Prostate cancer knowledge and barriers to screening among men at risk in northern Tanzania: A community-based study

BACKGROUND

Although prostate cancer (Pca) screening plays important role in early diagnosis and reduction of mortality, Tanzanian men are relatively unscreened. We aimed to investigate Pca knowledge level and barriers to screening among at-risk men in northern Tanzania.

METHODS

This community-based survey was conducted in northern Tanzania from May to September 2022, involving men age ≥40 years. Participants were invited by announcing in local churches, mosques, brochures, and social media groups. Participants attended a nearby health facility where survey questionnaires were administered. Knowledge level was measured on the Likert scale and scored as poor (<50 %) or good (≥50 %).

RESULTS

A total of 6205 men with a mean age of 60.23 ± 10.98 years were enrolled in the study. Of these, 586 (9.5 %) had ever been screened for Pca. Overall, 1263 men (20.4 %) had good knowledge of Pca. Having health insurance, knowing at least 1 risk factor or symptoms of Pca, and hospital as the source of Pca information were significantly associated with ever being screened. The most common reasons for not being screened were a belief that they are healthy (n = 2983; 53.1 %), that Pca is not a serious disease (n = 3908; 69.6 %), and that digital rectal examination (DRE) as an embarrassing (n = 3634; 64.7 %) or harmful (n = 3047; 54.3 %) procedure.

CONCLUSION

Having Pca knowledge, health insurance and hospital source of information were correlated with increased screening. False beliefs about DRE and the seriousness of Pca had negative effects on screening. Increasing community knowledge and universal health coverage would improve uptake of Pca screening.

Management of ossifying fibroma of the bone of the maxilla: a case report and review of the literature

Ossifying fibroma (OF) is a slow-growing benign fibro-osseous neoplasm. It is mostly odontogenic in origin, and it arises in the jaws, particularly the mandible. OF is characterized by the production of bone and cementum-like calcifications in a fibrous stroma. OF reports of the bone of the maxilla are uncommon. Diagnosing OF can be challenging due to the considerable overlap of clinico-pathological characteristics with those of other neoplasms. Herein, the authors describe a case report OF in a 26-year-old male who presented with a huge fibro-osseous tumor of the maxilla. Histopathology established the diagnosis of maxillary OF. The tumor was surgically removed via a Weber-erguson approach with satisfactory functional and cosmetic results. No recurrence has been found after one year of follow-up. Clinical, radiological, and pathological characteristics, as well as surgical treatment approaches, are further discussed. This is one of a few documented cases of maxillary OF in our setting.

Giant intravesical prostatic protrusion mimicking bladder carcinoma: Navigating diagnostic and management challenges

INTRODUCTION AND IMPORTANCE

Benign prostate hyperplasia is common condition among elderly men, but giant intravesical prostatic protrusion is rare and may be confused with bladder carcinoma.

CASE PRESENTATION

We report an unusual case of giant intravesical prostatic protrusion mimicking bladder carcinoma. A diagnosis of giant intravesical prostatic protrusion was confirmed with the assistance of cystoscopy and patient was managed by transvesical simple open prostatectomy where he had uneventfully recovery.

CLINICAL DISCUSSION

Both bladder carcinoma and benign prostate hyperplasia are more prevalent in elderly men and they all present with lower urinary tract symptoms. Ultrasound and computer tomography may all suggest bladder carcinoma. The two conditions are treated differently, and therefore having correct diagnosis is mandatory. Cystoscopy is an important investigation that can act as a tiebreaker in differentiating giant intravesical prostatic protrusion from bladder carcinoma. Transvesical simple open prostatectomy is the preferred surgical approach with good postoperative outcome.

CONCLUSION

This case report reminds urology surgeons on the possibility of having giant intravesical prostate mimicking bladder carcinoma and the importance of cystoscopy in differentiating the two. Transvesical simple open prostatectomy has promising result.

A case report of two synchronous primary urologic malignancies in one patient

It is quite unusual to have numerous primary malignant tumors at the same time in the same patient. These cancers are classified as metachronous or synchronous. The occurrence of synchronous urologic tumors poses diagnostic and treatment challenges and has always been a subject of controversy in the clinical decision-making process. Unfortunately, no clear standardized management protocols for these patients exist. Therefore, diagnosis and treatment may be difficult, especially with few resources. We present a 75-year-old man with simultaneous prostate and kidney cancers successfully treated at our center. This is one of the rare cases in the English literature with two primary urologic cancers.

Gestational macromastia complicating pregnancy: A case report of unusual bilateral giant breasts in a patient who had no such problem in her previous pregnancies

Key Clinical Message

Gestational macromastia is a rare disorder involving excessive breast tissue enlargement during pregnancy, potentially threatening the fetus and the mother. Our patient's previous pregnancies were more physiological, without any associated symptoms.

Abstract

Moderate bilateral enlargement of the breasts is a normal finding during pregnancy and lactation. Occasionally, there is a continuity from this physiological hypertrophy to massive breast hyperplasia or gigantomastia, causing complications that threaten the wellbeing of the fetus and the mother or raising alarm for a malignant disease. We present a case of a 28-year-old G3P2L2 with a gestational age of 29 weeks complaining of massive bilateral breast enlargement for 6 months, accompanied by a threatened abortion. The masses began gradually after conception and increased gradually over time. Notably, the breasts had been unremarkable in her two previous pregnancies. The breast ultrasonography and mammography findings pointed to a benign neoplasm. Histopathology of the lesions reported bilateral ductal hyperplasia. Conservative management and close follow-up were initiated. A cesarean section was performed due to cord prolapse, and a 1.3 kg male baby was extracted. Unfortunately, the neonate succumbed after 3 days due to apnea of prematurity. The patients' breast size subsided considerably with time. Unusually large tumors can cause alarm for other pathologies, such as breast cancer. The radiological tests should reassure the attending practitioner, and the histological examination should confirm the diagnosis. An understanding of the typical and atypical clinico-pathologic characteristics of breast lesions occurring in pregnancy and lactation is essential for appropriate patient care.

Management of a pure uterine corpus rhabdomyosarcoma in a postmenopausal patient: A rare case report and review of the literature

Key Clinical Message

Rhabdomyosarcoma of the female genital tract often involves the vagina and cervix. It usually occurs in infants and children. Such tumors are uncommon in the uterus, especially in adults. Treatment options are based on studies of younger individuals.

Abstract

Rhabdomyosarcoma (RMS) is a malignant mesenchymal neoplasm with a tendency to differentiate into skeletal muscle cells. RMS is an aggressive tumor that tends to develop in children and younger patients. A vast majority of genital tract RMSs occur in the vagina and cervix. Such tumors rarely occur in adults. Usually, these tumors either occur as a component of a biphasic uterine tumor (carcinosarcoma or adenosarcoma) or can be a pure heterologous tumor. Pure uterine RMSs are extremely rare in adult patients and difficult to diagnose. Accurate diagnosis of these tumors depends on precise histopathological evaluation. The present report describes a rare case of embryonal RMS of the uterus in a postmenopausal female and explores the most recent literature. The aim is to strengthen the existing literature and aid clinicians in the management of similar cases. A 64-year-old postmenopausal female presented with a history of abdominal pain associated with abdominal distension, per vaginal bleeding, and foul-smelling discharge for 6 months. A transabdominal ultrasound revealed a bulky uterus with a well-circumscribed heterogeneous lesion. Histopathology confirmed the diagnosis of high-grade embryonal RMS within the corpus region of the uterus. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, followed by adjuvant chemotherapy to prevent relapse of the disease. Six months after oncological care has passed, the patient remains symptoms-free without evidence of recurrence or metastasis.

Distal penile pyogenic granuloma: A case report

Key Clinical Message

The mainstays of treatment for granuloma pyogenicum include careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, and close monitoring to check relapse and management.

Abstract

Pyogenic granuloma is an acquired noncancerous vascular proliferation that arises from the mucosa and skin, seldom subcutaneously or intravascularly. It is also referred to as telangiectasis granuloma or lobular capillary haemangioma. The risk factors include vascular abnormalities, medicines, hormones, and microtrauma. We discussed the case of a 24-year-old man who had a poorly managed ventral distal penile polypoid lesion at a peripheral hospital. Upon further histopathological examination, the diagnosis of pyogenic granuloma was made. Histopathologically speaking, the term "pyogenic granuloma" is misleading because the illness is not linked to the production of granulomas. Pyogenic granuloma's etiopathogenesis is still unknown; true hemangioma is thought to be a reactive hyperproliferative of the vasculature brought on by a variety of stimuli; pyogenic granuloma may be caused by uneven angiogenic factor production in response to minor local trauma or cutaneous disease. Histopathological analysis and surgical excision are the methods used for diagnosis and treatment. The mainstay of treatment for granuloma pyogenic granuloma includes careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, close follow-up to check for relapse, and early management.

Giant liposarcoma of the thigh: A case report

Liposarcoma is a tumor derived from primitive cells that undergo adipose differentiation. They comprise 10%-35% of all soft tissue sarcomas. We present a 46-year-old female patient with a 4-year history of a giant swelling on the lateral aspect of the left thigh. Wide local excision of the mass was performed and histopathological analysis revealed a well-differentiated liposarcoma. Liposarcomas commonly appear in the extremities and have distinct features on imaging studies. Surgical treatment and histology are the most important prognostic factors for patients with lipomatous tumors, as complete surgical excision reduces local recurrence rate.

Colon Lipoma Causing Colo-Colic Intussusception in an Adult: A Case Report from Tanzania

Intussusception is rarely seen in adulthood but is commonly seen in the pediatric age group. Causes of intussusception in adults are commonly due to tumors and inflammatory diseases. Intussusception in adults accounts for less than 5% of intestinal obstruction. Colonic lipomas are usually asymptomatic and are mostly managed surgically with promising outcomes as seen in our case.

Ventricular silent rupture leading to sudden death: Navigating diagnostic challenges in a resource-constraint setting

Key Clinical Message

Ventricular myocardial rupture is a rare complication of myocardial infarction. It occurs within hours to weeks after an infarction. Mortality is high. Antemortem diagnosis is a challenge in low-resource settings, leading to potential misdiagnosis.

Abstract

Left ventricular myocardial rupture is a potentially fatal yet common complication in acute myocardial infarction patients. Rupture can occur as early as hours after an infarction. However, rupture may also occur later in the first week in the setting of myocardial necrosis and neutrophilic infiltration. Patients may survive several days to weeks before rupture occurs, and cardiac tamponade may present subacutely with a slow or repetitive clinical course. Sudden death can be attributed to ventricular rupture, more commonly during this time frame. Myocardial rupture can also occur as a result of trauma, infections, or cancer. Mortality is exceedingly high if surgical intervention is delayed. In most patients, myocardial rupture manifests as a catastrophic event within days of a first, small, uncomplicated acute myocardial infarction. Acute onset of shortness of breath, chest pain, shock, diaphoresis, unexplained emesis, cool and clammy skin, and syncope may herald the onset of ventricular septal rupture after acute myocardial infarction. Sudden death from myocardial rupture during acute myocardial infarction in patients with no apparent previous symptoms of myocardial ischemia represents a challenge for medical examiners, law enforcement officers, and society as a whole. An autopsy is critical for establishing the cause of death. We present the case of a 54-year-old male whose body was found beside the road after a trivial quarrel a day before. Further medical information about the deceased was not available. The preliminary cause of death was presumed to be traumatic. No evidence of trauma was seen during the autopsy. Massive pericardial blood collection compressing the heart and concealed left ventricular myocardial rupture were noted. Histopathological examination of the heart demonstrated myocardial infarction with a tear associated with bleeding that was contained in the pericardial sac. We ruled cardiac tamponade as the cause of death due to an infarcted myocardial rupture. Antemortem diagnosis of myocardial rupture can be challenging in low-resource settings, leading to potential misdiagnosis and negative impacts such as community conflicts.

Giant pilomatrix carcinoma of the scalp with intracranial extension: A case report

Key Clinical Message

A very rare skin cancer. Malignant variant of pilomatricoma. It is unique because of its highly aggressive behavior. Responds poorly to chemotherapy and radiotherapy. Treated with a wide surgical excision with safe margins.

Abstract

Pilomatrix carcinoma is uncommon and locally aggressive tumor of the hair follicle matrix. It is a malignant variant of pilomatricoma. If left untreated for a long time may attain massive size and has the potential for distant spread. Only few cases with brain extension have been reported in the literature. Diagnosis of these tumors is established by histopathology. Although pilomatrixoma and pilomatrix carcinoma are well-recognized lesions, clinically they are frequently misdiagnosed as other skin conditions. The tumors respond poorly to chemotherapy and radiotherapy. Thus, recommended treatment is a wide surgical excision with safe margins. Herein, we report the case of a 39-year-old African woman with pilomatrix carcinoma of the scalp eroding the skull bone with intracranial extension.

A case report of atypical presentation of a solitary brain metastasis from a primary lung cancer in a low resource setting

INTRODUCTION AND IMPORTANCE

Brain metastasis is the most common associated consequence of primary lung cancers, and it has a major detrimental influence on patients' survival and quality of life. Modern imaging modalities such as brain MRIs and PET scans are preferred for assessing these lesions. Complete surgical resections have been shown to enhance survival.

CASE PRESENTATION

We present the case of a 59-year-old male patient who had a history of progressive left-sided weakness and right-sided headaches with no respiratory symptoms. A solitary brain lesion was noticed, prompting a surgical resection. Histology findings confirmed brain metastases, and a thoracic CT scan revealed a primary lung tumour. The patient was scheduled for chemotherapy.

DISCUSSION

Primary lung tumors often disseminate to the brain. The brain metastatic lesions in advanced lung cancer are often numerous and smaller in size, based on MRI imaging. The patient's symptomatology obscured the existence of an underlying lung tumour, delaying focused therapy. The early symptomatology and scans of our patient indicated the probability of a solitary brain tumour, necessitating a surgical excision.

CONCLUSION

Prompt management of brain metastatic lesions is crucial. Yet, some patients emerge with atypical characteristics of the lesions that hint to a primary brain lesion and conceal the presence of a lung tumour. Enhancing these patients' prognoses necessitates a targeted therapy that includes a comprehensive examination, radiological imaging, and recognition of the distinctive brain patterns in patients with lung cancer. The merits of complete or incomplete resections for multiple brain metastatic lesions might be a fascinating subject of discussion.

Why Am I Ill? Beliefs in Supernatural and Natural Causes of Ill Health at the Time of Diagnostic Workup of Patients With Esophageal Cancer in Tanzania

PURPOSE

An understanding of the cultural and context-specific perceptions of the causes of cancer is an important prerequisite for designing effective primary health prevention and early detection strategies. We aimed to use the Murdock Ill Health Theoretical Model to conceptualize views on illness causation among dysphagia-suffering patients undergoing diagnostic workup for esophageal cancer (EC) in Tanzania.

METHODS

At the end of a structured interview on lifestyle habits, patients with suspected EC were asked about beliefs on the reasons behind their illness through (1) a set of questions with fixed binary answers, whose determinants were analyzed using logistic regression, and (2) a single question with free-text answers. Responses were coded using a hierarchy of natural and supernatural (godly and social constructs) causes.

RESULTS

Among 322 patients interviewed between November 2015 and December 2019, we found complex and varied views about the origins of their illness. Overall, 49% of patients attributed illness to natural causes and 39% to supernatural causes. Natural causes ranged from infection, use of alcohol and tobacco, other ailments, and the environment. The supernatural causes included attributing illness to God, curses, and spells from personal acquaintances. Belief in supernatural causes was more common in the less educated and those who sought help first via a traditional healer.

CONCLUSION

The results underscore the need for increased community awareness of biomedical causes of ill health and patient-based participatory research to inform prevention programs. The results also highlight the importance of building health systems that support a series of health-seeking behaviors that acknowledge both biomedical and local traditional healing belief systems.

Massive ossifying fibroma of mandible: A case report and review of the literature

Key Clinical Message

Benign fibro-osseous neoplasm. Massive size is rarely reported. May be confused with other pathologies such as fibrous dysplasia or osteosarcoma. Aggressive nature and high recurrence pose management challenges. Treated by surgery.

Abstract

Ossifying fibroma is a benign fibro-osseous neoplasm. It can affect both mandible and maxilla. Precise diagnosis can be challenging due to significant overlap of clinicopathological features with other neoplasms. Case reports with massive tumor sizes as presented in our case are uncommon. Huge tumor size can cause alarm for other pathologies such as osteosarcoma. The radiological tests should reassure the attending practitioner and histological examination confirm the diagnosis. The aim of the present report is to discuss a case of a giant ossifying fibroma in a 13-year-old male child. He presented with a progressive mandibular mass for 4 years. Clinical, radiological, and pathological characteristics and surgical treatment approaches are further discussed. This is one of the rare cases of massive ossifying fibroma in the English literature.

Invasive breast carcinoma of no special type with medullary pattern: A case report at a tertiary facility in Tanzania

Key Clinical Message

Describes a rare form of invasive breast cancer of no special type.Not a distinct morphological subtype.Characterized by dense lymphoid infiltrate, syncytial growth, pushing borders, and cells with high-grade nuclei.Clinically aggressive but carries a better prognosis than other more frequent invasive breast carcinomas.

Abstract

Invasive breast carcinoma of no special type with medullary pattern (BCNST-MP) is a rare form of breast tumor, accounting for less than 5% of all invasive breast carcinomas. Its diagnosis is based on histologic criteria. Historically, this tumor was known as medullary carcinoma. Poor morphological reproducibility led to re-classification. Despite having an aggressive biological behavior, these tumors usually carry a better prognosis compared with other more frequent forms of invasive breast carcinomas. Herein, we present a case of BCNST-MP in a 58-year-old African female, successfully treated in our institution through chemo-radiation, hormonal therapy and surgery.

Management of a giant pleomorphic adenoma of the soft palate: A case report

Key Clinical Message

Benign mixed salivary gland tumor is comprised of epithelial and myoepithelial cells and represents up to 80% of tumors of the parotid gland. It is relatively rare in the soft palate and in other minor salivary glands. Surgery is the standard care.

Abstract

Salivary gland tumors are relatively rare and morphologically diverse group of lesions. Pleomorphic adenoma (PA) is the most common salivary gland tumor, accounting for approximately 80% of all major and minor salivary gland tumors. PA usually affects the parotid gland. Huge PA occurring in soft palate is extremely rare. Patients with these tumors are usually between at the age of 40 and 60 years. The tumors exhibit pleomorphic nature microscopically that may pose diagnostic challenges to pathologists as may confuse PA histopathologically with other salivary gland tumors. Surgery is the standard treatment. The purpose of writing this case study is to describe unusual case of a giant PA of the soft palate found in a 44-year-old male successfully managed at our facility.

The haunting diagnosis of malignancy in women with treatable reproductive system tuberculosis

This study reports a case of female genital tuberculosis in a 46-year-old woman who presented to emergency department with abdominal pain and progressive abdominal distension. The patient was initially thought to have ovarian cancer based on clinical diagnosis and elevated cancer antigen-125 (CA-125) levels. Intra-operatively, no obvious ovarian tumor was encountered instead; disseminated creamy white patches on the uterus and left adnexa were seen. About 4500-mL straw-colored ascitic fluid and disseminated creamy white patches were also found on the bowels and omentum giving an impression of carcinomatosis. However, histopathology of the fallopian tube and ovary confirmed the diagnosis of female genital tuberculosis as the underlying cause. Female genital tuberculosis often mimics tumors in its clinical appearance and symptoms, leading to misdiagnosis and unnecessary treatment. The key to diagnosing female genital tuberculosis is being suspicious as it is challenging to diagnose through laboratory tests or radiology. The mainstay of treatment for female genital tuberculosis is a combination of four antituberculosis drugs. Consideration of female genital tuberculosis as a differential diagnosis in women presenting with symptoms mimicking reproductive tumors is highly recommended as highlighted in this case report.

Diagnostic dilemma in a rare case of nonfunctional parathyroid carcinoma at a referral facility in Northern Tanzania

Key Clinical Message

Rare cancer originating from parathyroid parenchymal cells. Preoperative diagnosis is often difficult. Presents with normal serum levels of calcium and parathyroid hormone. Treated by en bloc resection. Benefits of adjuvant therapy are unclear.

Abstract

Parathyroid carcinoma is an uncommon endocrine tumor. Its typical presentation is that of primary hyperparathyroidism with elevated serum calcium and parathormone levels. Nonfunctioning carcinoma of the parathyroid gland with normal serum calcium levels is extremely rare. This paper describes a case of nonfunctioning parathyroid carcinoma and brief literature review thereof.

Primary diffuse large B-cell lymphoma of the kidney: A rare case report and review of literature

INTRODUCTION AND IMPORTANCE

Lymphoma can either be Hodgkin or non-Hodgkin (NHL) with diffuse large B cell lymphoma (DLBL) being a type of the latter with an aggressive behavior. Although it is common for NHL to involve the kidney in its advanced stages, disease that primarily originates from the kidney is rare and therefore poses a diagnostic challenge.

CASE PRESENTATION

We presented a case of NHL that was initially thought to be Renal Cell Carcinoma (RCC) but later confirmed histologically to be diffuse large B cell Lymphoma. The patient was kept on doxorubicin, cyclophosphamide and dexamethasone. However, on day five of the treatment he succumbed.

CLINICAL DISCUSSION

Lymphoma can be broadly grouped into Hodgkin and non-Hodgkin Lymphoma. Primary kidney lymphoma accounts for <1 % with non-specific symptoms hence can be challenging in the diagnosis. Biopsy yields in the diagnosis and management is primarily chemotherapy.

CONCLUSION

This case reminds health care professional on the possibility of having primary Lymphoma of the kidney in a patients with renal mass. Treatment of lymphoma is different from RCC, a common renal malignancy in adult. Therefore, tissue biopsy for definitive diagnosis is mandatory before initiation of treatment.

Primary breast squamous cell carcinoma: A case report at a tertiary hospital in Northern Tanzania

Key Clinical Message

Primary SCC of the breast is a very rare disease.Metastasis from elsewhere should be excluded first.The tumor is a very aggressive with poor prognosis.No standard treatment approaches are available.Managed by surgical excision followed by chemotherapy and radiotherapy.

Abstract

Primary squamous cell carcinoma of the breast is an exceedingly rare disease, and its management is still unclear. A-65-year-old lady presented with a progressive swelling of her right breast that started spontaneously. Other potential primary sites were ruled out. She was kept on a neo-adjuvant chemotherapy (AC-T protocol) of doxorubicin, adriamycin, and paclitaxel. Later, she was underwent modified radical mastectomy with axillary lymph node dissection. Her post-operative recovery was uneventful. Currently, she is followed up at oncology outpatient clinic.

Management of huge verrucous carcinoma of lower lip: A case report at a tertiary hospital in northern Tanzania

Key Clinical Message

Well-differentiated variant of squamous cell carcinoma. Slow growing, exophytic, cauliflower-like growth easily confused with a viral wart. Cutaneous, anogenital, and oral variant exist. Risk factors for oral variant include alcohol and smoking. Histopathologically exhibits lobules with a pushing margin and blunt borders.

Abstract

Verrucous carcinoma (VC) is a low-grade variant of squamous cell carcinoma with specific clinicopathologic features and good prognosis when affecting skin. We report the case VC of lip in a-70-year-old lady. She underwent surgical excision with excellent outcomes. A brief review of the literature is provided.

The contribution of smoking and smokeless tobacco to oesophageal squamous cell carcinoma risk in the African oesophageal cancer corridor: Results from the ESCCAPE multicentre case-control studies

Tobacco use is a well-established risk factor for oesophageal squamous cell carcinoma (ESCC) but the extent of its contribution to the disease burden in the African oesophageal cancer corridor has not been comprehensively elucidated, including by type of tobacco use. We investigated the contribution of tobacco use (smoking and smokeless) to ESCC in Tanzania, Malawi and Kenya. Hospital-based ESCC case-control studies were conducted in the three countries. Incident cases and controls were interviewed using a comprehensive questionnaire which included questions on tobacco smoking and smokeless tobacco use. Logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of ESCC associated with tobacco, adjusted for age, sex, alcohol use, religion, education and area of residence. One thousand two hundred seventy-nine cases and 1345 controls were recruited between August 5, 2013, and May 24, 2020. Ever-tobacco use was associated with increased ESCC risk in all countries: Tanzania (OR 3.09, 95%CI 1.83-5.23), and in Malawi (OR 2.45, 95%CI 1.80-3.33) and lesser in Kenya (OR 1.37, 95%CI 0.94-2.00). Exclusive smokeless tobacco use was positively associated with ESCC risk, in Tanzania, Malawi and Kenya combined (OR 1.92, 95%CI 1.26-2.92). ESCC risk increased with tobacco smoking intensity and duration of smoking. Tobacco use is an important risk factor of ESCC in Tanzania, Malawi and Kenya. Our study provides evidence that smoking and smokeless tobacco cessation are imperative in reducing ESCC risk.

Mentorship of young researchers in resource-limited settings: experiences of the mentees from selected health sciences Universities in Tanzania

INTRODUCTION

Mentorship is an essential component of research capacity building for young researchers in the health sciences. The mentorship environment in resource-limited settings is gradually improving. This article describes mentees' experiences in a mentorship program for junior academicians amid the COVID-19 pandemic in Tanzania.

METHODS

This is a survey study that examined the experiences of mentees who participated in a mentorship program developed as part of the Transforming Health Education in Tanzania (THET) project. The THET project was funded by the US National Institutes of Health (NIH) under a consortium of three partnering academic institutions in Tanzania and two collaborating US-based institutions. Senior faculty members of respective academic institutions were designated as mentors of junior faculty. Quarterly reports submitted by mentees for the first four years of the mentorship program from 2018 to 2022 were used as data sources.

RESULTS

The mentorship program included a total of 12 mentees equally selected from each of the three health training institutions in Tanzania. The majority (7/12) of the mentees in the program were males. All mentees had a master's degree, and the majorities (8/12) were members of Schools/Faculties of Medicine. Most mentors (9/10) were from Tanzania's three partnering health training institutions. All mentors had an academic rank of senior lecturer or professor. Despite the onset of the COVID-19 pandemic, the regular weekly meetings between mentors and mentees were not affected. By the fourth year of the mentorship program, more than three-quarters of mentees had published research related to the mentorship program in a peer-reviewed journal, over half had enrolled in Ph.D. studies, and half had applied for and won competitive grant awards. Almost all mentees reported being satisfied with the mentorship program and their achievements.

CONCLUSION

The mentorship program enhanced the skills and experiences of the mentees as evidenced by the quality of their research outputs and their dissemination of research findings. The mentorship program encouraged mentees to further their education and enhanced other skills such as grant writing. These results support the initiation of similar mentorship programs in other institutions to expand their capacity in biomedical, social, and clinical research, especially in resource-limited settings, such as Sub-Saharan Africa.

Castleman's disease: A report of two cases at a tertiary hospital in Northern Tanzania

Castleman's disease is a rare lympho-proliferative disease entity characterized by variable clinical presentations, distinctive histological manifestations, and prognosis. Its incidence and etiology are unclear. An interplay of HIV and human herpesvirus-8 has been implicated. Although its localized variety is benign, other types can be multifocal with adverse systemic manifestations. Human herpesvirus-8 Castleman's disease affects mainly HIV-positive individuals; however, individuals who are immunocompromised from other causes can also be affected, thus necessitating investigations for HIV. Herein, we report two patients presenting with long-standing lymphadenopathy. Histopathology, immunohistochemical testing and clinico-pathological correlation confirmed the diagnosis of Castleman's disease. The patients were successfully treated with surgery and/or rituximab. They were symptoms free in the subsequent follow-up visits. A brief review of the literature is also provided.

No woman left behind: achieving cervical cancer elimination among women living with HIV

Cervical cancer is the fourth most common malignancy in women of reproductive age globally. The burden of this disease is highest in low-income and middle-income countries, especially among women living with HIV. In 2018, WHO launched a global strategy to accelerate cervical cancer elimination through rapid scale-up of prophylactic vaccination, cervical screening, and treatment of precancers and cancers. This initiative was key in raising a call for action to address the stark global disparities in cervical cancer burden. However, achieving elimination of cervical cancer among women with HIV requires consideration of biological and social issues affecting this population. This Position Paper shows specific challenges and uncertainties on the way to cervical cancer elimination for women living with HIV and highlights the scarcity of evidence for the effect of interventions in this population. We argue that reaching equity of outcomes for women with HIV will require substantial advances in approaches to HPV vaccination and improved understanding of the long-term effectiveness of HPV vaccines in settings with high HIV burden cervical cancer, just as HIV, is affected by social and structural factors such as poverty, stigma, and gender discrimination, that place the elimination strategy at risk. Global efforts must, therefore, be galvanised to ensure women living with HIV have optimised interventions, given their substantial risk of this preventable malignancy.

Huge primary retroperitoneal mature cystic teratoma mimicking adrenal incidentaloma: A case report and literature review

INTRODUCTION

Teratomas originating from extra-gonadal account for 15 % of all teratomas, while retroperitoneal site being the least site for teratoma 1-11 %, extremely rare adrenal teratoma is less than 4 % of the retroperitoneal teratomas. Usually, patients are asymptomatic and the tumours are detected incidentally during imaging.

PRESENTATION OF CASE

A case of a 29 years old female, presented with intractable pain for four weeks. Computed tomography scan study of the abdomen showed an avascular septate cystic lesion measuring 11.6 × 11.4 14.5 cm (cranial-caudal x transverse x anterior-posterior) with central fat density and large punctate calcification in the right suprarenal region displacing the inferior vena-cava laterally, abutting the gall bladder, pancreas and duodenum. Impressions of right adrenal teratoma and less likely adrenal myelipoma were suggested. She remarkably improved one day post operation. During clinic visit a month later, she was completely recovered and resumed her daily activities.

DISCUSSION

In adults primary retroperitoneal mature cystic teratoma are uncommon, mostly are secondary tumours and very rare will occur in adrenal gland. Adrenal incidentaloma have been seldom reported mimicking primary mature cystic teratoma. Biochemical and Imaging studies are of great importance in diagnosing and showing relationship of the tumour and other organs. This work has been reported in line with the SCARE criteria (Agha et al., 2018 [1]).

CONCLUSION

Primary retroperitoneal tumours are rare and surgery is the main stay of treatment whether it be open or laparoscopic, the latter being best for small lesion for it offers early recovery and complete excision gives excellent prognosis of 100 %.

An unusual presentation of penetrating bladder injury with vesicocutaneous fistula: a case report

BACKGROUND

Blunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms.

CASE PRESENTATION

We present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis.

CONCLUSION

Fistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management.

Giant perineal epidermoid cyst in adult man: a rare case report and review of literature

An epidermoid cyst is a common benign cutaneous mass that mostly occurs on the neck, face and trunk. The majority of epidermoid cysts are small and asymptomatic with the giant perineal epidermal cyst being rare and more liable to develop complications such as malignant transformation. The treatment of an epidermal cyst involves total excision of the cyst along with its wall to prevent recurrence. We present an unusual case of a giant perineal epidermal cyst in a 52-year-old male.

A giant metanephric adenoma in a young male

Metanephric adenoma is an uncommon renal tumor with almost exclusively benign behavior, which can clinically and radiologically imitate malignancy. The histological examination is therefore crucial in diagnosis. Herein, we report a case of an 18-year-old male with a huge left renal mass. Histopathology and immunohistochemistry of nephrectomy resection specimen confirmed it to be metanephric adenoma. We present our experience with this rare tumor entity and literature review with focusing on differential diagnosis.

Sclerosing epithelioid fibrosarcoma of the foot: A case report

Sclerosing epithelioid fibrosarcoma (SEF) is a rare and distinctive variant of fibrosarcoma. To date, about 100 cases only have been documented. Histopathologically, it resembles a variety of benign, pseudosarcomatous and other malignancies. Early diagnosis and treatment are vital for improving the treatment outcomes.

Unusual intrauterine retained fetal skeletal bony fragments: A case report and review of the literature

An unusual finding in hysterectomy specimen. Associated with a history of abortion. Etiology remains unclear. Clinically it presents with infertility, chronic pelvic pain, menorrhagia, and vaginal discharge. Treatment is by hysterescopic excision.

Concomitant squamous cell carcinoma of the bladder and renal tuberculosis: A case report from northern Tanzania

Concomitant squamous cell carcinoma (SCC) and renal tuberculosis (TB) are a rare presentation. It is associated with poor prognosis and poses a challenge in the management. To the best of our knowledge, we present a challenging first document case of locally advanced SCC of the bladder with coactive renal tuberculosis.

Frequency and distribution of ABO and Rh blood group systems among blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania: a retrospective cross-sectional study

OBJECTIVES

ABO and Rh blood group systems are the major factors affecting the blood transfusion safety. The frequency and distribution of these blood group systems vary worldwide. We aimed to determine the frequency and distribution of ABO and Rh blood group systems among first-time blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania.

DESIGN

Cross-sectional descriptive population-based study.

SETTING

Data on ABO and Rh blood group systems were obtained and analysed from the Northern Zone Blood Transfusion Center among first-time blood donors.

PARTICIPANTS

There were 65 535 first-time blood donors aged 15-55 years who donated at the Northern Zone Blood Transfusion Center from January 2017 to December 2019.

OUTCOME MEASURES

The percentage of ABO and Rh blood group systems among different categories of blood donors was calculated.

RESULTS

Retrospective data from Blood Establishment Computer System of 65 535 first-time blood donors were analysed in the present study. The mean age of the blood donors was 30.6±11.2 years (range: 15-55 years). The vast majority of the blood donors 84.2% (n=55 210) were men. Also, the majority 69.6% (n=45 595) were aged ≥35 years. Blood group O was the most common blood group which was found in over half 52.4% (n=34 333) of the blood donors and majority 95.3% (n=62 461) of the donors were Rh positive. Moreover, the majority 78.3% (n=51 336) were voluntary donors and the remaining 21.7% (n=14 199) were replacement donors.

CONCLUSION

Majority of the donors had blood group O and also the vast majority of the donors were Rh positive. Considering the large size of our study population, this has provided a more comprehensive information regarding the frequency and patterns of ABO and Rh blood group systems in Tanzania. The observed association of blood group A with one of the regions from which donors were coming from, is intriguing and further studies may confirm possible related genetic evolution.

Invasive breast cancer with Paget's disease: A rare case report from a tertiary facility in Northern Tanzania

Paget's disease of the breast is a rare pathology resulting from abnormal proliferation of glandular epithelial cells in the nipple-areolar epidermis. The disease is named after James Paget, a pathologist and surgeon, who reported a relationship between a nipple rash and mammary gland tumors in 1874. Early diagnosis may be quite difficult. Histopathology can give the definitive diagnosis and the treatment depends upon the presence or absence of an associated breast lump. The treatment options include simple lumpectomy, mastectomy or radical mastectomy depending upon the lump (cancer) in the diseased breast. Herein, we present a case of Paget's disease of the breast presented with a long history of nipple eczema.

Chondromyxoid fibroma: A rare benign tumor with potential for local recurrence

Chondromyxoid fibroma is one of the rarest benign cartilaginous tumors accounting for less than 0.5% of bone tumors and mostly found in the metaphysis of long bones. Diagnosis is by histology showing lobular pattern with stellate-shaped cells in a myxoid or chondroid background. Often they can be misdiagnosed as chondrosarcomas. Recommended treatment approach is surgically excision due to the high risk of malignancy. Although benign, local recurrence is common as presented from this case report.

Cervical cancer in Northern Tanzania-What do women living with HIV know

Background

Cervical cancer (CC) is more prevalent in women living with human immunodeficiency virus (HIV) infection compared to the general population. The magnitude is high among all countries burdened with HIV-Tanzania is no exception. Despite the unprecedented risk, women living with HIV (WLHIV) may not be aware of the risk and might have unfounded beliefs thereof. This study aimed to determine the knowledge, awareness, and beliefs on CC screening among WLHIV attending a clinic at the Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania.

Methods

This hospital-based cross-sectional study was conducted among 327 WLHIV attending care and treatment clinic (CTC) at KCMC. A pre-tested questionnaire was used to collect quantitative data. Both descriptive and regression methods were used to determine CC knowledge, awareness, and beliefs as well as factors associated with knowledge of CC among WLHIV using SPSS version 23.

Results

Participants' mean age was 46 ± 10.4 years. Although just half (54.7%) of WLHIV had insufficient knowledge of CC, the majority of the participants (83.5%) were able to recognize at least three risk factors, but with limited understanding of symptoms and prevention. The majority held positive beliefs on CC and screening practices. Factors associated with good knowledge of CC included being married (AOR: 3.66, 95% CI: 1.84-7.28), having used ART for at least 2 years (AOR: 4.08, 95% CI: 1.36-12.21), and having previously screened for CC (AOR: 1.62, 95% CI: 1.01-2.59).

Conclusion

WLHIV attending care and treatment center had insufficient knowledge about CC screening. To further improve screening and treatment for CC, at both facility and community levels, targeted awareness and education campaigns are warranted.

Papillary thyroid carcinoma arising from ectopic thyroid tissue in a neck branchial cyst

A 35-year-old man presented with a right lateral neck mass for 6 years. Thyroid function test was within normal limits. Computed tomography scan of the neck was suggestive of branchial cyst, tuberculous lymphadenopathy and normal thyroid gland. Fine needle aspiration cytology of cervical lymph node was suggestive of metastatic carcinoma. Branchial cystectomy spearing the thyroid gland was undertaken. Histopathology analysis of the resected specimen confirmed it to be papillary thyroid carcinoma originating from ectopic thyroid tissue in a branchial cyst. The patient was scheduled for total thyroidectomy and neck dissection. Unfortunately, he was lost to follow-up. A brief review of the literature regarding this unusual presentation of thyroid cancer has been provided.

NOHA: A Promising Biomarker for Determining Estrogen Receptor Status Among Patients With Breast Cancer in Resource-Constrained Settings

PURPOSE

Challenges to breast cancer control in low-and middle-income countries exist because of constrained access to care, including pathology services. Immunohistochemistry (IHC)-based estrogen receptor (ER) analysis is limited-nonexistent because of few and inadequately staffed and equipped pathology laboratories. We have identified N^w-hydroxy-L-Arginine (NOHA) as a blood-based biomarker to distinguish ER status in US patients with breast cancer. Here, we examine NOHA's clinical utility as an ER IHC alternative in Tanzanian patients.

MATERIALS AND METHODS

Following informed consent, 70 newly diagnosed, known or suspected patients with breast cancer were enrolled at Kilimanjaro Christian Medical Center; basic, deidentified clinical and sociodemographic data were collected. For each, a needle prick amount of blood was collected on a Noviplex plasma card and stored at -80°C. Plasma cards and unstained tumor pathology slides were shipped regularly to US laboratories for NOHA, histologic and IHC analysis. NOHA and IHC assay operators were blinded to each other's result and patient clinical status. Paired NOHA and IHC results were compared.

RESULTS

Slides from 43 participants were available for pathological analysis in the United States. Of those with confirmed malignancy (n = 39), 44%, 51%, 5% were ER-positive, ER-negative, and ER inconclusive, respectively. NOHA levels were available among 33 of 43 of those with pathological data and showed distinct threshold levels correlating 100% to tumor ER IHC and disease categorization where a level below 4 nM, from 4 to 8 nM, and above 8 nM signified ER-negative, ER-positive, and no cancer, respectively.

CONCLUSION

The results are consistent with findings from US patients and suggest NOHA's clinical utility as an accessible IHC replacement in determining ER status among low-and middle-income country patients with breast cancer, promising to extend access to cost-efficient, available hormonal agents and improve outcomes.

Performance of HPV testing, Pap smear and VIA in women attending cervical cancer screening in Kilimanjaro region, Northern Tanzania: a cross-sectional study nested in a cohort

OBJECTIVE

There is a concern about performance of the screening approaches, where information on the quality of novel and affordable screening approaches that will perform well in remote areas is warranted. This lack of information makes it difficult to prioritise resource use in efforts to improve cervical cancer outcomes. We aimed to compare the diagnostic value of human papillomavirus (HPV) testing on self-collected samples, Pap smear and visual inspection of the cervix with acetic acid (VIA) tests for detection of high-grade cervical intraepithelial neoplasia or worse (CIN2+).

DESIGN

A combined cross-sectional and cohort study.

SETTING

Three primary healthcare centres in Kilimanjaro region, Tanzania.

PARTICIPANTS

1620 women undergoing cervical cancer screening from December 2018 to September 2021. Inclusion criteria were being aged 25-60 years, and no history of premalignant or cervical cancer. Exclusion criteria were overt signs of cancer and previous hysterectomy.

INTERVENTIONS

Participants underwent HPV self-sampling with Evalyn Brush and Care HPV kit assay was used to determine prevalence of high-risk HPV infection. Women with positive HPV test were together with a random sample of HPV negative women scheduled for follow-up where VIA was performed, and Pap smear and cervical biopsies obtained.

RESULTS

Of 1620 women enrolled, 229 (14.1%) were HPV positive and 222 of these attended follow-up together with 290 (20.8%) women with negative HPV test. On VIA, 17.6% were positive. On Pap smear, 8.0% were classified as high-grade squamous intraepithelial lesion. The sensitivity and specificity, respectively, of the various tests, compared with histopathology for the detection of CIN2+ were: HPV test 62.5%, 59.3%; Pap smear 82.8%, 82.1% and; VIA 48.4%, 56.8%. When combined, the sensitivity and specificity for HPV and Pap smear were 90.6%, 70.6% while HPV and VIA were 65.6% and 75.5% for the detection of CIN2+.

CONCLUSIONS

The performance of care HPV testing on self-collected samples opens the possibility of increasing coverage and early detection in resource-constrained settings.

Management of juvenile trabecular ossifying fibroma of bone of the maxilla in a child: A case report at a tertiary hospital in Northern Tanzania

INTRODUCTION AND IMPORTANCE

Juvenile trabecular ossifying fibroma (JTOF) is a rare variant of ossifying fibroma. Though it is benign, it has aggressive clinical behavior. JTOF may pose diagnostic and therapeutic difficulties due to their clinical, radiological and histological variability. Herein, we describe our experience in encountering this unusual disease entity in terms diagnostics as well as surgical procedure and the differential diagnoses to be considered.

CASE PRESENTATION

An 8-year old female child presented to our facility because of a rapidly growing right maxillary swelling. Clinical examination revealed facial asymmetry resulted from the swelling on the right side of her face extra-orally, especially in her posterior upper jaw which was about 12 cm × 7 cm in dimension. Intra-oral examination revealed solitary mass, well-defined, firm in consistency and non-tender. There were no palpable lymph nodes. Infra- orbital nerves were bilaterally intact. Based on the clinical findings and history, the differential diagnoses of ossifying fibroma, ameloblastoma and fibrous dysplasia were given. Clinico-pathological and radiological correlation confirmed the diagnosis of JTOF. Hemimaxillectomy and reconstruction of maxilla with a rib were performed. Afterwards, the child reported with normal facial appearance, acceptable aesthetics and better chewing function.

CLINICAL DISCUSSION

The clinical presentation of JTOF, and its rapid growth, can cause alarm of other pathologies such as osteosarcoma. The radiological features should reassure the practitioner and a histological examination confirmed the diagnosis.

CONCLUSION

JTOF is a benign tumor and it should be operated at an early stage because of its rapid growth.

A very-hot food and beverage thermal exposure index and esophageal cancer risk in Malawi and Tanzania: findings from the ESCCAPE case-control studies

BACKGROUND

Consumption of very-hot beverages/food is a probable carcinogen. In East Africa, we investigated esophageal squamous cell carcinoma (ESCC) risk in relation to four thermal exposure metrics separately and in a combined score.

METHODS

From the ESCCAPE case-control studies in Blantyre, Malawi (2017-20) and Kilimanjaro, Tanzania (2015-19), we used logistic regression models adjusted for country, age, sex, alcohol and tobacco, to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for self-reported thermal exposures whilst consuming tea, coffee and/or porridge.

RESULTS

The study included 849 cases and 906 controls. All metrics were positively associated with ESCC: temperature of drink/food (OR 1.92 (95% CI: 1.50, 2.46) for 'very hot' vs 'hot'), waiting time before drinking/eating (1.76 (1.37, 2.26) for <2 vs 2-5 minutes), consumption speed (2.23 (1.78, 2.79) for 'normal' vs 'slow') and mouth burning (1.90 (1.19, 3.01) for ≥6 burns per month vs none). Amongst consumers, the composite score ranged from 1 to 12, and ESCC risk increased with higher scores, reaching an OR of 4.6 (2.1, 10.0) for scores of ≥9 vs 3.

CONCLUSIONS

Thermal exposure metrics were strongly associated with ESCC risk. Avoidance of very-hot food/beverage consumption may contribute to the prevention of ESCC in East Africa.

A large infected urachal mass in an adult: A case report in Tanzania

Introduction and importance

Urachal Mass results from a failure of obliteration of the urachal canal during fetal growth. The aetiology of urachal masses is ambiguous, being either of a cancerous or benign origin. Much literature is stipulated in children presenting with urachal-associated diseases but few in adult patients. This study aims at elucidating the existence of urachal mass with an abscess in a patient and the management modalities.

Presentation of case

We present a case report of a 52-year-old female patient with a two months history of abdominal pain and discomfort associated with intermittent low-grade fevers, anorexia and marked weight loss throughout her illness. An abdominal ultrasound revealed the presence of an intra-abdominal mass. A CT scan showed a multilobulated urachal mass. She eventually had a successful operation and quick recovery postoperatively.

Discussion

In the adult population, most urachal-associated diseases are malignant, with few being of benign origin. With different presentations between the two aetiologies, the most benign urachal masses may lead to infection and inflammation that typically present with a lower abdominal mass and fever. Diagnosis is made by ultrasound or CT scan of the abdomen. Surgical drainage and excision of the mass are the mainstay treatment modalities.

Conclusion

Urachal masses are rare in the adult population and are often missed in initial presentations. This will constitute poor management and outcome for patients. Physicians are to be alerted of the knowledge and make a clear assessment of patients perioperatively to avoid the delayed diagnosis, which may have consequent poor outcomes.

•

Rarely, The Urachus may be retained as a failure of obliteration during fetal development.

•

Associated retained urachal sinuses is a congenital anomaly that results in urachal abscesses.

•

Urachus associated diseases are most commonly benign but may have a cancerous etiology.

•

Poorly diagnosed patients result in poor prognosis. Early identification of the presentations with physical examinations, investigations and imaging is paramount.

Case series of high-grade soft tissue sarcoma of the lower limb with delayed diagnosis: Experience at a tertiary hospital in northern Tanzania

INTRODUCTION AND IMPORTANCE

Soft tissue sarcoma is an uncommon form of cancer with poor prognosis. Early diagnosis and treatment are vital for improving the treatment outcomes.

CASE PRESENTATION

We report a series of high-grade soft tissue sarcomas of the lower extremity with delayed diagnosis to gain insight into the presentation, treatments and outcomes for this rare disease and to determine whether limb-salvage surgery yields reasonable outcomes.

CLINICAL DISCUSSION

Timely health seeking has an impact on the outcome of the treatment of any particular disease. Patient delays are usually socio-economic factors. Soft tissues sarcomas are uncommon malignant tumors that even managed adequately have a poor 5-year survival. Limb salvage becomes questionable especially when patients present late with adverse symptoms.

CONCLUSION

In this series, we found that patients presented late and this led to unfavorable oncological outcomes, also limb salvage was not an option due to delayed presentation. Thus, early diagnosis is recommended so as to improve treatment outcome.

NOHA: A sensitive, low-cost, and accessible blood-based biomarker to determine breast cancer estrogen receptor status in low-resource settings

580

Background: Significant challenges to breast cancer control in low- and middle-income countries (LMICs) include late-stage disease presentation because of few/no early detection programs, inadequately staffed and equipped pathology laboratories, and constrained treatment options. Estrogen receptor (ER) expression is critical to determining candidacy for cost efficient and accessible hormonal agents in LMICs; however, access to standard immunohistochemistry (IHC)-based ER analysis is grossly limited/nonexistent due to cost and technical requirements. We have identified Nw-hydroxy-L-Arginine (NOHA) as a low cost and accessible blood-based biomarker to distinguish estrogen-receptor negative (ER–) from estrogen-receptor positive (ER+) breast cancer, differentiate ER– high grade versus low grade tumors, and correlate ER– molecular phenotype with ethnic variation. Our studies with US patients suggest the NOHA threshold of <4nM as a reliable indicator of ER– versus ER+ disease (Table 1). Here we examine the clinical utility of NOHA as an alternative to IHC in distinguishing ER– from ER+ breast tumors in Tanzanian patients. Methods: Following informed consent, 70 newly diagnosed breast cancer patients were recruited at Kilimanjaro Christian Medical Center (KCMC; Moshi, Tanzania). Prior to any treatment, a needle prick amount of blood was collected from each patient on a Noviplex plasma card (Shimadsu, U.S.) and stored at -80˚C. Plasma cards and unstained tumor pathology slides were shipped at 2-3 months intervals to US labs for NOHA and immunohistochemistry (IHC) ER testing. Statistical difference was set at p<0.01, with NOHA and IHC assay operators blinded to patient clinical status. Results: Our early data show correlation between NOHA levels and ER IHC results, providing a means to distinguish ER– from ER+ breast cancer in the low-resource setting. Plasma cards stored at -80˚C for up to 3 months retained NOHA stability in assays involving a proprietary antibody-based ELISA, and by LC-MS. Conclusions: This study suggests the clinical utility of NOHA as a cost-effective, accessible replacement for standard IHC testing in determining ER status among breast cancer patients in LMICs, promising to extend access to cost efficient and available hormonal agents and improving outcomes and quality of life. The present study provides foundational knowledge for broader studies of NOHA utility in global breast cancer control, as well as in ongoing development of NOHA rapid-testing technologies. [Table: see text]

The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania

Introduction

Adequate and timely access to pathology services is a key to scale up cancer control, however, there is an extremely shortage of pathologists in Tanzania. Telepathology (scanned images microscopy) has the potential to increase access to pathology services and it is increasingly being employed for primary diagnosis and consultation services. However, the experience with the use of telepathology in Tanzania is limited. We aimed to investigate the feasibility of using scanned images for primary diagnosis of pre-malignant and malignant cervical lesions by assessing its equivalency to conventional (glass slide) microscopy in Tanzania.

Methods

In this laboratory-based study, assessment of hematoxylin and eosin stained glass slides of 175 cervical biopsies were initially performed conventionally by three pathologists independently. The slides were scanned at x 40 and one to three months later, the scanned images were reviewed by the pathologists in blinded fashion. The agreement between initial and review diagnoses across participating pathologists was described and measured using Cohen’s kappa coefficient (κ).

Results

The overall concordance of diagnoses established on conventional microscopy compared to scanned images across three pathologists was 87.7%; κ = 0.54; CI (0.49–0.57).The overall agreement of diagnoses established by local pathologist on conventional microscopy compared to scanned images was 87.4%; κ = 0.73; CI (0.65–0.79). The concordance of diagnoses established by senior pathologist compared to local pathologist on conventional microscopy and scanned images was 96% and 97.7% respectively. The inter-observer agreement (κ) value were 0.93, CI (0.87–1.00) and 0.94, CI (0.88–1.00) for conventional microscopy and scanned images respectively.

Conclusions

All κ coefficients expressed good intra- and inter-observer agreement, suggesting that telepathology is sufficiently accurate for primary diagnosis in surgical pathology. The discrepancies in interpretation of pre-malignant lesions highlights the importance of p16 immunohistochemistry in definitive diagnosis in these lesions. Sustainability factors including hardware and internet connectivity are essential components to be considered before telepathology may be deemed suitable for widely use in Tanzania.

Prevalence of post-partum anemia and associated factors among women attending public primary health care facilities: An institutional based cross-sectional study

Background

Severe post-partum anemia is an important cause of maternal deaths and severe morbidity in sub-Saharan Africa. In Tanzania, little information is available to guide health care professionals in ensuring good health of women after delivery. The objective of our study was to determine the prevalence of post-partum anemia and associated factors among women attending public primary health care facilities.

Materials and methods

An institutional based cross sectional study was carried out. Women in post-partum period (the period from child birth to six weeks after delivery) attending the public primary health care facilities from October to December 2019 for children vaccination were recruited. The prick method was used to obtain blood for haemoglobin estimation. Post-partum anemia was defined as a haemoglobin level of less than 11g/dl. Participants found anaemic were asked to undertake malaria and helminths parasites tests from blood and stool samples respectively. The samples were examined by an experienced laboratory scientist on study sites according to the Tanzania national standard for medical laboratories protocols.

Results

A total of 424 women were enrolled with mean age of 27.8 years (SD 5.93). Most of the participants 234(55.2%) had primary education and nearly half 198(46.7%) of them were house wives. The overall prevalence of post-partum anemia was 145(34.2%). Among the anaemic participants, 34(23.5%) had positive blood slide for malaria parasite while 15(10.3%) had positive test for stool helminths infection. Delivery by vaginal route and low parity were protective against post-partum anemia (p<0.001).Other factors that were associated with post-partum anemia included absence of a marital partner (p<0.001) and inter pregnancy interval of less than two years (p<0.001). The risk of post-partum anemia in women with less than two years interval between their last two pregnancies was about 18 times more as compared to women with more than two years interval between their last two pregnancies, (COR = 18; 95% CI 8.617–38.617).Women without marital partners were 10 times more likely to get anemia as compared to married women, (COR = 10; 01.910–54.935).

Conclusions

The prevalence of anaemia among post-partum women found in this study points to a situation of public health problem according to WHO cut-off values for the public health significance of anaemia. Inter pregnancy interval of less than two years and absence of a marital partner were associated with post-partum anemia while delivery by vaginal route and low parity were protective against post-partum anemia. Strategies should therefore be put in place to encourage thorough health education and promotion programs among both pregnant and post-partum women.

Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study

Background

Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined.

Methods

This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach.

Discussion

This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research.

Trial registration

This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-09124-5.

An uncommon presentation of a large vulval wart in a child

Introduction and importance

Ano-genital warts are rare presentation in children. The main route of transmission is by sexual intercourse however horizontal transmission, self-inoculation and vertical transmission are also documented. Establishing the route of transmission when there is no evidence of sexual abuse may be difficult in pediatric and female virgins such as in our case report. Surgical excision remains one of the best options for treatment of large warts in pediatrics. To the best of our knowledge, this is the first report of novel case of large genital warts in pediatrics in Tanzania.

Case presentation

We present a case of female child of one year and 10 months old with large ano-genital cauli-flower masses admitted at Kilimanjaro Christian Medical Centre. The child's hymen was intact and with no evidence of sexual abuse identified. The masses were excised under general anesthesia and histology confirmed Condyloma acuminata.

Clinical discussion

Ano-genital warts are rare presentation in pediatrics and female virgins. Sexual abuse should be ruled out in pediatrics patients. Self-inoculation is described as a possible route of transmission in pediatrics and in female virgins. Horizontal and vertical transmissions are also possible route of transmission of HPV. It might be difficult to establish the route of transmission as in our case report. The warts were successful treated by surgical excision and cauterization.

Conclusion

Condyloma acuminata are rare in pediatrics and establishing the route of transmission may be difficult. Sexual abuse should be ruled out in pediatrics.

•

Large genital warts are uncommon to the pediatric population.

•

If encountered in children, sexual assault/abuse should be ruled out.

•

The exact route of transmission in pediatrics without sexual abuse and female virgins may be difficult to establish.

•

HPV can be transmitted through horizontal and self-inoculation.

•

Surgical excision and electro-cauterization are effective treatment for pediatric genital warts

Chronic purulent pericarditis: case report

Purulent pericarditis is an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on the tissue microscopy. In this case report, we will discuss a 31-year-old male who presented with a chief complaint of low-grade fevers, dry cough and difficulty breathing for about two weeks which preceded after removing of dental also two weeks prior. He was admitted and treated as COVID-19 in the isolation ward, he later developed cardiac tamponade and during pericardiocentesis thick pus was discharged. Pus culture and Gene Xpert tests were all negative. After his condition improved, the patient was transferred to the general ward with the pericardial window still discharging pus. Pericardiectomy was chosen as definitive management. The key takeaway in this report is that Empirical treatment with RHZE (rifampin, isoniazid, pyrazinamide, and ethambutol) in resource-limited settings is recommended due to difficulty in identifying the exact cause at a required moment.