Clinicopathologic features of renal cell carcinomas seen at the Aga Khan University Hospital in Kenya

Introduction: Kidney cancer accounted for 1. 8% of global cancer deaths according to Globocan 2020 estimates, with most of these being renal cell carcinomas. Lower rates of renal cell carcinoma are reported for Africa and these are expected to change for a combination of reasons. The clinical and morphologic characteristics of renal cell carcinoma seen within Kenya have not been described before. This study aims to partially fill this gap. Materials and methods: This was a cross-sectional descriptive study examining electronic histopathology reports from the Aga Khan University Hospital Nairobi Laboratory for the period January 2016 to May 2022. Results: Sixty cases of renal cell carcinoma were identified. The mean age at diagnosis was 55.3 years. The most common histologic subtype diagnosed was clear cell renal cell carcinoma (41.7%), followed by papillary renal cell carcinoma and renal cell carcinoma not further specified (both 21.7%), and chromophobe renal cell carcinoma (11.7%). The most frequent specimen type was resection, followed by cores of renal masses. The mean tumor size was 8.5 cm. Sixty-seven percent of patients presented with Stage III and above. Discussion: Renal masses were the commonest clinical indication for biopsy among the records reviewed. The male to female ratio, as well as the mean age at presentation were comparable to what is described in literature for other regions of the world. The proportions of the commonest histologic subtypes matched what is described in other parts of the world. Challenges in the identification of histologic subtypes included having a limited panel of antibodies for diagnosis and the lack of genetic molecular tests for histotyping. Conclusion: The spectrum of histologic subtypes of renal cell carcinoma seen at a tertiary referral hospital in Nairobi, Kenya was similar to that described in other parts of Africa and the globe. The age at presentation with renal cell carcinoma was consistent with what has been described in literature. Challenges were identified in the accurate histotyping of renal cell carcinoma due to constrained resources. Majority of cases diagnosed presented at advanced stage

Frequency of IDH1 mutation in adult-type diffuse astrocytic gliomas in a tertiary hospital in Kenya

The 2021 WHO classification of gliomas has separated gliomas based on their IDH mutation status, reflecting differences in their pathogenesis and clinical characteristics. There is a paucity of data on the prevalence of IDH mutations in gliomas in this region. This study aimed to determine the frequency of the IDH1 mutation in adult-type diffuse astrocytic gliomas in a tertiary hospital in Kenya. Approximately half of the gliomas were positive for the IDH1 mutation, with a slight male predominance. Our study provides crucial insights into the frequency of IDH1 mutations in gliomas in Kenya

Task Sharing and Shifting to Provide Pathology Diagnostic Services: The Kenya Fine-Needle Aspiration Biopsy Cytology and Bone Marrow Aspiration and Trephine Biopsy Training Program

Purpose: Fine-needle aspiration biopsy (FNAB) cytology is a simple, inexpensive, and accurate diagnostic test for benign, infectious, and malignant lesions of the breast, thyroid, lymph nodes, and other organs. Similarly, bone marrow aspiration and trephine (BMAT) biopsy procedures are relatively simple and inexpensive techniques that are important for diagnosing and monitoring many hematologic diseases including leukemias and lymphomas. However, the scarcity of pathologists in Kenya limits patient access to these simple diagnostic tests. We describe a task sharing and shifting program that sought to improve the provision of FNABs and BMAT biopsies in tertiary public hospitals in Kenya. Methods: Between January 2016 and February 2017, we trained pathologists, pathology residents, and technologists from the University of Nairobi and Aga Khan University Hospital, Nairobi, in FNAB and BMAT biopsies, who in turn trained pathologists, medical officers (MO), clinical officers (CO), and technologists at five tertiary public hospitals. The program involved curriculum development, training workshops, the establishment of new and strengthening existing FNAB and BMAT biopsy clinics, interim site visits, audits, and stakeholder workshops. Results: Fifty-one medical personnel at the tertiary hospitals were trained. The FNAB numbers increased by 41% to 1,681, with 139 malignant diagnoses (7.1%). BMAT biopsy numbers increased by 268% to 140, with 34 malignant cases. Between 60% and 100% of the FNAB and BMAT biopsy procedures were performed by MO and CO over the project period. One new FNAB and two new BMAT biopsy clinics were established. Conclusion: This project demonstrates a successful model of task sharing and shifting from specialist pathologists to MO and CO that improved access to important FNAB and BMAT biopsy services in a low-resource setting

Expression patterns of P53 and HER2/NEU in primary ovarian carcinomas

Background: Ovarian tumours are common neoplasms of the female genital tract and a leading cause of cancer mortality among women. There is paucity of local Kenyan data on the morphologic subtypes of ovarian tumours and the expression of select prognostic markers in ovarian carcinomas has not been previously investigated. The aim of this study was to determine the frequency and describe the patterns of p53 and HER2/neu expression in primary ovarian carcinomas and to describe the clinical and pathologic features of ovarian tumours diagnosed at the Pathology Laboratory of the Aga Khan University Hospital Nairobi. Methodology: A cross-sectional descriptive study was undertaken. Electronic histopathology reports of all ovarian tumours diagnosed over a three year period in the Histopathology department at the Aga Khan University Hospital Nairobi Laboratory were retrieved. Clinical and pathologic data were recorded. Haematoxylin-eosin stained slides of the ovarian carcinomas were reviewed and appropriate paraffin-embedded blocks selected and retrieved from the archives for immunohistochemistry. Additional paraffin blocks of primary ovarian carcinomas diagnosed consecutively over a 2 year period from the Aga Khan Hospital Kisumu, and the AICKijabeHospital were included in the study after review of haematoxylin-eosin stained slides. Sections were cut from all the selected ovarian carcinoma blocks and stained for HER2/neu and p53 using standard immunohistochemical techniques. The data were analyzed using SPSS version 17 and are presented in tables and charts. Results: Three-hundred and seventy-four ovarian tumours were diagnosed at Aga Khan University Hospital Nairobi during the study period. The median age for malignant tumours was 51.1 years. The most common benign tumour was mature cystic teratoma (44.3% 95%CI ±5.68%). The most common malignant tumour was serous carcinoma (44.7% 95%CI ±11.43%). Forty-three point three percent (95%CI 32.1-55.2%) of carcinomas were positive for p53 and 13.4% (95%CI 7.2-23.6%) were positive for HER2/neu. Serous carcinoma (61.1% 95%CI±15.9%) and adenocarcinoma, not otherwise specified (33.3% 95%CI ±11.3%) were more likely to be positive for p53. There was no association noted between the histologic grade or pathologic stage and positivity for p53. There was no association noted between staining for HER2/neu and histologic type, histologic grade or pathologic stage of carcinoma. Conclusion: The proportion of histologic subtypes of primary ovarian tumours that were diagnosed is similar that described in literature. There is no significant difference in the expression patterns of both p53 and HER2/neu from that described in literature

Data_Sheet_1_Clinicopathologic features of renal cell carcinomas seen at the Aga Khan University Hospital in Kenya.xlsx

IntroductionKidney cancer accounted for 1. 8% of global cancer deaths according to Globocan 2020 estimates, with most of these being renal cell carcinomas. Lower rates of renal cell carcinoma are reported for Africa and these are expected to change for a combination of reasons. The clinical and morphologic characteristics of renal cell carcinoma seen within Kenya have not been described before. This study aims to partially fill this gap.Materials and methodsThis was a cross-sectional descriptive study examining electronic histopathology reports from the Aga Khan University Hospital Nairobi Laboratory for the period January 2016 to May 2022.ResultsSixty cases of renal cell carcinoma were identified. The mean age at diagnosis was 55.3 years. The most common histologic subtype diagnosed was clear cell renal cell carcinoma (41.7%), followed by papillary renal cell carcinoma and renal cell carcinoma not further specified (both 21.7%), and chromophobe renal cell carcinoma (11.7%). The most frequent specimen type was resection, followed by cores of renal masses. The mean tumor size was 8.5 cm. Sixty-seven percent of patients presented with Stage III and above.DiscussionRenal masses were the commonest clinical indication for biopsy among the records reviewed. The male to female ratio, as well as the mean age at presentation were comparable to what is described in literature for other regions of the world. The proportions of the commonest histologic subtypes matched what is described in other parts of the world. Challenges in the identification of histologic subtypes included having a limited panel of antibodies for diagnosis and the lack of genetic molecular tests for histotyping.ConclusionThe spectrum of histologic subtypes of renal cell carcinoma seen at a tertiary referral hospital in Nairobi, Kenya was similar to that described in other parts of Africa and the globe. The age at presentation with renal cell carcinoma was consistent with what has been described in literature. Challenges were identified in the accurate histotyping of renal cell carcinoma due to constrained resources. Majority of cases diagnosed presented at advanced stage.</p

Kenyan nodular lymphocyte predominant Hodgkin lymphoma shares features with western cases and is not associated with EBV

Background: Pulmonary Langerhans cell histiocytosis (PLCH) is a distinctive form of tobacco associated interstitial lung disease. Therapeutic options other than lung transplantation are scarce when a fibrotic phase has been reached. One severe complication is the emergence of pulmonary hypertension that has been related to chronic hypoxia. A few papers describe its morphological characteristics focusing on arterial lesions. Otherwise, BRAF mutations have been recently described in systemic Langerhans cell histiocytosis and only one paper with five cases has been published on PLCH. Methods: We have revised morphological changes associated with pulmonary vasculature and the presence of Langerhans cells by routine and immunohistochemical methods (S100 protein, CD1a and Langerin) in 22 PLCH cases. We have used real time PCR to detect BRAF mutations in Langerhans cells using manual macrodisection in paraffin embedded tissue. Results: Six out of 22 patients (27%) showed some grade of capillary haemangiomatosis-like changes. Aggregates of Langerhans cells were located in interlobular septa in those cases. Two BRAF mutated cases were found, both of them in cellular/mixed lesions. Conclusion: We present six patients with capillary haemangiomatosis-like changes with infrequent located Langerhans cells in pulmonary Langerhans cell histiocytosis. We confirm the occurrence of BRAF mutations in this kind of disease

Breast camps for awareness and early diagnosis of breast cancer in countries with limited resources: A multidisciplinary model from Kenya

Background. Breast cancer is the most common cancer of women in Kenya. There are no national breast cancer early diagnosis programs in Kenya. Objective. The objective was to conduct a pilot breast cancer awareness and diagnosis program at three different types of facilities in Kenya. Methods. This program was conducted at a not-for-profit private hospital, a faith-based public hospital, and a government public referral hospital. Women aged 15 years and older were invited. Demographic, risk factor, knowledge, attitudes, and screening practice data were collected. Breast health information was delivered, and clinical breast examinations (CBEs) were performed. When appropriate, ultrasound imaging, fine-needle aspirate (FNA) diagnoses, core biopsies, and onward referrals were provided. Results. A total of 1,094 women were enrolled in the three breast camps. Of those, 56% knew the symptoms and signs of breast cancer, 44% knew how breast cancer was diagnosed, 37% performed regular breast self-exams, and 7% had a mammogram or breast ultrasound in the past year. Of the 1,094 women enrolled, 246 (23%) had previously noticed a lump in their breast. A total of 157 participants (14%) had abnormal CBEs, of whom 111 had ultrasound exams, 65 had FNAs, and 18 had core biopsies. A total of 14 invasive breast cancers and 1 malignant phyllodes tumor were diagnosed Conclusion. Conducting a multidisciplinary breast camp awareness and early diagnosis program is feasible in different types of health facilities within a low- and middle-income country setting. This can be a model for breast cancer awareness and point-of-care diagnosis in countries with limited resources like Kenya. The Oncologist 2016;21:1138–114

Geographic Variability of Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Clinicopathologic Reappraisal in the Modern Era

Objectives: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) differs from classic Hodgkin lymphoma (CHL) in terms of clinicopathologic features, including Epstein-Barr virus (EBV) association. CHL geographic variability is well known, with higher frequencies of mixed-cellularity subtype and EBV positivity in low/middle-income countries (LMICs), but there are few well-characterized series of NLPHL from LMICs. Methods: We detail clinicopathologic findings of 21 NLPHL cases received in consultation from Kenya and summarize reports of NLPHL with EBV testing published since 2000. Results:  Median age of consultation cases was 36 years, and male/female ratio was 3.2. All cases involved peripheral lymph nodes and showed at least some B-cell–rich nodular immunoarchitecture, with prominent extranodular lymphocyte-predominant (LP) cells and T-cell–rich variant patterns most commonly seen. LP cells expressed pan–B-cell markers, including strong OCT2; lacked CD30 and CD15 expression in most cases; and were in a background of expanded/disrupted follicular dendritic cell meshworks and increased T-follicular helper cells. LP cells were EBV negative in 18 cases. Historical cases showed a low rate of EBV positivity with no significant difference between LMICs and high-income countries. Conclusions: Unlike CHL, NLPHL shows few geographic differences in terms of clinicopathologic features and EBV association. These findings have implications for diagnosis, prognostication, and treatment of patients with NLPHL in LMICs