Hodgkin Lymphoma and Its Association With Epstein-Barr Virus in Kurdistan, Northern Iraq

Abstract

Background: Epstein Barr virus (EBV) has been linked to the etiology of several malignancies, including Hodgkin's Lymphoma (HL). However, the degree of this association varies between different geographical regions and age of EBV exposure. No study has addressed such an association in Kurdistan, northern Iraq, and thus this study was initiated. Patients and methods: A total of 91 patients diagnosed as HL over a 10 year period were studied. These patients had their records and slides reviewed and the additional immunohistochemistry, including that for LMP1 as well as in situ hybridization for EBER performed. Results: The patients had a mean age (SD) of 28.8 (16.2) years and had a male to female ratio of 1.7:1. They included 3.3% with Nodular Lymphocyte Predominant HL (NLPHL) and 96.7% Classical HL (cHL). The most common 2 subtypes of the latter were nodular sclerosis (NS) and mixed cellularity (MC) at 52.7% and 36.6% respectively. It was found that 40 cases (44.0%) were latent membrane protein 1 (LMP1) and/or EBER positive. The positivity was significantly higher in males (P=0.009), mixed cellularity subtype (P<0.001) and in the ages ≥45 and ≤15 years when compared to those 16-44 years (P=0.004). Conclusion: HL in Iraqi Kurdistan demonstrates a frequency of EBV virus infection that approaches the levels seen in Western countries and is coupled with a changing histological pattern of classical HL from MC to NS. This is likely to be a reflection of the improving socioeconomic status of the population of the region.