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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 41  |  Issue : 3  |  Page : 140-143

Clinical-pathological features and histological variants of Hodgkin's lymphoma: a study of 526 patients


1 Molecular Microbiology Laboratory, Health and Proteomics, Department of Biology, UDL-SBA, Ex-ITMA, Sidi Bel Abbes, Algeria
2 Environment and Cancer Laboratory, Department of Pathology, Central University Hospital, Sidi Bel Abbes, Algeria

Date of Submission24-Mar-2016
Date of Acceptance13-Apr-2016
Date of Web Publication27-Dec-2016

Correspondence Address:
Soumia Zeggai
89 Sidi Bel Abbes, 22000 Algeria
Algeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1067.196218

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  Abstract 

Context Hodgkin's lymphoma is an uncommon disorder with heterogeneous clinical, histological, and epidemiological characteristics.
Aims The aim of this study was to describe the epidemiological and histopathological characteristics in patients with Hodgkin's lymphoma in Western Algeria.
Materials and methods Our retrospective descriptive study was conducted at the Departments of Haematology in Western Algerian hospitals over 11 years (2001–2011).
Statistical analysis used SPSS 18.0 was used.
Results A total of 526 patients were identified in our study. There were 273 male and 253 female patients, with a male to female ratio of 1.07. The mean age of the patients was 33.33 years (range = 14–89 years), and most of the patients were young adults [20–29 years (38.2%)]. Nodular sclerosis was the most frequent histological type (51%), followed by mixed cellularity (26%); nodular sclerosis was more common among female patients, whereas mixed cellularity was more common among male patients compared with female patients. Staging classification of the disease indicated high frequency of early stage II, with 184 cases (35%).
Conclusion Most of the patients were young adults with nodal lymphoma at an early stage of disease and a dominance of nodular sclerosis as the histological type. Further studies are required to determine the factors that play a major role in the etiology of this disease.

Keywords: epidemiology, histological type, Hodgkin′s lymphoma, Western Algeria


How to cite this article:
Zeggai S, Harir N, Belkacem A, Tou A, Sellam F, Mrabent NM, Salah R. Clinical-pathological features and histological variants of Hodgkin's lymphoma: a study of 526 patients. Egypt J Haematol 2016;41:140-3

How to cite this URL:
Zeggai S, Harir N, Belkacem A, Tou A, Sellam F, Mrabent NM, Salah R. Clinical-pathological features and histological variants of Hodgkin's lymphoma: a study of 526 patients. Egypt J Haematol [serial online] 2016 [cited 2019 Dec 9];41:140-3. Available from: http://www.ehj.eg.net/text.asp?2016/41/3/140/196218


  Introduction Top


Hodgkin's lymphoma (HL) is a malignant disease of the lymphoid tissue, which originates from germinal center and postgerminal center B cells; it comprises 10% of all lymphomas and 0.6% among all cancers [1]. HL shows wide variation in incidence among different geographic regions and various races [2]. It is characterized by the presence of multinucleated giant cells, known as Red-Stenberg cells, in the background of numerous reactive lymphocytes [3],[4]. The etiology of HL is unknown; epidemiology suggests that viral factors, especially Epstein–Barr virus, may play a causal role [5]. The major risk factors that were reported with greater or less evidence include the following: genetics (variation in the HLA class II region); childhood environment and socioeconomic status; congenital and acquired immunodeficiency; medical conditions; and occupational exposure (the wood industry and its derivatives) [6]. Current insight on trends, cases, and mechanisms revealed that HL has a unique and distinct epidemiological history, treatment, and biology [7]. The current study aims to investigate the clinical–epidemiological and pathohistological types of Hodgkin's disease in Western Algeria, with a comparative review of literature.


  Materials and methods Top


This is a descriptive retrospective study covering all HL diagnosed over a period of 11 years (2001–2011) at the Departments of Haematology in Western Algerian Hospitals (Central University Hospital of Sidi Bel Abbes, Tlemcen, Oran, Military Hospital of Oran, Hospital of Mostaganem, Mascara and Saida). The data were collected from patients’ medical records and concerned demographical and clinical-pathological characteristics of the patients. They included patients’ age, sex, anatomical site, Ann Arbor staging, histopathological type, and classification of tumors based on WHO classification. Statistical analyses were conducted with SPSS 18.0, USA.


  Results Top


This study involved 526 patients, among whom 273 (51.9%) were male and 253 (48.1%) were female, with a male to female ratio of 1.07. The mean age of the patients was 33.33 years, ranging from 14 to 86 years. Patients’ age group rates were as follows: 14–19 years (15.4%), 20–29 years (38.2%), and 30–39 years (19.2%); they were comparatively higher than the patients in age groups of 40–49 years (10.1%), 50–59 (8.7%) years, and 60 years and above (8.4%).

The most common location of HL at the time of diagnosis was the lymphoma node, with a rate of occurrence of 96%. Extralymphatic disease was found in 21 patients, and the most common involvement was identified as the gastric site in seven patients (1.33%) and cutaneous site in six patients (1.14%). Other extralymphatic localizations were identified as ORL and lung ([Table 1]).
Table 1 Characteristic features of patients with Hodgkin's lymphoma

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Most of the patients had the histological types of nodular sclerosis (51%), followed by mixed cellularity (26.1%). Nodular sclerosis was more common among female patients, whereas the mixed cellularity was more common among male patients as compared with female patients ([Table 2]). A study of histological subtypes by patient age groups showed that nodular sclerosis type was more common in the age group of 20–29 years ([Table 3]).
Table 2 Sex distribution of histological types of Hodgkin's disease

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Table 3 Distribution of histological types with age groups

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Review of the clinical records of the patients showed that 80 cases (15.2%) had Ann Arbor stage I, 184 (35%) had stage II, 117 (22.2%) had stage III, and 113 (21.5%) had stage IV. The disease stage was not specified for 32 patients (6.1%) ([Table 1]).


  Discussion Top


HL cases in developed and developing countries display differences regarding their clinical and histopathological characteristics. It is one of the most common malignancies at young adult ages, and it is a curable disease in most patients [8]. The occurrence of HL in previous studies has shown that it is lower compared with non-Hodgkin's lymphoma in Algeria [9].The sex of individuals confers the greatest known risk for contracting lymphomas and leukemias [10]. A recent international consortium pooled patients’ data and identified male sex factor as one of the prognostic scores for advanced HL [11]. In our study, we did not observe an excess of male patients; the male to female ratio was 1.07, which is lower than another report from Nigeria (3.3) [12] and many other developing countries [13],[14]. The age of patients with these disorders varies among regions; it ranges between 31 and 38 years, with a peak around the age of 30 years. The median age of our patients was 33.33 years. It is similar to a published literature study by Yildirim et al.[15] (34 years) and Omoti and Halim [16] (33 years).

Epidemiological research showed that HL displayed a bimodal age distribution. The first peak occurs in young adulthood and the second peak occurs in advanced age [17]. Our results did show an increasing frequency in adult age, but it did not show an increasing incidence of HL in advancing age. This may be because of the underdiagnosis of lymphoma in this age group [18].

HL has less extranodal involvement as compared with non-Hodgkin's lymphoma [15]. It was very rarely seen (4%) in our study, which is close to a previous study from United Arab Emirates [19].

Similar to the studies from Jordan [20], Turkey [15], and China, nodular sclerosis was the most common type followed by mixed cellularity [21], but it was different from other studies that reported mixed cellularity as the most common type [22]. With regard to the analysis and the relationship of gender to histological types, there was a comparatively higher number of female patients with nodular sclerosis, a finding that is similar to that reported in studies from other parts of the globe [23].

For prognosis and therapeutic considerations, HL patients are conveniently divided into those with early-stage disease and those with the advanced-stage disease at presentation [24]. In our survey, there was a higher proportion of early-stage (stage II) disease according to the Ann Arbor classification, the results of which have been reported in previous studies [21], but it was in sharp contrast to the studies reported by Olu-Eddo and Omoti [12] and Yildirim et al.[15], in which the advanced stage was predominant.


  Conclusion Top


A notable feature in this study is a young adult predominance, and there is no bimodal distribution of age. Most patients initially present with nodal lymphoma at an early stage of disease, and nodular sclerosis is the predominant histological type followed by mixed cellularity. Further studies are required to determine the factors that play a role in the etiology of this disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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