Lamyaa A.M. El Hassan

Nasopharyngeal Cancer in Sudan: Epidemiology, Clinical and Histological Characteristics

Objectives To study the epidemiology, clinical features, staging, etiology and pathology of nasopharyngeal cancer in Sudan. Study design This is a retrospective study. Setting Ear, Nose and Throat Department Khartoum Teaching Hospital, Khartoum City, Sudan. Subjects and methods Patients suspected to have nasopharyngeal cancer were assessed during the period March 2004 to May 2010. Data from confirmed cases was obtained; it included clinical and epidemiological information. Results Three hundred and eighty five cases were studied. Bimodal age distribution of the disease was noted with two peaks, one at 15–19 years and one at 50–54 years. The male to female ratio was 2.6:1 and a distinct geographical distribution of the disease was noted, with clustering of cases in the towns of Dilling, Kadogli and the surrounding rural area of the Nuba Mountains. These areas in the Western States were reported to be of high background radiation due to naturally produced radioactive uranium. The Nuba tribe headed the list among other tribes, demonstrating a clear ethnic predilection. Sixty-eight cases presented at stage IV. There was a predominance of Type II (15.58%) and Type III (65.97%). Patients were treated by neoadjuvant chemoradiotherapy. Conclusions NPC is an important form of cancer in Sudan. Some tribes are significantly more affected than others. Patients present with advanced disease. Environmental and genetic factors need further studies. Screening at risk populations that aim at early diagnosis and management of patients is recommended.

Malignant gastric tumors in Sudan

Hematol Oncol Stem Cell Ther 1(2) April 2008 hemoncstem.edmgr.com 130 Gastric cancer is the second leading cause of death due to cancer worldwide.1 Its incidence varies widely in the world with Costa Rica and Japan having the first and the second highest incidence rates in the world.1,2 The risk for developing gastric cant cer in North Africa and the Middle East is less than in the developed countries.3 There is little information on the frequency of gastric malignancies in the rest of Africa. Previous reports from Sudan showed that these tumors were uncommon.4 Most of the cases were ret ported before endoscopy was introduced in the country in the last twenty years. The purpose of this paper is to report on the frequency of gastric malignancies seen in one pathology center over a period of 5 years in Sudan.

pathology of nasopharyngeal carcinoma in sudanese patients and its Association with epstein-Barr Virus: A Report from a single center in Khartoum

Objectives: The aim of this study is to describe the pathology of nasopharyngeal carcinoma in Sudanese patients and to investigate its association with the Epstein-Barr virus (EBV). Study design: This is a prospective descriptive cross-sectional study conducted at the ENT Khartoum Teaching Hospital, Khartoum City, Sudan. Subjects and methods: Patients with suspected nasopharyngeal carcinoma reporting to our centre between 2006 and 2008 were studied. Biopsy samples from the nasopharynx were obtained from 68 patients suspected to have NPC. Part of the biopsy was fixed in neutral 10% formalin and processed for light microscopy. The other part was not fixed and was used to extract DNA for the detection of EBV genome. The tumours in the formalin-fixed paraffin-embedded biopsies were classified according to the WHO system of classifying NPC. Genomic DNA was extracted from the fresh unfixed biopsies of patients with histologically confirmed NPC and individuals who had other non-NPC lesions or a normal mucosa. The majority of the lesions in the non-NPC cases were adenoids. The EBV genome was detected by PCR using EBNA-1, and LMP-1 primers. Results: Of the 68 patients studied, 58 had histologically proven nasopharyngeal carcinoma. The tumours were classified as type 2 in 23 patients, type 3 in 32 and mixed types 2 and 3 in 3 patients. EBV genome was detected in 77.6% and 84.5% of the tumours by EBNA-1 and LMP-1 primers, respectively. Of the non-NPC cases, the highest infection with EBV was in patients with adenoids. The virus was detected in 8 of the 44 adenoids (18.2.%) with EBNA-1 primer and in 11 (25%) samples with LMP-1 primer. The significance of these findings is discussed. Conclusion: In Sudan, EBV is strongly associated with nasopharyngeal cancinoma at a frequency comparable to that in countries with intermediate degree of endemicity for the tumour.

Bartonella Infection: An Emerging Neglected Zoonotic Disease in Sudan

Bartonella infection occurs in three forms: Cat scratch disease (CSD) due to Bartonella henselae, Trench fever due to Bartonella quintana and Carrion′s disease caused by Bartonella bacilliformis. CSD occurs worldwide and may be present wherever cats are found. The bacteria infect the red cells of cats which are usually symptomless. Transmission of the bacteria between cats is usually by fleas. Transmission to humans is by cat bites and scratches. In this paper we describe CSD for the first time in Sudan. Human cases were diagnosed pathologically at a single histopathology service center in Khartoum, Sudan. Following written informed consent, twenty four cases were enrolled in 2013, 2014 and the first quarter of 2015. The sites affected included the skin, subcutaneous tissue, lymph nodes, the lung, the spleen, brain, bone, breast, gallbladder and retro-peritoneum. In half of the cases (12/24; 50%), lymph nodes were infected. The majority (9/12; 75%) of the infected nodes were cervical. In the Hematoxylin and Eosin stained sections the bacteria were seen as clumps of black small filamentous structures. They stained positive for melanin by Masson Fontana and Melan-A. The bacteria were identified as Bartonella henselae by a specific monoclonal antibody. The disease may be more common than is realized. A high clinical index of suspicion has to be maintained to diagnose cases of Bartonella in Sudan.