Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients.

BACKGROUND: As a result of the lack of screening programs and the difficulty in making a proper diagnosis, the majority of hepatocellular carcinoma (HHC) patients present late in low-resource countries. The study therefore assesses the clinical features, stage and prognostic variables of patients with HCC in The Gambia. METHODS: From December 2015 to January 2019, patients with a confirmed diagnosis of HCC were enrolled. All patients' medical history, ultrasound scan, FibroScan and laboratory details were collected. RESULTS: Two hundred and sixty (260) patients were enrolled. The mean age of HCC patients was 40 years, and 210 (80.7%) of them were male. The most common gastrointestinal symptoms were early satiety 229 (88.1%) and abdominal pain 288 (87.7%), while the most common constitutional symptoms were weight loss 237 (91.2%) and easy fatiguability 237 (91.2%). Hepatomegaly 205 (78.8%) was the most common sign. On ultrasound scan, lesions were mostly multifocal 175 (67.3%), and the median FibroScan score was 75 kPa. The median fibrosis 4 and aspartate transferase platelet ratio index were 4.6 and 2.2, respectively. Hepatitis B surface antigen (HBsAg) was positive in 170 (65.4%) patients, and the median AFP level was 3263 ng/ml. HCC patients with positive HBsAg were more likely to be male 145 (85.3%) vs 62 (72.1%) (p = 0.011), much younger 39.9 vs 51.4 yrs (p = < 0.0001), more likely to have abdominal pain 156 (91.8%) vs 68 (79.1%) (p = 0.002), jaundice 78 (45.9%) vs 29 (33.7%) (p = 0.042), dark urine 117 (68.8%) vs 46 (53.5%) (p = 0.018), raised transaminases (Aspartate transaminases 224.5 (32-7886) vs 153 (18-610), p = < 0.01, Alanine transferases 71 (5-937) vs 47 (8-271), p = < 0.001) and decreased platelet count 207 (33-941) vs 252 (52- 641) (p = 0.021) compared to patients with HCC who were HBsAg-negative. CONCLUSIONS: The prognosis of patients with HCC is poor in developing countries such as The Gambia, where screening programs and treatment modalities are scarce. Young males are disproportionately affected, and HBV is a major cause of HCC in The Gambia.

Spectrum of Oral and Maxillofacial Tissue Biopsies at the Foremost Tertiary Institution in The Gambia: A Retrospective Review.

Introduction: Sub-Saharan Africa has a heavy burden of oral diseases and cancers. Also, there is a dearth of published records of oral pathology services in The Gambia. Therefore, this review aimed to determine the prevalence of biopsied oral and maxillofacial lesions in order to ascertain the uptake of oral histopathology services at the foremost tertiary institution in The Gambia. Materials and Methods: This was a retrospective study performed at the Pathology Department of Edward Francis Small Teaching Hospital. Reports of all oral and maxillofacial biopsies submitted for the period 2012 to 2021 were reviewed and data were extracted. Descriptive analysis was done using SPSS software, version 26. Results: Total number of biopsy reports was 158 representing 0.02% over the study period. The mean age of patients was 34.3 ± 19.7 years, the 3rd decade was the peak age of presentation and male-to-female ratio was 1:1.6. Majority (65/41.1%) of the cases were benign neoplastic lesions, and the mandible was the most (21/13.3%) common site of biopsy. Reactive lesions were the predominant (34/21.5%) group and squamous cell carcinoma had the highest (24/15.3%) number of lesions while odontogenic tumours constituted six cases only (3.8%). Conclusion: The findings of this study showed low uptake of oral histopathology services while biopsied oral and maxillofacial lesions were prevalent in female patients in the third decade of life. Also, the mandible was the most affected site whereas benign neoplastic diagnoses were most common. However, this study recorded a higher proportion of malignancies than some previous studies.