Pediatric Malignant Tumors in Malawi: A Diagnostic Report From the Kamuzu Central Hospital Pathology Laboratory 2011–2020

ABSTRACT Background In 2011, a partnership between Kamuzu Central Hospital (KCH) and the University of North Carolina (UNC) led to the opening of the first diagnostic pathology laboratory in Lilongwe, Malawi's capital. Procedure A retrospective case series of malignancies diagnosed at the KCH–UNC pathology laboratory between 2011 and 2020 in pediatric and adolescent patients aged 0–18 years. Results Between 2011 and 2020, 12761 specimens were received from 5137 pediatric and adolescent patients. A malignant diagnosis was confirmed in 1498 (29%) of patients, with a median age of 10 years (interquartile range (IQR) 5–14) and 810 (54%) males. The most common malignancy was lymphoma (38%, 571/1498), including both non‐Hodgkin lymphomas (NHLs) (86%, 387/571), with Burkitt lymphoma accounting for 80% (309/387) of NHLs, and Hodgkin lymphoma (HL) (22%, 125/571). Next were sarcomas (22%, 325/1498), including Kaposi sarcoma (KS) (34%, 111/325), rhabdomyosarcoma (21%, 68/325), and osteosarcoma (19%, 61/325). Then carcinomas (9%, 139/1498), with the majority (53%, 73/139) being squamous cell carcinoma. Next were acute leukemias (6%, 95/1498), including acute lymphoblastic leukemia (66%, 63/95) and acute myeloid leukemia (32%, 30/95). These were followed by Wilms tumor (WT) (6%, 90/1498), retinoblastoma (4%,66/1498), neuroblastoma (2%, 32/1498), hepatic tumors (2%, 31/1498), and germ cell tumors (1%, 22/1498). Conclusions The most common pediatric tumors diagnosed in the KCH–UNC pathology laboratory were NHL, HL, KS, and WT. Given the challenges of under‐diagnosis, obtaining tissue biopsies, and reliance on clinical diagnosis, we suspect there is an underrepresentation of many pediatric cancers, including acute leukemias, brain tumors, and WT. Pathology diagnostic services and techniques need to be expanded further to aid the categorization of carcinomas and sarcomas.