Epstein-Barr virus genome studies in Burkitt's and non-Burkitt's lymphomas in Uganda.

Burkitt's lymphoma (BL) has been widely investigated and has attracted attention because of the possible etiologic role of the Epstein-Barr virus (EBV). To further determine the role of EBV in the causation of this tumor, we measured EBV-specific nuclear antigen (EBNA) and EBV DNA using immunofluorescence and nucleic acid hybridization techniques, respectively. Of 34 BL biopsies, 27 tissues (79%) were EBNA-positive, whereas none of the 25 non-BL biopsy tissues were EBNA-positive. Of 15 BL tumors tested, 14 (93%) were EBV DNA-positive with a mean of 39 (range, 8-86) EBV genome equivalents per cell. Each of the 15 non-BL biopsy specimens subjected to nucleic acid hybridization had less than two virus genome equivalents per cell, although all had serologic evidence of past EBV infection. The findings further supported the possible etiologic role of EBV in African BL and negated the passenger hypothesis. The EBV genome could, therefore, be used as a separating marker between African BL and non-BL lymphomas.

Condylomatous tumours of vulva, vagina, and penis. Relation between histological appearance and age.

Among 237 cases of condyloma diagnosed in Uganda between 1964 and 1975 seven types of lesions were defined. Three of these were found within a wide age range in both young and elderly people, namely, the common (49.4%) and the flat (2.0%) condyloma acuminatum, and condyloma acuminatum of irregular outline (13.5%). Four variants, on the other hand, fell into different age groups. Condyloma acuminatum, showing marked cell death (5.1%) and observed exclusively among girls in the first decade of life, displayed numerous aciophil bodies, presumably reflecting single cell necroses. Condylomata acuminata showing marked acanthosis (16.9%) were found in patients between 12 and 30 years, dysplastic condylomata acuminata (5.9%) between 20 and 62 years, and proliferative (giant) condylomata acuminata (7.2%) between 31 and 80 years of age. In the latter two groups of lesions, the inflammatory stromal infiltrate was more prominent, but cytoplasmic vacuolation, often believed to be a sign of viral infection, was seen less frequently than in the remaining types. In young people, the features seen resemble, therefore, a cytocidal and/or vacuolating viral infection, whereas the dysplastic and proliferative changes observed in older patients are compatible with malignant transformation being under way.

A fatal case of strongyloidiasis with Strongyloides larvae in the meninges.

A case of fatal strongyloidiasis associated with pyogenic meningitis in an adult male African is reported. Strongyloides larvae were present in the purulent exudate in the the meninges, an observation not, to the authors knowledge, hitherto reported in man. Fatal strongyloidiasis due to autoinfection has been reported by several authors and De Paula (1962) reviewed the literature in 40 cases and added 10 others which he had studied. In Uganda fatal cases have been reported by Craven et al. (1971) and Poltera (1974). Although in some cases of fatal strongyloidiasis there was associated pyogenic meningitis (BROWN & PERNA, 1958; WILSON & THOMPSON, 1964; BASSAN-TREMINGER & EL-LANSHAR, 1968) we have not found in the literature any case in which Strongyloides stercoralis larvae or adult worms were found in the brain or meninges. We are, therefore, now reporting a case of fatal strongyloidiasis with pyogenic meningitis in which S. stercoralis larvae were present in the subarachnoid space.

Systemic amyloidosis in Uganda. An autopsy study.

Seventy-nine cases of systemic amyloidosis were found in a survey of the autopsy records of 23 years at Mulago Hospital, Kampala, an incidence of 0-57%. The variable world incidence is described. Fifty-two cases were secondary to chronic inflammation and in 27 cases no underlying disease was apparent. Primary amyloid is more common than might be expected, and appears to occur at a younger age to that seen in developed countries. The organ distribution of primary and secondary amyloid is similar, with heavy renal involvement. These findings might be explained by chronic antigenic stimulation enhanced by impaired thymic dependent immunity. Secondary amyloidosis is not as common as would be anticipated in view of the high incidence of chronic inflammatory disease.

Epidemiology of malignant degeneration of condylomata acuminata in Uganda.

A series of 73, 28 and 172 cases of condylomata acuminata and 133, 44 and 1,237 cases of carcinoma of vulva, vagina and penis is analysed. This material was derived from a country-wide biopsy service in Uganda between the years 1964-1975. Condylomata acuminata occurred mainly in young and elderly persons and thus preceded the cases of carcinoma by decades and years in age-distribution, respectively. Geographical correlations with cancer observed in the 18 districts of the country were high for all condylomata acuminata combined and for cases occurring in young and elderly persons. 12 cases were observed in which histological features suggestive of transition to malignancy had been noted in the biopsy report, and 7 out of 10 such cases with known age were seen among the elderly. A high rate of malignant degeneration was observed in the age-group 40 years and over, namely 5 or possibly 6 cases among 36 condylomata acuminata whereas in the lower age-groups none or possibly one example was found out of 210 cases. Another feature varying with age of the patient was the time-interval between the biopsy diagnosis of condylomata acuminata and cancer. The values amounted to months and several years in the higher age-groups in contrast to 8 years observed in the one case occurring in young age. Moreover, in a review of 35 cases found in the literature duration of malignant degeneration differed between decades in young and years and months in high age except in a medium age-range of 30-45 years in which observations varied widely. These findings adduce indirect, and, in the case of the observed rate of malignant degeneration, perhaps tentative direct evidence for the long postulated association between cancer, condylomata acuminata and thus possibly an underlying viral agent. Condylomata acuminata could be precancerous lesions showing a low risk and long time-interval to malignancy in young and a high risk and short time-interval in later age.

Burkitt's lymphoma in the appendicular skeleton.

Of 290 Ugandan children and adolescents with proven Burkitt's lymphoma 11 had lesions in the long bones or the pelvis. These started in the medulla as small osteolytic foci which coalesced and penetrated the cortex causing subperiosteal new bone formation in layers or spicules, and giving rise to large soft-tissue masses. Common sites were the femoral and tibial diaphyses and the metaphyses around the knee. Five were in the epiphyses. Other sites were the pelvis, humerus and ulna. One patient had a lymphomatous synovial effusion of the knee. In the lower limbs the lesions were often bilateral and symmetrical. Five patients had pathological fractures. Radiologically the lesions mimicked Ewing's sarcoma, osteosarcoma, osteomyelitis, acute leukaemia, syphilis and yaws, but clinically they were relatively painless, an important differential diagnostic feature. In the five patients with sustained remissions after chemotherapy the lesions and fractures healed well and the growth plates were undamaged.

Condylomata acuminata and their possible relation to cancer of the uterine cervix. Case report and geographic observations.

A unique case is described of a 21-year-old female with gonorrhea, condylomata acuminata of the vulva and the uterine cervix, a squamous-cell papilloma and precancerous changes in the cervix. In the observed lesion, a very gradual transition was seen from benign areas, displaying marked cytoplasmic vacuolization, to moderately dysplastic areas, with only slight vacuolization. Giant squamous cells with centrally located vesicular or hyperchromatic nuclei were a prominent feature of both the condylomatous and premalignant portions of the lesion. A geographic correlation was observed in the 18 districts of Uganda between the incidence of vulvar and vaginal condylomata acuminata and cervical cancer; the finding may include cervical warts since vulvovaginal changes often extend to the cervix uteri. In addition to the common flat condyloma, the acuminate variant may be a precursor of cervical cancer and progress to malignancy through the stage of a squamous-cell papilloma.