Histomorphological and anatomical analysis of primary extra nodal non-Hodgkin lymphoma – ten years study from a tertiary cancer centre in South India
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2017, Vol 5, Issue 1
Abstract
Abstract: A substantial percentage of non-Hodgkin lymphomas (NHL) arise from tissue other than lymph nodes and even from sites which normally contain no lymphoid tissue. These forms are referred to as primary extranodal lymphomas (pENL). From January 2006 to December 2015, a total number of 1529 cases of NHL diagnosed definitely with lymphoma were included. Clinical information including demographics (age, gender) and initial site of involvement was collected. Out of 1529 cases 335 cases were of extranodal origin. This study was undertaken to ascertain the prevalence, anatomical distribution, and histological subtypes of extranodal non-Hodgkin lymphoma (NHL). This is one of the largest data from a single institution from a tertiary referral hospital in Southern India. Extranodal lymphomas constituted 335/1529 (21.9%) of all NHL. These included 209 males and 126 females (M: F= 1.65:1) and peak incidence was during the 4th to 5th decade of life. 296/335 (88.5%) of pENL had B immunophenotype whereas T cell phenotype was observed in only 39/335 patients (11.5%). GIT was the most common site of extranodal lymphomas in our study constituting 32% followed by head and neck 27.5%, CNS 8%, bone 7.5%, skin 7%, mediastinum 5%, testis 4%, soft tissue 3.8%, breast 1.49% and ovary 1%.The least common sites being kidney, urinary bladder, lung/pleura, primary liver and primary spleen. Diffuse large B-cell lymphoma, not otherwise specified (DLBCL) was the most common histological type observed in 172/286 (60%), followed by extranodal marginal zone lymphoma of MALT type 43/286 (15%). The most common histological subtype in children (age<18) was Burkitt lymphoma 20/49(41%) followed by DLBCL 10/49(20%). In adults stomach was the commonest site with DLBCL as frequent histomorphology while in paediatric population it was ileocaecum with Burkitt lymphoma. The incidence of pENL in Indian subcontinent is low compared to data from other parts of the world. Gastrointestinal tract and head and neck were the two most common extra nodal sites observed. The commonest site of involvement was GIT (32%). This is similar to the data from western studies, but differs from the other Indian studies in which head and neck lymphomas and PCNSL were the commonest. Head and neck was the second most common in our study, the reason being Waldeyer's ring and tonsils, were considered as nodal and were excluded from the study. However in many respects, historically they have been included among the extranodal types. Follicular lymphomas were conspicuously very low in the extranodal sites. Compared to published series, no difference was noted in regard to gender predilection and morphology. Keywords: extranodal, non-Hodgkin lymphoma, primary
Authors and Affiliations
Suma Mysore Narayana, Chennagiri Premalata, Usha Amirtham, Geetha Kurlekar, Rekha V Kumar
Keywords
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