph node may pose a diagnostic conundrum. This report is aimed at highlighting the diagnostic challenges and treatment of this rare condition.

Objectives Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. Design A multicentre, international, collaborative cohort study. Setting 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. Participants Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. Main outcome measure All-cause mortality at 30 days and 90 days. Results 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). Conclusions The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.

Xanthogranulomatous oophoritis is an uncommon chronic inflammatory process in which native ovarian tissue is destroyed and replaced by marked infiltration by foamy histiocytes, accompanied by other inflammatory cells with or without foci of necrosis or fibrosis. The exact aetiology remains unclear but it has been linked to chronic pelvic inflammatory disease (PID) and Tuberculosis which are endemic in sub-Saharan Africa, including Nigeria. We report a case from a 25 year old female who presented with recurrent lower abdominal pain and an adnexal mass.

Objective Ovarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. Methods Patients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student’s t-test with significance set at p<0.05. Results Nigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01). Conclusion There is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation.

Context: Cancer ranks second among the major causes of death globally. A projection by 2020 indicated that developing countries would account for about 70% of total cancer-related death worldwide. Despite the great threat posed by cancer to this region of the world, reliable statistics on the trends and patterns of cancer are rare. Aims: The aim of the study is to review the cases of cancer recorded in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), Bauchi, from January 1, 2011 to December 31, 2019 Materials and Methods: This is a retrospective, descriptive study. Nine years records of all pathologically diagnosed cancer cases in the ATBUTH, Bauchi were retrieved, reviewed, and grouped in accordance with the International Classification of Diseases for Oncology. The results were presented as simple frequency tables and charts. Results: A total of 1284 cancer cases were diagnosed during the period, an average of 142.7 cases per annum. There was a female predominance of cancer cases (male: female ratio - 1:1.53. The age range was from seven months to 95 years, with mean and median ages of 49.6 and 50 years, respectively. More than half of the cases were reported in the fifth to seventh decades of life. Prostate (14.6%) and non melanoma skin cancer (11.2%) were the most common cancers seen in males. In females, cancers of the cervix (37.9%) and the breast (22.9%) were the most common. Conclusions: Breast cancer and cancer of the uterine cervix were the most common cancers in women in this review while prostate cancer was the most common cancer in men. The need to establish a hospital-based and/or population-based cancer registry that will generate reliable cancer data in our environment cannot be overemphasized.

Pathologists are responsible for rapidly providing a diagnosis on critical health issues. Challenging cases benefit from additional opinions of pathologist colleagues. In addition to on-site colleagues, there is an active worldwide community of pathologists on social media for complementary opinions. Such access to pathologists worldwide has the capacity to improve diagnostic accuracy and generate broader consensus on next steps in patient care. From Twitter we curate 13,626 images from 6,351 tweets from 25 pathologists from 13 countries. We supplement the Twitter data with 113,161 images from 1,074,484 PubMed articles. We develop machine learning and deep learning models to (i) accurately identify histopathology stains, (ii) discriminate between tissues, and (iii) differentiate disease states. Area Under Receiver Operating Characteristic (AUROC) is 0.805–0.996 for these tasks. We repurpose the disease classifier to search for similar disease states given an image and clinical covariates. We report precision@k = 1 = 0.7618 ± 0.0018 (chance 0.397 ± 0.004, mean ±stdev ). The classifiers find that texture and tissue are important clinico-visual features of disease. Deep features trained only on natural images (e.g., cats and dogs) substantially improved search performance, while pathology-specific deep features and cell nuclei features further improved search to a lesser extent. We implement a social media bot (@pathobot on Twitter) to use the trained classifiers to aid pathologists in obtaining real-time feedback on challenging cases. If a social media post containing pathology text and images mentions the bot, the bot generates quantitative predictions of disease state (normal/artifact/infection/injury/nontumor, preneoplastic/benign/low-grade-malignant-potential, or malignant) and lists similar cases across social media and PubMed. Our project has become a globally distributed expert system that facilitates pathological diagnosis and brings expertise to underserved regions or hospitals with less expertise in a particular disease. This is the first pan-tissue pan-disease (i.e., from infection to malignancy) method for prediction and search on social media, and the first pathology study prospectively tested in public on social media. We will share data through http://pathobotology.org. We expect our project to cultivate a more connected world of physicians and improve patient care worldwide.

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.

Myeloid sarcoma (MS) is a rare malignancy of immature myeloid cells and/or monocytes that occur in an extramedullary site. It is frequently mistaken for small-round-blue cell tumors, in the absence of immunohistochemistry. A case report of an unusual presentation of MS with a ruptured globe at a tertiary setting of North-western Nigeria is presented. The patient was a 12-year-old girl with progressive bilateral proptosis and spontaneous rupture of the left eye. A histologic diagnosis of embryonal rhabdomyosarcoma was made, but she had a minimal improvement in her clinical condition following chemotherapy. Further review showed bone marrow myeloblasts >98%. The previous tissue biopsy was subjected to immunohistochemistry and found to be CD117 – strongly positive and CD34 – patchy positive. The conclusion was that of myeloid leukemic infiltration of orbital tissue MS. The patient abandoned the treatment due to caregiver fatigue and financial exhaustion.

Introduction: Extranodal natural killer/T-cell lymphoma (NKTCL)- nasal type is a rare form of non-Hodgkin lymphoma. It mainly affects the midfacial structures (the nose, oropharynx, and hypopharynx). Prognosis is generally very poor and diagnosis is often delayed in Africans because of low index of clinical suspicion and resource constraints. Case report: The patient was a 30-year-old man who presented with a 5-month history of rhinorrhea associated with blockage of the left nasal cavity. Examination revealed a fleshy left nasal mass. Incisional biopsy of the mass was reported as nonspecific chronic inflammation but the diagnosis was reviewed to non-Hodgkin lymphoma after histologic examination of the excised mass. Subsequent immunohistochemical studies established a diagnosis of NKTCL 6 months after initial presentation. The patient was placed on chemotherapy and radiotherapy. He did not have access to radiotherapy because of financial constraints and defaulted from care after he has had three cycles of chemotherapy. The patient died 4 months after defaulting. Conclusion: It is very common to miss the diagnosis of the early phase of NKTCL before the appearance of the destructive facial lesion. Low index of suspicion and constraints of resources also play a role in the delayed diagnosis and poor outcome in Africa.

Malignant proliferating trichilemmal tumor, though uncommon, predominantly occurs in the scalp, trunk, head, and neck, and females are more commonly affected. It is rarely seen in the extremities, and malignant transformation is a rarity. Due to the rarity of malignant transformation, only a hand full of cases has been documented in the literature. We present an unusual case of gluteal malignant proliferating pilar tumor in an elderly male.

Introduction: Serum prostatic-specific antigen (PSA) concentration determination has established itself as the leading tool in screening for, as well as in estimating the prognosis of, adenocarcinoma of the prostate. This prognostication is usually done in conjunction with the Gleason score and other prognostic indices. The aim of this study was to determine the association between serum PSA concentration and the new (2016 modified) Gleason grade group of tumor among patients with adenocarcinoma of the prostate. Study Design: A retrospective, analytic study. Study Setting: Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria. Study Period: January 2006 to December 2013. Materials and Methods: A total of 211 patients with biopsy-based diagnosis of adenocarcinoma of the prostate were studied. Each of the cases was graded using the (2016 modified) Gleason grading system. Prebiopsy serum PSA concentration in each of the patients was retrieved from either the patient's case records in the Urology Unit of the hospital or from the values filled in by the requesting surgeon. Gleason grade groups of patients were correlated with serum PSA concentration. Results: Gleason grade group 1 was most common in our study with 68 (32.2%) of our patients falling within that category. The study revealed a statistically significant relationship between the serum PSA concentration and the Gleason grade group of cancer (P = 0.00). Conclusion: This study concluded that the serum PSA concentration has a statistically significant association with the Gleason grade group of the tumor in prostatic adenocarcinoma patients. Therefore, patients with high serum PSA concentrations are likely to have high tumor grade group.

Advanced prostate cancer usually presents with lower urinary tract symptoms (LUTS) or metastatic bone disease. Detection of an associated jaundice, suprapubic, or flank mass is unusual in advanced disease just as associated visceral or cutaneous metastasis is quite an uncommon presentation in prostate cancer. We report four cases in this series to highlight the unusual presentations of this cancer with a huge suprapubic mass (case 1); jaundice with associated multiple, nodal, and soft tissue metastasis (case 2); associated retroperitoneal mass (case 3); and synchronous primary renal cancer with background HIV infection (case 4). In conclusion, patients with unusual presentation of prostate cancer may constitute diagnostic dilemma, especially in the setting of retroperitoneal or suprapubic mass. Despite the fact that the findings highlighted in this series were unusual, their response to hormonal ablation was good.