|Year : 2015 | Volume
| Issue : 4 | Page : 557-561
Distribution of nodal lymphomas in a referral hospital of Mangalore city
H Zubair, PR Muktha, S Chakraborti, PR Radha
Department of Pathology, Kasturba Medical College, Mangalore, India
|Date of Web Publication||10-Mar-2016|
Department of Pathology, Kasturba Medical College, Mangalore
Source of Support: None, Conflict of Interest: None
CONTEXT: The distribution of different types of lymphoma varies across geographic regions. AIMS: The present study was done to understand the occurrence of nodal lymphomas in a referral hospital of Mangalore city. SETTINGS AND DESIGN: Descriptive study. SETTING: The present study was conducted on 95 lymph node biopsy specimens, received in a referral hospital of Mangalore city. MATERIALS AND METHODS: All cases of nodal lymphoma diagnosed between January 2007 and June 2010 in a referral hospital of Mangalore were selected for the study. The patients age and clinical details were obtained. Immunophenotyping was done for all cases of NHL and selected cases of HL. IPI score for NHL was noted and correlated with the outcome. STATISTICAL ANALYSIS USED: Chi square test was used. RESULTS: Out of the total 95 cases of nodal lymphoma 37 (39%) were HL while 58 (61%) were NHL. Classical HL was diagnosed in 35 cases (37%) while 2 cases (2%) were diagnosed NLPHL. B cell lymphoma formed 72% of NHL. Follicular lymphoma accounted for 28% of all NHL. T cell lymphoma formed 28% of NHL. CONCLUSIONS: In conclusion the following points are significant about the distribution of lymphomas in a referral hospital of Mangalore city. The incidence of NSHL is higher while national data suggests MCHL as the most common subtype. The incidence of FL as well as T cell NHL is much higher when compared to national incidence. The epidemiological factors for this high frequency (either genetic or environmental) needs to be studied further.
Keywords: Hodgkins lymphoma, Mangalore, Nodal lymphomas, Non Hodgkins lymphoma
|How to cite this article:|
Zubair H, Muktha P R, Chakraborti S, Radha P R. Distribution of nodal lymphomas in a referral hospital of Mangalore city. Indian J Cancer 2015;52:557-61
| » Introduction|| |
The distribution of different types of nodal lymphomas varies across geographic regions. The present study was done to understand the occurrence of nodal lymphoma in a referral hospital of Mangalore city.
| » Materials and Methods|| |
All cases of nodal lymphoma diagnosed between January 2007 and June 2010 in a referral hospital of Mangalore city. The patients name age and clinical details were obtained. Immunophenotyping was done for all cases of Non Hodgkins Lymphoma (NHL) and selected cases of Hodgkins Lymphoma (HL). Ann Arbor staging was done for all the cases. IPI score for NHL was noted and correlated with the outcome.
The Immunohistochemical markers used (Bio Genex) included CD3, CD5, CD10, CD15, CD20, CD30, CD45, Kappa, Lambda, Tdt, CD99, Bcl-2 and Cyclin-D1. The antibodies used in a given case were dependent on morphological evaluation and varied from two to seven. Pre diluted antibodies were used. IHC was performed according to Polymer HRP.
| » Results|| |
Out of the total 95 cases of nodal lymphoma 37 (39%) were HL while 58 (61%) were NHL. The mean age was 43 years, M: F ratio was 7:3 [Figure 1]. Four percent cases were HIV positive. DLBCL was the most common lymphoma in HIV positive patients (X2 = 0.936, P = 0.333, NS).
|Figure 1: Distribution of all cases by age group, X2 = 21.00, P = 0.0001, HS|
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Classical HL was diagnosed in 35 cases (37%) while 2 cases (2%) were diagnosed Nodular lymphocyte predominant Hodgkins lymphoma (NLPHL). A bimodal peak was seen in the age distribution of Classical HL [Figure 2]. Mean age was 34.6 years. NSHL was the most common subtype (71%) of Classical HL. MCHL (17%) was the second most common subtype of Classical HL [Figure 3]. Mediastinal involvement was present in 8 cases (32%) of NSHL. A male preponderance was seen in NSHL [Table 1]. Bone marrow involvement was present in 2 cases (5%) of HL. Immunophenotypic markers were done in 23 cases of HL of which all (100%) were positive for CD30. Fourteen (60%) cases were positive for CD15 [Photograph 1], [Photograph 2] and [Photograph 5]. InAQ4 one case of LRHL, RS cells were positive for CD20 (5.5%).
|Figure 2: Distribution of Classical HL by age group, X2 = 14.857, P = 0.005, HS|
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One case of Secondary HL following Mycosis Fungoides (MF) was diagnosed in a 48 year old male who was a known case of MF of 5 years duration and presented with cervical lymphadenopathy. The lymphoma cells were positive for CD15 and CD 30. The large cells were negative for CD3, CD20, CD 5 and EBV LMP.
Two cases were diagnosed as NLPHL. Both cases showed L and H cells in a background of small lymphocytes. Immunophenotypically in both cases CD20 was positive within the large popcorn cells, histiocyte like cells and small lymphocytes within the nodules. CD3 was positive in the background small lymphocytes.
Fifty eight cases of NHL (61%) were seen in this study. B cell lymphoma formed 72% of NHL while T cell lymphoma formed 28% of NHL. The distribution of cases by histological subtype, age and gender is shown in [Figure 4], [Table 2] and [Table 3]. B cell LBL identified by positivity of CD20 and Tdt accounted for seven% cases.
|Figure 4: Distribution of NHL cases by WHO subtypes, X2 = 32.034, P = 0.00001, HS|
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Follicular lymphoma accounted for 28% of all NHL. Five cases were diagnosed each as grade I II and III [Photograph 3] and [Photograph 4]. One case of FL in situ was noted.
Eighteen cases of DLBCL were seen forming 31% of all NHL. Six cases of DLBCL were classified as TCRBCL. Two cases of DLBCL had morphological features of anaplastic large cell lymphoma and showed CD 20 and CD 30 positivity in the large cells [Photograph 6],[Photograph 7],[Photograph 8].
Among the T cell neoplasms PTCL and ALCL accounted for 8.6% of all NHL. AITCL accounted for 5% of NHL. ALK-1 staining was considered necessary for further subtyping of ALCL.
High grade LBL were found to have a higher Ann Arbor Stage. Most cases in Stage III disease were of DLBCL, ALCL, PTCL and AITCL.
The percentage of patients with poor IPI score was higher in Mature T cell NHL (57%) when compared to Mature B cell NHL (18%).
Survival time from time of diagnosis to the last follow up was noted. One case of ALCL and LBL each, died within a year of diagnosis.
| » Discussion|| |
Ninety five cases of Lymphomas were studied in a referral hospital of Mangalore.
In the present study, mean age was 43 yrs. In the study by Morton et al., the incidence of lymphomas increased monotonically with age. On the contrary in the present study highest frequency (34.7%) was seen in the age group of 46-60 years and declined in the age group above 6th decade (17.9%).
In the study by Morton et al., M: F ratio was 1.5 to 1.6 while in the present study M: F ratio was 7:3.
Morton et al., observed more cases of NHL as against HL. In the present study the incidence of HL and NHL was comparable to Desai et al. However Kamthan et al. documented higher
incidence of HL compared to NHL.
The NHL: HD ratio in the present study was 1.56 a little higher than the ratio in Pondicherry (1.36) as reported by Naresh et al. Ioachim et al. in their study of 111 cases of AIDS associated lymphomas documented 11 cases of HL and 100 cases of NHL. In the present study all cases of AIDS had NHL alone. DLBCL was the most common NHL in HIV positive patients in the present study (X2 = 0.936, P = 0.333, NS). Similar observations have been documented by Ioachim et al.
Thirty five cases of Classical HL were included this study. Mean age was 34.6 years comparable to Colby et al. (29 years). A bimodal peak was seen in the age distribution.
In the present study NSHL was the most common subtype similar to the observation by Keller et al. and Selzer et al., However according to Patkar et al., MC was the most frequent type.
NSHL is described to be common in females when compared to other subtypes. In the present study a male preponderance was observed with a M: F ratio of 2:1 comparable to the series of Goswami et al. (1.7:1), Mauch et al. (1.04:1), and Baur et al. (1:1.03).,,
One case of Secondary HL following Mycosis Fungoides was seen in a 48 year old male. A differential diagnosis of Anaplastic transformation of Mycosis Fungoides was considered. The large cells were negative for CD3, CD20, CD 5 and EBV LMP. The lymphoma cells showed membrane and golgi positivity for CD15 and CD30 and diagnosis of Secondary HL following MF was considered.
Similar case of MF with HL like features was described by Kremer et al., in a 50 year old male. Our case differs from the one described by Kremer et al., as there was no bone marrow involvement.
Fifty eight cases of NHL were recorded in the present study. In the study by Morton et al. and NHL Classification Project  the incidence of B-cell NHL was higher when compared to the present study (72.4%). Our data is in agreement with the national incidence of NHL reported by Naresh et al.
In the study by Morton et al. and NHL Classification Project 
the incidence of T cell NHL was lower when compared to the present study (27.6%). The incidence of T cell NHL was higher in the present study when compared to the national incidence as reported by Naresh et al.
Seven cases of LBL (12%) were seen in the present study. The occurrence of LBL was higher than documented by Streuli et al. (5%). In the present study the age incidence ranged from 2 to 35 years with a mean age of 17 years, comparable. M: F ratio was 6:1. Most of the studies show male preponderance in the cases of LBL.,
Mature B cell NHL comprised 65% of all cases of NHL. DLBCL was the most commonest (37%) mature B cell NHL according to international data. Similarly in the present study, DLBCL was the commonest (47%) Mature B cell NHL. There were no cases of Burkitts lymphoma and Nodal marginal zone lymphoma in the present study.
DLBCL accounting for 31% was the single largest subset of NHL. Our data is in agreement with national incidence of DLBCL.
T cell/histiocyte rich B Cell Lymphoma
was diagnosed in 6 cases of DLBCL. Age range was 27-61 years. M: F ratio was 2:1. Jong et al. in their study of 12 cases had a similar M: F ratio of 2:1 with an age range of 23-82 years. The clinicopathologic findings were similar to the study of six cases by Delabie et al.
Follicular lymphoma accounted for 28% of all cases of NHL. The incidence is much higher when compared to national incidence as reported by Naresh et al. Based on WHO Classification, 6 cases were grade I, 5 cases were grade II and 4 cases were grade III. One case was of Follicular lymphoma in situ. The epidemiological factors for this high frequency (either genetic or environmental) need to be studied further.
In the present study Mature T cell NHL constituted about 22% of all NHL. In the present study PTCL and ALCL were the most common (38.4% each) of mature T cell NHL. In the present study PTCL comprised 8.6% of all NHLs and is much higher when compared to national incidence. The incidence of PTCL was higher in the study by Nash et al. (17%).
IPI score and NHL subtypes
In the study by NHL Classification project  highest frequency of poor IPI score were seen in PTCL (31%) followed by Lymphoblastic lymphoma (26%) similar to the present study. In the present study, two patients died within a year of diagnosis. One case was diagnosed as Anaplastic large cell lymphoma Stage III E B and the other was Precursor T cell LBL Stage III S B. Both cases had an IPI score of 4. Our data could not be compared with other studies as the follow up was less than three years in most cases.
| » Conclusion|| |
In conclusion the following points are significant about the distribution of lymphomas in a referral hospital of Mangalore city. The incidence of NSHL is higher while national data suggests MCHL as the most common subtype. The incidence of FL as well as T cell NHL is much higher when compared to national data. The epidemiological factors for this high frequency (either genetic or environmental) needs to be studied further.
| » Acknowledgements|| |
The authors would sincerely like to thank the management of KMC Mangalore and Manipal University along with the technical team of Department of Pathology for their support and help rendered.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]