title: Epstein-Barr virus infection is not the sole cause of high prevalence for Hodgkin's lymphoma in Saudi Arabia.
abstract: The age-adjusted incidence of Hodgkin's lymphoma (HL) is markedly higher in Saudi Arabia than in the USA, and accounts for 10.5% of all neoplasias in children aged 15 years or older in Saudi Arabia. Epstein-Barr virus (EBV) infection has been suspected to cause high HL incidence in developing countries. To investigate the role of EBV for the high frequency of HL in Saudi Arabia, we analysed 169 HLs from Saudi Arabia and 30 HLs from Europe for EBV infection by in situ hybridization with fluorescence in-conjugated EBV on tissue microarray sections. All Saudi Arabian and European HLs were analysed in one experiment under identical conditions. Unexpectedly, our data show only minor, insignificant differences in EBV infection rates between Saudi Arabian (42 out of 147 informative cases 28.6%) and European HL (nine out of 30 informative cases; 30%; P = 0.8752). Within the Saudi Arabian population, EBV infection was most frequently seen in mixed cellularity HL (52.4%). This was significantly more frequent than in nodular sclerosing HL (26.1%; P = 0.0236). EBV positivity was unrelated to patient prognosis. In conclusion, our data strongly suggest that EBV is not the main cause for the high prevalence of HL in Saudi Arabia. This would be consistent with a major role of genetic susceptibility genes for HL in these populations. The Saudi Arabian population, with high consanguinity and large families, would prove ideal for identifying HL susceptibility genes.
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Khawla
authors.initials: K
authors.lastname: Al-Kuraya
authors.forename: Rajeswari
authors.initials: R
authors.lastname: Narayanappa
authors.forename: Fouad
authors.initials: F
authors.lastname: Al-Dayel
authors.forename: Hassan
authors.initials: H
authors.lastname: El-Solh
authors.forename: Adnan
authors.initials: A
authors.lastname: Ezzat
authors.forename: Hoda
authors.initials: H
authors.lastname: Ismail
authors.forename: Asim
authors.initials: A
authors.lastname: Belgaumi
authors.forename: Prashant
authors.initials: P
authors.lastname: Bavi
authors.forename: Valerie
authors.initials: V
authors.lastname: Atizado
authors.forename: Guido
authors.initials: G
authors.lastname: Sauter
authors.forename: Ronald
authors.initials: R
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004198:Disease Susceptibility; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006689:Hodgkin Disease / Q000453:epidemiology / Q000209:etiology / Q000821:virology*; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012529:Saudi Arabia