Health
Vol.11 No.09(2019), Article ID:95483,9 pages
10.4236/health.2019.119092
Hepatocellular Carcinoma in Benin City, Nigeria: A Twenty-Five (1987-2011) Year Retrospective Histopathological Study
1Department of Pathology, FMC, Owerri, Imo State, Nigeria
2University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
Copyright © 2019 by author(s) and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
Received: April 15, 2019; Accepted: September 26, 2019; Published: September 29, 2019
ABSTRACT
Aim: To evaluate the demographic characteristics and histological variants of hepatocellular carcinoma (HCC) in Benin City. Methodology: The surgical daybooks of the Department of Anatomic Pathology, University of Benin Teaching Hospital were used for data collection. All the liver biopsies received in the period (1987-2011) under review diagnosed with HCC were analysed using SPSS version 16.0. Results: The male to female ratio was 2:1 and the peak age of incidence was in the 50 - 60 years age group. The mean ages were 44.24 ± 18.52 and 48.75 ± 12.92 and the age ranges were 1.5 to 82 years and 20 to 68 years for males and females respectively. The modal age was 60 years. Histological variants of hepatocellular carcinoma were the pseudoglandular/acinar pattern which accounted for 26 cases (44.07%), followed by the trabeculae pattern 17 cases (28.81%), the compact/solid variant 10 cases (16.95%) and the fibrolamellar pattern which was 6 cases (10.17%). Conclusion: Hepatocellular carcinoma has divergent demographic and histological characteristics which have clinical implications on the treatment outcomes; hence pathologists are encouraged to include the subtype in their reports for prognostication.
Keywords:
Hepatocellular Carcinoma, Benin City, Nigeria
1. Introduction
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer death worldwide [1]. HCC has a wide variation in its incidence in different parts of the world, East Asia and Sub-Saharan Africa has the highest number of cases [2]. In South-East Asia and Sub-Saharan Africa, 10 - 30 new cases per 100,000 males were reported each year, whereas, in northern Europe, North America and Australia, the annual incidence rates of HCC were less than 3 cases per 100,000 males [3]. Several reports from different parts of Nigeria demonstrated that HCC is the second, third, fourth and ninth most frequent cancer in Lagos, Ilorin, Jos, and Sokoto, respectively [4] [5] [6] [7]. In Ghana, Wiredu et al. [8] reported that HCC is the third most frequent malignancy in the female after cancer of the uterine cervix and breast. The incidence of HCC in Eastern, Central, and Western Africa is 24.2, 14.4 and 13.5 per 100,000 males respectively [9]. However, lower incidence rates were reported in northern (4.9/100,000 males) and southern (6.2/100,000 males) Africa which have incidence rates similar to Europe [9]. The Middle East has lower incidence rates of HCC when compared to South East Asia and Africa, with variations among different countries [10]. Moreover, Murugavel et al. [11] reported very low incidences of 0.2% to 1.9% of HCC in India compared to China, Japan, and other Southeast Asian countries.
Hepatocellular carcinoma is a complex tumour with variable histomorphological appearance [12]. The World Health Organization (WHO) recognised histological variants are scirrhous HCC, fibrolamellar carcinoma, combined HCC-cholangiocarcinoma (HCC-CC), sarcomatoid HCC, undifferentiated carcinoma, and lymphoepithelioma-like HCC. Other subtypes including clear cell HCC, diffuse cirrhosis-like HCC, steatohepatitic HCC, transitional liver cell tumour, and College of American Pathologist (CAP) carcinoma are also recognised [13]. Several reports demonstrated that histomorphological variants of
This is a study of the HCC diagnosed histologically in University of Benin Teaching hospital, Benin City South-south Nigeria with emphasis on the demographics and histological variants of the tumour.
2. Methodology
This is a retrospective study. The period under review was 25 years (January 1 1987 to December 31 2011). The data were collected from surgical daybooks, glass slides, tissue blocks, histology request and report forms of the Department of Pathology, University of Benin Teaching Hospital Benin City, Edo State, Nigeria. The demographic parameters of the patients histologically diagnosed with HCC were obtained. The Haematoxylin and Eosin (H&E) stained slides were reviewed and the histological variants of the hepatocellular carcinoma were recorded. In cases whose histology slides were damaged or missing, the formalin-fixed paraffin-embedded (FFPE) tissue blocks were selected and sectioned with a microtome. Fresh sections (3 - 4 µ) were processed on lysine coated glass slides, de-paraffinized with xylene, rehydrated in graded alcohol and stained with hematoxylin and eosin (H&E). Those liver biopsies which did not meet the inclusion criteria were excluded from the study. The data were analysed with SPSS version 16.0
3. Results
A total of 235 liver biopsies were received in the Department of Histopathology, University of Benin Teaching Hospital, Benin City during the period under review. Fifty-nine (59) of these cases were diagnosed histologically with HCC.
Of the 59 confirmed cases of HCC, 39 cases (66.10%) were male while 20 cases (33.90%) were females giving a male to female ratio of 2:1. The age range for all the patients was 1.5 to 82 years with a peak incidence in the 51 - 60 years age group which accounted for 13 cases (22.4%). See Table 1. The overall mean age was 48.16 ± 16.55 years. The modal age was 60 years. The age range for males and females were 1.5 to 82 years and 20 to 68 years, with a mean age of 44.24 ± 18.52 and 48.75 ± 12.92 respectively.
The dominant histological variant of hepatocellular carcinoma was the pseudoglandular/acinar pattern which accounted for 26 cases (44.07%), followed by
Table 1. The distribution of hepatocellular carcinoma for different age groups.
the trabecular pattern with 17 cases (28.81%), the compact/solid variant with 10 cases (16.95%) and the fibrolamellar pattern with 6 cases (10.17%). These findings are depicted in Figure 1.
4. Discussion
HCC is 2 - 7 times more common in males than females worldwide [23] except in Iran where there is a slight female preponderance [10]. In our study, the male to female ratio was 2:1. The mean age was 44.24 ± 18.52 and 48.75 ± 12.92 with age range of 1.5 to 82 and 20 to 68 years for males and females respectively. The peak age of incidence was 51 - 60 years (22.03%) followed by 31 - 40 and 41 - 50 age groups, which constituted 20.34% respectively. The gender ratio is relatively consistent with other reports from Enugu, Port Harcourt, Ile-Ife and Zimbabwe [24] [25] [26] [27]. However, the peak age of incidence in these reports are diverse, ranging from 20 - 39 in Enugu to 40 - 59 in Ile-Ife [24] [25] [26] [27]. In Kenya, Mutuma et al. [28] reported a male to female ratio of 5:2, mean age of 40 years and the peak age of incidence of 41 - 60 year age group. These reports demonstrated that HCC appears to be more prevalent between the ages of 30 and 70 years. In this study, 80% of all HCC occurred within this age range. In Pakistan, HCC is the second most prevalent liver disease and constituted 7.9% after viral hepatitis (68.3%), with a male to female ratio of 1:1 and peak age of incidence of 31 - 50 years [28]. In our study, the youngest patient was aged 1.5 years compared to 14 and 17 years in Port Harcourt [23] and Zimbabwe [27] respectively. Leong and Schandy et al. [29] [30] reported that HCC may occur in children who were exposed to HBV infection early in life, children who have other risk factors like biliary atresia, inborn errors of metabolism (hereditary tyrosinemia, Wilson’s diease, α1-antitrypsin deficiency and glycogen storage disease), giant cell hepatitis of infancy and genetic alterations in cancer suppressor genes.
There are several histologic variants of hepatocellular carcinoma. These include the pseudoglandular, trabecular, scirrhous, clear cell, giant cell, sarcomatoid,
Figure 1. A pie chart showing the histological variants of hepatocellular carcinoma in Benin City.
compact or solid type and fibrolamellar variants [2]. In this study, pseudoglandular pattern was observed in 24 cases (40.68%), trabecular pattern in 17 cases (28.81%), solid variants in 12 cases (20.34%) and fibrolamellar pattern in 6 cases (10.16%). In Port Harcourt, a city in the same geopolitical zone as Benin City, Seleye-fubara et al. [25] reported a different pattern. These histologic variants included trabecular/sinusoidal pattern 37 cases (49.3%), pseudoglandular/acinar pattern 21 cases (28%), compact/solid pattern 12 cases (16.09%), clear cell type 3 cases (4.0%) and fibrolamellar pattern 2 cases (2.7%) [25]. In East Africa country of Kenya, Mutuma et al. [28] reported that the histological variants of
Table 2. Shows the relative frequency of histologic variants of HCC in Nigeria and other countries.
*Current study, PH—Port-Harcourt.
variations, serum alpha-fetoprotein levels greater than 400 ng/ml,
5. Conclusion
Hepatocellular carcinoma has different demographic and histological characteristics, hence understanding its protean morphology and ensuring comprehensive histological reporting would improve the clinical outcomes.
Ethical Considerations
Ethical approval for this research was obtained from the Medical Research Ethics Committee of the University of Benin Teaching Hospital Benin City.
Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.
Cite this paper
Nnadi, I.G., Olu-Eddo, A.N. and Obaseki, D.E. (2019) Hepatocellular Carcinoma in Benin City, Nigeria: A Twenty-Five (1987-2011) Year Retrospective Histopathological Study. Health, 11, 1177-1185. https://doi.org/10.4236/health.2019.119092
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