RESUMEN
OBJECTIVE: To document the histopathological pattern and distribution of reactive localised inflammatory hyperplastic lesions of the oral mucosa diagnosed at the University of Nairobi Dental Hospital over a 14 year period. DESIGN: A retrospective, cross-sectional descriptive study. SETTING: Division of Oral Pathology and Oral Medicine, histopathology laboratory, School of Dental Sciences, University of Nairobi. SUBJECTS: A total of 3135 oral biopsies were accessioned in the oral diagnostic histopathological Laboratory registry over a period of 14 years from March 1991 to December 2005. RESULTS: Three hundred and thirty three cases were histopathologically diagnosed as reactive inflammatory hyperplasias of the oral mucosa. This constituted 10.6% of the total oral biopsy specimens analysed during this period. Fibrous epulis was the most common histological sub-type with 129 cases (38.7%) followed by pyogenic granuloma with 94 (28.3%) cases. Six (1.8%) cases were peripheral giant cell granuloma and three cases (0.9%) were those of denture irritation hyperplasia. The age distribution ranged from 2 to 78 years (mean = 30.5 years) with a peak at 20-29 years. Gender distribution showed that 107 (32%) cases occurred in males and 226 (68%) cases females. Similar trends were observed in most of the histological sub-types. Fibrous epulis occurred in 41 male (31.8%) cases and in 88 (68.2%) females with an age range of 2 to 78 years (mean = 30.5 years). As for the pyogenic granuloma, 26 (27.7%) lesions occurred in males and 68 (72.3%) in females with an age range of 2 to 75 years (mean = 30.1 years). Among all the histopathological sub-types it was shown that 223 (67.0%) cases were fibrous, 104 (31.2%) vascular and six (1.8%) peripheral giant cell granuloma. Gingival lesions were the most common with 257 (77.2%) cases followed by 28 (8.4%) in the tongue, 16 (4.8%) lips, 15 (4.5%) cheek, six (1.8%) palate and the rest on the floor of the mouth and other mucosal sites. The duration of these lesions was recorded in 182 (54.7%) cases and ranged from 1 week to 16 years (mean = 1.8 years). Only 15 (4.5%) cases were reported to have recurred and all of them were gingival lesions. CONCLUSION: The present study has shown that the prevalence of reactive localised inflammatory hyperplasia (RLIHs) of the oral mucosa was 10.6% with fibrous epulis and pyogenic granuloma having been the most common histopathological sub-types predominantly affecting females. Although RLIHs are distinguished on clinical or histopatholocal grounds, it is important to appreciate that they are variations of the same basic process.
Asunto(s)
Hiperplasia/patología , Enfermedades de la Boca/diagnóstico , Mucosa Bucal/patología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Inflamación/fisiopatología , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/epidemiología , Enfermedades de la Boca/patología , Úlceras Bucales/diagnóstico , Úlceras Bucales/epidemiología , Úlceras Bucales/patología , Prevalencia , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
OBJECTIVES: To determine the relative frequency of acute radiation morbidity and their perceived effect on quality of life among head and neck cancer patients treated with radical radiotherapy. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Thirty eight patients comprising 28 males and 10 females with ages ranging between 21 and 69 years were evaluated. RESULTS: Most of the tumours occurred in the nasopharynx (38.6%). The rest of the tumours were equally divided between the oral cavity and larynx (31.6%). All tumours except two were carcinomas. The two exceptions were a glomus tumour and a malignant melanoma. The patients had received doses of radiotherapy ranging between 58.5 Grey and 75.5 Grey. Of the 38 patients, 22 (53%) completed their treatment in the prescribed time while 16 (47%) had treatment interruption on account of radiation morbidity. The cumulative radiation done at the time of interruption ranged between 20 and 46 Grey. The most frequent symptom was dryness of the mouth while the most troublesome symptom was difficulty in tasting foods. The quality of life (QOL) did not vary by age, gender or tumour site. Patients who had treatment interruption had a better QOL than those who did not. CONCLUSION: This study provides information that should aid in communicating with the head and neck cancer patients scheduled for radiotherapy and in the design of preventive and interventional strategies aimed at enhancing patient support and rehabilitation.
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Neoplasias de Cabeza y Cuello/radioterapia , Calidad de Vida , Adulto , Anciano , Intervalos de Confianza , Estudios Transversales , Femenino , Neoplasias de Cabeza y Cuello/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Relaciones Médico-Paciente , Psicometría , Radioterapia/efectos adversos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: The most important prognostic factor in head and neck cancer is the stage of the disease at presentation. Early cancer has an excellent prognosis following treatment. Unfortunately most patients present with late disease that requires radical treatment with considerable morbidity and mortality. Clinical experience at Kenyatta National Hospital (KNH) shows that most patients present with late disease. OBJECTIVE: To determine the causes of late presentation of head and neck cancer. DESIGN: A prospective descriptive study. SETTING: Kenyatta National Hospital, Nairobi. RESULTS: Forty four cases were seen among whom 34 were males and 10 were females. The age range was 20 to 90 years with a peak incidence between 50 and 60 years. Most of the patients had little or no education and the majority lived in the rural areas. Seventy one percent of the patients came from the Central and Eastern provinces. Tobacco and alcohol use were the most common risk habits. The larynx was the most common site affected followed by the tongue. In 61% of the cases the size of the tumours at presentation was unknown. In 14% the size was 1-2cm, in 7% of the cases it was 2-4 cm while in 5% of the cases it was 4-6 cm. In 14% of the cases the tumour size was over 6 cm. The most common presenting symptom was hoarseness followed by swelling. The majority of the patients attended a public health facility nearest them. For most patients the facility lay within 5 km and could be accessed by walking. However, most of the patients went through multiple referrals to get to KNH. By the time the patients reached KNH, 35 patients (77%) had been treated with unspecified medications, two (4%) had had tooth extraction, and seven (16%) had had biopsies done. The time-lapse between the first symptom and consultation ranged from zero and eight months. Forty five percent of the patients presented to a medical facility within one month of their symptom and 45% presented after three months. The time lapse between referral and attendance at KNH ranged from zero and thirteen weeks and 45% of the patients presented to KNH within two weeks of referral. The overall duration of symptoms by the time of diagnosis ranged from zero months to unspecified years. Thirty two percent of the cases had experienced symptoms for six months or less by the time of diagnosis. However, a number of patients had had their symptoms for a number of years by the time of diagnosis. The distribution of the tumours by stage at the time of final diagnosis were as follows: stage I were 2%, stage II 6%, stage III 14% and stage IV 56%. CONCLUSION: This study showed that the referral system was the main cause of delayed presentation of head and neck cancer to Kenyatta National Hospital.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Estadificación de Neoplasias , Derivación y Consulta , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales , Hospitales de Enseñanza , Humanos , Kenia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Derivación y Consulta/organización & administración , Factores de TiempoRESUMEN
BACKGROUND: Currently there is a dearth of data on the pattern of occurrence of head and neck cancers in Kenya. OBJECTIVE: To provide a comprehensive analysis of the pattern of occurrence of head and neck cancers in a Kenyan population. DESIGN: Retrospective hospital-based descriptive study. SETTING: Kenyatta National Hospital, Nairobi. RESULT: A total of 793 cases were recorded consisting of 507 male and 286 female (M: F = 2:1). Most of the lesions arose from the upper aerodigestive pathway. The larynx was the most common site for aerodigestive malignancies. This was followed in order of frequency, by the tongue, the mouth, and the nasopharynx. Outside the aerodigestive pathway the eye was the most commonly affected site followed by the thyroid. Squamous cell carcinoma was the most common malignancy. Sarcomas were typically rare. Gender and age distribution showed an overall male preponderance and a wide age range. However, specific tumour sites and tumour types showed varying patterns of gender and age distribution. CONCLUSION: This study confirms the relative prominence of laryngeal, oral and nasopharyngeal cancers in the African population. It is, however, at variance with other African studies regarding the relative frequency of nasal and paranasal cancers.
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Neoplasias del Ojo/epidemiología , Neoplasias de Cabeza y Cuello/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: The pattern of cleft lip and palate in the African population remains uncertain. The few studies of clefts in African populations have suggested that the pattern of these defects may be significantly different from those reported in other population groups. However, most of these studies have been based on very small sample sizes bringing into question the validity of those findings. OBJECTIVE: To analyse the pattern of cleft lip and palate cases managed at a Nairobi hospital. DESIGN: A retrospective descriptive study. SETTING: Gertrude's Garden Children's Hospital, a private exclusive children's hospital in Nairobi, where cleft lip and palate treatment was being offered at subsidised rates to needy children under the sponsorship of an international organization. SUBJECTS: Three hundred and nine cases were seen during the study period. RESULTS: Age at presentation ranged between 1 week and 45 years, with 75% presenting between 0-5 years. The average age was 10 months. Gestation histories were missing for most cases but for those with gestation histories none were significant. Most children ranked between first to third birth orders, suggesting birth to young mothers. Six cases of associated deformities were identified among the cases. No syndromic clefts were seen. The most common cleft deformity was the cleft lip and palate (CL+P) followed by isolated cleft lip (CL). Isolated cleft palate was least common. There was a male preponderance in all cleft types and most of the clefts occurred on the left side. CONCLUSION: The pattern of clefts in this study does not differ significantly from those reported in the literature for the non-African populations.
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Labio Leporino/epidemiología , Fisura del Paladar/epidemiología , Adolescente , Adulto , Niño , Preescolar , Labio Leporino/clasificación , Fisura del Paladar/clasificación , Familia , Femenino , Hospitales Comunitarios , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Kaposi's sarcoma (KS) is associated epidemiologically with HIV infection and a number of countries have reported a dramatic increase in the incidence of KS with the advent of AIDS. Although AIDS is prevalent in Kenya, no studies on the impact of AIDS on the pattern of KS has been carried out. OBJECTIVE: To determine any changes in the pattern of KS that might have occurred since the advent of AIDS in the country. DESIGN: Retrospective descriptive study. SETTING: Kenyatta National Hospital (KNH). METHOD: Pathology records of cases of KS diagnosed at KNH from 1968 to 1997 were analysed with respect to relative frequency, age, sex and site distribution; and trend. The period was divided into the pre and post AIDS era from 1983, which is the time the first AIDS patient was reported in the country. RESULT: A total of 1108 cases of KS consisting of 911 males and 197 females were recorded. The relative frequency of KS ranged between 2% to 5% of the total malignancies. There was a gradual decline in the male to female ratio from about 10:1 in the sixties to about 2:1 in 1997. There was no dramatic difference in the age distribution in the pre and post AIDS era, although a large number of cases were recorded as adults without age specification in the post AIDS era. Site distribution was characteristic of the disease with most of the cases having the lesions occurring in the lower limbs and involving the skin. CONCLUSION: Although these findings do not demonstrate a dramatic alteration in the pattern of KS in the post AIDS era there were indications that such changes may have been obscured by under-reporting. The fall in the male:female ratio is a strong indication of a rise in KS among female patients. A further study is necessary to elucidate the true impact of AIDS on the pattern of KS in the country.
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Sarcoma de Kaposi/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Comorbilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por SexoRESUMEN
BACKGROUND: The epidemiology of oral cancer in the African population is still uncertain. Earlier reports suggested a relatively low incidence of oral cancer among Africans. However, there have been recent reports of an upward trend in the incidence of oral cancers in developing countries as a consequence of changes in life style and the emergence of new diseases. It is, therefore, reasonable to expect changes in the pattern of oral cancer in Kenya in view of these changes. OBJECTIVE: To determine changes in the pattern of oral cancer in the past 20 years. DESIGN: Retrospective descriptive study. SETTING: Kenyatta National Hospital, Nairobi. METHOD: Pathology records of cases of oral cancer diagnosed at Kenyatta National Hospital from 1978 to 1997 were analysed for relative frequency, age, sex and site distribution. RESULTS: Of a total 22,788 malignancies 821 cases (3.6%) were oral cancer. Yearly relative frequency of oral cancer ranged between 1.5% of the total malignancies. There was a small male predominance (M:F = 1.3:1). The most preferred site for oral cancer was the tongue but with a significant number involving the maxilla and mandible. Comparison with a previous study did not demonstrate a dramatic change in the pattern of oral cancer in Kenya. An overall gradual decline of cancers diagnosed at Kenyatta National Hospital was noted. This decline could not be accounted for in this study. CONCLUSION: This study does not show any increase in the frequency or change in the pattern of oral cancer in this population despite changes in life style and the emergence of AIDS disease in the country.
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Neoplasias de la Boca/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Distribución por SexoRESUMEN
Rhinocerebral mucormycosis is a rare, fulminating opportunistic fungal infection caused by a fungus of the order mucorales. These fungi are ubiquitous, subsisting on decaying vegetation and diverse organic material. Although the fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate aggressive and fulminating infection in the immune compromised host. Because rhinocerebral mucormycosis occurs infrequently it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. We present a patient with classical presentation of rhinocerebral mucormycosis involving the paranasal sinuses, the orbit and cranial base who, was treated by a combination of aggressive surgical and medical therapy and subsequently had surgical repair of the oral defect. The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management.
Asunto(s)
Mucormicosis/diagnóstico , Mucormicosis/terapia , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/terapia , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/terapia , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/terapia , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/terapia , Enfermedades Raras/diagnóstico , Enfermedades Raras/terapia , Base del Cráneo , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Terapia Combinada , Desbridamiento , Diabetes Mellitus Tipo 2/complicaciones , Diagnóstico Diferencial , Parálisis Facial/microbiología , Hemiplejía/microbiología , Humanos , Kenia , Masculino , Persona de Mediana Edad , Mucormicosis/etiología , Enfermedades Nasales/etiología , Infecciones Oportunistas/etiología , Enfermedades Orbitales/etiología , Enfermedades de los Senos Paranasales/etiología , Enfermedades Raras/etiología , Resultado del TratamientoRESUMEN
This paper presents an analysis of 568 jaw tumours and tumour-like conditions seen at the Kenyatta National Hospital over a period of fifteen years. For descriptive purposes, the term tumour is used here in its wider context to cover both neoplastic and dysplastic jaw lesions which present primarily as jaw swellings. The study reveals a pattern consistent with other African series and suggests a more aggressive progression and younger age at onset than elsewhere.
Asunto(s)
Neoplasias Maxilomandibulares/patología , Adolescente , Adulto , Distribución por Edad , Edad de Inicio , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Neoplasias Maxilomandibulares/clasificación , Kenia , Masculino , Persona de Mediana Edad , Derivación y Consulta , Distribución por Sexo , Salud UrbanaRESUMEN
A histological analysis of 3141 cases of oral tumours and tumour-like lesions diagnosed at Kenyatta National Hospital between 1978 and 1992 has been carried out. Squamous cell carcinoma, salivary gland tumours and lymphoid tumours form the majority of lesions. In general, the histological distribution of the oral tumours do not differ significantly from those reported in non African series save for the Burkitt's lymphoma.
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Neoplasias de la Boca/patología , Biopsia , Humanos , Incidencia , Kenia/epidemiología , Neoplasias de la Boca/epidemiología , Salud UrbanaRESUMEN
This paper presents the age, sex and site distribution of oral tumours and tumour like conditions in Kenya. It confirms some important points. First, there is an overall lower mean age for oral tumours in African series compared to non African series. Secondly, sex bias in the distribution of oral tumours is less marked for most tumours in Africans. Thirdly, there is difference in site distribution and oral tumours between Africans and non-African populations.
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Neoplasias de la Boca/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Vigilancia de la Población , Distribución por Sexo , Reino Unido/epidemiologíaRESUMEN
A case report of a primary malignant fibrous histiocytoma (MFH) in the mandible of a young adult male is presented and relevant literature reviewed. The clinical presentation and course of the case is typical of MFH of the jaw as reported in the literature.
Asunto(s)
Histiocitoma Fibroso Benigno/diagnóstico , Neoplasias Mandibulares/diagnóstico , Adolescente , Histiocitoma Fibroso Benigno/patología , Humanos , Kenia , Masculino , Neoplasias Mandibulares/patologíaRESUMEN
Verrucous carcinoma is a rare and distinct pathological and clinical variant of well-differentiated squamous cell carcinoma. Two case reports of histologically proven oral verrucous carcinoma are presented. One case presented with a history of tobacco chewing, snuff taking and miraa chewing. While the relationship between tobacco chewing or snuff dipping and verrucous carcinoma has been investigated and described, the role played by miraa chewing is still unknown and thus requires further study. Both cases were successfully managed by only conservative surgical excision. No radiotherapy was used. Clinical and histo-pathological examination of verrucous carcinoma is therefore very important in its diagnosis and treatment planning.
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Carcinoma Verrugoso/patología , Mucosa Bucal , Neoplasias de la Boca/patología , Neoplasias de la Lengua/patología , Adulto , Carcinoma Verrugoso/etiología , Carcinoma Verrugoso/cirugía , Catha , Estimulantes del Sistema Nervioso Central/efectos adversos , Mejilla , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/etiología , Neoplasias de la Boca/cirugía , Extractos Vegetales/efectos adversos , Plantas Tóxicas , Tabaco sin Humo/efectos adversos , Neoplasias de la Lengua/etiología , Neoplasias de la Lengua/cirugíaRESUMEN
Four hundred and seventeen tumours of salivary glands in Kenya were analysed. There is no evidence of higher incidence of salivary tumours than in non-African countries. The pattern of distribution differed from that of western countries, but in conformity with most African series showed a low proportion of tumours of the parotid gland and high proportion of tumours in the submandibular gland and the palate. The involvement of the palate by salivary gland tumour is very prominent in the African series and particularly more so in the females. Malignant tumours of the palate and parotid glands were frequent but were lower than those reported in other African series. On the other hand malignant salivary gland tumours of the submandibular glands while lower than those of the western countries, were higher than those of other African series.
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Neoplasias de las Glándulas Salivales/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Hospitales Urbanos , Humanos , Incidencia , Lactante , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de las Glándulas Salivales/patología , Factores SexualesRESUMEN
This communication presents the first case report of ossifying fibroma of the jaw from Kenya and reviews the literature including the available published case reports from Africa. The relationship between ossifying fibroma and other related benign fibro-osseous lesion of the jaws is briefly discussed. Intensified research work on this condition in Africans is called for so that more cases should be published since it is reportedly more common in black race. The majority of the African cases are generally reported in advanced stages indicating neglect or delay in seeking for medical help. Since ossifying fibroma is a well encapsulated and expansile benign bone neoplasm, surgical enucleation appears to be the treatment of choice; recurrence is rare.