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   Table of Contents - Current issue
July-December 2021
Volume 13 | Issue 2
Page Nos. 31-66

Online since Thursday, February 24, 2022

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Editorial p. 31

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Consensus molecular subtyping of colorectal cancer by immunohistochemistry, an imperative for a resource limited setting: Report of a Nigerian study p. 33
Fatimah B Abdulkareem, Galina Khramtsova, Lateef A Odukoya, Kabir B Badmos, Tunde Adedokun, Olorunda Rotimi, Abiola Ibraheem, Andrey Khramtsov, Lise Sveen, Ian Hurley, Masaya Hattori, Dezheng Huo, Olufunmilayo I Olopade
Background and Objectives: Studies of colorectal cancer (CRC) molecular heterogeneity have used genome-wide gene expression-based data to group patients into four consensus molecular subtypes (CMS), but the cost and sophistication of analysis has limited its clinical application. This study aimed at using immunohistochemistry (IHC) to classify CRC specimens in a cohort of patients in Lagos University Teaching Hospital. Materials and Methods: Tissue microarrays were constructed from 75 FFPE tissue blocks of CRC. These were stained for mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, and PMS2) and four other markers (CDX2, HTR2B, ZEB1, and Ki-6) by IHC. Semi-quantitative scoring was performed for the other four markers. A panel of CDX2, HTR2B, and ZEB1 was then used to distinguish between CMS4 and CMS2/CMS3 subtypes, whereas Ki-67 was used to separate CMS2 from CMS3 subtype. MMR status was used to identify CMS1 subtype. Results: Of the total evaluable 75 CRC cases, 38% were <40 years old, 60% were males, with mean of 44.8 years (standard deviation [SD] = 16.1). Fifty-nine patients (79%) had microsatellite stable (MSS) tumor, and the remaining 16 (21%) had microsatellite unstable (MSI) tumor (i.e., CMS1). Thirty-seven (49%) were classified as CMS2 (n = 24) or CMS3 (n = 13) and 22 (29%) of the cases were classified as CMS4. The CMS4 subtype was significantly more likely to occur among young patients (P < 0.001). CMS1 subtype was more in patients older than 40 years and 75% of right-sided cancers were CMS1 (P < 0.001). Conclusion: The study confirms that IHC-based CMS classification and stratification of CRC patients could be a cost-effective prognostic and predictive tool suitable for resource-limited settings.
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Impact of quadruple eradication therapy on the elements of the Sydney system in chronic Helicobacter pylori gastritis in Abidjan (Ivory Coast) p. 40
Doffou Adjéka Stanislas, Constant Assi, Hamidine Illa, Antonin Wilson Ndjitoyap Ndam, Bangoura Aboubacar Demba, Nigue Luc, Attia Koffi Alain
Background: The effect of eradicating Helicobacter pylori on the course of chronic gastritis (CG) is controversial. The aim of this study was to assess the impact of H. pylori eradication treatment on CG. Materials and Methods: This was a retrospective (January 2016 to December 2018) multicenter study. All medical records of patients treated with a quadruple therapy to eradicate H. pylori who were confirmed with histology at least 4 weeks after the end of treatment were included. The evolution of the CG ratings after treatment was analyzed. Results: The records of 170 patients (male/female ratio 0.95, average age 49.3 ± 12.2 years) were included. Respectively, inflammation and H. pylori levels decreased (P < 0.001) in antrum (2.09 to 1.45; 1.95 to 0.63) and fundus (1.82 to 1.27; 1.76 to 0.55). Gastric atrophy levels regressed in antrum (0.28 to 0.18; P = 0.0655) and fundus (0.19 to 0.09; P = 0.0096) on sequential quadruple therapy (0.42 to 0.26; P = 0.2384), with bismuth (0.27 to 0.1l8; P = 0.6232) or with concomitant therapy for 14 days (0.20 to 0.13; P = 0.1288). Gastric intestinal metaplasia progressed in the antrum (0.05 to 0.06; P = 0.5930) and the fundus (0.02 to 0.03; P = 0.2568); in sequential quadruple therapy (0.04 to 0.07; P = 0.3173) and in bismuth therapy groups (0.04 to 0.09; P = 0.5637) even after eradication of H. pylori (0.03 to 0.09; P = 0.0455). Conclusions: The eradication treatment for H. pylori improved elements of the Sydney CG system except for intestinal metaplasia.
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An audit of evolving colonoscopy practice in two tertiary hospitals in South-East Nigeria p. 47
Christopher Nonso Ekwunife, Chukwuemeka Osuagwu, Stephen E Enendu, Chigozirim Onyekpere, Chinelo Uzoamaka Ekwunife
Introduction: Colonoscopy is quite essential in the management of gastrointestinal pathologies. Its practice in most developing countries is suboptimal. Aim: The aim of this study was to determine the common indications and findings at colonoscopy in a patient population in South-eastern Nigeria, as well as to assess the documentation of quality indicators of colonoscopy service. Materials and Methods: The endoscopy records of patients who underwent colonoscopy at two tertiary institutions (Federal Medical Centre, Owerri and Imo State University Teaching Hospital, Orlu) from January 2014 to December 2016 were reviewed. Information on patient demographics, colonoscopy indications, colonoscopy findings, and polyp detection were sought for. Data analysis was done with SPSS version 21. Results: Two hundred and nineteen patients had colonoscopy within the period. Age range of the patients was 16 to 94 years (mean age: 55 ± 14.8 years). The most common indications for colonoscopy were bleeding per rectum 100 (45.7%) and change in bowel habit 36 (16.4%). Tumors in the colon/rectum were seen in 44 (19.9%) patients and polyp detection rate was 10.9% (n = 24). Records were not comprehensively kept. Conclusion: The high percentage of findings of tumors in patients undergoing colonoscopy in our population suggests that this service should have an expanded coverage to enable earlier diagnosis of colorectal malignancies. A better endoscopy record and data management will also be helpful.
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Surgical management of solid pseudopapillary tumors of the pancreas in female Nigerians: A report of two cases p. 52
Olanrewaju Samuel Balogun, Oluwole Ayoola Atoyebi
Solid pseudopapillary tumor of the pancreas (SPT) is a rare subtype of pancreatic tumor with a prevalence of 0.13%–2.7%. Most SPTs occur in young females and are slow-growing. The tail of the pancreas is mostly affected. Clinical features are nonspecific. Abdominal computed tomography (CT) is invaluable in the preoperative diagnosis of SPT. Prognosis is good with complete surgical resection.
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Metastatic ovarian cancer presenting as multiple hepatic cysts and paraneoplastic manifestation p. 56
Dauda Ayuba Dayar, Yusuf Abiola Raheem, Abubakar Yerima, Lawan Mohammed, Abba Bukar Zarami
Background: Metastatic ovarian diseases are often found on the peritoneal surfaces including the liver, bowel, bladder, and uterus. Recent studies showed liver metastases as the most common presentation of stage-IV disease in patients with epithelial ovarian cancer (EOC). Paraneoplastic syndromes in ovarian cancers may be associated with rheumatologic disorders like polymyositis due to autoimmune mechanisms. Case Presentation: We report a case of a 61-year-old postmenopausal woman who presented with a 2-month history of progressive right hypochondrial swelling and pain, with progressive weight loss and weakness of the limbs. Examination revealed tender hepatomegaly with proximal muscle weakness. Abdominopelvic computed tomography (CT) scan revealed enlarged liver with multiple cystic lesions and right adnexal mass. CA125 and creatine kinase were elevated and ultrasound scan (USS)-guided trucut biopsy of both the hepatic and adnexal masses revealed papillary cystadenocarcinoma. Conclusion: We, therefore, concluded that the diagnosis in our patient is metastatic ovarian cancer to the liver with paraneoplastic phenomenon of polymyositis.
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Accidental ingestion of a denture in a Nigerian man: A case report p. 60
Daniel Ekhaeyouno Ezuduemoih, Emuobor Aghoghor Odeghe, Oluwafunmilayo Funke Adeniyi, Ganiyat Kikelomo Oyeleke
The tooth contributes to the esthetic appearance of the face. As a result of tooth loss from caries and periodontal diseases, there is an increase in the number of people wearing dentures, and thus a proportionate increase in the incidence of foreign body in the esophagus. We report the case of a 49-year-old man who presented to the Endoscopy suite at our institution with a 6-week history of severe retrosternal pain, dysphagia, and odynophagia after inadvertently swallowing his old denture. At gastroscopy, the denture was seen to be impacted in the esophagus at about 25 cm from the incisor. When managing patients with chest pain, dysphagia, and odynophagia, a high index of suspicion for foreign body ingestion is needed, even with prolonged symptoms. Obtaining a history of use of dentures, and duration, is important, and a thorough examination of the oral cavity and dentition is essential.
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Abstracts Presented at the 13th Scientific Conference of Society for Gastroenterology and Hepatology in Nigeria Held July 26–30, 2021 p. 63

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