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      An 8-year Pattern of Orofacial Sarcoma from the National Referral Hospital in United Republic of Tanzania

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          ABSTRACT

          Aim:

          This study aimed at evaluating the pattern of head and neck sarcomas among patients treated at Muhimbili National Hospital, Tanzania.

          Background

          Sarcomas of the head and neck are very rare, representing only 1% of all primary tumors arising within the head and neck region and accounting for 4 to 10% of all sarcomas, with more than 50 distinct existing histologic subtypes.

          Materials and methods

          It was a retrospective study whereby histological results of the lesions arising from oral and maxillofacial region between 2008 and 2016 were analyzed. Patient's demographic data, histopathological diagnosis, and the type of sarcoma were recorded. The lesions were broadly grouped as soft and hard tissue sarcomas (HTSs). Data analysis was done using Statistical Package for the Social Sciences version 19 computer program.

          Results

          Sarcomas accounted for 7% of all lesions occurring in orofacial region. Male to female ratio was 1:1.4. The age ranged from 3 to 81 years, mean age being 33 ± 16 years. The most affected age groups were of 30 to 39 followed by 20 to 29 years. Approximately half of the patients were aged below 30 years and three quarters below 40 years. Kaposi's sarcoma (KS) and rhabdomyosarcoma were the most common soft tissue sarcoma (STS), while osteosarcoma and chondrosarcoma were the commonest HTS.

          Conclusion

          The analysis demonstrated that the head and neck sarcomas are a very rare group of neoplasm, with approximately 20 cases per year. The STSs are more common than the HTSs, while KS is the most common, followed by osteosarcoma and rhabdomyosarcoma. Generally, patients less than 40 years of age are the mostly affected, with a slightly higher female predominance.

          Clinical significance

          By contributing to the identification of the incidence of sarcomas at a tertiary hospital in Tanzania, this study promotes scientific understanding of pattern of occurrence and underscores the necessity of early detection of sarcomas, since the affected are young individuals.

          How to cite this article

          Moshy JR, Owibingire SS, Sohal KS. An 8-year Pattern of Orofacial Sarcoma from the National Referral Hospital in United Republic of Tanzania. Int J Head Neck Surg 2016;7(4):207-212.

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          Most cited references29

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          The Epidemiology of Sarcoma

          Sarcomas account for over 20% of all pediatric solid malignant cancers and less than 1% of all adult solid malignant cancers. The vast majority of diagnosed sarcomas will be soft tissue sarcomas, while malignant bone tumors make up just over 10% of sarcomas. The risks for sarcoma are not well-understood. We evaluated the existing literature on the epidemiology and etiology of sarcoma. Risks for sarcoma development can be divided into environmental exposures, genetic susceptibility, and an interaction between the two. HIV-positive individuals are at an increased risk for Kaposi’s sarcoma, even though HHV8 is the causative virus. Radiation exposure from radiotherapy has been strongly associated with secondary sarcoma development in certain cancer patients. In fact, the risk of malignant bone tumors increases as the cumulative dose of radiation to the bone increases (p for trend <0.001). A recent meta-analysis reported that children with a history of hernias have a greater risk of developing Ewing’s sarcoma (adjusted OR 3.2, 95% CI 1.9, 5.7). Bone development during pubertal growth spurts has been associated with osteosarcoma development. Occupational factors such as job type, industry, and exposures to chemicals such as herbicides and chlorophenols have been suggested as risk factors for sarcomas. A case-control study found a significant increase in soft tissue sarcoma risk among gardeners (adjusted OR 4.1, 95% CI 1.00, 14.00), but not among those strictly involved in farming. A European-based study reported an increased risk in bone tumors among blacksmiths, toolmakers, or machine-tool operators (adjusted OR 2.14, 95% CI 1.08, 4.26). Maternal and paternal characteristics such as occupation, age, smoking status, and health conditions experienced during pregnancy also have been suggested as sarcoma risk factors and would be important to assess in future studies. The limited studies we identified demonstrate significant relationships with sarcoma risk, but many of these results now require further validation on larger populations. Furthermore, little is known about the biologic mechanisms behind each epidemiologic association assessed in the literature. Future molecular epidemiology studies may increase our understanding of the genetic versus environmental contributions to tumorigenesis in this often deadly cancer in children and adults.
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            Rhabdomyosarcoma: review of the Children's Oncology Group (COG) Soft-Tissue Sarcoma Committee experience and rationale for current COG studies.

            The prognosis for children and adolescents with rhabdomyosarcoma (RMS) has improved with refinements in multi-modal therapy. Since 1972, the Intergroup Rhabdomyosarcoma Study Group (now the Children's Oncology Group Soft-Tissue Sarcoma Committee) has conducted serial studies for RMS. This review describes the IRSG and COG experience with RMS, presents the current risk stratification definitions, and provides rationale for the current generation of COG RMS studies. Copyright © 2012 Wiley Periodicals, Inc.
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              Using Epidemiology and Genomics to Understand Osteosarcoma Etiology

              Osteosarcoma is a primary bone malignancy that typically occurs during adolescence but also has a second incidence peak in the elderly. It occurs most commonly in the long bones, although there is variability in location between age groups. The etiology of osteosarcoma is not well understood; it occurs at increased rates in individuals with Paget disease of bone, after therapeutic radiation, and in certain cancer predisposition syndromes. It also occurs more commonly in taller individuals, but a strong environmental component to osteosarcoma risk has not been identified. Several studies suggest that osteosarcoma may be associated with single nucleotide polymorphisms in genes important in growth and tumor suppression but the studies are limited by sample size. Herein, we review the epidemiology of osteosarcoma as well as its known and suspected risk factors in an effort to gain insight into its etiology.
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                Author and article information

                Contributors
                Role: Senior Lecturer
                Role: Lecturer
                Role: Postgraduate Student
                Journal
                IJHNS
                International Journal of Head and Neck Surgery
                IJHNS
                Jaypee Brothers Medical Publishers
                0975-7899
                0976-0539
                October-December 2016
                : 7
                : 4
                : 207-212
                Affiliations
                [1,2 ] Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, United Republic of Tanzania
                [3 ] Department of Dental Service, Muhimbili National Hospital Dar-es-Salaam, United Republic of Tanzania
                Author notes
                Karpal S Sohal, Postgraduate Student, Department of Dental Service, Muhimbili National Hospital, Dar-es-Salaam, United Republic of Tanzania, Phone: +255712723917, e-mail: karpal@ 123456live.com
                Article
                10.5005/jp-journals-10001-1290
                e9372d56-eea6-4c67-804e-6404d0bc615f
                Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.

                Creative Commons Attribution 4.0

                History
                Categories
                RESEARCH ARTICLE
                Custom metadata
                ijhns-2016-7-207.pdf

                General medicine,Pathology,Surgery,Sports medicine,Anatomy & Physiology,Orthopedics
                Sarcomas,Osteosarcoma,Head and neck,Kaposi's sarcoma

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