Dichotomous associations of liver pathology with hepatocellular carcinoma morphology in Middle Africa: the situation in Cameroon

BMC Research Notes, Jul 2018

Objective This study evaluates the occurrence of the various morphological subtypes of hepatocellular carcinoma (HCC) and their connections with some risk factors in Cameroonian patients. The database of the 360 liver biopsies received and associated medical records were reviewed for histological and demographic analysis. Archival formalin-fixed and paraffin embedded liver biopsy specimens or slide were re-evaluated in malignancies patients. HCC classification was determined according to the World Health Organization criteria. Results Malignancies were confirmed in 24.7% (89/360) of liver biopsies. Primary liver tumors consisted in 80 cases of HCC and one case of hepatoblastoma. The distribution of the morphological variants of HCC was trabecular pattern (n = 45/80, 56.25%), acinar/pseudoglandular (32.5%) or scirrhous (11.2%). Remarkably, liver steatosis was present in 60.0% (48/80) of patients with HCC, most of them infected with hepatitis C virus (75.8%). Well-differentiated trabecular tumors were significantly associated with important fibrotic and necro-inflammatory activities in livers (P = 0.008) whereas acinar pattern was more frequent on fatty livers (P = 0.02). Our finding indicates that in Middle Africa the morphology of HCC subtypes correlates with changes affecting non-tumor liver tissue. Trabecular subtype is installed by strong liver injury whereas acinar pattern is more often associated with lipid metabolism defects.

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Dichotomous associations of liver pathology with hepatocellular carcinoma morphology in Middle Africa: the situation in Cameroon

Amougou et al. BMC Res Notes Dichotomous associations of liver pathology with hepatocellular carcinoma morphology in Middle Africa: the situation in Cameroon Marie Atsama Amougou 0 2 3 Paul Jean Adrien Atangana 0 3 Alice Ghislaine Ndoumba Afouba 0 3 Paul Fewou Moundipa 2 Pascal Pineau 1 Richard Njouom 0 3 0 Virology Unit, Centre Pasteur of Cameroon , BP 1274 Yaoundé , Cameroon 1 Unité « Organisation nucléaire et Oncogenèse », INSERM U993, Institut Pasteur , Paris, 75015 Paris , France 2 Laboratory of Pharmacology and Toxicology, University of Yaounde I , BP 815 Yaounde , Cameroon 3 Virology Unit, Centre Pasteur of Cameroon , BP 1274 Yaoundé , Cameroon Objective: This study evaluates the occurrence of the various morphological subtypes of hepatocellular carcinoma (HCC) and their connections with some risk factors in Cameroonian patients. The database of the 360 liver biopsies received and associated medical records were reviewed for histological and demographic analysis. Archival formalinfixed and paraffin embedded liver biopsy specimens or slide were re-evaluated in malignancies patients. HCC classification was determined according to the World Health Organization criteria. Results: Malignancies were confirmed in 24.7% (89/360) of liver biopsies. Primary liver tumors consisted in 80 cases of HCC and one case of hepatoblastoma. The distribution of the morphological variants of HCC was trabecular pattern (n = 45/80, 56.25%), acinar/pseudoglandular (32.5%) or scirrhous (11.2%). Remarkably, liver steatosis was present in 60.0% (48/80) of patients with HCC, most of them infected with hepatitis C virus (75.8%). Well-differentiated trabecular tumors were significantly associated with important fibrotic and necro-inflammatory activities in livers (P = 0.008) whereas acinar pattern was more frequent on fatty livers (P = 0.02). Our finding indicates that in Middle Africa the morphology of HCC subtypes correlates with changes affecting non-tumor liver tissue. Trabecular subtype is installed by strong liver injury whereas acinar pattern is more often associated with lipid metabolism defects. Hepatocellular carcinoma; Liver biopsy; Hepatoblastoma; Steatosis; Trabecular; Cameroon Introduction Primary liver cancer (PLC) is associated with a high mortality rate and it is the second cause of cancer-related death worldwide [ 1 ]. Sub Saharan Africa (SSA) represents a major region both in terms of incidence and mortality from HCC, the principal form of PLC [ 2, 3 ]. In Cameroon, little is known about the cancer burden in general. According to the GLOBOCAN 2012, however, PLC is the second type of cancers in term of incidence and the first cause of cancer-related mortality in the country [4]. Globally, the two main histological types of PLC are hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) [ 5 ]. Of these two types, HCC is known as the leading form of liver cancer worldwide [ 6 ]. In addition, HCC is a heterogeneous disease with four majors morphological subtypes such as trabecular, pseudoglandular/acinar or solid patterns [ 7 ]. It is now clear that hepatitis B virus (HBV) and hepatitis C virus are the main etiological viral factor for HCC development worldwide [ 8, 9 ] and both viruses are highly endemic in middle Africa [ 10–12 ]. No recent study describing the distribution of PLC histotypes and morphologies is available in the country. Furthermore, despite the importance of HCC in the region, recent pathological reports about this tumor are scarce in SSA as a whole. Such descriptions are all the more important that the global epidemiology of HCC is currently changing with the growing importance taken by dysmetabolic conditions such as liver steatosis and non-alcoholic steatohepatitis among major risk factors [ 13–16 ]. The importance of these conditions is poorly known in SSA despite the ongoing nutritional transition that concern segments of the African populations and the growing prevalence of non-communicable diseases such diabetes and obesity. The aim of the present study was, thus, to fill this gap using liver biopsies diagnosed over a 10-year period in Yaounde. Main text Materials and methods Data collection and inclusion criteria This retrospective study was conducted in the Pathology Unit of Centre Pasteur of Cameroon recognized as the national reference Laboratory of the Country. This study was the continuity of another project on primary liver Cancers approved by the Cameroonian Ethics Commitee and the Ministry of Health. All the biopsies received from January 2004 to January 2013 were reviewed and revealed a total of 2068 biopsies. Only the 360 patients identified with liver biopsy were include in the present study. Histological and demographic data regarding age at diagnosis and sex information were obtained from medical record and the database of the Unit. The study did not include information regarding clinical features concerning patients affected with the tumors b (...truncated)


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Marie Atsama Amougou, Paul Jean Adrien Atangana, Alice Ghislaine Ndoumba Afouba, Paul Fewou Moundipa, Pascal Pineau, Richard Njouom. Dichotomous associations of liver pathology with hepatocellular carcinoma morphology in Middle Africa: the situation in Cameroon, BMC Research Notes, 2018, pp. 451, Volume 11, Issue 1, DOI: 10.1186/s13104-018-3560-x