Pakistan Journal of Medical Sciences

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ORIGINAL ARTICLE

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Volume 24

January - March 2008

Number  1


 

Abstract
PDF of this Article

Hodgkins lymphoma in
cervical lymphadenopathy

Waseem Memon1, Abdul Samad2, Gul Muhammad Sheikh3

ABSTRACT

Objective: To determine the proportion of Hodgkins lymphoma in cervical lymphadenopathy.

Methodology: This is a prospective study conducted at Isra University Hospital, Hyderabad between January 2002 to December 2006. The data was collected for all patients presenting with cervical lymphadenopathy during the above mentioned period. All the patients with cervical lymphadenopathy were subjected to detailed history, clinical examination, investigations and histopathological examination.

Results: Out of 498 patients presenting with cervical lymphadenopathy, 40 patients were found to be having Hodgkin’s lymphoma. The gender distribution was predominantly male making up about 80%. About 50% patients had mixed cellularity whereas about 37.5% patients had nodular sclerosis. Most of the patients were having stages II and III disease. The over all five years survival rate was about 75%.

Conclusion: The proportion of Hodgkin’s lymphoma in cervical lymphadenopathy is relatively low in our population as compared to the western world.

KEY WORDS: Hodgkin lymphoma, Cervical lymphadenopathy, Staging, Histopathology.

Pak J Med Sci    January - March 2008    Vol. 24 No. 1    118-121


1. Dr. Waseem Memon,
Senior Registrar,
2. Dr. Abdul Samad,
Associate Professor,
3. Prof. Gul Muhammad Sheikh,
1-3: Department of Surgery,
Isra University Hospital,
Hyderabad - Sindh,
Pakistan.

Correspondence

Dr. Waseem Memon,
House no 107/A,
Tando Wali Muhammad,
Hyderabad - Sindh,
Pakistan.
E-mail: dr_waseem1973@hotmail.com

* Received for Publication: April 26, 2007

* Revision Received: May 31, 2007

* 2nd Revision Received: October 20, 2007

* Final Revision Accepted: October 26, 2007


INTRODUCTION

Hodgkins disease is prevalent worldwide with considerable geographical and regional variation.1 Age distribution, histological subtypes, clinical presentation and outcome differ between regions and between ethnic and socioeconomic groups.

World Health Organization (WHO) has divided this disease into four subtypes: Nodular Scelerosis, Mixed cellularity, lymphocytic predominate and lymphocytic depletion. The head and neck region is the third most common site of involvement by malignant Lymphoma.1,2 Hodgkins Lymphoma accounts for 20-45% of malignant lymphoma in western countries, but this is significantly less common in asian countries such as Korea, Japan, Taiwan, and the Phillippines with prevalence rates of 4.4-18%.3-6

The aim of the present study was to determine the proportion of Hodgkin Lymphoma in the cervical lymphadenopathy along with their pathology and pattern of clinical presentation.

PATIENTS AND METHODS

This study was conducted over a period of five years from January 2002 to December 2006 in the surgery department of Isra University Hospital Hyderabad.

This is a prospective study of all patients presenting with cervical Lymphadenopathy during the above mentioned period. All patients were subjected to a detailed clinical history and their age, gender and duration of symptoms were recorded. The clinical features of these patients at the time of presentation were also noted. A thorough physical examination of chest, abdomen, cardiovascular & central nervous systems along with all lymph nodes especially cervical group of lymph nodes was carried out. The size, consistency, mobility and tenderness of lymph nodes were recorded. Routine investigations including blood complete picture, urine detailed report and X-Ray chest were carried out. The lymph nodes which were mobile and easily accessible underwent excision biopsy. The lymph nodes which were fixed or difficult to access or excise underwent incision biopsy.

RESULTS

During the period of study, 498 patients presented with cervical lymphadenopathy fulfilling the inclusion criteria. These include 281 males and 217 females with cervical lymphadenopathy. Three hundred eleven patients underwent incision biopsy whereas 187 patients underwent excision biopsy. Hodgkins Lymphoma was observed in 40 patients and these include 29 males and 11 females.

The mean age was 23 years with the range of 1-35 years. Anorexia, fever, night sweats and weight loss were the common presenting clinical features. The details of presenting clinical features are mentioned in Table-I. Other groups of lymph nodes such as axillary, inguinal and mediastinal Lymph nodes were also involved in 22 patients.

The enlarged cervical lymph nodes were non-tender, discrete, mobile and firm in consistency in all patients of Hodgkins Lymphoma. Among these 40 patients, the juglo-diagastric and jugulo-omohyoid groups were the main contributors. Detailed distribution of Hodgkins lymphoma among various groups of cervical lymph nodes is mentioned in Table-II.

Mixed cellularity and nodular sclerosis are the major histopathological features. Detailed description of histopathological features is mentioned in   Table-III.

Most of the patients had stage III disease. The detailed distribution of patients among various stages of lymphoma is mentioned in Table-IV. Most patients of stage I-II underwent radiotherapy except for those with B symptoms and bulky disease who received chemotherapy with or without radiotherapy.

The duration of clinical follow up ranged from 1 to 65 months with median of 26 months. The over all five years survival rate was 75%. The patients with organ infiltration (stage IV) had poor prognosis than those with Nodal disease (stage II-III)

DISCUSSION

Hodgkin’s Lymphoma is relatively rare and its incidence varies with age, geographical location and socioeconomic class. The consistently low rates of Hodgkin’s Lymphoma in Asians suggest genetic resistance to disease development.7 Other risk factors include smoking history, environmental exposure to cancer causing agents or immunocompromised status. The proportion of Hodgkin’s lymphoma in this study was 8% and is comparable to the figures reported form various Asian countries.3-6

There was equal distribution among various age groups unlike western studies which show a typically bimodal pattern.8 In a study, about 20% of the patients were above 60 years. Several other studies have shown that Hodgkins disease in older adults had a poorer prognosis than in younger adults.8-11 There is male preponderance with male to female ratio of 3:1. This male preponderance is also reported form developed countries like United States.12

The nodular Sclerosis is reported to be the most common subtype of Hodgkin’s Lymphoma in western countries, whereas, mixed cellularity is a more common feature of third world countries like Pakistan. A comparison of different sub types of Hodgkin’s Lymphoma in this study with other countries is shown in Table-V.13-17

Another study of 34 patients with Hodgkin’s Lymphoma from Taiwan revealed extremely high incidence (80.6%) of advanced clinical stages III and IV.18 In this study, the proportion of advanced clinical stages III and IV was 54%. The treatment of choice for Hodgkin’s Lymphoma is radiotherapy and /or chemotherapy depending on clinical stages. The five years survival rate in this study was 75% and is comparable to another study reporting about 83% five years survival rate.19 Improved survival rate and lower incidence of advanced stages might result from early diagnoses because of comprehensive clinical evaluation.

CONCLUSION

The proportion of Hodgkins lymphoma in cervical lymphadenopathy is relatively low and poor prognosis is observed in patients with advanced stage of disease.

REFERENCES

1. Sawyer R, Rosenthal DI, Maniglia AJ, Goodwin WJ. Unusual head and neck manifestation of Non-Hodgkins lymphoma in children and adult. Laryngoscope 1987;69:1136-40.

2. Shikhani A, Samara M, Allama C, Salem P, Lenhard R. Primary lymphoma in the salivary gland: report of 5 cases and review of the literature. Laryngoscope 1987;69:1438-42.

3. Liang R, Choi P, Todd D, Cham TK, Choy D, Ho F. Hodgkins disease in Hong Kong Chinese. Hematological oncology 1989;7:395-403.

4. Paulino AF, Paulino–Cabrera E, Weiss LM, Medeiros LJ. Hodgkins disease in the Philippines. Modern Pathology 1996;9:115-9.

5. Lymphoma study Group of Japanese Pathologists. The World Health Organization classification of malignant lymphomas in Japan: Incidence of recently recognized entities. Pathology international 2000;50:696-702.

6. Ko YH, Kim CW, Park CS, Jang HK, Lee SS, Kin SH. Real classification of malignant lymphomas in the Republic of Korea: Incidence of recently recognized entities and changes in clinico pathologic features. Cancer 1998;3:806-12.

7. Sally CG, Joe LH. Hodgkins lymphoma in Asian. Incidence patterns and risk factors in population - based data. Leukemia Research 2000;26:261-9.

8. Kennedy BJ, Loeb V, Peterson VM, Donegan WL, Natarajan N, Mettlinc. National Survey of pattern of care for Hodgkine disease. Cancer 1985;56:2547-56.

9. Walker A, Sehoenfield ER, Lowman JT, Mettlin CJ, McMillan J, Grufferman S. Survival of the older patient compared with the younger patient with Hodgkin disease. Cancer 1990;65:1635-40.

10. Guinea VF, Giacco GG, Durad M, Van der Blink JW, Gustavasson A, Mc Vie JG, et al. The prognosis of Hodgkin disease in older adults. J Clinical Oncology 1991;9:947-53.

11. Erdkamp FL, Breed WP, Bosch LJ, Wijen JT, Blijham GB. Hodgkins disease in the elderly a registry – based analysis. Cancer 1992;70:830-4.

12. Taylor PRA, Angus B, Owen JP, Proctor SJ. On behalf of the Northern Region lymphoma group Hodgkins disease a population adjusted clinical epidemiology study of management at presentation. J Medicine 1998;91:131-9.

13. Medeiros LJ, Greiner TC. Hodgkins disease. Cancer 1995;75:357-69.

14. Georgii A, Fischer R, Hubner K. Classification of Hodgkins disease biopsies by a panel of four histopathologists. Report of 1140 patients from German National Trial. Leuk lymphoma 1993;9(4-5):365-70.

15. Siddiqui T, Pervez S. Spectrum of Hodgkins disease in children and adults. Impact of combined morphologic and phenotypic approach for exclusion of look alikes. J Pak Med Assoc 1999;49(9):211-4.

16. Ramdas K, Sankaranaryanan R, Nair MK. Adult Hodgkins disease in Kerala, Cancer 1994;73:2213-7.

17. Abu eL Hassan MS, Ahmed ME, Fatah-A Gadir. Differences in the presentation of Hodgkins disease in Sudan and Western countries. Trop Geogr Med 1993;45:28-9.

18. Hog RL Suij, Chen YCH, Sieh HC, Wang CH, Liu CH, Shen MC. Hodgkins disease and Non-Hodgkins Lymphoma containing Reed-Sternberg- Like giant cells in Taiwan. A clinicopathologic analysis of 50 cases. Cancer 1992;92:1254-8.

19. Kennedy BJ, Fremgen AM, Menck HR. The national cancer database report on Hodgkins disease for 1985 – 1989 and 1990-1994. Cancer 1998;83:1041-7.


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