What Can We Learn From Africa 4 - Report

The fourth meeting entitled "What can we learn from Africa" took place, as planned, at the Arusha Palace Hotel, Arusha, Tanzania from Feb13th to 15th 2014. Although we were expecting only some 50 people to

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participate, in the event, there were 73 participants, the majority from various African centers.

Background Information: This is the fourth meeting in a series of meetings of the same name that have been held on an annual basis, from 2011 to 2014. The first was held in Siena, Italy, the second in Paris, France, and the third in Mombasa, Kenya. Following a series of visits to pathology laboratories in several African countries to assess resources and skills (of both technologists and pathologists, the focus being on hematopathology) it became clear that most diagnoses are made on the basis of histology alone, or, in the case of Burkitt lymphoma (BL) fine needle aspirate (FNA) alone. In the absence of immuno-histochemistry, the World Health Classification cannot be used since immunophenotyping is required. But for optimal treatment the diagnosis must be correct, and it is important that as many centers in Africa as possible establish pathology laboratories capable of performing immunophenotyping, firstly with the objective of differentiating haematological neoplasms from non-haematological neoplasms and secondly distinguishing one haematological neoplasm from another.

The special lecture by Prof Falko Fend and the key note lecture given by Prof Harald Stein on the biology of B cells and the role of Epstein Barr Virus in Hodgkin lymphoma were of particular value in understanding the reasons that different neoplasms express different functional molecules on the cell surface. It is these functional molecules that enable the tumour cells to survive in unusual (for them) sites of the body, which is one of the characteristics of malignant cells. Sometimes, in order to do this, they must recreate their own microenvironment by secreting chemical messengers referred to as cytokines or chemokines. The presence of viral proteins or cellular proteins caused to be inappropriately expressed by virtue of molecular genetic changes, then, are the immediate cause of the malignant state. The inappropriately expressed cytokines and chemokines are capable of attracting specific cells to the vicinity of the neoplastic cells, and create a microenvironment in which they can flourish.

Purpose/Goals: In order to rectify the inability of most African laboratories to perform immunohistochemistry or other forms of immunophenotyping (flow cytometry can be used, for example, in the case of liquid tumors (leukemias), it was decided to try to establish immunohistochemistry by on-site training in at least 2 or 3 hospitals and to hold a meeting on the diagnosis of hematological malignancies in Africa on an annual basis in order to improve the knowledge and skills of African hematopathologists and clinicians with regard to the diagnosis and treatment of hematological malignancies.

This workshop as the previous editions also addressed the role of infectious agents in the pathogenesis of lymphoma – the high incidence of chronic infections in tropical countries results in African countries having the highest overall rates of infection related cancer. Knowing this, preventive measures, whether by means of vaccines, or treatment can not only reduce the incidence of the primary disease, but also reduce the incidence of cancers that are associated with these infectious agents.

The meeting was held under the auspices of INCTR's Pathology Program and Coordinated by Lorenzo Leoncini, Martine Raphael, KK Naresh, N. Hurwitz, Ian Magrath
Other INCTR Organizers: AMCC, INCTR (Brussels). Dr Edda Vuhahula, Dar-es-Salaam, was the local host.

Institutions: The workshop was attended by participants from various African countries including Tanzania, Democratic Republic of Congo, Senegal, Nigeria, Rwanda, South Africa, Uganda and Kenya. The Faculty included pathologists from Italy, Germany, France and the USA
There were 74 participants including pathologists, haematologists, clinicians (especially oncologists) and research scientists

Sponsors: INCTR would like to thank the generous sponsorships provided by: the European Association for Haematopathology; Office of HIV and AIDS Malignancies, NCI, USA; Center for Global Health, NCI, USA; Aga Khan Foundation; Institut National du Cancer, France; Leica Microsystems; Dako; Bactlabs, East Africa, Ltd.

Evaluation: The meeting of professionals, both pathologists and clinicians, from Africa, Europe and USA not only stimulates further research, particularly into aetiology and pathogenesis, but also enhances knowledge about diagnostic methods and therapy. This meeting also provided an opportunity for African haematopathologists and haematologists to discuss cases with their colleagues from Europe and the USA, and to share experiences on maximal use of limited resources. On this topic there was an excellent talk by Prof Ethel Ceserman on developing a PCR machine powered by solar energy to improve the early diagnosis of Kaposi Sarcoma on the field. The session “Challenges in Lymphoma Diagnosis in Africa," included an excellent presentation from the participants from Nairobi, Eldoret, Mwanza and Dakar, illustrating the improvements that have taken place in diagnosis since the introctution of basic immunohistochemestry in the last few years, mainly due to knowledge obtained from attending this series of workshops, according to the African presenters.

The "tutorial session" gave the participants an opportunity to learn about the value of diagnostic techniques that often make the difference between a right and wrong diagnosis.

Throughout the course of the meeting, a microscope was set up and made available for individual African pathologists to discuss their own cases with members of INCTR’s Pathology Program, including Professor Lorenzo Leoncini, Dr Kikkeri Naresh, Dr Martine Raphael and Dr Nina Hurwitz.

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