PRIMARY HEPATOMA IN UGANDA - A PROSPECTIVE CLINICAL AND EPIDEMIOLOGIC STUDY OF 46 PATIENTS

Forty-six patients with primary hepatoma were studied in Mulago Hospital, Uganda, over a nine month period. This represented 2.1 per cent of all medical admissions. The age peak was twenty-five to forty-five years and the male to female ratio was 2:1. The predominant clinical picture was abdominal pain and hepatomegaly with a hard, frequently tender mass in the right upper quadrant and rapid clinical deterioration and death within several months. Jaundice, fever, hepatic coma and other signs of active hepatocellular disease were infrequent in contrast to observations in the United States and Europe. An unexplained hypercholesterolemia was noted in approximately one third of the patients. Bloody ascites occurred in 19 per cent of the patients and was a helpful diagnostic sign. Acute hemoperitoneum occurred in 15 per cent. The clinical diagnosis of hepatoma, prior to histologic confirmation, was correct in 86 per cent of the patients. The disease was found more frequently in the poorer immigrants from Rwanda and Burundi than in the local Baganda tribe. Epidemiologic study revealed no significant difference in the medical, nutritional or alcoholic history between the patients, the patient's neighbors or a hospital control series. Although histologically hepatomas from different areas appear to be similar, differences in the clinical and epidemiologic features suggest that hepatoma in Uganda differs from the disease as seen in the United States, possibly due to different causative factors. © 1969.