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. 2018 Jul-Sep;9(3):363-369.
doi: 10.4103/jnrp.jnrp_562_17.

Clinicopathologic Features and Early Surgical Outcome of Astrocytomas in Eldoret, Kenya

Clifford C Mwita  1   2 , Florentius Koech  1 , Titus Sisenda  1 , Kirtika Patel  3 , Benson Macharia  4 , Devendra Rahangdale  5
Affiliations

Clinicopathologic Features and Early Surgical Outcome of Astrocytomas in Eldoret, Kenya

Clifford C Mwita et al. J Neurosci Rural Pract. 2018 Jul-Sep.

Abstract

Background: Astrocytomas are primary central nervous system tumors arising from astrocytes and accounting for up to 37.8% of all brain tumors seen in hospital-based studies from Africa. Despite being common, their patterns and short-term outcomes remain poorly studied in Kenya.

Materials and methods: A prospective, descriptive study involving consecutive patients with a histological diagnosis of astrocytoma seen in three hospitals located in Eldoret, Kenya. Clinicopathologic characteristics and outcomes were recorded and patients followed up for 12 weeks.

Results: Thirty-one patients were recruited over a 1-year period. Majority of them were female (51.6%). Headache (83.9%) and focal neurological deficits (64.5%) were the most common presenting features. Among patients with high-grade tumors, mean duration of illness was 106.03 ± 162.16 days, median functional status was Karnofsky performance status (KPS) score 50, mean tumor size was 110.22 ± 46.16 cm3, and median magnetic resonance imaging (MRI) score was 17. Among patients with low-grade astrocytomas, mean duration of illness was 213.03 ± 344.93 days, median functional status was KPS score 40, mean tumor size was 53.49 ± 54.96 cm3 and median MRI score was 9. Glioblastoma multiforme (GBM) (71%) and diffuse astrocytoma (22.6%) were the predominant histological subtypes. The median Ki-67 proliferative index was 6% for pilocytic astrocytoma, 1.6% for diffuse astrocytoma, and 60% for GBM. Systemic and regional surgical complications occurred in 6.5% and 38.7% of patients, respectively. In-hospital mortality was 19.4% and increased to 25.8% at 12 weeks. The KPS score at discharge was 50 and improved to 60 at 12 weeks. Only 9.7% of patients had acceptable functional status at 12 weeks follow-up.

Conclusions: In this locality, headache, focal neurological deficits, and reduced functional status are the most common presenting features of astrocytomas while GBM is the most common histological subtype. Tumors are highly proliferative and in the short-term, both surgical and functional outcome are suboptimal.

Keywords: Astrocytoma; Ki67; brain neoplasms; glioblastoma.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Photomicrograph showing pilocytic (Grade I) astrocytoma. Mild cellularity, fibrillar background, and microcysts (H and E, ×40)
Figure 2
Figure 2
Photomicrograph showing pilocytic (Grade I) astrocytoma. Ki-67 immunostain (×40) showing few immunolabeled nuclei
Figure 3
Figure 3
Photomicrograph showing diffuse (Grade II) astrocytoma. Moderate cellularity and fibrillar background (H and E, ×40)
Figure 4
Figure 4
Photomicrograph showing diffuse (Grade II) astrocytoma. Ki-67 immunostain (×40) showing few immunolabeled nuclei
Figure 5
Figure 5
Photomicrograph showing glioblastoma multiforme (Grade IV astrocytoma). High cellularity, mitoses, and zonal necrosis (H and E, ×40)
Figure 6
Figure 6
Photomicrograph showing glioblastoma multiforme (Grade IV astrocytoma). Ki-67 immunostain (×40) showing numerous immunolabeled nuclei
See this image and copyright information in PMC

References

    1. CBTRUS. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2004-2008. 23 March, 2012 Revision. 2012
    1. Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, et al. CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006-2010. Neuro Oncol. 2013;15(Suppl 2):ii1–56. - PMC - PubMed
    1. Ohgaki H, Kleihues P. Epidemiology and etiology of gliomas. Acta Neuropathol. 2005;109:93–108. - PubMed
    1. Mwang’ombe NJ, Ombachi RB. Brain tumours at the Kenyatta National Hospital, Nairobi. East Afr Med J. 2000;77:444–7. - PubMed
    1. Zalata KR, El-Tantawy DA, Abdel-Aziz A, Ibraheim AW, Halaka AH, Gawish HH, et al. Frequency of central nervous system tumors in Delta region, Egypt. Indian J Pathol Microbiol. 2011;54:299–306. - PubMed

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