Molecular typing of mycobacteria isolated from tuberculous lymphadenitis cases in Addis Ababa, Ethiopia

BACKGROUND

In Ethiopia, one of the world's 22 high tuberculosis (TB) burden countries, one third of the tuberculosis (TB) cases are attributed to tuberculosis lymphadenitis (TBLN). However, information on the molecular type of the mycobacterial species and strains that cause TBLN in the country is scarce.

OBJECTIVE

To identify the species and strains of mycobacteria that cause TBLN in Ethiopia.

METHODS AND RESULTS

A cross-sectional study was conducted among 206 presumed TBLN cases to characterise positive culture isolates. Mycobacterium tuberculosis complex species and strains were identified using region of difference 9 deletion and SITVIT WEB, respectively. Of the 206 fine-needle aspirate samples collected, 74 (36%) were culture-positive: 73 (98.6%) of the isolates were M. tuberculosis, and the remaining 1.4% were M. bovis. Further characterisation of the 73 M. tuberculosis isolates led to 26 distinct spoligotype international types (SITs) and 13 newly identified patterns. The most prevalent strains were SIT149, SIT53, SIT26 and SIT37 of sublineages T3-ETH, T1, CASI-DELHI and T3, respectively; these accounted for 52.6% of the total number of strains.

CONCLUSION

TBLN was mainly caused by M. tuberculosis and highly clustered strains SIT149, SIT53, SIT26 and SIT37 of sublineages T3-ETH, T1, CASI-DELHI and T3, respectively.

Breast cancer survival in Ethiopia: a cohort study of 1,070 women

There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in 2005-2010. Patients underwent regular follow-up; estrogen receptor-positive and -unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n = 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n = 644). Ductal carcinoma predominated (79.2%, n = 1,070) as well as grade 2 tumors (57%, n = 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome.

Solitary plasmacytoma of the mesentery with nodular amyloid deposits: a case report with immunohistochemical evaluation

The mesentery is unusual site for plasmacytoma. We have observed a solitary primary mesenteric plasmacytoma with marked nodular deposits of Congophilic amyloid in a 38 year-old man. We believe the present case represents the first case of primary extraosseous mesenteric plasmacytoma in the English literature. The clinical picture, pathologic findings and immuno-histochemical studies are discussed. Autopsy and long-term follow up are needed to determine whether this patient is at risk of developing multiple myeloma, local recurrence, metastatic foci or probable complications related to amyloidosis.

Pattern of histopathologic diagnosis of lymph node biopsies in a teaching hospital in Addis Ababa, 1981-1990 G.C

To determine the pattern of diseases that are responsible for lymph node biopsy, a retrospective study was carried out by reviewing daily register and pathologic reports for surgical biopsy specimens for the year 1981-1990 in the Department of Pathology, Medical Faculty, Addis Ababa University. Among 33,924 biopsy specimens 3,396 (10%) were lymph node biopsies (1,378 females, 2018 males). The results showed that 57% were cervical, 15.17% axillary and 8.7% inguinal lymph nodes. The three main causes of lymphadenopathy were tuberculosis (47.8%), reactive lymphadenopathy (26.3%) and malignant lesions (19.8%). In general this study has shown that the majority of lymphadenopathies in patients under 40 years of age are mainly due to tuberculosis and non specific (reactive) lesions and we think this may serve as a basic information for clinicians in their daily activities.

Fine needle aspiration cytology of breast lesions: a clinicocytologic review of 1211 cases

Fine needle aspiration (FNA) is a widely accepted cytologic technique for the early diagnosis of palpable breast lesions. Early diagnosis and treatment of benign and malignant breast lesions in turn are associated with increased chance of long term survival. Clinical data and results of fine needle aspiration done at the Department of Pathology in Tikur Anbessa Hospital between January 1991 to December 1994 were reviewed to study the cytologic features of breast lesions and to elucidate the clinical use of fine needle aspiration. A total of 9,946 fine needle aspirations were done in the department, out of which 1,211 (12.2%) were from breast lesions. Results from breast lesions were reported as: malignant, benign suspicious and unsatisfactory. Repeat aspiration was performed for all unsatisfactory cases. Fine needle aspiration of the 1,211 breast lesions in the four year period revealed 255 (21%) malignant, 901 (74%) benign, 15 (1.2%) suspicious and 40 (3.3%) unsatisfactory cases. The malignant lesions ranged from small, mobile, firm nodules measuring 4 cm to fixed ulcerated and fungating mass, measuring 20 cm or more. The benign lesions were small and mobile, measuring from 2 cm to 6 cm, mostly fibroadenoma (38%). Biopsy result was found for 20 patients. Out of these 14 were benign lesions and 6 were malignant lesions, confirmed by surgical biopsy. The mean age of patients with malignant lesions was 43 years (range: 24 to 80 years), while it was 27 years (range: 15 to 50 years) for those with benign lesion. There were 1132 (93.5%) females and 79 (6.5%) males. Fine needle aspiration diagnostic technique is recommended to be widely introduced into the health system of Ethiopia in order to ensure timely diagnosis of benign and malignant breast lesions. Furthermore a properly designed study will be beneficial to elucidate the cytologic and clinical characteristics of breast lesions in Ethiopian setting.

Classical congenital mesoblastic nephroma in an adult: a case report on an Ethiopian

A 54-year-old Ethiopian woman presented to Tikur Anbessa Hospital with left flank pain and left renal tumour mass in October 1996, and biopsy from nephrectomy specimen was reported as classical congenital mesoblastic nephroma (CMN). The clinical presentation, laboratory data and the pathologic findings of the patient are described in detail. In Ethiopia, there is no report of congenital mesoblastic nephroma of adulthood. In this report, the clinical presentation and the pathological features of congenital mesoblastic nephroma are also reviewed from available literature.

Kaposi's sarcoma diagnosed in the Department of Pathology, Addis Ababa University Medical Faculty: a 15 years retrospective review of biopsy results 1981-1994

This is a fifteen years' retrospective analysis of 37 kaposi's sarcoma cases diagnosed in the Department of Pathology, Addis Ababa University Medical Faculty between 1981-1994 G.C.. There were 12 female (32%) and 25 male (66%) patients. The median age was 35 years. There was a marked increase in 1994 when 14 cases (38%) were diagnosed. The most frequent site of the lesion is the lower extremeties followed by lymph nodes. The predominant histologic findings were spindle cell proliferation, vascular proliferation, extravasation and slit spaces. The authors believe that the finding of this study may serve as a base-line data for future studies.