Global Cancer Care: Diagnostic Pathology. Dr. Michael Wilson, University of Colorado September 17, 2016 ASCP Annual Meeting Sessions 9104 & 9105

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1 Global Cancer Care: Diagnostic Pathology Dr. Michael Wilson, University of Colorado September 17, 2016 ASCP Annual Meeting Sessions 9104 & 9105

2 Global Cancer Care: Diagnostic Pathology In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation.

3 Global Cancer Care: Diagnostic Pathology General Concepts Regarding Global Health Partners in Cancer Diagnostics and Treatment in Sub-Saharan Africa Diagnostic Considerations in Global Health Questions/Discussion

4 Diagnostic Considerations in Lymphadenopathy Global Health Differential Diagnosis Different Than in USA/EU Presentation is Often Later in Disease Course Co-Morbidity: Higher Incidence of HIV Infection, Chronic Malaria, Tuberculosis, Others

5 Diagnostic Considerations in Lymphadenopathy Global Health Nigeria: 14-year Retrospective Histopathologic Study of 720 Lymph Node Biopsies at Lagos University Teaching Hospital Chronic Non-Specific Lymphadenitis 245 (34%) Tuberculosis 125 (17.4%) Metastatic Lesions 242 (33.6%) Lymphomas 102(14.2%) Most Common Lymph Node Group: Cervical 283 (39.3%) Anunobi CC, Banjo AA, Abdulkareem FB, Daramola AO, Abudu EK Review of the histopathologic patterns of superficial lymph node diseases, in Lagos ( ). Niger Postgrad Med J 2008;15:243-6

6 Diagnostic Considerations in Lymphadenopathy Global Health Malawi: Cross-Sectional Study of Cervical Lymph Node Specimens From Kamuzu Central Hospital 179 Cases: 143 (77%) Histopathology, 34 (23%) Cytology Adults: Most Common Diagnosis Was Malignancy (n=41, 35%) Children: 15 Cases Each of Malignancy And Benign Masses Only 6 Cases (5%) of TB in Adults, 4 Cases (6%) in Children Mabedi C, Kendig C, Liomba G, Shores C, Chimzimu F, Kampani C, Krysiak R, Gopal S. Causes of cervical lymphadenopathy at Kamuzu Central Hospital. Malawi Med J 2014;26:16-9

7 Diagnostic Considerations in Lymphadenopathy Global Health Nigeria: 15-Year Retrospective Review of 1,180 Superficial Lymph Node Biopsies, University of Nigeria Teaching Hospital 172 Cases of TB (14.6%), 23 HIV-Infected Acid-Fast Bacilli Seen in 15.1% (26/172) of Cases (Ziehl-Neelsen) Most Common Site for TB Was Cervical 127/172, 73.8%), Axillary (24/172, 14%), and Inguinal (8/172, 4.7%) Remarkable Decline in TB Lymphadenitis in South-Eastern Nigeria. Ukekwe FI, Olusina DB, Banjo A, Akinde OR, Nzegwu MA, Okafor OC, Ocheni S. Tuberculous Lymphadenitis in South- Eastern Nigeria: A 15 Year Histopathologic Review ( ). Ann Med Health Sci Res 2016;6:44-9

8 Diagnostic Considerations in Global Health Lymphadenopathy - Infectious Approach to Evaluation Different From USA/EU Availability of Ancillary Studies Such as Microbiological Cultures Often Limited Availability of Immunohistochemical Stains/ISH Often Limited Histopathologic Findings Can Vary For Some Infections

9 Diagnostic Considerations in Global Health Lymphadenopathy Infectious If Available, Cultures Should be Performed Bacterial, Fungal, Mycobacterial Histopathologic Correlation With Clinical Findings And/or Culture Results is Critical Viral Lymphadenopathy Not as Common But Does Occur

10 Diagnostic Considerations in Global Health Lymphadenopathy Infectious Use of Molecular Tests Still Limited Tanzania: 75 Children With Lymphadenopathy Against Composite Reference Standard: Sensitivity Specificity Xpert MTB/RIF 58% 93% EasyNAT 19% 100% Cytology 100% 94.7% Bholla M, Kapalata N, Masika E, Chande H, Jugheli L, Sasamalo M, Glass TR, Beck HP, Reither K. Evaluation of Xpert MTB/RIF and Ustar EasyNAT TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study. BMC Infect Dis 2016;16:246

11 Case Clinical History 32-Year-Old Female Presents With Fever, Non- Productive Cough, Pleuritic Chest Pain, Fatigue No Previous Medical Care at Hospital

12 Case Clinical Findings Febrile Non-Tachycardic Tachypneic In Mild Distress

13 Case Radiographic Findings Multiple Cavities And Scarring of Right Lung No Acute Infiltrates Minimal Hilar Lymphadenopathy Enlarged Cervical Lymph Nodes

14 Case Laboratory Findings Normal Total White Blood Cell Count Mild Normocytic/Normochromic Anemia Sputum Smears X3 Negative For Mycobacteria Sputum Cultures X3 Negative For Mycobacteria

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17 Case Clinical-Pathological Correlation Clinical History Suggests TB Radiographic Findings Consistent With Old TB Laboratory Findings Not Consistent With Active TB

18 Case Lessons Learned Most American Hospitals Have 0-5 Annual TB Cases Not All Medical Providers Are Experienced With Treating Patients With Suspected TB Lack of Experience With Complicated TB Cases

19 Diagnostic Considerations in Global Health Lymphadenopathy Neoplastic Geographic Variation in Burkitt s Lymphoma HIV Co-Infection and Kaposi s Sarcoma Parasitic Infections Common in Some Regions Metastatic Tumors Not Uncommon

20 Diagnostic Considerations in Global Health Questions?