Spectrum of Hodgkin's disease in children and adults: impact of combined morphologic and phenotypic approach for exclusion of "look-alikes".
OBJECTIVE
To determine the prevalence of Hodgkin's disease (HD) and its various subtypes in children and adults and assess the use of immunohistochemical (IHC) studies in confirming HD cases and excluding its close mimicries/look-alikes.


METHODS
All 265 Hodgkin's disease cases diagnosed at The Aga Khan University Hospital, Karachi over the last 6 years (July 1991-July 1997) were included. Of these 219 were diagnosed on routine H&E examination while in the remaining 46 cases, diagnosis was made after a thorough IHC workup. (This group initially included 161 cases labelled as lymphoproliferative disorder with HD as one of the differentials).


RESULTS
Out of a total of 265 HD cases (206) 78% were males and (59) 22% were females in a ratio of 3.5:1.26% (69) cases were < 15 years while 74% (196) were > 15 years old. In both age groups, the commonest subtype proved to be Mixed Cellularity (MC) (60% of < 15 years old and 40% of > 15 years old) followed by Nodular Sclerosing (NS) (20% of < 15 years old and 27% of > 15 years old). Lymphocyte Predominant (LP) and Lymphocyte Depleted (LD) were seen less frequently. With the help of IHC studies performed on 161 cases in which HD was part of the differential diagnosis, 46 were conclusively diagnosed as HD. In the rest of the cases the main different was Non-Hodgkin's Lymphoma (NHL) that accounted for 72 of the cases.


CONCLUSIONS
This study shows that the most common sub-type of HD in our series in MC followed by NS. This study also suggests reasons why the more aggressive sub-type MC is predominant in Third world countries like ours compared to the better prognostic NS seen more in developed countries and why LP and LD are less and less commonly diagnosed.
Siddiqui
T
T
Department of Pathology, Aga Khan University Hospital, Karachi.
Pervez
S
S
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006689:Hodgkin Disease / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence