Cirrhosis and Primary Liver Carcinoma in Uganda Africans

Abstract

(Knowelden, 1957) suggest that the incidence of liver cancer in Uganda males is two and a half times that of a corresponding Danish population but that an elevated frequency in Uganda females could not be shown. Relative to other malignant tumours, liver cancers ranked fourth, being exceeded only by those of the uterine cervix, skin and penis (Davies, 1957). Carcinoma of the liver thus is an important and major neoplastic disease in Uganda. Most cancers arise in cirrhotic livers so that the cirrhosis also demands study.This report will attempt to characterise the pathological features both of cirrhosis and of cancer in Uganda Africans. Because the ultimate objective is to find aetiological factors, special attention was paid during this study to the histopathogenesis of the lesions and to possible causative agents of both diseases. It is known from Africa (Berman, 1951) and other countries (Steiner, 1954) that where the frequency of liver cancers is high, the disease often comes on early in life. The higher yield of tumours and the possible shortened induction time suggest that the aetiological factors are intensified. A study of the exaggerated situation might reveal cause-and-effect relationships not apparent where the frequency is low.Some special problems given consideration included the following:-1. Is the high incidence of liver cancer due merely to more cases of the usual morphological types or do new varieties enter the picture ?

Primary cancer of the liver in Kenyan children

“…All 8 patients were between the ages of 12 and 20 years. Steiner and Davies (1957) Wainwright (1961) Prates (1961) Gelfand, Castle and Buchanan (1972) Anthony (1973) Cameron and Warwick (this paper) (Fig. 7).…”

Liver cell dysplasia: a premalignant condition

“…Available evidence suggests that there may be a geographical variability in the occurrence of liver cell dysplasia in that it appears to be less common in North America (Steiner and Davies, 1957) and in Europe (Scheuer, 1968). This lower incidence would parallel the lower incidence of liver cell carcinoma in these areas (Doll et al, 1966).…”

“…Gross morphological abnormality of liver cells in cirrhosis has been noted from time to time (Edmondson and Steiner, 1954;Steiner and Davies, 1957;Higginson and Steiner, 1961), particularly in the macronodular (posthepatitic or postnecrotic) types (Scheuer, 1968). The terms 'liver cell atypia', 'hyperplastic nodule', and 'regeneration' have been applied to this change.…”

“…The terms 'liver cell atypia', 'hyperplastic nodule', and 'regeneration' have been applied to this change. Steiner and Davies (1957) commented on its relative frequency in African, as compared with American cirrhotic livers. The distinction between an atypical nodule and well differentiated liver cell carcinoma may be difficult (Higginson and Steiner, 1961).…”

“…The distinction between an atypical nodule and well differentiated liver cell carcinoma may be difficult (Higginson and Steiner, 1961). However, these foci of cellular atypia have not been thought to represent a premalignant or malignant change, the arguments against this being that the histopathological features were different from carcinomas arising in the same livers (Steiner and Davies, 1957) or that such foci could persist in cirrhotic livers for years without carcinoma supervening (Scheuer, 1968). In experimental pathology similar changes may be produced by a variety of means and their interpretation remains uncertain (Butler, 1971).…”