• Users Online: 27
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2016  |  Volume : 41  |  Issue : 3  |  Page : 140-143

Clinical-pathological features and histological variants of Hodgkin's lymphoma: a study of 526 patients

1 Molecular Microbiology Laboratory, Health and Proteomics, Department of Biology, UDL-SBA, Ex-ITMA, Sidi Bel Abbes, Algeria
2 Environment and Cancer Laboratory, Department of Pathology, Central University Hospital, Sidi Bel Abbes, Algeria

Date of Submission24-Mar-2016
Date of Acceptance13-Apr-2016
Date of Web Publication27-Dec-2016

Correspondence Address:
Soumia Zeggai
89 Sidi Bel Abbes, 22000 Algeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1110-1067.196218

Rights and Permissions

Context Hodgkin's lymphoma is an uncommon disorder with heterogeneous clinical, histological, and epidemiological characteristics.
Aims The aim of this study was to describe the epidemiological and histopathological characteristics in patients with Hodgkin's lymphoma in Western Algeria.
Materials and methods Our retrospective descriptive study was conducted at the Departments of Haematology in Western Algerian hospitals over 11 years (2001–2011).
Statistical analysis used SPSS 18.0 was used.
Results A total of 526 patients were identified in our study. There were 273 male and 253 female patients, with a male to female ratio of 1.07. The mean age of the patients was 33.33 years (range = 14–89 years), and most of the patients were young adults [20–29 years (38.2%)]. Nodular sclerosis was the most frequent histological type (51%), followed by mixed cellularity (26%); nodular sclerosis was more common among female patients, whereas mixed cellularity was more common among male patients compared with female patients. Staging classification of the disease indicated high frequency of early stage II, with 184 cases (35%).
Conclusion Most of the patients were young adults with nodal lymphoma at an early stage of disease and a dominance of nodular sclerosis as the histological type. Further studies are required to determine the factors that play a major role in the etiology of this disease.

Keywords: epidemiology, histological type, Hodgkin′s lymphoma, Western Algeria

How to cite this article:
Zeggai S, Harir N, Belkacem A, Tou A, Sellam F, Mrabent NM, Salah R. Clinical-pathological features and histological variants of Hodgkin's lymphoma: a study of 526 patients. Egypt J Haematol 2016;41:140-3

How to cite this URL:
Zeggai S, Harir N, Belkacem A, Tou A, Sellam F, Mrabent NM, Salah R. Clinical-pathological features and histological variants of Hodgkin's lymphoma: a study of 526 patients. Egypt J Haematol [serial online] 2016 [cited 2022 Aug 19];41:140-3. Available from: http://www.ehj.eg.net/text.asp?2016/41/3/140/196218

  Introduction Top

Hodgkin's lymphoma (HL) is a malignant disease of the lymphoid tissue, which originates from germinal center and postgerminal center B cells; it comprises 10% of all lymphomas and 0.6% among all cancers [1]. HL shows wide variation in incidence among different geographic regions and various races [2]. It is characterized by the presence of multinucleated giant cells, known as Red-Stenberg cells, in the background of numerous reactive lymphocytes [3],[4]. The etiology of HL is unknown; epidemiology suggests that viral factors, especially Epstein–Barr virus, may play a causal role [5]. The major risk factors that were reported with greater or less evidence include the following: genetics (variation in the HLA class II region); childhood environment and socioeconomic status; congenital and acquired immunodeficiency; medical conditions; and occupational exposure (the wood industry and its derivatives) [6]. Current insight on trends, cases, and mechanisms revealed that HL has a unique and distinct epidemiological history, treatment, and biology [7]. The current study aims to investigate the clinical–epidemiological and pathohistological types of Hodgkin's disease in Western Algeria, with a comparative review of literature.

  Materials and methods Top

This is a descriptive retrospective study covering all HL diagnosed over a period of 11 years (2001–2011) at the Departments of Haematology in Western Algerian Hospitals (Central University Hospital of Sidi Bel Abbes, Tlemcen, Oran, Military Hospital of Oran, Hospital of Mostaganem, Mascara and Saida). The data were collected from patients’ medical records and concerned demographical and clinical-pathological characteristics of the patients. They included patients’ age, sex, anatomical site, Ann Arbor staging, histopathological type, and classification of tumors based on WHO classification. Statistical analyses were conducted with SPSS 18.0, USA.

  Results Top

This study involved 526 patients, among whom 273 (51.9%) were male and 253 (48.1%) were female, with a male to female ratio of 1.07. The mean age of the patients was 33.33 years, ranging from 14 to 86 years. Patients’ age group rates were as follows: 14–19 years (15.4%), 20–29 years (38.2%), and 30–39 years (19.2%); they were comparatively higher than the patients in age groups of 40–49 years (10.1%), 50–59 (8.7%) years, and 60 years and above (8.4%).

The most common location of HL at the time of diagnosis was the lymphoma node, with a rate of occurrence of 96%. Extralymphatic disease was found in 21 patients, and the most common involvement was identified as the gastric site in seven patients (1.33%) and cutaneous site in six patients (1.14%). Other extralymphatic localizations were identified as ORL and lung ([Table 1]).
Table 1 Characteristic features of patients with Hodgkin's lymphoma

Click here to view

Most of the patients had the histological types of nodular sclerosis (51%), followed by mixed cellularity (26.1%). Nodular sclerosis was more common among female patients, whereas the mixed cellularity was more common among male patients as compared with female patients ([Table 2]). A study of histological subtypes by patient age groups showed that nodular sclerosis type was more common in the age group of 20–29 years ([Table 3]).
Table 2 Sex distribution of histological types of Hodgkin's disease

Click here to view
Table 3 Distribution of histological types with age groups

Click here to view

Review of the clinical records of the patients showed that 80 cases (15.2%) had Ann Arbor stage I, 184 (35%) had stage II, 117 (22.2%) had stage III, and 113 (21.5%) had stage IV. The disease stage was not specified for 32 patients (6.1%) ([Table 1]).

  Discussion Top

HL cases in developed and developing countries display differences regarding their clinical and histopathological characteristics. It is one of the most common malignancies at young adult ages, and it is a curable disease in most patients [8]. The occurrence of HL in previous studies has shown that it is lower compared with non-Hodgkin's lymphoma in Algeria [9].The sex of individuals confers the greatest known risk for contracting lymphomas and leukemias [10]. A recent international consortium pooled patients’ data and identified male sex factor as one of the prognostic scores for advanced HL [11]. In our study, we did not observe an excess of male patients; the male to female ratio was 1.07, which is lower than another report from Nigeria (3.3) [12] and many other developing countries [13],[14]. The age of patients with these disorders varies among regions; it ranges between 31 and 38 years, with a peak around the age of 30 years. The median age of our patients was 33.33 years. It is similar to a published literature study by Yildirim et al.[15] (34 years) and Omoti and Halim [16] (33 years).

Epidemiological research showed that HL displayed a bimodal age distribution. The first peak occurs in young adulthood and the second peak occurs in advanced age [17]. Our results did show an increasing frequency in adult age, but it did not show an increasing incidence of HL in advancing age. This may be because of the underdiagnosis of lymphoma in this age group [18].

HL has less extranodal involvement as compared with non-Hodgkin's lymphoma [15]. It was very rarely seen (4%) in our study, which is close to a previous study from United Arab Emirates [19].

Similar to the studies from Jordan [20], Turkey [15], and China, nodular sclerosis was the most common type followed by mixed cellularity [21], but it was different from other studies that reported mixed cellularity as the most common type [22]. With regard to the analysis and the relationship of gender to histological types, there was a comparatively higher number of female patients with nodular sclerosis, a finding that is similar to that reported in studies from other parts of the globe [23].

For prognosis and therapeutic considerations, HL patients are conveniently divided into those with early-stage disease and those with the advanced-stage disease at presentation [24]. In our survey, there was a higher proportion of early-stage (stage II) disease according to the Ann Arbor classification, the results of which have been reported in previous studies [21], but it was in sharp contrast to the studies reported by Olu-Eddo and Omoti [12] and Yildirim et al.[15], in which the advanced stage was predominant.

  Conclusion Top

A notable feature in this study is a young adult predominance, and there is no bimodal distribution of age. Most patients initially present with nodal lymphoma at an early stage of disease, and nodular sclerosis is the predominant histological type followed by mixed cellularity. Further studies are required to determine the factors that play a role in the etiology of this disease.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009; 59:225–249.  Back to cited text no. 1
Ariad S, Lipshitz I, Benharroch D, Gopas J, Barchana M. A sharp rise in the incidence of Hodgkin's lymphoma in young adults in Israel. Isr Med Assoc J 2009; 11:453–455.  Back to cited text no. 2
2011; Mirsadraee S, Farzadnia M, Heidary F, Rahimi M, Jabbar iNoghabi H, Kakhki S. A comparative immumohistochemical diagnosis of Hodgkin's lymphoma with conventional method.  Back to cited text no. 3
Classical H, Michael C, Jame A, Wyndham HW, Elaine SJ. Bethesda handbook of clinical hematology. Philadelphia:Lippincott Williams & Wilkins; 2009.  Back to cited text no. 4
Weiss LM, Strickler JG, Warnke RA, Purtilo DT, Sklar J. Epstein–Barr viral. DNA in tissues of Hodgkin's disease. AMJ Pathol 1987; 129:86–91.  Back to cited text no. 5
Ferris TJ, Garcia CJ, Lopez AJA, Clar GS, Berbel TO. Risk factors for Hodgkin's lymphoma. An Esp Pediatr 2001; 55:239–243.  Back to cited text no. 6
Caporaso NE, Goldin LR, Anderson WF, Landgren O. Current insight on trends, causes and mechanisms of Hodgkin's lymphoma. CancerJ 2009; 15:117–123.  Back to cited text no. 7
Flowers CR, Armitage JO. A Decade of progress in lymphoma: advances and continuing challenges. Clin Lymphoma Myeloma Leuk 2010; 10:414–423.  Back to cited text no. 8
Zeggai S, Harir N, Touhami H. Epidemiology and pathological profile of lymphomas of the adults in the Algerian West: a report about 1,544 cases. JAC 2013; 5:127–132.  Back to cited text no. 9
Cartwright RA, Gurney KA, Moorman AV. Sex ratios and the risks of haematological malignancies. Br J Haematol 2002; 118:1071–1077.  Back to cited text no. 10
Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin's disease: International Prognostic Factors Project on Advanced Hodgkin's disease. N Engl J Med 1998; 339:1506–1514.  Back to cited text no. 11
Olu-Eddo AN, Omoti CE. Hodgkin lymphoma: clinicopathologic features in Benin City, Nigeria and update on its Biology and classification. Niger J Clin Pract 2011; 14:440–444.  Back to cited text no. 12
Riyat MS. Hodgkin's disease in Kenya. Cancer 1992; 69:1047–1051.  Back to cited text no. 13
Motawy SM, Omar YT. Hodgkin's disease in children in Kuwait. Cancer 1986; 57:2255–2259.  Back to cited text no. 14
Yıldırım M, Yıldız M, Kurtoğlu E, Karakılınç H, Utku Dönem Dilli U, Göktaş S. Epidemiology and histological subtypes of Hodgkin lymphoma in the south-west of Turkey. Gulhane Med J 2012; 54:216–219.  Back to cited text no. 15
Omoti CE, Halim NKD. Adult lymphomas in Edo state, Niger Delta region of Nigeria-clinicopathological profile of 205 cases. Clin Lab Haem 2005; 27:302–306.  Back to cited text no. 16
Glaser SL, Dorfman RF, Clarke CA. Expert review of the diagnosis and histologic classification of Hodgkin's disease in a population-based cancer registry. Cancer 2001; 92:218–224.  Back to cited text no. 17
Glaser SL, Swartz WG. Time trends in Hodgkin's disease incidence. The role of diagnostic accuracy. Cancer 1990; 66:2196–2204.  Back to cited text no. 18
Castella A, Joshi S, Raaschou T, Mason N. Pattern of malignant lymphoma in the United Arab Emirates – a histopathologic and immunologic study in 208 native patients. Acta Oncologica 2001; 40:660–664.  Back to cited text no. 19
Obeidat M, Abu Kamar A, Arabeat A, Al-jdayeh M, Bawaeneh A. Clinicopthological characteristics of Hodgkin lymphoma in Jordan. J Bio Agrand Health 2013; 3:45–47.  Back to cited text no. 20
Law MF, Ng TY, Chan HN, Lai HK, Ha CY, Leung CH et al. Clinical features and treatment outcomes of Hodgkin's lymphoma in Hong Kong Chinese. Arch Med Sci 2014; 10:498–504.  Back to cited text no. 21
Al-Sayes FMO, Sawan A. Clinico-pathological study of Hodgkin's disease in King Abdulaziz University Hospital, Jeddah. JTU Med Sci 2006; 1:48–56.  Back to cited text no. 22
Cozen W, Katz J, Mack TM. Risk patterns of Hodgkins disease in Los Angeles vary by cell type. Cancer Epidemiol Biomarkers Prev 1992; 1:261–268.  Back to cited text no. 23
Aisenberg AC. Problems in Hodgkin's disease management. Blood 1999; 93:761–779.  Back to cited text no. 24


  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Clinical Characteristics and Histopathological Patterns of Hodgkin Lymphoma and Treatment Outcomes at a Tertiary Cancer Center in Ethiopia
Makka Adam,Yonas Bekueretsion,Abdulaziz Abubeker,Fisihatsion Tadesse,Anna Kwiecinska,Rawleigh Howe,Beyene Petros,Mats Jerkeman,Amha Gebremedhin
JCO Global Oncology. 2021; (7): 277
[Pubmed] | [DOI]
Ruth Prasanna M,Satya Prakash Venkatachalam T
Journal of Evidence Based Medicine and Healthcare. 2019; 6(27): 1854
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and me...
Article Tables

 Article Access Statistics
    PDF Downloaded173    
    Comments [Add]    
    Cited by others 2    

Recommend this journal