Changing patterns in the frequency of Hodgkin lymphoma subtypes and Epstein-Barr virus association in Taiwan

Abstract

Epstein-Barr virus (EBV) infection is a risk factor for Hodgkin lymphoma (HL). To test whether the frequency of HL subtypes and their association with EBV has shifted with rising socioeconomic status in Taiwan, we compared the pathological features and EBV status, detected by in situ hybridization, of HL diagnosed between 1996 and 2007 (99 cases) and 1982 and 1995 (74 cases). The male-to-female ratio was 121:52 (2.3:1) and the mean age at presentation was 41.5 years. The overall EBV positivity rate was 50% (86/173 cases). Comparing the distribution of HL cases diagnosed at two different time periods, we found an increased frequency of the nodular sclerosis (NS) subtype (53 vs 68%, P = 0.045), a decreased frequency of the mixed cellularity subtype (35 vs 13%, P < 0.001), a reduced male-to-female ratio (2.9:1 compared to 1.4:1) and mean age (42.4 vs 36.6 years) in the NS subtype, and a significant decrease in EBV positivity rates among the NS and lymphocyte-depletion subtypes (61 vs 39%, P = 0.03). These data indicate shifts in the frequency of histological subtype and EBV association for HL in Taiwan over the last decade, with a trend closer to that seen in Western countries and Japan.

Figure 1

Epstein–Barr virus (EBV)‐encoded early RNA (EBER1) in situ hybridization for Hodgkin lymphoma (HL) cases shows positive signals in tumor cells with larger nuclear appearance. (a–d) The tumor cells of this nodular sclerosis Hodgkin's lymphoma case best appreciated by (a) hematoxylin–eosin (HE) section are positive for (b) CD30 and (c) CD15. (d) The distribution of EBER‐positive tumor cells corresponds to that seen in the HE section. (e) Sections of tissue microarray for cases from Veterans General Hospital Taipei show positive signals mainly in large nucleated tumor cells, (f) although a few inflammatory cells show weaker staining. (a–d) Original magnification 40×, inset 400×; (e) original magnification 10×; (f) original magnification 200×.