Beyond Endemic Burkitt Lymphoma: Navigating Challenges of Differentiating Childhood Lymphoma Diagnoses Amid Limitations in Pathology Resources in Lilongwe, Malawi.

Autor:	El-Mallawany NK; Baylor College of Medicine, Houston, TX, USA.; Texas Children's Cancer and Hematology Centers, Houston, TX, USA., Mutai M; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Kamuzu Central Hospital, Lilongwe, Malawi., Mtete I; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Kamuzu Central Hospital, Lilongwe, Malawi., Gopal S; UNC Project-Malawi, Lilongwe, Malawi.; University of North Carolina, Chapel Hill, NC, USA., Stanley CC; UNC Project-Malawi, Lilongwe, Malawi., Wasswa P; Texas Children's Cancer and Hematology Centers, Houston, TX, USA.; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Kamuzu Central Hospital, Lilongwe, Malawi., Mtunda M; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Kamuzu Central Hospital, Lilongwe, Malawi., Chasela M; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Kamuzu Central Hospital, Lilongwe, Malawi., Kamiyango W; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Kamuzu Central Hospital, Lilongwe, Malawi., Villiera J; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.; Kamuzu Central Hospital, Lilongwe, Malawi., Fedoriw Y; University of North Carolina, Chapel Hill, NC, USA., Montgomery ND; University of North Carolina, Chapel Hill, NC, USA., Liomba GN; UNC Project-Malawi, Lilongwe, Malawi., Kampani C; UNC Project-Malawi, Lilongwe, Malawi., Krysiak R; UNC Project-Malawi, Lilongwe, Malawi., Westmoreland KD; University of North Carolina, Chapel Hill, NC, USA., Kim MH; Baylor College of Medicine, Houston, TX, USA.; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi., Slone JS; Baylor College of Medicine, Houston, TX, USA.; Texas Children's Cancer and Hematology Centers, Houston, TX, USA., Scheurer ME; Baylor College of Medicine, Houston, TX, USA.; Texas Children's Cancer and Hematology Centers, Houston, TX, USA., Allen CE; Baylor College of Medicine, Houston, TX, USA.; Texas Children's Cancer and Hematology Centers, Houston, TX, USA., Mehta PS; Baylor College of Medicine, Houston, TX, USA.; Texas Children's Cancer and Hematology Centers, Houston, TX, USA., Kazembe PN; Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
Jazyk:	angličtina
Zdroj:	Global pediatric health [Glob Pediatr Health] 2017 Jun 23; Vol. 4, pp. 2333794X17715831. Date of Electronic Publication: 2017 Jun 23 (Print Publication: 2017).
DOI:	10.1177/2333794X17715831
Abstrakt:	Background. Although Burkitt lymphoma (BL) is the most common childhood lymphoma in sub-Saharan Africa, Hodgkin lymphoma (HL) and other non-Hodgkin lymphomas occur. Diagnosing non-jaw mass presentations is challenging with limited pathology resources. Procedure. We retrospectively analyzed 114 pediatric lymphomas in Lilongwe, Malawi, from December 2011 to June 2013 and compared clinical versus pathology-based diagnoses over two time periods. Access to pathology resources became more consistent in 2013 compared with 2011-2012; pathology interpretations were based on morphology only. Results. Median age was 8.4 years (2.1-16.3). The most common anatomical sites of presentation were palpable abdominal mass 51%, peripheral lymphadenopathy 35%, and jaw mass 34%. There were 51% jaw masses among clinical diagnoses versus 11% in the pathology-based group ( P < .01), whereas 62% of pathology diagnoses involved peripheral lymphadenopathy versus 16% in the clinical group ( P < .01). The breakdown of clinical diagnoses included BL 85%, lymphoblastic lymphoma (LBL) 9%, HL 4%, and diffuse large B-cell lymphoma (DLBCL) 1%, whereas pathology-based diagnoses included HL 38%, BL 36%, LBL 15%, and DLBCL 11% ( P < .01). Lymphoma diagnosis was pathology confirmed in 19/66 patients (29%) in 2011-2012 and 28/48 (60%) in 2013 ( P < .01). The percentage of non-BL diagnoses was consistent across time periods (35%); however, 14/23 (61%) non-BL diagnoses were pathology confirmed in 2011-2012 versus 16/17 (94%) in 2013. Conclusions. Lymphomas other than Burkitt accounted for 35% of childhood lymphoma diagnoses. Over-reliance on clinical diagnosis for BL was a limitation, but confidence in non-BL diagnoses improved with time as pathology confirmation became standard. Increased awareness of non-BL lymphomas in equatorial Africa is warranted. Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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