title: Primary carcinoma of the liver in Malawi: a review of 24 cases.
abstract: A consecutive series of 24 cases of primary carcinoma of the liver in Malawi has been investigated. Histologically, all were hepatocellular carcinomas (HCC). All patients were African Bantus, the average age was 42.7, and the sex ratio was men 3.5:women 1. The duration of symptoms attributable to HCC was about 5 months previous to admission to hospital and was in no case preceded by clinically manifest cirrhosis. The clinical picture was rather uniform with pain in the region of the liver, emaciation and nodular hepatomegaly as the most important features. One of the patients had repeated attacks of hypoglycaemic coma. Sera from 11 out of 13 patients contained alpha-feto-protein. Hepatitis-associated antigen and antibody in the serum were found in 7 and 6 out of 16 and 14 cases respectively. Serum B12 and serum unsaturated B12 binding capacity were moderately raised in most patients. The prognosis was poor, the average time of survival was 4.8 weeks after admission. The cause of death was most frequently hepatic coma. HCC in the African Bantu shows some different features from the same disease in the Western Hemisphere: The incidence is much higher; the patients are younger. The neoplasm commonly develops in a clinically latent cirrhosis. The latter is not caused by alcohol, but is presumably a sequel of hepatitis. It is possible that aflatoxin is the carcinogenic factor, acting more readily in a cirrhotic than in a normal liver.
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology; D006510:Hepatitis B Antibodies / Q000302:isolation & purification; D006511:Hepatitis B Antigens / Q000302:isolation & purification; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D008295:Malawi; D008297:Male; D008875:Middle Aged; D012737:Sex Factors
chemical_list: D006510:Hepatitis B Antibodies; D006511:Hepatitis B Antigens