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. IMPLICATIONS FOR PRACTICE: This work describes a novel breast cancer awareness and early diagnosis demonstration program in a low- and middle-income country within a limited resource setting. The program includes breast self-awareness and breast cancer education, clinical exams, and point-of-care diagnostics for women in three different types of health facilities in Kenya. This pilot program has the potential of being replicated on a national scale to create awareness about breast cancer and downstage its presentation.

Expression of p53 and HER2/Neu in Kenyan Women With Primary Ovarian Carcinoma.

Ovarian carcinomas are a leading cause of cancer mortality among women. Two of the more commonly described markers of prognostic significance in primary ovarian carcinomas are p53 and HER2/neu. Overexpression of both markers is associated with poor prognosis. This study aimed to determine the frequency and pattern of p53 and HER2/neu expression in primary ovarian carcinomas in Kenyan women and to describe the clinical and pathologic features of ovarian carcinomas diagnosed at 3 different hospitals in Kenya. Primary ovarian carcinomas diagnosed at the Departments of Pathology at Aga Khan University Hospital, Nairobi; the Aga Khan Hospital, Kisumu; and the AIC Kijabe Hospital in Kenya over a period of 3 years from January 2009 to December 2011 were recorded. Sixty-seven ovarian carcinomas were identified and blocks retrieved from archives. Hematoxylin-eosin-stained slides of these were reviewed and appropriate sections were stained for p53 and HER2/neu using standard immunohistochemical techniques. The primary outcome was presence and intensity of staining for p53 and HER2/neu. The most frequent malignancy was serous carcinoma. A total of 43.3% (95% confidence interval, 32.1%-55.2%) of carcinomas were positive for p53, and 13.4% (95% confidence interval, 7.2%-23.6%) were positive for HER2/neu. Serous carcinoma and adenocarcinoma, not otherwise specified were more likely to be positive for p53. There was no association noted between the histologic grade or pathologic stage and positivity for either p53 or HER2/neu. The expression of p53 and HER2/neu in primary ovarian carcinomas in Kenyan women is not different from that described in the literature.

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.

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.

A Case of Oxalate Nephropathy in a Known Diabetic Patient following Acute Alcoholic Pancreatitis.

This was a case of a 39-year-old gentleman known to have diabetes mellitus since February 2021 on insulin glargine (Lantus) 16 units nocte and sitagliptin/metformin 50/500 mg once a day who presented to a tertiary teaching hospital in Kenya in May 2021 with a three-week history of vomiting and diarrhea. He had been previously admitted to a different facility with acute alcoholic pancreatitis. His examination was nonremarkable except for mild dehydration and pallor. He had moderate metabolic acidosis and deranged renal function. Prior to this, his creatinine was normal. As part of the evaluation for the rapid deterioration of renal function, a kidney biopsy performed revealed oxalate nephropathy. He was started on renal replacement therapy with hemodialysis.

Geographic Variability of Nodular Lymphocyte-Predominant Hodgkin Lymphoma.

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.

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.