Pattern of adult malignancies in Zambia (1980-1989) in light of the human immunodeficiency virus type 1 epidemic.

This study analysed histopathological and haematology records of 7836 neoplasms seen during the period 1980-1989 at the University Teaching Hospital, Lusaka, Zambia. The crude incidence rate of each malignancy per 100,000 adults per year was calculated and the patterns of malignancies were compared for the periods 1980-1983 and 1984-1989, the later coinciding with the advent of the human immunodeficiency virus (HIV) epidemic. The six most common tumours were carcinoma of the cervix (19.6%), Kaposi's sarcoma (7%), bladder carcinoma (6.3%), hepatoma (5.8%), lymphoma (4.6%) and carcinoma of the breast (4.4%). Significant increases in the crude incidence rates of Kaposi's sarcoma (KS) and carcinoma of the breast were observed during the last 6 years of the study period (P = 0.001). Nodal KS showed the most significant rise from a crude incidence rate of 0.25 per 100,000 adults per year in the 1980-1983 period to 1.11 during the 1984-1989 period. In contrast to findings from Europe and the USA, no significant increase in non-Hodgkin's lymphoma was detected in Zambia following the HIV epidemic.

PIP: In the West, Kaposi's sarcoma and non-Hodgkin's lymphoma have been closely associated with HIV-induced immunosuppression. To date, however, there has been no published account of the impact of HIV infection upon malignancies prevalent in Africa where the HIV epidemic is widespread. The authors describe the pattern of malignant disorders among adult indigenous Zambians over the period 1980-89 in the attempt to discern the impact of HIV infection upon the prevailing malignancies. Histopathological and hematology records of 7836 neoplasms seen during 1980-89 at the University Teaching Hospital in Lusaka, Zambia, were analyzed. The crude incidence rate of each malignancy per 100,000 adults per year was calculated and the patterns of malignancies compared for the periods 1980-83 and 1984-89. The latter period corresponds to the advent of the HIV epidemic. Carcinoma of the cervix, Kaposi's sarcoma, bladder carcinoma, hepatoma, lymphoma, and carcinoma of the breast were the six most commonly observed tumors, occurring, respectively, among 19.6%, 7%, 6.3%, 5.8%, 4.6%, and 4.4% of cases. The crude incidence rates of Kaposi's sarcoma and carcinoma of the breast increased significantly during the last six years of the study period, with nodal KS exhibiting the most significant rise from a crude incidence rate of 0.25 per 100,000 adults per year during 1980-83 to 1.11 during 1984-89. In contrast to findings from Europe and the US, no significant increase in non-Hodgkin's lymphoma was detected in Zambia following the arrival of the HIV epidemic.

Impact of immunodeficiency virus (HIV) on Fournier's gangrene: observations in Zambia.

The results of a prospective study in the University Teaching Hospital, Lusaka, Zambia, on the impact of Human Immunodeficiency Virus on the incidence and prognosis of Fournier's gangrene is presented; Zambia has been in the grip of an HIV epidemic since the early 1980s. A total of 10 patients with an average age of 32 years was observed during a 14-month period (March 1992-April 1993); eight patients had associated HIV infection. A contributory factor to the development of Fournier's gangrene was also present in seven patients, of which six involved the urinary tract. All patients were managed by early surgical débridement under antibiotic cover. Two patients died, only one of whom had associated HIV disease. This study has recorded a significant rise in the prevalence of Fournier's gangrene in Zambia since the advent of the HIV epidemic. It has also been documented that provided aggressive treatment along established lines is initiated without delay, the coexisting HIV infection does not adversely affect the prognosis of Fournier's gangrene.

Influence of HIV epidemic on the incidence of Kaposi's sarcoma in Zambian children.

Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (KS) is well documented in adults. However, very little information is available about KS in the pediatric age group. A retrospectively study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia, to define the incidence and clinical profile of KS in Zambian children over the last 13 years and to determine the influence, if any, of the current human immunodeficiency virus (HIV) epidemic on the pattern of pediatric KS. All the histopathological records from 1980 to 1992 were reviewed and all cases of KS along with the total number of malignancies, both in children and adults, were analyzed. Along with this, 17 of 23 case files of pediatric KS patients treated at the UTH since 1984 were retrieved and clinical details recorded. Of a total of 915 cases of KS, 85 (9.25%) were in children < 14 years of age. The age ranged from 7 months to 14 years, with an average of 5.62 years; the male/female ratio was 1.76:1. A significant increase in the incidence of pediatric KS has been recorded since 1987 (p < 0.001). This coincides with the advent of the HIV epidemic in the country. The disease was aggressive and fulminant in pediatric patients. More than 80% HIV seropositivity was detected. Children with blood transfusion-related HIV infection had cutaneous or lymphocutaneous disease, indicating that the mode of acquisition of HIV infection may influence the clinical appearance of KS. Thus, HIV-associated KS in children is becoming a common entity in Zambia. An urgent prospective epidemiologic study is needed to address this problem in HIV-affected regions.

The pattern of paediatric malignancy in Zambia (1980-1989): a hospital-based histopathological study.

The pattern of malignancies among indigenous Zambian children is described. The study, based upon an analysis of histopathology, autopsy and haematology records for a 10-year period (1980-1989), reveals a total of 525 neoplasms with a peak prevalence in the 5-9 year age group. Non-Hodgkin's lymphoma (17.5%) was the most common disorder followed by Burkitt's lymphoma (13.9%), retinoblastoma (11.4%), Kaposi's sarcoma (8.8%), Hodgkin's disease (5.9%), Wilms' tumour (5.9%), acute lymphocytic leukaemia (4%), rhabdomyosarcoma (3.4%), nasopharyngeal carcinoma (2.7%) and osteogenic sarcoma (2.1%). Kaposi's sarcoma and Hodgkin's disease revealed a significant male dominance; the former presented mainly in nodal form. Compared to an earlier report from Zambia (1968-1972), a significant increase in the incidence of Kaposi's sarcoma and nasopharyngeal carcinoma was noted in the present series.

Haematuria frequency syndrome in patients with positive HIV serology: observations in Zambia.

Observations are presented on 9 patients recently treated in the University Teaching Hospital, Lusaka, Zambia, for painful urinary frequency, suprapubic pain and microscopic and/or macroscopic haematuria without any demonstrable urinary tract infection. At cystoscopy the bladder mucosa of all patients depicted a highly characteristic, uniformly congested appearance with no demonstrable ulcers; there was no significant reduction in bladder capacity. The histological appearance was essentially non-specific in type with an apparent resemblance to that of interstitial cystitis; mast cells were, however, absent in all specimens. An important feature common to all patients was an associated HIV infection; cytochemistry of the bladder tissue did not reveal an associated cytomegalovirus cystitis. No such case was observed in Zambia prior to the advent of HIV infection and the phenomenon was observed only in seropositive patients. It has been suggested that the virus is likely to be associated with the genesis of the bladder symptoms. The natural history of the disorder, its incidence among the seropositive individuals and its pathogenesis remain unclear.

Pattern of urological malignancy in Zambia. A hospital-based histopathological study.

The pattern of urological malignancy among the indigenous population of Zambia (determined on the basis of histopathological reports from a major national hospital during an 8-year period) is presented. A total of 6514 malignancies were observed, of which 784 (12%) were of urological origin. Bladder carcinoma, predominantly squamous type, was the commonest urological tumour (51%), followed by carcinoma of the prostate (26%), carcinoma of the penis (18%), renal tumours (4.3%) and testicular malignancy (0.7%). In nearly 32% of the bladder tumours, bilharzial ova were demonstrated histopathologically. Nephroblastoma accounted for 70% of the renal tumours and from a total of 7 cases of testicular tumours 5 were embryonal carcinoma and 2 seminoma. A brief reference is made to the pattern and aetiology of urological malignancies in some neighbouring countries.

Preliminary nephrostomy and total ileal replacement of both ureters in advanced bilharzial obstructive uropathy.

Total substitution of both ureters in 5 patients with advanced obstructive uropathy due to extensive ureteric bilharziasis is described. It is recommended that ureteric replacement in the presence of marked obstructive uropathy should not be undertaken without preliminary renal drainage. An open through-and-through nephrostomy is recommended for this purpose. It is suggested that this approach will help to minimise the incidence of nephrectomy in areas of endemic urinary bilharziasis.

Giant fibrous pseudotumor of the testicular tunics in association with Schistosoma haematobium infection.

A giant fibrous pseudotumor of the right testicular tunics in a 27-year-old Zambian is presented. It has been suggested that associated Schistosoma haematobium infection could have contributed to the giant size and rapid growth of the lesion.

Schistosomiasis of the prostate and the seminal vesicles: observations in Zambia.

The pattern of schistosomiasis of the prostate and seminal vesicles in Zambia is presented. The results were based on histological examination and digestion of tissue obtained from 50 cadavers. Compared to the bladder (62%) and seminal vesicles (58%), the infestation was least common (50%) in the prostate. The infection was due to Schistosoma haematobium alone in all organs. The most significant finding was the histological inactivity secondary to this parasitic infection. It is suggested that schistosomiasis of these organs is unlikely to be causally related to male infertility in Zambia.

Haemospermia: observations in an area of endemic bilharziasis.

Observations are presented on 11 cases of haemospermia in the University Teaching Hospital, Zambia, a country where bilharziasis is endemic. Seven patients were severely hypertensive but only two had urinary bilharziasis. The incidence of Schistosoma haematobium infection of the prostate and seminal vesicles is discussed and it is concluded that there is no significant association between the parasitic infection and haemospermia.

Use of a ureteric nipple in the surgical management of bilharzial ureteric strictures.

Experience in the use of a ureteric nipple in ten patients with bilharzial strictures of 15 ureters is presented. It is recommended that this method should be the procedure of choice in the surgical management of selected cases of bilharzial ureteropathy. The need for further experience in its use in calcified ureters is stressed.