Shefaa El Orman Oncology Hospital (SOH): diagnosing rare cancers

In mid-2017, Girgis Phot noticed the appearance of multiple itchy skin lesions on his genitalia. He sought medical advice and received multiple antibiotics with no improvement. Six months later, the sole of his left foot showed the same lesions, which progressed to the dorsum of both feet, and he also developed multiple painless groin swellings. Living in Luxor, Egypt, he sought medical advice at a specialised centre and visited Shefaa El Orman Oncology Hospital (SOH) for the first time in January 2019.

The medical oncology team at SOH immediately started full laboratory and radiological investigations. They suspected Kaposi sarcoma and, although there was no history of sexually transmitted infections, intravenous drug injections or blood transfusions, HIV testing was included in the investigations list. HIV tests were repeated twice and were consistently negative for both HIV-1 and -2.

The radiology team found that Girgis’s chest x-ray and abdominal ultrasound showed no significant abnormality, yet the PET-CT scan revealed multiple active enlarged cervical, abdominal and inguinal lymph nodes, and lesions above the left kidney.

The surgical team carried out an inguinal lymph node excision biopsy for histopathological evaluation. In the histopathology laboratory, a detailed pathological analysis of the specimen, including immunoprofiling, showed that Girgis had double pathologies within the lymph node, including both nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) and intranodal Kaposi sarcoma.

Kaposi sarcoma is a vascular disorder that occurs mainly in HIV-infected patients. Lymph node involvement is a rare event in classical Kaposi sarcoma but occurs in African and epidemic forms. The intranodal form of Kaposi sarcoma is more frequently observed in children and adolescents, independent of HIV status. The antibody for immunostaining for the Kaposi sarcoma-associated virus (human herpes virus 8 [HHV-8]) is not available at SOH or other laboratories in Egypt to our knowledge. To gather proof for this rare diagnosis, unstained slides were sent to a UK-based laboratory to perform the HHV-8 test with the help of Professor Mona El-Bahrawy, Imperial College London, confirming the diagnosis. The presence of both NLPHL and Kaposi sarcoma within the same lymph node is extremely rare and only five similar cases have been reported in the English literature; one was HIV negative, two had AIDS and two had no documented HIV status.

Improving Egypt’s medical services, and with them the care those like Girgis receive

The existence of such a hospital in this medically deprived region was a lifebuoy for hundreds of cancer patients who previously had to travel to Cairo to get the required medical service. SOH saved me time and money and I am now confident I will get the proper care.​​​​

For many years, Upper Egypt suffered from a lack of comprehensive medical services, especially for cancer patients. SOH is the first charity oncology hospital in this region, established in 2016 to meet increasing demand for this service in Upper Egypt. In recognition of the pivotal role of laboratory medicine, SOH provided all the support to establish a histopathology laboratory operating to international standards. The SOH histopathology laboratory provides an excellent service – it is an exemplary referral laboratory and training hub.

Girgis has now finished two cycles of chemotherapy and is showing a good response to treatment – there has been a decrease in the size of the enlarged lymph nodes and the number of skin lesions. Two more cycles of chemotherapy are scheduled and further management will be planned on review of his status following completion of chemotherapy.