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Research Article | | Peer-Reviewed

Demographics and Pathomorphology of Ameloblastoma: A 9 Year Retrospective Review at a Tertiary Health Care Centre in North-Central Nigeria

Philip Ojile Akpa*,  Innocent Emmanuel,  Barka Vandi Kwaghe,  Ijeoma Ahunna Okwudire-Ejeh,  Ayuba Madachi Dauda,  Olugbenga Akindele Silas
Published in Biomedical Sciences (Volume 10, Issue 2)
Received: 19 March 2024     Accepted: 1 April 2024     Published: 17 April 2024
Views:       Downloads:
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Abstract

Ameloblastoma is a benign but locally invasive neoplasm that arises from odontogenic epithelium of the dental lamina. It is classified into the conventional, unicystic, extraosseous/peripheral and metastasizing variants. It is the most common odontogenic tumour in Nigeria and other developing countries. It affects individuals of all ages, has a peak of occurrence in the fourth and fifth decades with no sex predilection. The Mandible is the most commonly affected site and the conventional variant is predominant. The aim of this study is to document the demographics and Pathomorphology of ameloblastoma diagnosed at the Jos University Teaching Hospital over the past nine years. There is no previous documentation of the pattern of this tumour in the North-central region of Nigeria making this study relevant. This is a retrospective observational review of all cases of ameloblastoma diagnosed histologically at the Jos University Teaching Hospital between January 1st 2015 to December 31st 2023. Materials utilized consisted of patient clinical case files, electronic histopathology result records, histopathology glass slides and formalin fixed paraffin embedded tissue blocks. The patient age, sex, anatomic location of tumour in the Jaw/face and pathomorphological features were recorded for all cases. The data obtained was analysed using Epi-info 7 (version 3.5.4) and Microsoft-Excel. Results were presented in tables and charts. Fifty one cases of ameloblastoma were diagnosed during the 9 years of review. Their ages ranged between 6 and 65 years with a mean age of 30.9±13.8 years and a peak of occurrence in the third decade. There were 29 males and 22 females with a male to female ratio (M:F) of 1.3:1. Ninety-two percent of cases occurred in the mandible and 8% in the maxilla. The conventional variant accounted for 72.5% of cases and the unicystic variant 27.5%. The follicular type accounted for 64.8% of cases of conventional ameloblastoma. Ameloblastoma occurred more commonly in males with a peak in the third decade. A vast majority of cases involved the mandible and the conventional type was predominant. This demographic pattern supports existing evidence that ameloblastoma occurs more commonly in males and in relatively younger patients in Africa.

Published in Biomedical Sciences (Volume 10, Issue 2)
DOI 10.11648/j.bs.20241002.12
Page(s) 23-29
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

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Copyright © The Author(s), 2024. Published by Science Publishing Group
Previous article
Keywords

Ameloblastoma, Jos, North-Central, Nigeria, Conventional, Mandible

1. Introduction
Ameloblastoma is a benign but locally invasive neoplasm that arises from odontogenic epithelium of the dental lamina
[1, 2]
. The 2017 World Health Organisation (WHO) Classification of head and neck tumours classifies benign ameloblastoma into the conventional, unicystic, extraosseous/peripheral and metastasizing variants
[1]
. It is an infiltrative aggressive tumour with a high tendency to recur and metastasize in rare instances
[1, 2]
. Its aggressive behavior and ability to undergo malignant transformation makes it the most clinically significant odontogenic tumour
[3]
.
Ameloblastoma is a relatively rare tumour with an estimated annual incidence of 0.5 cases per million of population, it is the most common odontogenic tumour worldwide excluding odontomas
[1]
. It accounts for about 12% of all odontogenic tumours and 1% of all tumours diagnosed in the oral region
[4]
. In Nigeria and other developing countries ameloblastoma is outrightly the most common odontogenic tumour
[2, 5-9]
. Studies reveal a higher frequency of diagnosis of ameloblastoma is African-Americans as compared to Caucasian Americans suggesting a genetic predisposition in Africans
[7]
.
Ameloblastoma affects individual of all ages. The Conventional variant occurs in individuals from the first to the tenth decade of life with a peak in the fourth and fifth decades, while the Unicystic variant occurs from the first to eight decades with its own peak of diagnosis in the second decade
[1]
. Diagnosis of ameloblastoma occurs about a decade earlier in blacks in comparison to individuals of European descent with a mean age at diagnosis of 30.4 years and 42.3 years respectively
[10]
. The mean age at diagnosis in the largest multicenter research on ameloblastoma in Nigeria was 32.5±14.5 years
[2]
.
There is no gender bias in ameloblastoma diagnosis
[11]
. This usually holds true in the conventional variant while the unicystic variant may have a slight male bias
[1]
. A male predominance of diagnosis has been frequently reported in Nigeria
[12-16]
. Agbaje et al reported a slight male predominance in a study which pooled data from 10 tertiary hospitals in 5 out of the 6 geopolitical regions of Nigeria
[2]
. Some Nigerian authors have postulated that a male bias especially in the northern part of the country reflects reduced access of females to health care rather than a true male predominance
[15]
.
The mandible is the commonest site of diagnosis of ameloblastoma (80% of cases), the maxilla is the next most common site while the sinonasal tract is also rarely affected
[1]
. In Nigeria, authors have reported an overwhelming predilection for occurrence in the mandible, the maxilla has much fewer cases and peripheral ameloblastoma being very rare
[2, 13-17]
.
Ameloblastoma usually starts as a painless expansile mass with more advanced cases manifesting as mal-occlusion of the jaw, loosening of teeth, difficulty in chewing, limitation in opening of the mouth, facial deformity and airway obstruction
[1, 16, 18, 19]
. Radiographically, a honey-comb like radiolucency which is a corticated multilocular appearance is commonly seen in conventional ameloblastoma, while the unicystic variant presents as a unilocular radiolucency connected with an unerupted tooth
[1]
.
Most cases of ameloblastoma are of the conventional variant. Grossly conventional ameloblastoma could be solid or variably cystic while the unicystic variant occurs as a single cystic cavity
[1]
. The conventional type of ameloblastoma are more aggressive and has an almost 90% recurrence rate with conservative surgery while the unicystic type is less aggressive with a lower recurrence rate
[18, 20]
.
The follicular histological type of ameloblastoma is the most common of the conventional variant with the plexiform type coming second. Other histopathological types of conventional ameloblastoma include the acanthomatous, granular, basaloid and desmoplastic
[1]
. An admixture of histopathological types can also be found in one surgical sample. Such as an admixture of the follicular type with the acanthomatous or plexiform type
[1, 14, 17]
. The unicystic type could be a luminal, intraluminal or mural type depending on the pattern of proliferation and distribution of ameloblastic epithelium within the lesion
[1]
.
2. Materials and Methods
This study is a retrospective observational study that reviewed all cases of ameloblastoma diagnosed histologically at the Jos University Teaching Hospital (JUTH) between January 1st 2015 to December 31st 2023. JUTH is a tertiary healthcare facility located in Jos, Plateau state, in the North-central part of Nigeria. It receives Maxillofacial/Dental referrals from all over the state of Plateau and Neighboring North-Central states. Materials utilized for this research consisted of patient clinical case files, electronic histopathology result records, histopathology glass slides and formalin fixed paraffin embedded tissue blocks. The patient age, sex, anatomic location of tumour in the Jaw/face and pathomorphological features were recorded for all cases using the aforementioned materials. Archived glass slides and freshly made slides from tissue blocks in cases of missing or poor-quality slides were used for evaluation of histopathology diagnosis. The glass slides of all cases of ameloblastoma were reviewed by the authors of this research to confirm the diagnosis. The data obtained was analysed using Epi-info 7 (version 3.5.4) and Microsoft-Excel. Results were presented in tables and charts.
3. Results
The clinical records, laboratory records and histopathology glass slides of fifty two (52) cases of ameloblastoma were reviewed, fifty one met the inclusion criteria and one case was excluded for incomplete data. An average of 5.7 cases of ameloblastoma were diagnosed per year over the 9 years of review. Their ages ranged between 6 and 65 years with an average age of 30.9±13.8. Fifteen percent (15%) of cases were diagnosed in individuals less than 18 years (table 1). There were 29 males and 22 females with a male to female ratio (M:F) of 1.3:1 (table 2). Ninety-two percent (92%) of cases occurred in the mandible and 8% in the maxilla (table 3). The conventional variant accounted for 72.5% of cases and the unicystic variant 27.5% (figure 1). The follicular type accounted for 64.8% of cases of conventional ameloblastoma (figure 2). Photomicrographs of histopathological types of ameloblastoma are shown below (figure 3).
Table 1. Age distribution of the morphological variants of ameloblastoma.

0-10

11-20

21-30

31-40

41-50

51-60

61-70

Total

Unicystic

0

3

4

4

2

1

0

14

Follicular

1

5

9

4

3

0

2

24

Plexiform

0

1

0

0

0

2

0

3

Acanthomatous

0

0

1

0

0

0

0

1

Follicular-Acanthomatous

0

2

3

1

0

1

0

7

Follicular-plexiform

0

0

0

2

0

0

0

2

Total

1

12

17

11

6

4

2

51
Table 2. Sex distribution of the Morphological variants ameloblastoma.

Male

Female

Total

Unicystic

8

6

14

Follicular

15

9

24

Plexiform

1

2

3

Acanthomatous

0

1

1

Follicular-Acanthomatous

4

3

7

Follicular-plexiform

1

1

2

Total

29

22

51
Table 3. Anatomical distribution of the morphological variants ameloblastoma.

Mandible

Maxilla

Total

Unicystic

12

2

14

Follicular

23

1

24

Plexiform

2

1

3

Acanthomatous

1

0

1

Follicular-Acanthomatous

7

0

7

Follicular-plexiform

2

0

2

Total

47

4

51
Figure 1. Chart showing the morphological variants of ameloblastoma.
Figure 2. Chart showing the histopathological types of conventional ameloblastoma.
Figure 3. Photomicrographs x 100 magnification (Hematoxylin and Eosin stain) A. Follicular ameloblastoma with islands of odontogenic epithelium surrounded by fibrous stroma. B. Plexiform ameloblastoma showing cords of anastomosing odontogenic epithelial cells. C. Acanthomatous ameloblastoma showing squamous metaplasia and variable keratinization in stellate reticulum-like cells. D. Unicystic ameloblastoma showing a cyst lined by ameloblastic epithelium.
4. Discussion
Patient ages ranged between 6 and 65 years with an average age of 30.9±13.8 and a peak of occurrence in the third decade. This correlates with the findings of other Nigerian authors who also documented a peak in the third decade
[12-14, 17].
The mean ages at diagnosis were 31.67 and 31.43 years in Lagos, South-Western Nigeria and Sokoto, North-Western Nigeria respectively
[13, 14]
. Worldwide the peak of occurrence is in the fourth and fifth decades which indicates a younger age at diagnosis in individuals of African descent
[10]
. The mean ages documented in India (32.1 years)
[21]
and China (32.7 years)
[22]
are similar to figures seen in Nigeria while the mean ages reported in Australia (43 years)
[23]
and the United States of America (53 years)
[24]
are significantly higher than our observations. Fifteen percent of cases in our study occurred in the pediatric age group. This figure approximates the 14.6% documented by Olaitan et al in Kaduna, North-Western Nigeria
[25]
but is lower than the 21.9% reported by Arotiba et al in a multi-center study involving four tertiary hospitals spanning two geopolitical regions of Nigeria
[16]
. Studies have revealed that as much as 25% of cases of ameloblastoma diagnosis among Africans occur in children as compared to 10-15% in Non-Africans
[3]
. Older reports from the western world suggested that ameloblastoma occurred rarely in children
[26]
. Only one case in our study was diagnosed in the first decade (a 6-year-old male), which corelates with the youngest age of diagnosis of ameloblastoma in the multi-center study by Arotiba et al
[16]
. Our findings support established literature that ameloblastoma is very rare in children in the first decade
[18, 27]
. The mean ages of ameloblastoma diagnosis appear to be directly related to the life expectancy of the population, with higher mean ages reported for countries with higher life expectances. The unicystic variant of ameloblastoma is documented to occur at a younger average age than the conventional variant
[1]
. There was no significant difference in the mean ages for the conventional (31.2±14 years) and unicystic (30.4±12 years) variants of ameloblastoma in our study. This may be due to the small number of cases in our study.
Our study revealed a male predominance with a male to female ratio of (M:F=1.3:1). This male predominance was essentially the same for both the Conventional (M:F=1.3:1) and unicystic variants (M:F=1.3:1). Most other Nigerian studies report varying magnitudes of a male predominance
[12-16]
. A male predominance of a lesser magnitude than ours was reported by Soyele et al (1.02:1) in a multicenter study
[15]
and Ladeinde et al (1.1:1) in Lagos South-Western Nigeria
[13]
while higher male to female ratios than ours was reported by Olaitan et al (1.6:1) in Kaduna North-Western Nigeria
[28]
and Omitola et al (2:1) in Gombe North-Eastern Nigeria
[29]
. The findings in these Nigerian studies is at variance with the global picture which shows an equal gender distribution
[1]
. A male predominance was however also reported by Tatapudi et al and Oomens et al in India and the Netherlands respectively
[30, 31]
.
A majority of ameloblastoma cases (92%) in our study occurred in the mandible with only 8% involving the maxilla. This correlates exactly with a study by Ladeinde et al in Lagos whereby 92.8% of cases occurred in the mandible but is higher than the 83.6% documented by Ibikunle et al in Sokoto
[13, 14]
. A multicenter study by Soyele et al which pooled data from 5 tertiary health centers in Southern Nigeria documented 93.6% of cases in the mandible
[15]
. World-wide a majority of cases occur in the mandible with an average of 80% of ameloblastoma cases affecting this site
[1]
. The predominance of mandibular cases is as a result of a higher number of dental lamina rest cells in the mandible as compared to the maxilla
[29]
.
The conventional and Unicystic variants of ameloblastoma accounted for 72.5% and 27.5% of cases respectively in our study. Our findings appear similar to that of a multicenter study involving five tertiary healthcare facilities across Nigeria in which 80% and 20% were of conventional and unicystic variants respectively
[15]
. The percentage distribution of the variants however varies significantly across Nigeria. Fifty-eight percent (58.4%) and 41.6% were of the conventional and Unicystic variant in a report by Castano et al in Lagos Nigeria
[12]
. While a study by Ibikunle et al in Sokoto reported over Ninety percent of cases as the conventional variant, with only 7.5% being Unicystic
[14]
. Collation of data by the world health organization revealed a predominance of the conventional type with the unicystic variant accounting for between 5-22%, the peripheral variant accounting for between 1-10% and the metastasizing type occurring rarely
[1]
. The follicular type (64.8%) was the most common of the conventional ameloblastoma variant in our study, this aligns with the reports of other Nigerian authors such as Ibikunle et al, Omitola et al and Ladeide et al who all documented a predominance of the follicular variant
[13, 14, 29].
As much as 24.3% of cases were of the mixed histological type in our study with a mixed follicular-acanthomatous pattern being predominant. The percentages of mixed ameloblastoma documented by authors in other parts of Nigeria are lower. Adebiyi et al and Ibikunle et al reported 9% and 16.5% of their cases as mixed histology ameloblastoma in Ife, South-Western Nigeria and Sokoto, North-Western Nigeria respectively
[14, 17]
.
5. Conclusion
Ameloblastoma showed a male bias with a peak of occurrence in the third decade which is one decade younger than the global average. The mandible was overwhelmingly affected and majority of cases were of the conventional variant. The demographics and pathomorphological pattern of ameloblastoma in our study aligns with the reports from other regions of Nigeria and strengthens the evidence that ameloblastoma in individuals of African descent have a male predominance and occur at a relatively younger age.
Abbreviations
WHO: World Health Organisation
JUTH: Jos University Teaching Hospital
Author Contributions
Philip Ojile Akpa: Conceptualization, Resources, Data curation, Software, Formal Analysis, Supervision, Validation, Investigation, Writing - original draft, Methodology, Visualization, Project administration, Writing - review & editing
Innocent Emmanuel: Conceptualization, Resources, Data curation, Software, Formal Analysis, Supervision, Validation, Investigation, Writing - original draft, Methodology, Visualization, Project administration, Writing - review & editing
Barka Vandi Kwaghe: Conceptualization, Resources, Data curation, Software, Formal Analysis, Supervision, Validation, Investigation, Writing - original draft, Methodology, Visualization, Project administration, Writing - review & editing
Ijeoma Ahunna Okwudire-Ejeh: Conceptualization, Resources, Data curation, Formal Analysis, Supervision, Validation, Investigation, Writing - original draft, Methodology, Visualization, Writing - review & editing
Ayuba Madachi Dauda: Data curation, Formal Analysis, Supervision, Investigation, Writing - original draft, Methodology, Visualization, Project administration, Writing - review & editing
Olugbenga Akindele Silas: Data curation, Formal Analysis, Supervision, Validation, Investigation, Writing - original draft, Methodology, Visualization, Project administration, Writing - review & editing
Conflicts of Interest
The authors declare no conflicts of interest.
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    Akpa, P. O., Emmanuel, I., Kwaghe, B. V., Okwudire-Ejeh, I. A., Dauda, A. M., et al. (2024). Demographics and Pathomorphology of Ameloblastoma: A 9 Year Retrospective Review at a Tertiary Health Care Centre in North-Central Nigeria. Biomedical Sciences, 10(2), 23-29. https://doi.org/10.11648/j.bs.20241002.12

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    Akpa, P. O.; Emmanuel, I.; Kwaghe, B. V.; Okwudire-Ejeh, I. A.; Dauda, A. M., et al. Demographics and Pathomorphology of Ameloblastoma: A 9 Year Retrospective Review at a Tertiary Health Care Centre in North-Central Nigeria. Biomed. Sci. 2024, 10(2), 23-29. doi: 10.11648/j.bs.20241002.12

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    AMA Style

    Akpa PO, Emmanuel I, Kwaghe BV, Okwudire-Ejeh IA, Dauda AM, et al. Demographics and Pathomorphology of Ameloblastoma: A 9 Year Retrospective Review at a Tertiary Health Care Centre in North-Central Nigeria. Biomed Sci. 2024;10(2):23-29. doi: 10.11648/j.bs.20241002.12

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  • @article{10.11648/j.bs.20241002.12,
  author = {Philip Ojile Akpa and Innocent Emmanuel and Barka Vandi Kwaghe and Ijeoma Ahunna Okwudire-Ejeh and Ayuba Madachi Dauda and Olugbenga Akindele Silas},
  title = {Demographics and Pathomorphology of Ameloblastoma: A 9 Year Retrospective Review at a Tertiary Health Care Centre in North-Central Nigeria
},
  journal = {Biomedical Sciences},
  volume = {10},
  number = {2},
  pages = {23-29},
  doi = {10.11648/j.bs.20241002.12},
  url = {https://doi.org/10.11648/j.bs.20241002.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.bs.20241002.12},
  abstract = {Ameloblastoma is a benign but locally invasive neoplasm that arises from odontogenic epithelium of the dental lamina. It is classified into the conventional, unicystic, extraosseous/peripheral and metastasizing variants. It is the most common odontogenic tumour in Nigeria and other developing countries. It affects individuals of all ages, has a peak of occurrence in the fourth and fifth decades with no sex predilection. The Mandible is the most commonly affected site and the conventional variant is predominant. The aim of this study is to document the demographics and Pathomorphology of ameloblastoma diagnosed at the Jos University Teaching Hospital over the past nine years. There is no previous documentation of the pattern of this tumour in the North-central region of Nigeria making this study relevant. This is a retrospective observational review of all cases of ameloblastoma diagnosed histologically at the Jos University Teaching Hospital between January 1st 2015 to December 31st 2023. Materials utilized consisted of patient clinical case files, electronic histopathology result records, histopathology glass slides and formalin fixed paraffin embedded tissue blocks. The patient age, sex, anatomic location of tumour in the Jaw/face and pathomorphological features were recorded for all cases. The data obtained was analysed using Epi-info 7 (version 3.5.4) and Microsoft-Excel. Results were presented in tables and charts. Fifty one cases of ameloblastoma were diagnosed during the 9 years of review. Their ages ranged between 6 and 65 years with a mean age of 30.9±13.8 years and a peak of occurrence in the third decade. There were 29 males and 22 females with a male to female ratio (M:F) of 1.3:1. Ninety-two percent of cases occurred in the mandible and 8% in the maxilla. The conventional variant accounted for 72.5% of cases and the unicystic variant 27.5%. The follicular type accounted for 64.8% of cases of conventional ameloblastoma. Ameloblastoma occurred more commonly in males with a peak in the third decade. A vast majority of cases involved the mandible and the conventional type was predominant. This demographic pattern supports existing evidence that ameloblastoma occurs more commonly in males and in relatively younger patients in Africa.
},
 year = {2024}
}

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  • TY  - JOUR
T1  - Demographics and Pathomorphology of Ameloblastoma: A 9 Year Retrospective Review at a Tertiary Health Care Centre in North-Central Nigeria

AU  - Philip Ojile Akpa
AU  - Innocent Emmanuel
AU  - Barka Vandi Kwaghe
AU  - Ijeoma Ahunna Okwudire-Ejeh
AU  - Ayuba Madachi Dauda
AU  - Olugbenga Akindele Silas
Y1  - 2024/04/17
PY  - 2024
N1  - https://doi.org/10.11648/j.bs.20241002.12
DO  - 10.11648/j.bs.20241002.12
T2  - Biomedical Sciences
JF  - Biomedical Sciences
JO  - Biomedical Sciences
SP  - 23
EP  - 29
PB  - Science Publishing Group
SN  - 2575-3932
UR  - https://doi.org/10.11648/j.bs.20241002.12
AB  - Ameloblastoma is a benign but locally invasive neoplasm that arises from odontogenic epithelium of the dental lamina. It is classified into the conventional, unicystic, extraosseous/peripheral and metastasizing variants. It is the most common odontogenic tumour in Nigeria and other developing countries. It affects individuals of all ages, has a peak of occurrence in the fourth and fifth decades with no sex predilection. The Mandible is the most commonly affected site and the conventional variant is predominant. The aim of this study is to document the demographics and Pathomorphology of ameloblastoma diagnosed at the Jos University Teaching Hospital over the past nine years. There is no previous documentation of the pattern of this tumour in the North-central region of Nigeria making this study relevant. This is a retrospective observational review of all cases of ameloblastoma diagnosed histologically at the Jos University Teaching Hospital between January 1st 2015 to December 31st 2023. Materials utilized consisted of patient clinical case files, electronic histopathology result records, histopathology glass slides and formalin fixed paraffin embedded tissue blocks. The patient age, sex, anatomic location of tumour in the Jaw/face and pathomorphological features were recorded for all cases. The data obtained was analysed using Epi-info 7 (version 3.5.4) and Microsoft-Excel. Results were presented in tables and charts. Fifty one cases of ameloblastoma were diagnosed during the 9 years of review. Their ages ranged between 6 and 65 years with a mean age of 30.9±13.8 years and a peak of occurrence in the third decade. There were 29 males and 22 females with a male to female ratio (M:F) of 1.3:1. Ninety-two percent of cases occurred in the mandible and 8% in the maxilla. The conventional variant accounted for 72.5% of cases and the unicystic variant 27.5%. The follicular type accounted for 64.8% of cases of conventional ameloblastoma. Ameloblastoma occurred more commonly in males with a peak in the third decade. A vast majority of cases involved the mandible and the conventional type was predominant. This demographic pattern supports existing evidence that ameloblastoma occurs more commonly in males and in relatively younger patients in Africa.

VL  - 10
IS  - 2
ER  -

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Author Information

  • Philip Ojile Akpa

    Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria; Department of Pathology, University of Jos, Jos, Nigeria

    Contact Email

    http://orcid.org/0000-0001-8328-7411

  • Innocent Emmanuel

    Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria; Department of Pathology, University of Jos, Jos, Nigeria

    Contact Email

  • Barka Vandi Kwaghe

    Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria

    Contact Email

  • Ijeoma Ahunna Okwudire-Ejeh

    Anatomic Pathology and Forensic Medicine Department, Asokoro District Hospital, Abuja, Nigeria

    Contact Email

  • Ayuba Madachi Dauda

    Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria; Department of Pathology, University of Jos, Jos, Nigeria

    Contact Email

  • Olugbenga Akindele Silas

    Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria; Department of Pathology, University of Jos, Jos, Nigeria

    Contact Email

    http://orcid.org/0000-0003-1585-9988

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