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)