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Thirty‐seven Ugandan Africans with Kaposi's sarcoma were studied prospectively and a clinical classification was devised based on the clinical presentation of the disease and the appearance of the cutaneous tumours. The disease could be sub‐classified into four major groups. The first consisted of patients with nodular disease which was associated with a relatively benign clinical course. Patients in the next two groups (florid and infiltrative) had more aggressive disease with extensive cutaneous lesions on one or more extremities, generally associated with involvement of adjacent bone. Cutaneous lesions in the florid group were exophytic tumours while in the infiltrative group deep lesions associated with dense fibrosis predominated, Finally, the lymph‐adenopathic variety occurred mainly in children where lymph‐node involvement was usually the sole manifestation, and in young adults where skin involvement was seen concomitantly. Differing histological patterns were found to correlate with the four clinical types of involvement.

Six painful hips in five patients were examined with magnetic resonance (MR) imaging and were found to have diffuse signal abnormalities in the marrow of the femoral head and neck, which extended into the intertrochanteric area in five cases. The abnormal regions were low in signal intensity on images obtained with a short repetition time (TR) and a short echo time (TE) and were isointense or hyperintense on long TR/TE images--findings that have been attributed by others to bone marrow edema. Edema was also seen in marrow just above the acetabulum in two cases. No focal abnormalities characteristic of osteonecrosis were seen. Osteonecrosis was subsequently shown to be present in all six femoral heads at core biopsy (three cases) or by subsequent development of focal MR abnormalities reported to be highly specific for osteonecrosis (three cases). The affected hips had been radiographically normal or subtly osteopenic and had shown intense radionuclide uptake in the femoral head at scintigraphy, with lesser abnormality in the neck and intertrochanteric region. Follow-up MR examinations of five of the six femoral heads showed the diffuse abnormalities to have been transient. Although diffuse MR abnormalities in the proximal femur are not specific, they may indicate the presence of osteonecrosis of the femoral head.

Three hundred twelve histologically proven tumors of the eye and adnexa arising in the African population of Uganda between 1961 and 1966 are presented. As a group, these tumors appear to be more common in African countries than in other parts of the world. Individually, tumors show a very different incidence compared with Caucasian communities. Some of these differences appear to be of racial etiology, for example, the extreme rarity of intraocular melanoma and basal cell carcinoma of the eyelid. Others appear to be due to environmental factors, as with Burkitt lymphoma and squamous carcinoma of the conjunctiva. Retinoblastoma and rhabdomyosarcoma have a similar incidence, histology and mode of spread as in Europeans. A number of exceedingly rare tumors are included in the series.

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Six hundred twenty‐four cases of Kaposi's sarcoma occurring in Ugandan Africans have been reviewed. Thirty‐four patients came to necropsy, and almost all were found to have visceral lesions. Patients with nodular cutaneous disease usually had a long history of disease and often had small numbers of visceral nodules which only very seldom produced symptoms. Locally aggressive tumors occurred more commonly in Ugandans than in whites; in spite of locally destructive growth, they seldom metastasized widely and were often present for many years. Young people with generalized involvement were seen rarely and most of these patients had had malaria. The pattern of disease was of two types: in African children, tumor was found predominantly in nodes, whereas in young adults involvement of skin nodes and viscera was seen. The prognosis in such cases was poor. Africans seem to be less likely to develop a second neoplasm than whites. Females suffer from Kaposi's sarcoma less frequently than males but are relatively more likely to develop rapidly fatal generalized forms of the disease.

The differential diagnosis of proptosis in African children poses a bewildering number of possibilities (Davies, I968). Many of these cases prove to be due to inflammation of neighbouring sinuses or to invasion of the orbit by parasites or fungi. Orbital tumours causing proptosis occur frequently, and a series of sixty cases of proptosis in childhood caused by neoplasms in the orbit is reviewed in this paper. Materials and methodsThe Department of Pathology, Makerere University, Kampala, has for many years provided the only histopathological service available in Uganda, a country of nearly io million people. During the period I964 to I968 biopsies from approximately 7,000 malignant tumours were studied histologically. This collection is at present under review and during this work it became apparent that a significant collection of orbital tumours had accumulated. Conditions such as pseudotumour, myelocele, and ossifying fibroma, although not strictly speaking neoplasms, are included in this review in those cases in which a biopsy was required to confirm the diagnosis. Sixty cases of proptosis in patients under the age of I6 years were reviewed. Sections from all cases were stained with haematoxylin and eosin. Other stains used as necessary included PAS, Glees Marsland for neural elements, reticulin stains, PTAH, Fontana, and the naphthol AS-D chloroacetate esterase reaction in suspected cases of chloroma. ResultsThe diagnoses made in the sixty cases are shown in the Table. There were forty males and twenty females, the male excess being least marked in cases of Burkitt's tumour. Children with Burkitt's tumour were aged between 3 and I5 years (mean 7.3): sixteen male and twelve female.The youngest patient with chloroma associated with acute myeloblastic leukaemia was a child aged i year, but otherwise the ages ranged from 5 to I2 years. The peripheral blood was normal in two cases though the marrow always showed leukaemic changes.Three of the six patients with orbital myelocele presented before the age of 6 months except for one child first seen at the age of 3 years. Five out of these six patients were males.Six cases of fibrous dysplasia causing proptosis were seen and again five of the six patients were males; the average age at presentation was io years.Only two out of seventy patients with nasopharyngeal carcinoma (lymphoepithelioma) presented because of proptosis; one was aged I 2 and the other I 5 years. The commonest presenting sign was that of lymph node enlargement with or without symptoms of nasal obstruction.Orbital rhabdomyosarcoma is seen fairly frequently in Uganda, but it so happened that, although six cases were recorded in I963, only one was seen in the period of this survey (I964-I968).

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