Benign breast lesions in Kenya: a histological study.

During 1981-85, 1084 cases of benign breast lesions were seen at Kenyatta National Hospital, Nairobi, Kenya. In the same period, 417 cases of breast carcinoma were diagnosed. Amongst the benign lesions fibroadenoma was the most common diagnosis (531 cases) followed by mastopathy (177 cases). The incidence rate of fibroadenoma was 1.6 per 100,000 person-years. Classic tubular adenoma was seen in 26 cases and in 26 cases a mixture of fibroadenoma and tubular adenoma was seen. These findings suggest that breast adenoma is probably one tumour with different expressions of the glandular and fibrous areas. We found no specific gross or microscopical features by which it was possible with certainty to distinguish between fibroadenoma and giant fibroadenoma and therefore suggest that the term giant fibroadenoma be avoided. The histopathologic pattern of mastopathy showed great variation, but the lesions were without difficulty divided into three main categories, i.e. cystic, fibrous and hyperplastic mastopathy. This distinction is important as cases with marked epithelial hyperplasia have been shown to have an increased cancer risk. Except for low parity no similarities in risk factors for mastopathy and breast cancer have been shown so far.

Breast cancer in Kenya: a histopathologic and epidemiologic study.

During 1981-1985, 417 cases of breast cancer were seen at the Department of Human Pathology, Kenyatta National Hospital, Nairobi, Kenya. During this period, 8041 cases of cancer were reported. Cancer of the breast accounted for 5% of all malignancies in Kenya and only second in number to cancer of the cervix. The incidence rate in females was 1.08 per 100,000 person-years. The incidence was low because the rural Kenyans have difficult access to the oncology facilities in Nairobi. The age specific incidence rates decreased after menopause. This is also found in other African countries but is in contrast with North America and Europe, where there is a rise after menopause. Young age of the first pregnancy, many pregnancies and a low fat content of the diet may contribute to the low incidence in post menopausal women. The distribution of the histological types was the same in Kenya with predominance of premenopausal cases and in the western world with predominance of postmenopausal cases. Invasive ductal carcinoma was the most common cancer type. Poorly differentiated tumours were common. This is probably explained by the fact that most patients seek medical help at a late state with advanced cancer. Only two cases of non-invasive intraductal carcinoma were found and in cases where lymphnodes were removed 88% had metastases.

A clinical, biochemical and histochemical study of carcinoma of the cervix as seen at the Kenyatta National Hospital.

PIP: This research report studies several biochemical and histochemical aspects of cervical carcinoma and explores their use in follow-up of patients undergoing radiotherapy. Material came from 19 patients with invasive cervical carcinoma admitted to Kenyatta National Hospital. A control group consisted of 20 women matched for age who attended clinics at the hospital but were not suffering from any malignant disease; control tissue for histological examination was obtained from 3 women who had undergone hysterectomy for uterine fibroids. Biochemical assays for alkaline and acid phosphatases in patients with cervical carcinoma show an increase in alkaline phosphatase in carcinomatous tissue (35.7 umoles/hr/mg) as opposed to normal tissue (7.2). Acid phosphatase values were only moderately raised. Assays of the same enzymes in blood showed a less marked difference between patients and controls (ranges of 7.5-20.8 and 3-14, respectively). When examined histochemically, increased alkaline phosphatase activity was observed in connective tissue, epithelium of the glands and blood capillaries of tumor tissue. 1 section containing normal tissue bordering carcinomatous tissue demonstrated normal alkaline phosphatase activity in the normal tissue and increased activity in the tumor tissue. In summary, there is increased enzyme activity around the tumor areas, but values for serum levels show an overlap of normal and abnormal cases and are therefore not predictive. Results demonstrate a clear difference in activities of these enzymes in carcinomatous tissue and normal tissue, which may be of value in follow-up care.^ieng

An epidemiological study of osteogenic sarcoma in Kenya: the variations in incidence between ethnic groups and geographic regions, 1968-1978.

Kenya is a country of marked environmental and ethnic diversity. A study of osteogenic sarcoma occurring in Kenya from 1968 to 1978 revealed 251 cases, representing between 89% and 100% of the predicted number. Variations in age, sex and anatomical location were within classical limits. However, the incidence of osteogenic sarcoma amongst the Central Bantu was significantly higher than predicted (P less than 0.0001), whilst the incidence among the Western Bantu was significantly lower (P less than 0.002), despite their similar ethnic origins. Two geographically dissimilar areas likewise exhibited significant differences in incidence. The Eastern province showed a higher incidence (P less than 0.02), whereas the Nyanza Province (P less than 0.001) and the adjacent Western Province (P less than 0.005) showed a lower than predicted incidence. These observations suggest that in Kenya a geomedical variable affects the incidence of osteogenic sarcoma and that genetic variation has no effect on incidence.

HLA antigens in East African Black patients with Burkitt's lymphoma or nasopharyngeal carcinoma and in controls: a pilot study.

A pilot study is reported of HLA-A, B, and C antigens in 141 East African Blacks comprising patients with Burkitt's lymphoma or nasopharyngeal carcinoma, either with active disease or in long-term remission, together with comparable controls. This study forms part of a wider program investigating host factors in these diseases. A protocol was selected for optimal testing of cells processed and cryopreserved between 1972 and 1976, largely under field conditions, which employed a two-color fluorochromasia typing procedure. Antigen distribution and computed haplotype frequencies in the total unrelated population are given. New findings include an approximately equal frequency of Aw23 and Aw24, a high (18%) incidence of Bw21, and the gametic associations of Aw36 with Bw44, and Aw30 with Bw45. Of the major group of B15-related antigens reported earlier. SV is the most common, and there are strong linkages of SV with Cw2 and Bu with Cw3. The possible presence of further variants at the A- and B-loci is reported. The proportion of B-locus antigen "blanks" in this study is 5.9%. Relationships have been sought between the HLA antigens and diseases studied: the antigen A29, possibly in linkage with Bw42, shows a correlation with disease susceptibility, and associations are suggested between Bw44 (in possible combination with Aw36) and resistance to both BL and NPC, and between Bw45 and long-term remission in NPC.

Testicular neoplasms in Kenyan Africans.

Over a 9-year period 40 testicular and paratesticular neoplasms were seen at the Kenyatta National Hospital, Nairobi, Kenya. Their incidence rate was 0.08 per annum per 100,000 Kenyan males. This low incidence was largely accounted for by a decrease in tumors of germ cell origin. The proportional distribution of the testicular neoplasms, however, was not significantly different from findings in the United States. An inheritable factor apparently controls the decreased susceptability to testicular neoplasms.