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Gastrointestinal, Liver and Biliary Tract Pathology: A Histopathological and Epidemiological Perspective from Pakistan with a Review of the Literature

  • Ahmad, Zubair (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Arshad, Huma (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Fatima, Saira (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Idrees, Romana (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Ud-Din, Nasir (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Ahmed, Rashida (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Ahmed, Arsalan (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Memon, Aisha (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Minhas, Khurram (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Arif, Muhammad (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Fatima, Samia (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Haroon, Saroona (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Pervez, Shahid (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Hasan, Sheema (Pathology and Microbiology, Histopathology, Aga Khan University Hospital) ;
  • Kayani, Naila (Pathology and Microbiology, Histopathology, Aga Khan University Hospital)
  • Published : 2013.11.30

Abstract

Aim: To present an epidemiological and histological perspective of diseases of the gastrointestinal tract (including liver and biliary tract) at the Section of Histopathology, Department of Pathology, AKUH, Karachi, Pakistan. Materials and Methods: All consecutive endoscopic biopsies and resections between October 1 and December 31, 2012 were included. Results: A total of 2,323 cases were included. Carcinoma was overwhelmingly the commonest diagnosis on esophageal biopsies (69.1%); chronic helicobacter gastritis (45.6%) followed by adenocarcinoma (23.5%) were the commonest diagnoses on gastric biopsies; adenocarcinoma (27.3%) followed by ulcerative colitis (13.1%) were the commonest diagnoses on colonic biopsies; acute appendicitis (59.1%) was the commonest diagnosis on appendicectomy specimens; chronic viral hepatitis (44.8%) followed by hepatocellular carcinoma (23.4%) were the commonest diagnoses on liver biopsies; chronic cholecystitis was the commonest diagnosis (over 89%) on cholecystectomy specimens. Conclusions: Squamous cell carcinoma comprised 88.8% of esophageal cancers. About 67% were in the lower third and 56.5% were moderately differentiated; mean ages 49.8 years for females and 55.8 years for males; 66% cases were from South West Pakistan. Over 67% patients with gastric adenocarcinoma were males; mean ages 59 and 44 years in males and females respectively, about 74% gastric carcinomas were poorly differentiated; and 62.2% were located in the antropyloric region. About 63% patients with colorectal adenocarcinoma were males; mean ages 46.1 and 50.5 years for males and females respectively; tumor grade was moderately differentiated in 54%; over 80% were located in the left colon. In 21.2% appendicectomies, no acute inflammation was found. Acute appendicitis was most common in young people. Hepatitis C (66.3%) was more common than hepatitis B (33.7%); about 78% cases of hepatocellular carcinoma occurred in males; females comprised 76.7% patients with chronic cholecystitis; and 77.8% patients with gall bladder carcinoma. All resection specimens showed advanced cancers. Most cancers occurred after the age of 50 years.

Keywords

References

  1. Abdifard E, Ghaderi S, Hosseini S, Heidari M (2013). Incidence trends of colorectal cancer in the West of Iran during 2000-2005. Asian Pac J Cancer Prev, 14, 1807-11. https://doi.org/10.7314/APJCP.2013.14.3.1807
  2. Abdo AA, Sanai FM, Al-Faleh FZ (2012). Epidemiology of viral hepatitis in Saudi Arabia: are we off the hook? Saudi J Gastroenterol, 18, 349-57. https://doi.org/10.4103/1319-3767.103425
  3. Ahmed FB (1996). Tuberculous enteritis. BMJ, 313, 215-7. https://doi.org/10.1136/bmj.313.7051.215
  4. Ahuja V, Tandon RK (2010). Inflammatory bowel disease in the Asia-Pacific area: a comparison with developed countries and regional differences. J Dig Dis, 11, 134-47. https://doi.org/10.1111/j.1751-2980.2010.00429.x
  5. AIR TUM working group (2009). Italian cancer figures, report 2009: Cancer trend (1998-2005). Epidemiol Prev, 33, 1-168.
  6. Arshad H, Ahmad Z (2012). Histologic findings in biopsies/resection specimens from the small intestine with special emphasis on celiac disease: experience from a developing country in South Asia. Ann Diag Pathol, 16, 436-40. https://doi.org/10.1016/j.anndiagpath.2012.03.003
  7. Bafandeh Y, Hashemzadeh S, Sokouti M, Esmaili H (2006). Clinicopathologic characteristics of esophageal cancer patients in northwest Iran-very low incidence of adenocarcinomas. Asian Pac J Cancer Prev, 7, 480-2.
  8. Bateson MC (2000). Gallstones and cholecystectomy in modern Britain. Postgrad Med J, 76, 700-3. https://doi.org/10.1136/pmj.76.901.700
  9. Bhurgri Y, Bhurgri A, Hussainy AS, et al (2003). Incidence of cancer esophagus in Quetta and Karachi, Pakistan. Indian J Gastroenterol, 22, 170-2.
  10. Bhurgri Y, Bhurgri A, Pervez S, et al (2005). Cancer profile of Hyderabad, Pakistan 1998-2002. Asian Pac J Cancer Prev, 6, 474-80.
  11. Bhurgri Y, Faridi N, Kazi LA, et al (2004). Cancer esophagus Karachi 1995-2002: epidemiology, risk factors and trends. J Pak Med Assoc, 54, 345-8.
  12. Bhurgri Y, Khan T, Kayani N, et al (2011). Incidence and current trends of colorectal malignancies in an unscreened, low risk Pakistan population. Asian Pac J Cancer Prev, 12, 703-8.
  13. Bhurgri Y, Pervez S, Kayani N, et al (2009). Rising incidence of gastric malignancies in Karachi, 1995-2002. Asian Pac J Cancer Prev, 10, 41-4.
  14. Burisch J, Munkholm P (2013). Inflammatory bowel disease epidemiology. Curr Opin Gastroenterol, 29, 357-62. https://doi.org/10.1097/MOG.0b013e32836229fb
  15. Carbonnel F, Jantchou P, Monnet E, Cosnes J (2009). Environmental risk factors in Crohn's disease and ulcerative colitis: an update. Gastroenterol Clin Biol, 33, 145-57.
  16. Center MM, Jemal A, Smith RA, Ward E (2009). Worldwide variations in colorectal cancer. CA Cancer J Clin, 59, 366-78. https://doi.org/10.3322/caac.20038
  17. Codlin AJ, Khowaja S, Chen Z, et al (2011). Short report: gender differences in tuberculosis notification in Pakistan. Am J Trop Med Hyg, 85, 514-7. https://doi.org/10.4269/ajtmh.2011.10-0701
  18. Crew KD, Neugut AI (2006). Epidemiology of gastric cancer. World J Gastroenterol, 12, 354-62. https://doi.org/10.3748/wjg.v12.i3.354
  19. Curado MP, Edwards B, Shin HR, et al (2007). (eds): Cancer incidence in five continents, IARC, Lyon, France.
  20. Edge SB, Byrd DR, Compton CC, (eds). AJCC cancer staging manual, ed 7, Newyork, springer, 2010.
  21. Efremidou EI, Liratzopoulos N, Papageorgiou SM, et al (2008). Colorectal carcinoma: correlation between age, gender and subsite distribution. Chirurgia (Bucur), 103, 659-63.
  22. Fares N, Peron JM (2013). Epidemiology, natural history, and risk factors of hepatocellular carcinoma. Rev Prat, 63, 216-7.
  23. Ferley J, Shin H-R, Bray F, et al (2008). Globocan 2008: Cancer Incidence and Mortality worldwide. IARC Cancer Base No. 10 IARC, Lyon 2010, 1023-5614.
  24. Fock KM, Ang TL (2010). Epidemiology of Helicobacter pylori infection and gastric cancer in Asia. J Gastroenterol Hepatol. 25, 479-86. https://doi.org/10.1111/j.1440-1746.2009.06188.x
  25. Fock KM, Katelaris P, Sugano K, et al (2009). Second Asia-Pacific consensus guidelines for helicobacter pylori infection. J Gastroenterol Hepatol, 24, 1587-600. https://doi.org/10.1111/j.1440-1746.2009.05982.x
  26. Forde KA, Tanapanpanit O, Reddy KR (2013). Hepatitis B and C in African Americans: current status and continued challenges. Clin Gastroenterol Hepatol, 1542-3565.
  27. Gearry RB, Richardson AK, Frampton CM, Dodgshun AJ, Barclay ML (2010). Population-based case control study of inflammatory bowel disease risk factors. J Gastroenterol Hepatol, 25, 325-33. https://doi.org/10.1111/j.1440-1746.2009.06140.x
  28. Gilmore OJ, Browett JP, Griffin PH, et al (1975). Appendicitis and mimicking conditions. A prospective study. Lancet, 2, 421-4.
  29. Goh K, Xiao SD (2009). Inflammatory bowel disease: a survey of the epidemiology in Asia. J Dig Dis, 10, 1-6. https://doi.org/10.1111/j.1751-2980.2008.00355.x
  30. Haidari M, Nikbakht MR, Pasdar Y, Najaf F (2012). Trend analysis of gastric cancer incidence in Iran and its six geographical areas during 2000-2005. Asian Pac J Cancer Prev, 13, 3335-41. https://doi.org/10.7314/APJCP.2012.13.7.3335
  31. Herszenyi L, Tulassay Z (2010). Epidemiology of gastrointestinal and liver tumors. Eur Rev Med Pharmacol Sci, 14, 249-58.
  32. Horner MJ, Ries LAG, Krapcho M, et al (2009). SEER cancer statistics review, 1975-2006, National Cancer Institute. Bethesda, Maryland. Based on November 2008 SEER data submission, posted to the SEER website.
  33. Inoue M, Tsugane S (2005). Epidemiology of gastric cancer in Japan. Postgrad Med J, 81, 419-24. https://doi.org/10.1136/pgmj.2004.029330
  34. Jantchou P, Monnet E, Carbonnel F (2006). Environmental risk factors in Crohn’s disease and ulcerative colitis (excluding tobacco and appendicectomy). Gastroenterol Clin Biol, 30, 859-67. https://doi.org/10.1016/S0399-8320(06)73333-4
  35. Ji BT, Devesa SS, Chow WH, Jin F, Gao YT (1998). Colorectal cancer incidence trends by subsite in urban Shanghai, 1972-1994. Cancer Epidemiol Biomarkers Prev, 7, 661-6.
  36. Jubelirer SJ, Wells JB, Emmett M, Broce M (2003). Incidence of colorectal cancer in West Virginia from 1993-1999: an update by gender, age, subsite and stage. WV Med J, 99, 182-6.
  37. Kappelman MD, Moore KR, Allen JK, Cook SF (2013). Recent trends in the prevalence of Crohn's disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci, 58, 519-25. https://doi.org/10.1007/s10620-012-2371-5
  38. Karlinger K, Gyorke T, Mako E, Mester A, Tarjan Z (2000). The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol, 35, 154-67. https://doi.org/10.1016/S0720-048X(00)00238-2
  39. Khan A, Farooqui A, Raza Y, et al (2013). Prevalence, diversity and disease association of Helicobacter pylori in dyspeptic patients from Pakistan. J Infect Dev Ctries, 7, 220-8.
  40. Khuhaprema T, Srivatanakul P (2008). Colon and rectum cancer in Thailand: an overview. Jpn J Clin Oncol, 38, 237-43. https://doi.org/10.1093/jjco/hyn020
  41. Khurshed A, Ahmed R, Bhurgri Y (2007). Primary gastrointestinal malignancies in childhood and adolescence--an Asian perspective. Asian Pac J Cancer Prev, 8, 613-7.
  42. Kim JY, Cho J, Hwang SH, et al (2012). Behavioral and healthcare-associated risk factors for chronic hepatitis C virus infection in Korea. J Korean Med Sci, 27, 1371-7. https://doi.org/10.3346/jkms.2012.27.11.1371
  43. Li H, Zhang Q, Xu L, et al (2009). Factors predictive of prognosis after esophagectomy for squamous cell cancer. J Thorac Cardiovasc Surg, 137, 55-9. https://doi.org/10.1016/j.jtcvs.2008.05.024
  44. Lin Y, Totsuka Y, He Y, et al (2013). Epidemiology of esophageal cancer in Japan and China. J Epidemiol, 23, 233-42. https://doi.org/10.2188/jea.JE20120162
  45. Lin Y, Ueda J, Kikuchi S, et al (2013). Comparative epidemiology of gastric cancer between Japan and China. World J Gastroenterol, 17, 4421-8.
  46. London WT, Evans AA (1996). The epidemiology of hepatitis viruses B, C, and D. Clin Lab Med, 16, 251-71.
  47. Luckmann R, Davis P (1991). The epidemiology of acute appendicitis in California: racial, gender, and seasonal variation. Epidemiology, 2, 323-30. https://doi.org/10.1097/00001648-199109000-00003
  48. Miwa H, Go MF, Sato N (2002). H pylori and gastric cancer: the Asian enigma. Am J Gastroenterol, 97, 1106-12. https://doi.org/10.1111/j.1572-0241.2002.05663.x
  49. Molodecky NA, Soon IS, Rabi DM, et al (2012). Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterol, 142, 46-54. https://doi.org/10.1053/j.gastro.2011.10.001
  50. Nelson PK, Mathers BM, Cowie B, et al (2011). Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet, 378, 571-83. https://doi.org/10.1016/S0140-6736(11)61097-0
  51. Ola SO, Otegbayo JA, Odaibo GN, Olaleye DO (2012). HBV infectivity among Nigerians. Afr J Med Med Sci,41, 133-7.
  52. Ola SO, Akere A, Otegbayo JA, et al (2012). Are patients with primary hepatocellular carcinoma infectious of hepatitis B, C and D viruses? Afr J Med Med Sci, 41, 187-91.
  53. Osias GL, Osias KB, Srinivasan R (2001). Colorectal cancer in women: an equal opportunity disease. J Am Osteopath Assoc, 101, 7-12.
  54. Poethko-Muller C, Zimmermann R, Hamouda O, et al (2001). [Epidemiology of hepatitis A, B, and C among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 56, 707-15.
  55. Prideaux L, Kamm MA, De Cruz PP, Chan FK, Ng SC (2012). Inflammatory bowel disease in Asia: a systematic review. J Gastroenterol Hepatol, 27, 1266-80. https://doi.org/10.1111/j.1440-1746.2012.07150.x
  56. Randi G, Franceschi S, La Vecchia C (2006). Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer, 118, 1591-602. https://doi.org/10.1002/ijc.21683
  57. Reporting on cancer specimens. Case summaries and background documentation. College of American pathologists (CAP). CAP press 2012.
  58. Roder DM (2002). The epidemiology of gastric cancer. Gastric Cancer, 5, 5-11. https://doi.org/10.1007/s10120-002-0203-6
  59. Safaee A, Fatemi SR, Moghimi-Dehkordi B, Ghiasi S, Zali MR (2013). Epidemiology and histopathological features of esophageal cancer. East Afr J Public Health, 9, 7-9.
  60. Schirmer BD, Winters KL, Edlich RF (2005). Cholelithiasis and cholecystitis. J Long Term Eff Med Implants, 15, 329-38. https://doi.org/10.1615/JLongTermEffMedImplants.v15.i3.90
  61. Shiota S, Murakawi K, Suzuki R, Fujioka T, Yamaoka Y (2013). Helicobacter pylori infection in Japan. Expert Rev Gastroenterol Hepatol, 7, 35-40. https://doi.org/10.1586/egh.12.67
  62. Talley NJ, Fock KM, Moayyedi P (2008). Gastric Cancer Consensus Conference recommends Helicobacter pylori screening and treatment in asymptomatic persons from high-risk populations to prevent gastric cancer. Am J Gastroenterol, 103, 510-4. https://doi.org/10.1111/j.1572-0241.2008.01819.x
  63. Te HS, Jensen DM (2010). Epidemiology of hepatitis B and C viruses: a global overview. Clin Liver Dis, 14, 1-21. https://doi.org/10.1016/j.cld.2009.11.009
  64. Weedon D (1994). Diseases of the gall bladder. In: MeSween RMN, Antony PP, Bua AD, eds. Pathology of the Liver, 3rd edition. New York: Churchill Livingstone, 514-34
  65. WHO classification of tumors of the Appendix. In Bosman FT, Carneiro F, Hruban RH, Theise ND eds. WHO classification of tumors of the digestive system. 4th edition, IARC, Lyon, 2010: 120.
  66. WHO classification of tumors of the Digestive System. Bosman FT, Carneiro F, Hruban RH, Theise ND, 4th edition, IARC, Lyon, 2010.
  67. Xie WC, Chan MH, Mak KC, Chan WT, He M (2012). Trends in the incidence of 15 common cancers in Hong Kong, 1983-2008. Asian Pac J Cancer Prev, 13, 3911-6. https://doi.org/10.7314/APJCP.2012.13.8.3911
  68. Zidan A, Scheuerlein H, Schule S, Settmacher U, Rauchfuss F (2012). Epidemiological pattern of hepatitis B and hepatitis C as etiological agents for hepatocellular carcinoma in Iran and worldwide. Hepat Mon, 12, 6894.

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