Frequency and distribution of lymphoma types in a tertiary care hospital in South India: analysis of 5115 cases using the World Health Organization 2008 classification and comparison with world literature

Abstract

This study aimed to analyze the distribution of lymphoid neoplasms in a single tertiary care center in India using the World Health Organization (WHO) 2008 classification. Histological material of 5115 patients with histopathological diagnosis of lymphoma, diagnosed over a period of 10 years (2001-2010), was analyzed retrospectively. Hodgkin lymphoma (HL) constituted 21.3% (n = 1089) and non-Hodgkin lymphomas (NHLs) constituted 78.7% (n = 4026). Of these, B-cell neoplasms accounted for 78.6% (n = 3166) and T-cell/natural killer (NK)-cell neoplasms 20.2% (n = 815) of the NHLs. The commonest subtype of NHL was diffuse large B-cell lymphoma (n = 1886, 46.9%). The frequency of peripheral T-cell/NK-cell lymphomas in this study was higher than in the Western literature but less than the frequency documented in some Asian countries. Similar to the Western literature but in contrast to previous Indian studies, peripheral T-cell lymphoma, not otherwise specified (PTCL NOS) (n = 238) was the commonest histological subtype of T-cell/NK-cell NHL in this study and constituted 5.9% of the total NHLs. Mixed cellularity (MC-CHL) (n = 488, 45%) was the major subtype of HL. Primary extranodal lymphoma (ENL) accounted for 32.8% (n = 1321) of all NHLs and most frequently involved the gastrointestinal tract. This study also documents the frequency of many rare types of lymphoma in South India.

Non-Hodgkin lymphoma in the developing world: review of 4539 cases from the International Non-Hodgkin Lymphoma Classification Project

“…Other studies from the developing world have also reported lower median ages in B-NHL patients. 19,20,34,42 Our finding that B-NHL occurs at an earlier age seems to correlate with a lower gross domestic product in the developing world, 43 and suggests that socioeconomic factors may play a role in lymphomagenesis. The much lower median age of patients with HG B-NHL observed in SAF can be attributed to HIV infection, which predominantly affects young blacks.…”

“…16 Other studies from developing countries have reported a similar distribution pattern of Bcell lymphoma, with a high relative frequency of DLBCL and a low frequency of FL. [17][18][19][20] These differences are likely multifactorial in origin. In North America, whites have the highest incidence of FL of all races.…”

Epidemiology of Non-Hodgkin's Lymphoma in India

“…B-cell NHL make up 80-85% of all NHLs in India [10,13,14] . Diffuse large B-cell NHL is the most common subtype (60%) followed by indolent lymphoma (12-20%).…”

Peripheral T cell lymphoma in Asia

“…The incidence and distribution of T-and NK-cell lymphomas in several Asian countries is summarized in Fig. 1 and Table 1 [ [4][5][6][7][8][9][10][11][12][13][14][15].The frequencies of T-and NK-cell lymphomas seem to increase from West to East Asia. The occurrence rate of Tand NK-cell lymphomas are relatively low (\20 % of NHL) mainly in West Asia (Turkey 16.2 %, Iraq 19 %, and Kuwait 18 %) and South Asia (Pakistan 11.3 %, and India 20.2 %), but relatively high mainly in East Asia (China 32.5 %, Korea 22 %, and Japan 24.9 %) and Southeast Asia (Thailand 25 %).…”

“…The incidence and distribution of T-and NK-cell lymphomas in several Asian countries is summarized in Fig. 1 and Table 1 [ [4][5][6][7][8][9][10][11][12][13][14][15].…”