Below: Distribution of the cases by sex. The Pie chart shows the distribution of males and females in the study. There were 68.2% female and 32.8% male
Below: The distribution of types of Lesions by age. The figure shows the distribution of cancers by age of diagnosis in HIV-1 cases in Kenyatta National Hospital between 2001 and 2011
Below: The distribution of neoplasms Reported between 2000 and 2011. The figure shows the cancers identified in Kenyatta National Hospital in 2001–2011 using patient charts and FFPE
Below: The distribution of neoplasms by site. The figure shows specific types of neoplasms detected at Kenyatta National Hospital with respect to site
A total of 173 lesions were reviewed and analyzed. Of these 118 (68 %) were from females and 55 from males (32 %). The male to female ratio was 1:2. The age range was from two to 56 years with a median of 36 years. Kaposi sarcoma is the leading AIDS defining malignancy in Kenya while invasive squamous cell carcinoma of the conjunctiva is the leading non-AIDS defining malignancy. This is closely followed by invasive squamous cell carcinoma of the cervix and NHL.
Kaposi sarcoma is the leading AIDS associated neoplasm in Kenya. Physicians and caretakers managing and following up on HIV/AIDS patients should look out for Kaposi sarcoma as a form of IRIS following the institution of HAART in all HIV/AIDS patients. The incidence of invasive squamous cell carcinoma of the conjunctiva is increasing in PLWAS in Kenya. There is therefore a need to introduce early screening programs for squamous intraepithelial neoplasm of the conjunctiva in HIV/AIDS patients.
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(a–c) Hyperkeratotic verrucous tumours of the fingertips originating from the nailbed. Following surgical removal and destruction of nail matrices, tumours recurred and eventually invaded into adjacent periungual skin. Histology revealed invasive squamous cell carcinomas. (d) Massive involvement of the perianal region with whitish-brown plaques (leucoplakias). Multiple biopsies revealed high-grade squamous intraepithelial neoplasias. Aggregates of hyperkeratotic condylomata acuminata are widely disseminated on the genitalia, perineum and buttocks.
Summary:
Squamous cell carcinoma (SCC) of the nail unit is a rare disorder. An association with high-risk genital human papillomavirus (HPV) infection has been reported. We report a 28-year-old human immunodeficiency virus (HIV)-infected bisexual man who had multiple invasive SCC of the fingers, infected with the rare type HPV 26. Classification of HPV 26 as high- or intermediate-risk type has been uncertain, due to its rare presence in cervical cancer. Despite successful treatment with highly active antiretroviral therapy (HAART), the patient developed extensive hyperkeratotic nailbed proliferations of all fingers. Tumours were refractory to treatment and invaded into adjacent tissues. X-rays of the hands demonstrated bone invasion, necessitating amputation of distal phalanges of several fingers. Histologically, highly differentiated preinvasive and invasive verrucous SCCs were identified. Molecular DNA typing identified HPV 26 in the SCCs and in some premalignant lesions. By in situ hybridization HPV 26 DNA was detected in numerous tumour cells, indicating productive infection with high-level amplification of the viral genome. In the remaining proliferations, high-risk HPV type 58, cutaneous HPVs and a putative new HPV type were identified. HPV 26 infection appears to be causally involved in the development of SCC of the nail unit in this immunosuppressed patient. Timely evaluation of chronic verrucous nailbed tumours is recommended, especially in immunocompromised patients. Identification of HPV 26, besides known high-risk HPV types, may identify patients at risk for developing SCC of the nailbed and possibly at other locations.
