Renal cell carcinoma diagnosed by the Department of Anatomical Pathology at the University of the Free State, South Africa: a 10 year histopathological review
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Date
2020-08
Authors
Muller, Louis Johannes
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Publisher
University of the Free State
Abstract
Background: Globally, the incidence of renal cell carcinoma varies widely between populations and geographic areas, with the lowest incidence reported in Africa. Very little information is available on the epidemiology or histopathological profile of renal cell carcinoma (RCC) in the South African population, and most studies on RCC in Africa are from Nigeria. The determination of the incidence, demographic and histopathological features of RCC would provide the latest and most up to date information on RCC epidemiology in the state sector in central South Africa and would serve as a foundation for future research. Aim: The purpose of this study was determine the number of cases of RCC seen over a ten year period by the Department of Anatomical Pathology, University of the Free State and National Health Laboratory Service and to describe the demographic profile of the patients identified as well as the histological spectrum. We further aimed to determine the agestandardised incidence rate (ASR) of RCC for state sector patients from the Free State Province. Methods: A retrospective descriptive review with an analytical component was performed. All histologically confirmed cases of RCC identified between 1 January 2005 and 31 December 2014 were included in the study. The pathology reports were reviewed to collect the demographic information for each case and the H&E slides were reviewed to confirm the diagnosis and the specific histological subtype. ASRs were calculated using the population data from the South African census as performed in 2011. ASRs were only calculated for the Free State Province and patients from the North West and Northern Cape Provinces were excluded for these calculations as the department does not receive all the specimens from these two provinces. Results: A total of 105 patients with RCC were diagnosed with a male:female ratio of 1.2:1 and a mean age of 55.1 years. The age standardized incidence rate for the Free State province was 0.4 per 100 000 population. Ten patients (9.5%) were younger than 40 years. The majority of cases were identified in the age group 50 to 59 years (33.3%). The majority of patients (58.1%) were black and they were found to present on average a decade earlier than white patients. The most common histological subtype was clear cell RCC (58.1%). Patients diagnosed with papillary RCC were found to be significantly more likely to be male than female (72.7% vs 27.3%; p=0.03) and were also more likely to be black than white (81.8% vs 13.6%; p<0.01). Patients with chromophobe RCC were more likely to be female (80%) and black (60%). Two cases of a new entity, clear cell RCC with giant cells and emperipolesis were identified. All five patients with MiT family translocation RCC were diagnosed in black females. Conclusion: To our knowledge this is the most comprehensive study on RCC performed in our region. Our study demonstrated that the incidence of RCC in our population is lower than reported in the rest of the world. The age distribution correlates closely with other African studies, with black patients presenting a decade earlier than white patients. In addition, our findings identified distinct age, sex and racial differences for the various RCC subtypes, which warrants further research.
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Keywords
Renal cell carcinoma, Epidemiology, Histological type, Incidence, Central South Africa, Dissertation (M.Med (Anatomical Pathology))--University of the Free State, 2020