Annals of Tropical Pathology

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Background : The practice of diagnostic histopathology in the Tropics is beset by numerous challenges, including a dearth of anatomical pathologists, and inability to retain both locally and foreign-trained pathologists. Several inhabitants of the region have no access to any form of healthcare, let alone pathology services. This review article examines trends in the practice of histopathology in a developing country in the Tropics. Materials and methods: A critical review of the MEDLINE and other online and published resources was undertaken. Results: The role of various diagnostic tools in autopsy and surgical pathology are outlined and the current availability of these modalities is discussed. The haematoxylineosin method remains the basic minimum for histological diagnosis, assisting in the choice of more specific techniques. Histochemical staining methods have a critical role to play in several diagnostic scenarios, particularly in the resource-limited setting of third world economies. There is a trend of increasing availability of hands-on immunohistochemical staining in several indigenous histopathology laboratories. However, more sophisticated capital intensive methods such as electron microscopy, flow cytometry, and molecular genetics procedures are still largely research methodologies, even in the most developed countries, and remain outside the scope of routine diagnostic practice in the tropical setting for a long while yet. Conclusions: It is hoped that newly discovered surrogate immunohistochemical markers for specific genes will in the near future be added to the arsenal of the routine histopathology laboratory of developing countries such as Nigeria.

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Tropical Haematology in current usage in medical literature and practice is understood to mean haematological manifestations of either primary or secondary haematological diseases/disorders which have been influenced or driven by infectious agents and poor nutrition and their sequelae. In this communication, the common examples of infectious agents with serious impact on human haematological manifestations discussed are malaria parasite and HIV. Malaria has contributed greatly to shaping the human genome and driven our evolutionary history. The roles of hookworm and schistoma parasites in relation to the prevalence of iron deficiency anaemia-a component of nutritional anaemia, in the tropics, are mentioned. Poor nutrition itself constitutes a common cause of nutritional anaemia, a common cause of morbidity and deaths in the tropics. Primary haematological malignancies such as the leukaemias and lymphomas [including lymphomas secondary to HIV infection], are also considered. Similarly, common inherited disorders believed to be the consequences of malaria infections in the past, i.e. the haemoglobinopathies e.g. Sickle Cell diseases/anaemia, and the enzymopathies, eg Glucose-6-phosphate dehydrogenase deficiency [G6Pd], are also mentioned, as are inherited disorders of haemostasis eg the less common inherited disorder, the Haemophilias. The impact of Genomics, the most recent and far-reaching development in molecular biological research is bound to have profound impact on Tropical Haematology as it already has been in other knowledge areas of human medicine. These early findings in genomics clearly emphasize the need for all haematologists in the Tropics to acquire adequate knowledge, and many, the expertise in Genomics, and for some specialized Centres/Institutes in Genomics to be established in different countries in the Region as a matter of utmost urgency.

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Aim: To describe the histopathological features of gastric carcinoma as seen in a tertiary institution in Nigeria and compare these with those of other populations. Methods: This is a retrospective study in which gastric surgical and endoscopic biopsies specimens seen over a 10 year period were reviewed with respect to age, sex and histopathological characteristics. Statistical analysis was performed for differences in proportion using Chi square by SPSS version 13. Results: Ninety-seven cases consisting of 37 gastrectomy specimens, 10 open biopsies and 50 endoscopic biopsies were studied. There was a slight male preponderance with a male to female ratio of 1.2:1. The peak age of occurrence was the 6th decade of life (mean age was 52.8 years). Most cases were located in the antro-pyloric region. Majority of the tumours were either fungating or excavated. The vast majority of cases were intestinal-type carcinomas. There were 40 well-differentiated, 30 moderatelydifferentiated and 27poorly-differentiated tumours. More than 90% of the tumours were advanced carcinomas with majority showing evidence of metastatic spread most commonly to peri-gastric lymph nodes. Majority of the tumours were associated with chronic gastritis and H. pylori infection. Conclusion: This report highlights fundamental differences between the histopathological features of gastric carcinoma in Nigerians and those in other parts of the world, suggesting possible differences in their pathogenetic mechanisms and biologic behavior. It will be instructive to further investigate these differences.

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Background: Imatinib mesylate (IM) has become established as the first-line therapy for all patients with chronic myeloid leukaemia (CML) who have cytogenetic or molecular evidence of BCR/ABL mutation. However, animal studies have suggested some teratogenic potential. Additionally, it has been variously associated with reduced fertility due to hypospermia and oligomenorrhoea. In spite of the latter however, several conceptions have been reported among patients or their partners. Patient and Methods: We report the first case of a CML patient conceiving twice in a 12-month period while on IM therapy. OE, a 34-year-old Nigerian lady with CML, who had been on IM since November 2006, became pregnant in March 2007, stopped IM as soon as pregnancy was confirmed, and was delivered vaginally at term of a healthy baby girl in November 2007. While lactating in February 2008, she became pregnant again, but she opted for elective termination due to a failure to attain complete cytogenetic remission from frequent therapy interruptions. Results and Conclusion: Her baby continues to thrive normally after 16 months of follow-up. This suggests that the drug may not reduce the ability to conceive in some patients.

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Background: In developing countries, few hospitals have direct access to histopathology services for the management of patients. With the advent of the internet, however, such services can be extended even to remote areas. Design: A histopathology services collaborative system. Setting: The histopathology laboratory of the University of Maiduguri Teaching Hospital extends services to the Kolofata District Hospital in Cameroon. Materials and Methods: Once a week, preserved surgical biopsy specimens are sent by courier from Kolofata to our laboratory in Maiduguri. Complementary information such as x-ray films and photographs of gross specimens are sent to us by e-mail. Results: In 91.9% of cases, results of histopathology analysis are communicated by e-mail and received by the requesting physician within 48 hours. Conclusion: We encourage clinicians, especially those in remote areas where histopathology services are not available, to consider embracing this collaborative system.

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Online since 21^st November 2017.