Report 2010 Pathology Program

INCTR, with the support of the NCI Office of HIV and AIDS Malignancies, is working to establish improved pathological diagnosis in the context of the African Burkitt lymphoma (BL) Strategy Group study entitled, "The Treatment and Characterization of BL in Africa" which seeks to compare the presentation features and outcomes of HIV+ and HIV- BL patients in equatorial Africa. The program's goal is to achieve central pathology review for the treatment study and to improve pathology, services in participating countries.

  • Visit to Africa by INCTR's Pathology Team - January, 2010

In January 2010, a team of experienced hematopathologists visited histopathology departments in Cameroon and Nigeria. The objectives of the visit were to determine the concordance between the original diagnosis of lymphoid malignancies made by the local pathology teams and an expert consensus review diagnosis, to assess the available histopathology resources, including infrastructure, staff and technical resources for the purposes of establishing basic immunohistochemistry to facilitate lymphoma diagnosis and to determine whether the departments could support iPath for the purposes of training and consultation. At the two Nigerian centers visited, diagnostic material from cases of BL entered onto the INCTR protocol in addition to other cases of lymphomas and reactive or atypical lymph nodes were reviewed. Independent review by two expert hematopathologists was performed and responses were analyzed for consensus. Discordant cases were further discussed to arrive at a consensus diagnosis. Discussions were held with the host institution pathology teams - for discrepant cases and for more complex cases. As the reviewers encountered problems related to the quality of the fine needle aspirates, they provided practical demonstrations of this technique in addition to non-aspiration cytology techniques. These practical sessions were attended by hematologists, histopathologists and trainees. It was learned that individuals in both of the Nigerian centers had had some exposure to immunohistochemistry and this was considered encouraging since it would ease the introduction of performing this on a more routine basis. A limited panel of monoclonal antibodies to distinguish lymphoid and non-lymphoid malignancies could be developed and training provided through regional workshops, coordinated faculty visits and the introduction of telepathology for continuous support in diagnosis and education.

One of the pathologists, Dr. Nina Hurwitz also visited Kenya and Tanzania to move the implementation of the iPath telepathology program forward in these two countries. Institutions included in these visits included the Kenyatta National Hospital, University of Nairobi, Aga Khan University, the Kenya Wellcome Trust Research Progam at Kalifi in Kenya and the Muhimbili University Hospital. In each University visited, equipment and technical services were assessed. Cases were reviewed by the expert pathology team as was done in the prior visit to E Africa, and difficult cases or particularly interesting cases were sent for further studies in the laboratories of the visiting pathology team. These cases will be discussed at a workshop to be held in Paris in early 2011 and a "Tutorial in Pathology" will take place later in 2011. The latter will focus on practical hematopathology, including procedures and basic interpretational skills.

  • The INCTR Program for Online Consultation and Continuing Education Using iPath

INCTR's program for web-based case consultations, iPath, continues to grow as more members submit cases and the program is used for a broader range of diseases (it was initiated with hematopathology) and oncology as well as pathology, and is used increasingly for teaching purposes. The program is directed by Dr. Nina Hurwitz, assisted by Monika Hubler.

The iPath program was introduced to the pathology teams at the two Nigerian centers at the time of the January 2010 visit and also to other pathologists from surrounding areas. Representatives from the Ministry of Health also attended this introductory meeting and expressed an interest in expanding iPath to many other institutions throughout the country in order to improve pathology services.

The program was presented by Dr Hurwitz, Dr Jessie Githang'a, Chairman of the Department of Human Pathology at the Kenyatta National Hospital (KNH) and Dr. E Walong, a pathology resident at KNH at the meeting of the East and South African Pathologists at the 10th Biennial Conference of Pathologists from East, Central and Southern Africa (APECSA) Kampala, Uganda September 13th-17th 2010. This conference was focused on "Repositioning pathology practice in sub-Sahara Africa; opportunities and challenges". Pre-conference meetings were held on the 13th through the 15th and addressed hematopathology and the role of pathology in cancer diagnosis and care - two key components of INCTR's Pathology Program.

  • Pathology Workshop in Siena "What can we learn from Africa? New insights to lymphoma classification, heterogeneity, molecular epidemiology & biology

The Siena workshop took place in May 2010 and was designed to provide a platform to illustrate pitfalls in lymphoma diagnoses, and to identify measures to counter the diagnostic difficulties. The aim was to share the experience of the visiting hematopathologists with pathologists from different backgrounds and different sites across the globe, and also include discussions of more recent developments in the field - e.g., modification of the WHO Classification system for lymphoid neoplasms. The meeting was also intended to provide an opportunity to plan future clinical and research studies in lymphomas in Africa, and to support twinning programs in hematopathology between the developed and the developing countries.
The meeting included some 80 people, about a third from various sub-Saharan African countries, and several members of the AIDS Malignancy Consortium as well as Dr Mostafa Nokta, Director of the Office of HIV and AIDS malignancies at the NCr. In all, the meeting, held in the beautiful monastery of Certosa di Pontignano belonging at the time to the University of Siena, was a great success. A report of the meeting was published in the September edition of NETWORK Magazine.
Pediatric Oncology
The goal of the Pediatric Oncology Program is to improve the quality of care for children and adolescents with cancer in LMIC. The specific aims of the program are to provide education and training in pediatric cancer and its management, including supportive care, psychosocial support and palliative care, to establish relevant programs addressing aspects of pediatric cancer care within institutions or settings where there are identified needs and to establish centers of excellence in the delivery of pediatric cancer care.
Establishment of a Comprehensive Pediatric Oncology Program for Tikur Anbessa Hospital (Black Lion Hospital) in Addis Ababa, Ethiopia
INCTR USA, in collaboration with the Division of Pediatric Hematology/Oncology, Blood and Marrow Transplantation Program at the Lombardi Cancer Center, Georgetown University launched a 3 year pilot program to improve pediatric cancer survival rates at Tikur Anbessa Hospital through the training of health care professionals to deliver protocol-based treatment for children with highly curable cancers. The program will include the development of appropriate palliative care and pain management services for these patients. Tikur Anbessa Hospital sees 400 to 600 new cases of pediatric cancer each year.
In late 2010, plans were made to hold a meeting entitled, "1st International Symposium in Pediatric and Adolescent Oncology in Ethiopia". The meeting is intended to be a four day symposium and is being organized in partnership with the Addis Ababa University, Tikur Anbessa Hospital, Georgetown University Hospital and INCTR, USA. Pediatricians, medical residents and interns, nurses and pharmacists from Ethiopia have been invited to attend this meeting. An international faculty, including other LMIC that have faced similar challenges confronting Ethiopia when establishing pediatric cancer care programs have been invited along with Ethiopian physicians to provide the lectures for the symposium. An educational workshop
INCTR Progress Report 2010
INCTR Aisbl- 642 rue Engeland - B-1180 Brussels - Belgium -Web site: www.inctr.org35

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