Burkitt\'s lymphoma in Uganda: the role of immunohistochemistry in diagnosis

Background: Haematoxylin and eosin staining has remained the standard diagnostic method for Burkitt\'s lymphoma. Ancillary tests including immunohistochemistry, not widely available in developing countries, are important tools in verifying the diagnosis of lymphomas with equivocal morphological findings. Objective: To evaluate the reliability of haematoxylin and eosin staining in the diagnosis of Burkitt\'s lymphoma using immunohistochemistry as the gold standard. Design: Cross sectional study. Setting: Department of Pathology laboratory, Makerere University Medical School, Uganda. Subjects: One hundred and thirty eight formalin fixed paraffin embedded biopsies of Burkitt\'s lymphoma diagnosed from January 2001 to December 2005. Results: Of the 138 tumours, 88.4% were extra-nodal: jaw 36.2%, ovary 21%, gastrointestinal tract 12.3% other abdominal 11.6%. Males (55.8%) predominated. The sensitivity and specificity of haematoxylin and eosin were 93.2% and 50% respectively. The positive and negative predictive values were 91.7% and 55.6%. Conclusion: Histology using haematoxylin and eosin staining is sensitive in the diagnosis of Burkitt\'s lymphoma but not very specific. Immunohistochemical staining with CD20, Ki-67 and bcl-2 is necessary for difficult cases. East African Medical Journla Vol. 85 (5) 2008: pp. 207-21

Myelodysplasia in Ugandan Patients with HIV/AIDS: An Autopsy Study

Background: Myelodysplasia has been reported to occur quite frequently in the spectrum of HIV/AIDS disease and is thought to be partly responsible for bone marrow failure in these patients. However, the frequency and type of myelodysplasia appear to differ at different stages of the disease in different populations with mechanisms of its development not well understood.Objective: To document the pattern of myelodysplasia in Ugandan patients with terminal HIV/AIDS disease.Design: Prospective descriptive study.Setting: Department of Pathology, Faculty of Medicine, Makerere University College of Health Sciences.Subjects: Bone marrow necropsies from patients who died with AIDS disease at Mulago teaching hospital in Kampala, Uganda during a one-year period.Results: Eighty-four (84%) of the 50 cases studied had myelodysplasia with 39 cases having megakaryocytic myelodysplasia. Myelodysplasia involving erythroid cell series occurred in 23 and in 20 of these cases was in combination with megakaryocytic dysplasia. Granulocyte myelodysplastic features were observed in only two cases and these two cases did not have other cell lines involved.Conclusion: Myelodysplastic features are common in HI V patients with megakaryocytic and eythroid cell lines being the most affected. This could be due to the direct HIV effect, or the combined effect of opportunistic infections, neoplasms, drugs and HIV itself affecting the haemopoietic stem cell and or its microenvironment

Cancer survival in Kampala, Uganda

Epidemiological data on the occurrence of cancer in sub-Saharan Africa are sparse, and population-based cancer survival data are even more difficult to obtain due to various logistic difficulties. The population-based Cancer Registry of Kampala, Uganda, has followed up the vital status of all registered cancer patients with one of the 14 most common forms of cancer, who were diagnosed and registered between 1993 and 1997 in the study area. We report 5-year absolute and relative survival estimates of the Ugandan patients and compare them with those of black American patients diagnosed in the same years and included in the SEER Program of the United States. In general, the prognosis of cancer patients in Uganda was very poor. Differences in survival between the two patient populations were particularly dramatic for those cancer types for which early diagnosis and effective treatment is possible. For example, 5-year relative survival was as low as 8.3% for colorectal cancer and 17.7% for cervical cancer in Uganda, compared with 54.2 and 63.9%, respectively, for black American patients. The collection of good-quality follow-up data was possible in the African environment. The very poor prognosis of Ugandan patients is most likely explained by the lack of access to early diagnosis and treatment options in the country. On the policy level, the results underscore the importance of the consistent application of the national cancer control programme guidelines as outlined by the World Health Organization

Lymphomas diagnosed in Uganda during the HIV/AIDS pandemic

Background: There are numerous reports from different countries documenting a change in frequency and profile of lymphomas after the onset of the HIV/AIDS pandemic. In Uganda little is known concerning the distribution of lymphoma subtypes diagnosed at the Department of Pathology, Makerere University College of Health Sciences during this period.Objective: To examine the frequency and diagnostic profile of lymphomas diagnosed in Uganda in the HIV/AIDS era.Design: Retrospective study.Setting: Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda.Subjects: One thousand and thirteen patients diagnosed with lymphomas in the period 1980-1989.Results: The most common type of non-Hodgkin lymphoma was Burkitt lymphoma (36%). The frequencies of lymphocytic and histiocytic types were 34.5% and 8.2% respectively.Conclusion: There was a decrease in histopathologically diagnosed lymphomas in Uganda in the period 1980-1989. Burkitt lymphoma continues to be the most common subtype diagnosed, some major lymphoma subtypes like T-cell and follicular lymphomas were not reported in the country in the HIV/AIDS era

Heterogeneity among Mycobacterium ulcerans isolates from Africa

Mycobacterium ulcerans causes Buruli ulcer, an ulcerative skin disease in tropical and subtropical areas. Despite restricted genetic diversity, mycobacterial interspersed repetitive unit-variable-number tandem repeat analysis on M. ulcerans revealed 3 genotypes from different African countries. It is the first time this typing method succeeded directly on patient samples

Pyomyositis in Nodding Syndrome (NS) patient - A case report

We report a case of Pyomyositis in a 13-year-old boy diagnosed using WHO surveillance definition of Probable Nodding syndrome. Complete blood count showed Leukocytosis with immature granulocytes and atypical lymphocytes. Except for the liver enzymes which were high the renal functions and serum electrolytes were within normal range values. Culture of a pus-swab grew Staphylococcus aureus. Abdominal ultrasound scan showed a focal mass on the internal and external oblique muscles of the right abdominal wall. Incision and drainage was performed. Histology of the muscle showed non-specific inflammation of the external and internal oblique muscles. This finding may highlight some of the other tropical diseases that occur in children with Nodding syndrome

Helicobacter pylori and cancer among adults in Uganda

Data from Africa on infection with Helicobacter pylori (H. pylori) are sparse. Therefore, as part of an epidemiological study of cancer in Uganda, we investigated the prevalence and determinants of antibodies against H. pylori among 854 people with different cancer types and benign tumours. Patients were recruited from hospitals in Kampala, Uganda, interviewed about various demographic and lifestyle factors and tested for antibodies against H. pylori. In all patients combined, excluding those with stomach cancer (which has been associated with H. pylori infection), the prevalence of antibodies was 87% (723/833) overall, but declined with increasing age (p = 0.02) and was lower among people who were HIV seropositive compared to seronegative (p <0.001). Otherwise, there were few consistent epidemiological associations. Among those with stomach cancer, 18/21 (86%) had anti-H. pylori antibodies (odds ratio 0.8, 95% confidence intervals 0.2–2.9, p = 0.7; estimated using all other patients as controls, with adjustment for age, sex and HIV serostatus). No other cancer site or type was significantly associated with anti-H. pylori antibodies. The prevalence of H. pylori reported here is broadly in accord with results from other developing countries, although the determinants of infection and its' role in the aetiology of gastric cancer in Uganda remain unclear

pRb2/p130 protein expression and RBL2 mutation analysis in Burkitt lymphoma from Uganda

<p>Abstract</p> <p>Background</p> <p>The members of the retinoblastoma protein family, pRb, p107 and pRb2 (p130), are central players in controlling the cell cycle. Whereas disturbed function of pRb is commonly seen in human cancers, it is still an open question whether pRb2 is involved in tumorigenic processes. However, altered subcellular localization of pRb2 and mutations in the pRb2-encoding gene <it>RBL2 </it>have been described for some tumours, including Burkitt lymphomas (BL).</p> <p>Methods</p> <p>We retrieved 51 biopsy specimens of endemic BL cases from Uganda. The expression of pRb2 was determined by immunohistochemistry. Exons 1922 of the <it>RBL2 </it>gene, the region known to contain a nuclear localization signal, were screened for mutations by PCR amplification and direct DNA sequencing.</p> <p>Results</p> <p>Nearly all of our cases (84.0%) were positive for pRb2 protein expression although this protein is a marker for growth arrest and Burkitt lymphoma is characterized by a high proliferation rate. Of the positive cases, 73.8% were scored as expressing the protein at a high level. Subcellular pRb2 localization was predominantly nuclear and no cases with expression restricted to the cytoplasm were observed. We did not detect any <it>RBL2 </it>mutations in the part of the gene that encodes the C-terminal end of the protein.</p> <p>Conclusion</p> <p>The majority of endemic BL cases from Uganda express pRb2, but somatic <it>RBL2 </it>mutations affecting the protein's nuclear localization signal appear to be rare.</p

Clinico-pathological pattern and early post-operative complications of gastro-duodenal perforations at Mulago Hospital Kampala- a prospective cohort study

Background: Gastro-Duodenal Perforations are one of the commonest causes of mortality and morbidity in conditions that require emergency surgery. The main objective of this study was to determine the clinico-pathological pattern and evaluate factors for early post operative complications of Gastro-duodenal perforations in Mulago. Methods: This was a prospective cohort study of patients with gastro-duodenal perforations managed by simple repair between September 2014 and April 2015 in Mulago was studied. Primary/ secondary outcomes were mortality and complications respectively. Data was managed using stata-12 and multivariate analysis using log-binomial regression model. Results: A total of 65 patients were operated for Gastro-duodenal perforations in the study period. 86.2% were male (M: F 6.2:1). Median age was 35 years (range 16- 80 years). 93.9% had gastric perforations. Clinical diagnosis was predicted in 89.3%. H. pyloriwas present in 7.9%. Mortality was 18.5% and complications developed in 58.5%. Age above 35 and presence of   co morbidity predicted mortality (CI 1.22- 21.12, p= 0.009) (CI 1.26- 8.82, p= 0.024) and early post-operative complications (CI 1.03- 2.44, p= 0.031) (CI 1.23- 2.44, p= 0.011) respectively. Conclusion: Gastroduodenal perforations remain a common surgical emergency in Mulago hospital affecting mainly young men below 35 years. Majority are gastric perforations. Mortality and early post-operative complications are high, and increase with age and presence of co morbidity. Keywords: gastro-duodenal perforations, perforated peptic ulcer disease, gastric perforation