Publications by authors named "Alex Mremi"

37 Publications

Xanthogranulomatous pyelonephritis in an eight year old male child: A case report and review of the literature.

Int J Surg Case Rep 2021 May 30;82:105943. Epub 2021 Apr 30.

Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania; Department of Urology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania.

Introduction And Importance: Xanthogranulomatous pyelonephritis is an extremely rare but known form of chronic pyelonephritis resulting from prolonged suppuration of the kidney. Pre-operatively, it may mimic renal tuberculosis or neoplastic lesions including renal cell carcinoma due to its vague clinical presentation, equivocal laboratory and radiological investigations. Due to its rarity and academic interest, herein we report such a rare case we recently encountered in our clinical practice.

Case Presentation: An-eight-year old male child patient resented to our hospital with three months history of abdominal distension associated with progressive left flank pain. Preoperative investigations including CT-scan were suggestive of nephroblastoma with differential diagnosis of clear cell sarcoma. Radical nephrectomy was performed and histopathology of the specimen confirmed the diagnosis of Xanthogranulomatous pyelonephritis. The patient fared well postoperatively and he had no symptoms in the subsequent follow up visits.

Clinical Discussion: Xanthogranulomatous pyelonephritis is a rare, severe and atypical form of chronic pyelonephritis due to infection (E. coli, Proteus) or stones. The disease may resemble renal cell carcinoma preoperatively. Thus, high index of suspicion is necessary for preoperative diagnosis.

Conclusion: Preoperative diagnosis of Xanthogranulomatous pyelonephritis may be a daunting task related to the rarity of its presentation. Thus, scrupulous histopathological evaluation is essential for the definitive diagnosis. Radical nephrectomy is the mainstay treatment of choice especially in diffuse cases.
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http://dx.doi.org/10.1016/j.ijscr.2021.105943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114108PMC
May 2021

Non-Hodgkin lymphoma of bone of the femur and humerus: a case report and review of the literature.

Oxf Med Case Reports 2021 Apr 28;2021(4):omab024. Epub 2021 Apr 28.

Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.

Lymphoma of bone is a rare neoplasm composed of malignant lymphoid cells, producing a tumefactive lesion within bone. We report a 13-year-old male who presented with progressively increasing swellings at the right shoulder and right mid-thigh for one month. Radiological images revealed lytic destructive lesions associated with soft tissue masses in both sites and a pathological fracture on the right humerus. The patient had no significant medical history. Histological, immunohistochemical and fluorescent in-situ hybridization assessment of biopsies from the lesions confirmed the diagnosis of primary non-Hodgkin lymphoma of bone. Unfortunately, due to coronavirus disease 2019 outbreak, the patient was unable to follow-up treatment and died shortly after establishment of the diagnosis. Delay in diagnosis and treatment is of serious concern when it comes to improve the prognosis of patients with this disease.
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http://dx.doi.org/10.1093/omcr/omab024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082228PMC
April 2021

Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report.

Int J Surg Case Rep 2021 May 15;82:105889. Epub 2021 Apr 15.

Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania; Department of Urology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania.

Introduction And Importance: Advanced prostate cancer often presents with lower urinary tract symptoms together with features of cancer on digital rectal examination. The commonest sites of metastasis include bone, liver and lungs. Metastasis to axillary lymph nodes is extremely unusual particularly as initial presentation of the disease.

Case Presentation: We report an atypical case of a 40-year male patient presented with left axillary mass and normal initial urological evaluation. Histopathology and immunohistochemistry of the biopsies from the axillary mass and prostate confirmed the diagnosis of prostate adenocarcinoma. The patient declined anti-androgen monotherapy treatment and succumbed two months after establishment of the diagnosis.

Clinical Discussion: Prostate cancer contributes significantly to the overall global cancer burden. Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer and only a few cases have been reported in the literature. Therefore, clinical diagnosis of patients presenting with axillary lymphadenopathy may cause diagnostic delay. Careful physical and imaging examinations combined with pathological analysis are essential in the diagnosis of advanced prostate cancer with unusual presentation.

Conclusion: In theory, prostate cancer can cause metastatic spread to any part of the body. However, metastasis to axillary nodes has not been frequently noticed. Our report highlights the importance of considering prostate cancer among differential diagnoses in Afro-Caribbean males presenting with symptoms suggestive of chest and abdomino-pelvic cancer.
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http://dx.doi.org/10.1016/j.ijscr.2021.105889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081923PMC
May 2021

Transfusion-Transmitted Infections and associated risk factors at the Northern Zone Blood Transfusion Center in Tanzania: A study of blood donors between 2017 and 2019.

PLoS One 2021 24;16(3):e0249061. Epub 2021 Mar 24.

Northern Zone Blood Transfusion Center (NZBTC), Moshi, Tanzania.

Background: Blood transfusion saves many people every year that would otherwise have died. The present study aimed to provide an update and insightful information regarding prevalence of the common Transfusion-Transmitted Infections (TTIs) and associated factors among blood donors in Tanzania.

Methods: This was a cross-sectional study involving retrospectively collected data of blood donors from the Tanzania Northern Zone Blood Transfusion Center between 2017 and 2019. Descriptive statistics were performed to describe characteristics of the blood donors. Univariable and multivariable logistic regression analyses were performed to determine association between prevalence of TTIs and socio-demographic factors. P-value <0.05 was considered statistically significant.

Results: A total of 101, 616 blood donors were included in the present study of which 85,053(83.7%) were males while 16,563 (16.3%) were females. Of all participants, the majority 45,400 (44.7%) were aged between 18 and 25 years; 79,582 (78.3%) were voluntary non-remunerated donors while 22,034 (21.7%) were replacement donors. The vast majority of them 99,626 (98%) were first time blood donors while 1990 (2%) were multiple donors. The overall prevalence of TTIs was 10.1% (10,226 out of 101,616) of which the leading was HBV accounting for 5.1% (5,264 out of 101,616). Being a replacement donor was associated with all the four types of TTIs: HIV (AOR = 1.22, 95% CI = 1.10-1.35), HBV (AOR = 1.35, 95% CI = 1.27-1.44), HCV (AOR = 1.28, 95% CI = 1.12-1.46), and syphilis (AOR = 1.33, 95% CI = 1.20-1.48).

Conclusions: Our study has demonstrated that Tanzania has relatively high prevalence of TTIs compared to some countries in Sub-Saharan Africa. HBV infection seems to be the most common infection among blood donors and replacement blood donors are at a higher risk of harboring the commonest TTIs among blood donors.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249061PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990303PMC
March 2021

Acceptability and feasibility of self-sampling and follow-up attendance after text message delivery of human papillomavirus results: A cross-sectional study nested in a cohort in rural Tanzania.

Acta Obstet Gynecol Scand 2021 04 12;100(4):802-810. Epub 2021 Mar 12.

Department of Clinical Research, University of Southern Denmark, Odense, Denmark.

Introduction: The objective was to determine if self-collection of vaginal samples for human papillomavirus (HPV) testing was acceptable and feasible in rural Tanzania and to assess the extent of attendance at a follow-up appointment among women who tested HPV-positive after delivery of HPV results via text messages.

Material And Methods: A combined cross-sectional and cohort study was conducted among women aged 25-60 years from rural Kilimanjaro, Tanzania. Women were offered HPV self-sampling or traditional visual inspection of the cervix with acetic acid. If HPV self-sampling was preferred, participants received instructions on self-collection with an Evalyn Brush. A questionnaire was used to assess the acceptability and feasibility of the self-sampling procedure for the participants and delivery of HPV results via text messages. A mobile text message platform was used to send private text messages with the screening results to the participants.

Results: A total of 1108 women were enrolled and self-collected an HPV sample; 11.8% tested positive for high-risk HPV. The majority (98.9%) agreed that they had no trouble in understanding the instructions on how to perform the self-collection and that they would recommend it to a friend (94.5%) or as a standard screening method in Tanzania (95.5%). A minority of women experienced bleeding (2.4%) or pain (6%) while collecting the sample, while some were worried that they would get hurt (12.7%) or felt embarrassed (3.5%). The majority (98.4%) of women would like to receive the screening test results via text messages. Eighty-two per cent of those who tested positive for high-risk HPV attended the follow-up appointment after receiving a text message reminder and an additional 16% attended after receiving both a text message and a phone call reminder whereas 2% did not attend follow up at all. Attendance was not influenced by age, marital status, education level, parity, or HIV status.

Conclusions: Human papillomavirus self-sampling and text-message feedback delivery are generally well-perceived and accepted among rural Tanzanian women, and the majority of HPV-positive women attended a follow-up appointment after receiving their HPV results and follow-up appointment via text messages. This screening method may have potential to be transferrable to other low-income countries with a high incidence of cervical cancer and so improve cervical cancer screening attendances.
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http://dx.doi.org/10.1111/aogs.14117DOI Listing
April 2021

Immature teratoma of the ovary in a 1 year and 9-month-old child: a case report and review of the literature.

J Surg Case Rep 2021 Jan 30;2021(1):rjaa609. Epub 2021 Jan 30.

Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.

Immature teratoma of the ovary is a rare malignant germ cell tumor whose etiology is unknown. Preoperative diagnosis and treatment of this tumor can be challenging for clinicians. We present a 1-year and 9-month female child who presented with a 1- month history of progressive nontender abdominal distension. Computed tomography scan of the abdomen revealed a huge well-defined heterogenous mass arising from the peritoneal cavity. Surgical resection was performed. Histopathology coupled with immunohistochemical analysis of the specimen confirmed it to be an ovarian immature teratoma, grade one. The child recovered well postoperatively. Surgery alone is curative for most children and adolescents with resectable ovarian immature teratoma thus avoiding the long-term effects of chemotherapy in most children with this disease.
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http://dx.doi.org/10.1093/jscr/rjaa609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849942PMC
January 2021

Intestinal ischemia in a COVID-19 patient: case report from Northern Tanzania.

J Surg Case Rep 2021 Jan 25;2021(1):rjaa537. Epub 2021 Jan 25.

Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Novel coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, and declared by World Health Organization as a pandemic in March 2020. Since then, it has been well known for COVID-19 patients to present with clinical manifestations of severe acute respiratory syndrome (SARS-CoV-2) similar to the influenza. However, in the course of the disease, various pathological complications of high clinical significance have remained unknown. Impaired blood supply to the visceral vascular system can cause serious life-threatening acute damage. We report a case of a 60-year-old female with difficulty in breathing and extensive acute intestinal ischemia confirmed to be associated with SARS-CoV-2 infection. The patient developed a sudden abdominal pain and succumbed shortly after admission before imaging studies were performed. Autopsy revealed massive bowel ischemia. This case highlights the importance of paying attention to serious and less known clinical manifestations other than pulmonary symptoms and fever.
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http://dx.doi.org/10.1093/jscr/rjaa537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837360PMC
January 2021

Primary intratesticular rhabdomyosarcoma in children: a case report and review of the literature.

J Med Case Rep 2021 Jan 31;15(1):37. Epub 2021 Jan 31.

Department of pathology, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania.

Background: The importance of this paper is to help to emphasize the importance of chemotherapy for children with pure intratesticular rhabdomyosarcoma after radical inguinal orchiectomy is done as first treatment of rhabdomyosarcoma. The information provided in this paper about the follow-up outcomes of the patient described in this paper, it highlights that, recurrence and even metastasis of intratesticular rhabdomyosarcoma in children are more likely to occur if surgery it not combined with chemotherapy.

Case Presentation: Herein, we present a 6-year old African male child with a 3 months history of a painless right intratesticular tumour. The tumour was poorly vascularized and was in continuity with the spermatic cord. Pelvic computer tomography (CT) scan showed a heterogeneous mass with well-defined margins without microcalcification and multiple bilateral inguinal enlarged lymph nodes were noticed without pelvic lymphadenopathy. The tumour measured 3.8 × 2.8 × 3.9 cm. The tumour marker panel showed: lactate dehydrogenase of (472 UI/l), alpha-fetoprotein (1.43 UI/ml) and human chorionic gonadotrophin beta (2.9 mUI/ml). Microscopically, the tumour was composed of small to medium size undifferentiated cells. These were oval to spindle, hyperchromatic cells to stromal myxoid degeneration were noted. Tunica albuginea and rete testis both were infiltrated by tumour. The tumour showed high mitotic count which measured 50 mitoses per 10 High Power Field (HPF). The diagnosis of rhabdomyosarcoma (RMS) was confirmed by immunohistochemistry (IHC) testing using myoD antibody which showed strong and diffuse intranuclear staining of the tumour cells. Currently, he is on cyclophosphamide and vincristine chemotherapy regime and his condition has improved much.

Conclusions: The experience obtained from the index case is crucial for the management of patients with intratesticular rhabdomyosarcoma which should always make sure that radical inguinal orchiectomy is covered by chemotherapy and/or radiotherapy. This will potentially lower the possibilities of recurrence and/or metastasis of the tumour, hence improving the prognosis of the patients. We report the clinical, radiological, and laboratory characteristics as well as the outcome of the patient.
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http://dx.doi.org/10.1186/s13256-020-02599-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847602PMC
January 2021

Skin maculae, chronic diarrhea, cachexia, and splenomegaly-Late presentation of the first autochthonous case of visceral leishmaniasis in Tanzania.

PLoS Negl Trop Dis 2021 01 14;15(1):e0008925. Epub 2021 Jan 14.

Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania.

A 20-year-old man from Simanjiro district in northern Tanzania presented with a 3-year history of splenomegaly, fatigue, cachexia, skin maculae, and recent onset of watery diarrhea at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Due to laboratory findings of pancytopenia, diagnostic workup included bone marrow aspiration cytology and biopsy. Although the rapid test (IT LEISH, rK39 RDT) was negative, blood smear showed amastigote forms of leishmaniasis in macrophages. Repeat bone marrow aspiration and PCR eventually confirmed visceral leishmaniasis (VL). The patient denied travel to known endemic areas of VL. Treatment was initiated with Amphotericin B, but the patient died on the fourth day of treatment from respiratory insufficiency. An autopsy revealed massive organ manifestations of VL. This is the first reported autochthonous case of VL in Tanzania. Clark and colleagues detected the vector Phlebotomus martini in Northern Tanzania in 2013, in a region bordering the district of our patient. The negative rapid test draws attention to the fact that sensitivity and specificity were found to be low in East African VL patients as displayed earlier by a Kenyan study. Therefore, tissue samples (spleen or bone marrow) remain necessary for diagnosis. The variety of symptoms in this presented case was remarkable, including the occurrence of post-kala-azar dermal leishmaniasis (PKDL) and VL at the same time. This has been described in East African VL cases before as well as the occurrence of chronic diarrhea. An elongated undiagnosed period likely led to a mixed clinical picture that included hepato-splenomegaly, PKDL, cachexia, and diarrhea.
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http://dx.doi.org/10.1371/journal.pntd.0008925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808674PMC
January 2021

Altitude-Related Disorders on Mount Kilimanjaro, Tanzania: Two-Year Survey in a Local Referral Center.

Wilderness Environ Med 2021 Mar 9;32(1):36-40. Epub 2021 Jan 9.

Department of Medicine, Kilimanjaro Christian Medical Center, Moshi Kilimanjaro, United Republic of Tanzania.

Introduction: A significant number of climbers on Mount Kilimanjaro are affected by altitude-related disorders. The aim of this study was to determine the main causes of morbidity and mortality in a representative cohort of climbers based on local hospital records.

Methods: We conducted a 2-y retrospective chart review of all patients presenting to the main referral hospital in the region after a climb on Mount Kilimanjaro, including all relevant records and referrals for postmortem studies.

Results: We identified 62 climbers who presented to the hospital: 47 inpatients and 15 outpatients. Fifty-six presented with high altitude illness, which included acute mountain sickness (n=8; 14%), high altitude pulmonary edema (HAPE) (n=30; 54%), high altitude cerebral edema (HACE) (n=7; 12%), and combined HAPE/HACE (n=11; 20%). The mean altitude of symptom onset ranged from 4600±750 m for HAPE to 5000±430 m for HAPE/HACE. The vast majority of inpatients (n=41; 87%) were improved on discharge. Twenty-one deceased climbers, most having died while climbing (n=17; 81%), underwent postmortem evaluation. Causes of death were HAPE (n=16; 76%), HAPE/HACE (n=3; 14%), trauma (1), and cardiopulmonary (1).

Conclusions: HAPE was the main cause of death during climbing as well as for hospital admissions. The vast majority of climbers who presented to hospital made a full recovery.
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http://dx.doi.org/10.1016/j.wem.2020.10.003DOI Listing
March 2021

Metastatic Papillary Renal Cell Carcinoma in a 13-Year Old Girl: A Case Report and Review of the Literature Mainly Focusing on Treatment and Prognosis.

Int J Surg Case Rep 2020 27;77:791-794. Epub 2020 Nov 27.

Department of Pathology, Kilimanjaro Christian Medical Center (KCMC), Moshi, Tanzania; Faculty of Medicine, Kilimanajro Christian Medical University College (KCMUCO), Moshi, Tanzania.

Introduction: Renal cell carcinoma (RCC) accounts for less than 0.3% of all tumours occurring in children and adolescents and it also affects 2.6% of all renal tumours for the pediatriac population. The aim of this report is to present the case of a 13-year old girl with metastatic papillary RCC and to review the literature mainly on treatment modalities and prognosis of children and adolescents with RCC.

Presentation Of Case: The case of a 13-year old girl is presented. The girl presented with a painless abdominal mass in the right side for three months. Abdominal ultrasound revealed a heterogeneous mass of 15 cm in diameter with metastasis to the liver. Also CT scan of the abdomen and lungs revealed metastasis to the liver and lungs. She underwent radical right nephrectomy.

Discussion: Pediatric RCC is an aggressive malignancy and some series have reported a 50% incidence of metastasis at the point of initial diagnosis similar to our patient who had metastasis to both lungs and liver at the time of initial diagnosis. Over 50% of metastasis of RCC in the pediatric population occurs in the lungs and liver.

Conclusion: RCC in children is extremely rare with no known specific treatment regimen. Early diagnosis when the tumour is still confined to the kidney provides better clinical outcomes since radiotherapy, chemotherapy and immunotherapy have not been found to improve the prognosis.
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http://dx.doi.org/10.1016/j.ijscr.2020.11.116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718312PMC
November 2020

Placental pathology and maternal factors associated with stillbirth: An institutional based case-control study in Northern Tanzania.

PLoS One 2020 31;15(12):e0243455. Epub 2020 Dec 31.

Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Objective: To determine the placental pathologies and maternal factors associated with stillbirth at Kilimanjaro Christian Medical Centre, a tertiary referral hospital in Northern Tanzania.

Methods: A 1:2 unmatched case-control study was carried out among deliveries over an 8-month period. Stillbirths were a case group and live births were the control group. Respective placentas of the newborns from both groups were histopathologically analyzed. Maternal information was collected via chart review. Mean and standard deviation were used to summarize the numerical variables while frequency and percentage were used to summarize categorical variables. Crude and adjusted logistic regressions were done to test the association between each variable and the risk of stillbirth.

Results: A total of 2305 women delivered during the study period. Their mean age was 30 ± 5.9 years. Of all deliveries, 2207 (95.8%) were live births while 98 (4.2%) were stillbirths. Of these, 96 stillbirths (cases) and 192 live births (controls) were enrolled. The average gestational age for the enrolled cases was 33.8 ±3.2 weeks while that of the controls was 36.3±3.6 weeks, (p-value 0.244). Of all stillbirths, nearly two thirds 61(63.5%) were males while the females were 35(36.5%). Of the stillbirth, 41were fresh stillbirths while 55 were macerated. The risk of stillbirth was significantly associated with lower maternal education [aOR (95% CI): 5.22(2.01-13.58)], history of stillbirth [aOR (95%CI): 3.17(1.20-8.36)], lower number of antenatal visits [aOR (95%CI): 6.68(2.71-16.48), pre/eclampsia [aOR (95%CI): 4.06(2.03-8.13)], and ante partum haemorrhage [OR (95%CI): 2.39(1.04-5.53)]. Placental pathology associated with stillbirth included utero-placental vascular pathology and acute chorioamnionitis.

Conclusions: Educating the mothers on the importance of regular antenatal clinic attendance, monitoring and managing maternal conditions during antenatal periods should be emphasized. Placentas from stillbirths should be histo-pathologically evaluated to better understand the possible aetiology of stillbirths.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243455PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775101PMC
January 2021

Missing and decayed teeth, oral hygiene and dental staining in relation to esophageal cancer risk: ESCCAPE case-control study in Kilimanjaro, Tanzania.

Int J Cancer 2020 Dec 15. Epub 2020 Dec 15.

Environmental and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France.

In the African esophageal squamous cell carcinoma (ESCC) corridor, recent work from Kenya found increased ESCC risk associated with poor oral health, including an ill-understood association with dental fluorosis. We examined these associations in a Tanzanian study, which included examination of potential biases influencing the latter association. This age and sex frequency-matched case-control study included 310 ESCC cases and 313 hospital visitor/patient controls. Exposures included self-reported oral hygiene and nondental observer assessed decayed+missing+filled tooth count (DMFT index) and the Thylstrup-Fejerskov dental fluorosis index (TFI). Blind to this nondental observer TFI, a dentist independently assessed fluorosis on photographs of 75 participants. Odds ratios (ORs) are adjusted for demographic factors, alcohol and tobacco. ESCC risk was associated with using a chewed stick to brush teeth (OR 2.3 [95% CI: 1.3-4.1]), using charcoal to whiten teeth (OR 2.13 [95% CI: 1.3, 4.1]) and linearly with the DMFT index (OR 3.3 95% CI: [1.8, 6.0] for ≥10 vs 0). Nondental observer-assessed fluorosis was strongly associated with ESCC risk (OR 13.5 [95% CI: 5.7-31.9] for TFI 5+ v 0). However, the professional dentist's assessment indicated that only 43% (10/23) of participants assessed as TFI 5+ actually had fluorosis. In summary, using oral charcoal, brushing with a chewed stick and missing/decayed teeth may be risk factors for ESCC in Tanzania, for which dose-response and mechanistic research is needed. Links of ESCC with "dental fluorosis" suffered from severe exposure misclassification, rendering it impossible to disentangle any effects of fluorosis, extrinsic staining or reverse causality.
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http://dx.doi.org/10.1002/ijc.33433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048942PMC
December 2020

Virchow's node as the initial presentation of metastatic prostate cancer: a case series of a common cancer in uncommon location.

J Surg Case Rep 2020 Nov 30;2020(11):rjaa476. Epub 2020 Nov 30.

Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Prostate cancer is one of the commonest cancers among men contributing significantly to the overall cancer burden globally. Most patients present with lower urinary tract symptoms. Metastasis to supraclavicular lymph nodes is unusual presentation, which has been rarely reported particularly as the primary presentation. We report two rare cases of advanced prostatic adenocarcinoma presenting with firm, non-tender lump in the left supraclavicular region between the two heads of the sternocleidomastoid muscle, (that is Virchow's node) as initial primary symptom. Examination of the patients revealed an elevated prostatic-specific antigen (PSA) of > 100 ng/ml levels, and the diagnosis was confirmed by histological evaluation and immunostaining with PSA of the supraclavicular lymph nodes and prostate biopsies. This case series emphasizes the importance of considering prostate cancer in the differential diagnosis of male patients with supraclavicular lymphadenopathy.
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http://dx.doi.org/10.1093/jscr/rjaa476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703372PMC
November 2020

Minimally invasive esophageal sponge cytology sampling is feasible in a Tanzanian community setting.

Int J Cancer 2021 Mar 21;148(5):1208-1218. Epub 2020 Nov 21.

Section of Environment and Radiation, International Agency for Research on Cancer (IARC/WHO), Lyon, France.

Esophageal sponge cytology is an endoscopy alternative well accepted by patients with extensive data for accuracy in the context of adenocarcinoma. Few studies have assessed its feasibility in asymptomatic community members, and fewer still in East Africa, where esophageal squamous cell carcinoma (ESCC) rates are high. We aimed to assess the feasibility of a capsule-based diagnosis of esophageal squamous dysplasia (ESD), an ESCC precursor, which may benefit epidemiological and early detection research. We collected Cytosponge collections in 102 asymptomatic adults from Kilimanjaro, Tanzania. Uptake, acceptability and safety were assessed. Participants scored acceptability immediately following the procedure and 7 days later on a scale of 0 (least) to 10 (most acceptable). Slides from paraffin-embedded cell clots were read by two pathologists for ESD and other pathologies. All participants (52 men, 50 women, aged 30-77) swallowed the device at first attempt, 100 (98%) of which gave slides of adequate cellularity. Acceptability scores were 10 (53%), 9 (24%), 8 (21%), 7 (2%) and 6 (1%), with no differences by age, sex or time of asking. Cytological findings were esophageal inflammation (4%), atypical squamous cells of uncertain significance (1%), low-grade dysplasia (1%), gastritis (22%) and suspected intestinal metaplasia (6%). Setting-specific logistical and ethical considerations of study implementation are discussed. We demonstrate the safety, acceptability and feasibility of Cytosponge sampling in this setting, paving the way for innovative etiology and early-detection research. Targeted sampling strategies and biomarker development will underpin the success of such initiatives. The study protocol is registered on ClinicalTrials.gov (NCT04090554).
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http://dx.doi.org/10.1002/ijc.33366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839767PMC
March 2021

Ovarian malignant mixed Müllerian tumor: a rare case report from Tanzania.

J Surg Case Rep 2020 Oct 20;2020(10):rjaa406. Epub 2020 Oct 20.

Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Malignant mixed Müllerian tumor of the ovary is rare aggressive tumor that is histologically defined by the presence of malignant epithelial and stromal components. We report a 37-year-old woman who consulted our facility complaining of abdominal distention and a painful palpable mass over her lower abdomen. Physical examination including computerized tomography revealed a complex cystic mass lesion on the left ovary with extensive omental involvement. Ovarian cancer was suspected and the patient underwent debulking surgery. The histopathology of the specimen revealed a high-grade tumor composed of both malignant epithelial and sarcomatous elements. Both epithelial and stromal components stained positive for p53 immunostaining. Before the initiation of chemotherapy, on 5th day postoperation, the patient was found unresponsive. The stage of the disease seems to be the most important prognostic factor, thus emphasis should be made to identify it in earlier stages.
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http://dx.doi.org/10.1093/jscr/rjaa406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571862PMC
October 2020

Giant isolated hydatid lung cyst: two case reports.

J Med Case Rep 2020 Oct 24;14(1):200. Epub 2020 Oct 24.

Kilimanjaro Christian Medical University College, P. O. Box 2240, Moshi, Tanzania.

Background: Echinococcosis is a parasitic disease caused by Echinococcus granulosus and causes cystic lesions in the liver and lungs commonly. It is endemic in many parts of the world, and though humans are incidental hosts of the parasite, the disease can have severe consequences.

Case Presentation: We present two patients from pastoralist (Maasai) communities in rural Tanzania with long-standing chest pain accompanied by hemoptysis. Both were managed surgically after diagnosis, but one patient died of the complications following rapture of the cyst during surgery. Histopathological evaluation of the specimens confirmed the diagnosis of giant hydatid cysts.

Conclusion: Animal-keeping communities such as the Maasai are at risk of echinococcosis because of their close proximity to animals. The diagnosis can be made on the basis of history and radiological as well as laboratory findings. Surgery is a recommended mode of treatment, though it carries a high risk, especially when the cyst ruptures. Primary preventive measures are thus necessary in order to avoid the secondary and tertiary complications of the management of giant hydatid cysts, which is difficult in resource-limited endemic areas.
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http://dx.doi.org/10.1186/s13256-020-02524-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585214PMC
October 2020

Cancer spectrum in HIV-infected patients: A zonal hospital experience in Tanzania.

Cancer Treat Res Commun 2020 29;25:100213. Epub 2020 Sep 29.

Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Duke Global Health Institute, Duke University Medical Center, Durham, NC, United States of America; Department of Internal Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, United States of America.

Background: Although the burden of human immunodeficiency virus (HIV) infection in Tanzania is high, limited data are available on cancers in HIV-infected patients. We aimed to determine the spectrum and prevalence of cancers in HIV-infected patients attending care at a zonal hospital in Tanzania.

Materials And Methods: Clinical records of HIV-infected patients from 2009 to 2019 were identified and retrospectively reviewed.

Results: A total of 3398 HIV-infected patients were recruited with median age of 37 years. Cancer was diagnosed in 9% of the patients after enrollment into HIV clinical care, with an increasing prevalence from 7.2% between years 2009 and 2013 to 8.6% between years 2017 and 2019 (p-value <0.0001). Majority (89.2%) were on antiretroviral therapy (ART) during the time of cancer diagnosis. The proportions of acquired immunodeficiency syndrome (AIDS)-defining cancers and non-AIDS defining cancers were 28% and 72% respectively. Kaposi's sarcoma was the most common (13.2%) AIDS-defining cancer while esophageal cancer was the most common (11.1%) non-AIDS defining cancer. The median duration of time from HIV infection to cancer diagnosis was 715 days (IQR: 98-2570). The median CD4T-cell count was 318(IQR 159-690) cells/µl at the time of cancer diagnosis and 40.7% of the patients had advanced immunosuppression with CD4 count less than 200 cells/µl at the time of cancer diagnosis.

Conclusion: Non-AIDS defining cancers were much more common than AIDS-defining cancers suggesting increased longevity due to ART access. The prevalence of cancer among HIV-infected patients was 9% with an increasing trend over time; highlighting the importance of promoting cancer screening in this vulnerable population and implementation of vaccinations programs for liver and cervical cancers as well as tobacco control policies for smoking-related cancers.
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http://dx.doi.org/10.1016/j.ctarc.2020.100213DOI Listing
September 2020

Metaplastic carcinoma of breast: a report of two cases.

Oxf Med Case Reports 2020 Sep 22;2020(9):omaa070. Epub 2020 Sep 22.

Department of Pathology, Kilimanjaro Christian Medical Center (KCMC), Moshi, Tanzania.

The pathogenesis of metaplastic breast carcinoma (MBC) is still debatable and it has been hypothesized that MBC develops as a result of transformation of epithelial cells into mesenchymal cells along with formation of a favorable tumor microenvironment. This favorable tumor microenvironment helps the transformed cells to undergo further mutations and clonal expansion. Case 1 was a 42-year old female with a 1-year history of a right breast fungating mass which was histologically confirmed to be matrix-producing type of MBC. Case 2 was a 47-year old female who presented with a recurrent left breast mass. Histologically, the tumor was confirmed to be carcinosarcomatous type of MBC. MBC is a rare, heterogeneous tumor with poor prognosis due to its aggressive behavior. It is more likely to mimic other benign breast conditions, therefore contributing to delay of diagnosis as it was for both of our patients herein presented.
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http://dx.doi.org/10.1093/omcr/omaa070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507866PMC
September 2020

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management.

Afr J Emerg Med 2020 Sep 10;10(3):111-117. Epub 2020 Mar 10.

Mbeya Zonal Referral Hospital, P.O. Box 419, Mbeya, Tanzania.

Background: Appropriate referrals of injured patients could improve clinical outcomes and management of healthcare resources. To gain insights for system development, we interrogated the current situation by assessing burden, patient demography, causes of injury, trauma mortality and the care-process.

Methods: We used an observational, cross-sectional study design and convenience sampling to review patient charts from 3 major hospitals and the death registry in Tanzania.

Results: Injury constitutes 9-13% of the Emergency Centre census. Inpatient trauma-deaths were 8%; however, the trauma death registry figures exceeded the 'inpatient deaths' and recorded up to 16%. Most patients arrive through a hospital referral system (82%) and use a hospital transport network (76%). Only 8% of the trauma admissions possessed National Health Insurance. Road traffic collision (RTC) (69%), assault (20%) and falls (9%) were the leading causes of injury. The care process revealed a normal primary-survey rate of 73-90%. Deficiencies in recording were in the assessment of: Airway and breathing (67%), circulation (40%) and disability (80%). Most patients had non-operative management (42-57%) or surgery for wound care or skeletal injuries (43%). Laparotomies were performed in 26%, while craniotomy and chest drain-insertion were each performed in 10%.

Conclusion: The burden of trauma is high, and the leading causes are: RTC, assault, and falls. Deaths recorded in the death registries outweigh in-hospital deaths for up to twofold. There are challenges in the care process, funding and recording. We found a functional hospital referral-network, transport system, and death registry.
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http://dx.doi.org/10.1016/j.afjem.2020.01.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474232PMC
September 2020

Gastric perforation resulting into pneumoperitoneum in a neonate: a case report.

J Surg Case Rep 2020 Aug 26;2020(8):rjaa298. Epub 2020 Aug 26.

Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Gastric perforation in a neonate is a rare surgical emergency in routine practice. The causes and predisposing factors for gastric perforation in a neonate vary from traumatic to benign conditions like inflammatory processes. Early detection, intensive care, stabilization and prompt surgery yield positive outcome. Early diagnosis is important for better prognosis. Simple investigation such as plain abdominal X-ray can adequately lead to the diagnosis by showing pneumoperinoneum. We present a 3-day-old neonate; born at term who presented with abdominal distension and vomiting. Plain abdominal X-ray revealed pneumoperitoneum. Emergency laparotomy was performed where a gastric perforation was found measuring 0.5 by 0.5 cm located on the anterior aspect of the stomach body near the pylorus. The baby underwent successful surgical intervention and recovered well.
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http://dx.doi.org/10.1093/jscr/rjaa298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449603PMC
August 2020

Diagnosis of primary osteosarcoma of the urinary bladder in a resource-limited setting: a case report and review of the literature.

J Surg Case Rep 2020 Jul 23;2020(7):rjaa236. Epub 2020 Jul 23.

Department of Biomedical Science, College of Health Sciences (CHS), The University of Dodoma, Dodoma, Tanzania.

Extraskeletal osteosarcoma is a rare malignant mesenchymal soft tissue tumor without attachment to the bone and is able to produce osteoid or cartilaginous matrix. Rendering a definitive diagnosis may pose a challenge particularly in a resource-limited setting. We report a case of primary osteosarcoma of the urinary bladder presenting with hematuria, dysuria and positive history of schistosomal contact. Computed tomography intravenous urogram revealed a large heterogeneous mass at the right superolateral aspect of the urinary bladder. Morphological evaluation of the biopsy and a minimal panel of immunohistochemical antibodies of vimentin and cytokeratin 20 ruled out potential differentials and thus confirmed the diagnosis of osteosarcoma.
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http://dx.doi.org/10.1093/jscr/rjaa236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378020PMC
July 2020

Ovarian cancer: diagnostic accuracy and tumor types distribution in East Africa compared to North America.

Diagn Pathol 2020 Jul 16;15(1):86. Epub 2020 Jul 16.

Department of Pathology, Mbeya Referral Hospital, Box 419, Mbeya, Tanzania.

Background: Ovarian cancer is a spectrum of several histologically distinct tumor types that differ in etiology, response to therapy, and prognosis. In resource-limited settings, the diagnosis of ovarian cancer can be challenging. This study describes the distribution of ovarian cancer tumor types in East Africa as well as assessing the diagnostic accuracy by using contemporary methods.

Methods: Data from 210 women identified from the records with a diagnosis of ovarian cancer in a period of 15 years were included. Two tissue microarrays were constructed and stained with 20 antibodies relevant to ovarian cancer subtyping. An integrated diagnosis was reached by the review of full Haematoxylin and Eosin stained sections, with consideration of immunohistochemical results. The integrated diagnoses were compared with the original diagnoses, and the degree of agreement was evaluated by percentage and Kappa statistics.

Results: Though limited by selection bias, the results suggest lower rates of ovarian cancer in East Africa compared to a North American population from Alberta, Canada. There was a higher proportion of sex cord stromal tumors and germ cell tumors in the East African population. Diagnostic accuracy for main ovarian tumor type categories was substantial (Kappa 0.70), but only fair for specific ovarian carcinoma histotypes (Kappa 0.34). Poor Haematoxylin and Eosin stain was the main factor hindering the correct diagnosis, which was not related to tissue processing.

Conclusions: In a resource-limited setting, where immunohistochemistry is not routinely carried out, diagnostic accuracy for the main categories of ovarian carcinoma is substantial and could be further improved by standardization of the basic Haematoxylin and Eosin stain.
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http://dx.doi.org/10.1186/s13000-020-01000-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364467PMC
July 2020

Gynecological hysterectomy in Northern Tanzania: a cross- sectional study on the outcomes and correlation between clinical and histological diagnoses.

BMC Womens Health 2020 06 12;20(1):122. Epub 2020 Jun 12.

Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.

Background: Hysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and their risk factors are bound to differ based on locations, availability of resources and level of surgical training. Documented complications rates and their correlates are reported from high income countries while data from low- and middle-income countries including Tanzania is scare.

Methods: This was a hospital based cross-sectional study conducted at a tertiary facility in northern Tanzania where 178 women who underwent elective gynecological hysterectomies in the department of obstetrics and gynecology within the study period were enrolled. Logistic regression was performed to determine the association between risk factors and occurrence of surgical complication where p-value of < 0.05 was considered statistically significant. The degree of correlation between pre-operative clinical and histological diagnosis was determined by kappa correlation test.

Results: A total of 75 (42%) of women had surgical complications within 10 days of surgery. Blood transfusion and intra-operative bleeding were the most common complications observed in 34 (19.1%) and 17 (9.6%) women respectively. Independent risk factors for complications included obesity (OR 3.9; 95% CI 1.44-10.46), previous abdominal operations (OR 8.44; 95% CI 2.52-28.26) and longer duration of operation (> 2 h) (OR 5.02; 95% CI 2.18-11.5). Both uterine fibroid and adenomyosis had good correlation of clinical and histological diagnosis (p-value < 0.001).

Conclusion: Bleeding and blood transfusion were the most common complications observed in this study. Obesity, previous abdominal operation and prolonged duration of operation were the most significant risk factors for the complications. Local tailored interventions to reduce surgical complications of hysterectomy are thus pivotal. Clinicians in this locality should have resources at their disposal to enhance definitive diagnosis attainment before surgical interventions.
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http://dx.doi.org/10.1186/s12905-020-00985-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291471PMC
June 2020

Schistosomiasis and cancer: Experience from a zonal hospital in Tanzania and opportunities for prevention.

J Surg Case Rep 2020 May 1;2020(5):rjaa144. Epub 2020 Jun 1.

Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.

Schistosomiasis infection is endemic in many parts of Tanzania. The morbidity due to Schistosomiasis and its association with cancer remains to be of great concern and poses greater challenge that needs to be assessed. Cancer is an increasing public health problem in most sub-Saharan African countries, and yet, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This article aims to discuss case series of patients diagnosed with urinary bladder, prostate and colorectal cancer together with Schistosoma infection. We further highlight the opportunities for combating new Schistosomiasis infection, a potential to reduce its oncological complications particularly in low-resource setting.
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http://dx.doi.org/10.1093/jscr/rjaa144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263752PMC
May 2020

Missed opportunity of deworming a Maasai boy from nomadic family leading to life threatening intestinal obstruction.

J Surg Case Rep 2020 May 26;2020(5):rjaa096. Epub 2020 May 26.

Department of pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Mass deworming against soil-transmitted helminthiasis, including (AL), is one of the largest public health interventions in low- and middle-income countries. The prevalence of in Tanzania is 6.8%. We present a 3-year-old male of a known Tanzanian nomadic tribe (Masaai tribe) with history of missed deworming, who was brought to the emergency department with a 3-day history of constipation, nonprojectile, bilious vomiting, generalized abdominal distension and pain.

He was diagnosed with intestinal obstruction by the use of a plain abdominal X-ray, which revealed marked gaseous distension of the stomach and bowels without significant air-fluid levels. He was initially treated with intravenous ceftriaxone 50 mg/kg, metronidazole 15 mg/kg and acetaminophen 15 mg/kg. An explorative laparotomy was then performed. Intraoperative findings demonstrated a dense collection of worms in the gangrenous proximal jejunum and duodenum. Thorough abdominal lavage was carried out and abdomen was closed.
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http://dx.doi.org/10.1093/jscr/rjaa096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251234PMC
May 2020

Ovarian sex cord tumour with annular tubules in a 13-year-old female: a case report.

Oxf Med Case Reports 2020 Apr 23;2020(4):omaa024. Epub 2020 May 23.

Department of Pathology, Kilimanjaro Christian Medical Center (KCMC), Moshi, Tanzania.

Sex cord tumour with annular tubules (SCTAT) is uncommon and distinctive type of sex cord-stromal tumours of the ovary which develops from sex cord cells. Most of SCTATs are strongly associated with Peutz-Jeghers syndrome (PJS) and have low malignancy potential; however, 20% of non-PJS-associated SCTATs have been reported to have high malignancy potential. Herein, we present a 13-year-old female who presented with severe abdominal pain localized in the right lower side, associated with nausea. Based on histopathological and immunohistochemical findings, the diagnosis was confirmed to be SCTAT. SCTAT of the ovary is extremely rare in the paediatric population as compared to the general population. Its occurrence among paediatrics as it was the case in the patient described in this paper may pose diagnostic challenges due to lack of clinical suspicion and therefore resulting in delay of diagnosis.
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http://dx.doi.org/10.1093/omcr/omaa024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243713PMC
April 2020

Advanced mucinous colorectal carcinoma in a 14-year old male child: A case report and review of the literature.

Int J Surg Case Rep 2020 11;70:201-204. Epub 2020 May 11.

Department of Biomedical Science, College of Health Science (CHS), The University of Dodoma, P. O. Box 395, Dodoma, Tanzania. Electronic address:

Introduction: ColorectaI carcinoma is extremely rare in children and presents with a poor prognosis.

Presentation Of Case: The present report describes the case of a 14-year old male child who presented with complaints of general weakness and recurrent abdominal pain, caused by a mucinous adenocarcinoma of the transverse colon (Dukes stage which was inoperable.

Discussion: Mucinous histopathological type is the most common type with increased ability to invade the adjacent stromal tissue. This biological behaviour has been reported to be attributable to its aggressive behaviour. Additionally, delay of diagnosis of colorectal carcinoma in children accounts for the advanced disease at diagnosis.

Conclusion: Colorectal carcinoma occurring in both children and adolescents usually have poor prognosis because of not having specific symptoms which contributes to delay of diagnosis. Mimicking of its symptoms with other non-malignant conditions such as intestinal obstruction and acute appendicitis also has been found to contribute to delay of diagnosis as it was in our present case.
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http://dx.doi.org/10.1016/j.ijscr.2020.04.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229418PMC
May 2020

The Role of a Minimum Immunohistochemical Antibody Panel in Confirming Undifferentiated Nasopharyngeal Carcinoma: A Cross-Sectional Study at the Muhimbili National Hospital, Dar-es-Salaam, Tanzania.

Niger Med J 2019 Nov-Dec;60(6):279-284. Epub 2020 Feb 24.

Department of Pathology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.

Introduction: Nasopharyngeal carcinoma (NPC) is a malignant epithelial neoplasm arising in the nasopharyngeal mucosa that shows light microscopic and/or ultrastructural evidence of squamous differentiation. Immunohistochemistry (IHC) can be used to reliably distinguish undifferentiated NPC from other malignant tumors, and the technique may be a necessary tool toward the arrival of a definitive diagnosis, particularly when dealing with challenging cases.

Materials And Methods: This was a cross-sectional hospital-based study which was conducted at Muhimbili National Hospital. The study involved 120 patients with NPC who were diagnosed on histopathological basis between 2009 and 2013.

Results: The sensitivity and specificity of hematoxylin and eosin (H and E) stain in diagnosing NPC were 99% and 30.4%, respectively. The accuracy of H and E stain to diagnose NPC and lymphoma was 94.2% and 30.4%, respectively. CD45 antibody helped to confirm 16 cases which were diagnosed as NPC on H and E stain to be lymphoma. Further, AE1/AE3 antibody helped to confirm one case who was diagnosed as rhabdomyosarcoma on H and E stain to be NPC.

Conclusions: The sensitivity and accuracy of H and E stains to diagnose NPC were very high whereas the specificity was very low. A significant proportion of previously diagnosed NPC cases by routine H and E stains were confirmed not to be so by a minimal IHC antibody panel of pan-cytokeratin cocktail (AE1/AE3) and leukocyte common antigen (CD45). This highlights the paramount importance of a minimum IHC panel in assisting to obtain a definitive diagnosis in challenging cases of NPC.
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http://dx.doi.org/10.4103/nmj.NMJ_134_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053275PMC
February 2020

Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges.

JCO Glob Oncol 2020 03;6:375-381

Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Purpose: A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital.

Methods: Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed.

Results: Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type.

Conclusion: High proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.
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http://dx.doi.org/10.1200/JGO.19.00301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113073PMC
March 2020