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  Table of Contents    
ORIGINAL ARTICLE  
Year : 2012  |  Volume : 55  |  Issue : 4  |  Page : 429-432
Peripheral T-cell lymphoma: Frequency and distribution in a tertiary referral center in South India


Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India

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Date of Web Publication4-Mar-2013
 

   Abstract 

Background and Aim: Peripheral T/NK-cell lymphomas are uncommon types of non-Hodgkin's lymphoma (NHL) with a higher frequency in Far East countries as compared to the West. This study was undertaken to ascertain the frequency and distribution pattern of peripheral T-cell lymphomas (PTCLs) diagnosed in a tertiary care center in South India. Materials and Methods: This retrospective study was carried out in Department of General Pathology, Christian Medical College, Vellore. The time period was for 2 years from 1 st January 2008 till 31st December 2009. All PTCLs were reviewed and classified according to the World Health Organization (WHO) 2008 classification. Results: Of a total of 1032 cases of NHL, 180 cases were PTCL, which accounted for 17.4% cases of all the NHLs. Of these, PTCL, not otherwise specified (PTCL, NOS) was the most common subtype (48 cases, 26.1%), followed by anaplastic large cell lymphoma (41 cases, 22.8%), mycosis fungoides (21 cases, 11.7%), angioimmunoblastic T-cell lymphoma (16 cases, 8.9%), subcutaneous panniculitis like T-cell lymphoma (15 cases, 8.4%), extranodal NK/T-cell lymphoma, nasal type (12 cases, 6.7%), and hepatosplenic T-cell lymphoma (10 cases, 5.6%). The most common primary site of presentation was nodal accounting for 42% followed by cutaneous (34%), upper aerodigestive sites (8.9%), spleen (6.7%), and gastrointestinal tract (GIT; 3.3%). Conclusions: This is the largest single study on PTCLs in India and we document that its frequency is higher than that reported in Western literature and previous Indian studies and almost similar to that reported in some Far East studies. The frequency of mycosis fungoides, subcutaneous panniculitis like T-cell lymphoma, and hepatosplenic T-cell lymphoma was higher than that reported in the World literature and previous Indian studies. The frequency of extranodal NK/T-cell lymphoma and angioimmunoblastic T-cell lymphoma was much lower than that reported in the Far East literature.

Keywords: Lymphomas, non-Hodgkin′s lymphoma, peripheral T-cell lymphomas

How to cite this article:
Burad DK, Therese MM, Nair S. Peripheral T-cell lymphoma: Frequency and distribution in a tertiary referral center in South India. Indian J Pathol Microbiol 2012;55:429-32

How to cite this URL:
Burad DK, Therese MM, Nair S. Peripheral T-cell lymphoma: Frequency and distribution in a tertiary referral center in South India. Indian J Pathol Microbiol [serial online] 2012 [cited 2019 Dec 12];55:429-32. Available from: http://www.ijpmonline.org/text.asp?2012/55/4/429/107770



   Introduction Top


Peripheral T-cell lymphomas (PTCLs) are uncommon types of non-Hodgkin's lymphomas (NHLs) and constitute 4-12% in Western studies [1],[2],[3] and 12-26% in Far East studies. [1],[4],[5],[6],[7] Earlier Indian studies have shown a frequency of 9-12% which is similar to that in the West. [8],[9] These studies show that a considerable variation exists in the frequency and distribution of PTCLs across the world. The present study was undertaken to ascertain the frequency and distribution of PTCLs in southern India as there are no large studies documented in literature from this region.


   Materials and Methods Top


This retrospective study was carried out in Department of General Pathology, Christian Medical College, Vellore. The time period of the study was 2 years from 1 st January 2008 till 31 st December 2009. This study included biopsy material of patients registered within the hospital and referral biopsies from outside. All tissue samples were fixed in 10% buffered formalin. Then, 4 μm sections were cut and the slides were stained with Hematoxylin and Eosin (H and E). Immunohistochemistry (IHC) was done for all cases with appropriate positive control using the Envision technique developed with diaminobenzidine (DAB) subjected to pretreatment by heating in a Pascal pressure cooker in 0.01 M citrate buffer (pH 6)/1 mM ethylenediaminetetraacetic acid (EDTA) buffer (pH 8) or to the proteolytic enzyme trypsin, depending on the antibody used [Table 1]. Appropriate panel of antibodies was chosen after morphological evaluation of the cases. All the cases were classified according to the World Health Organization (WHO) 2008 classification. [10] Data entry and all statistical analyses were done using epi-info software. Descriptive statistics such as frequency and percentage were used. Categorical variables were analyzed using χ2 test with Yates's continuity correction and Fischer's exact test. A P value of <0.05 was considered statistically significant.
Table 1: Immunohistochemical antibodies used in the study

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   Results Top


During this study period, a total of 180 cases (17.4%) of PTCL were diagnosed among 1032 cases of NHL. PTCL, not otherwise specified (PTCL, NOS) was the most common subtype (48 cases, 26.1%), followed by anaplastic large cell lymphoma (ALCL) (41 cases, 22.8%), mycosis fungoides (MF) (21 cases, 11.7%), angioimmunoblastic T-cell lymphoma (AITL) (16 cases, 8.9%), subcutaneous panniculitis like T-cell lymphoma (SPTCL) (15 cases, 8.4%), extranodal NK/T-cell lymphoma, nasal type (12 cases, 6.7%), and hepatosplenic T-cell lymphoma (HSTL) (10 cases, 5.6%). The frequencies of the different subtypes are given in [Figure 1].
Figure 1: Frequency of peripheral T/NK cell lymphoma subtypes in our study, *includes 1 case of peripheral T cell lymphoma, not further classifiable in view of inadequate tissue for further immunomarkers

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The most common primary site of presentation was lymph nodes [Figure 2] accounting for 42% (76 of 180 cases), followed by cutaneous 34% (61 of 180 cases), upper aerodigestive sites 8.9% (16 of 180 cases), spleen 6.7% (12 of 180 cases), and gastrointestinal tract (GIT) 3.3% (6 of 180 cases). The frequencies of other sites of involvement are shown in [Figure 3]. Distribution of different subtypes of PTCLs according to the site is shown in [Table 2].
Figure 2: Sites of involvement of peripheral T/NK cell lymphomas (frequency in percentage)

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Figure 3: Primary extranodal extracutaneous sites of involvement of peripheral T/NK cell lymphomas (percentage)

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Table 2: Distribution of different subtypes of PTCLs according to the site

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   Discussion Top


PTCL constituted 17.4% of all NHLs in our study, which is slightly higher than that reported in western studies (4-11.5%) [1],[11],[12] and in the previous Indian studies (10-12%) (P < 0.01), [8],[9] but almost similar to the Far East studies (13-25%). [13],[14] The frequency of PTCL in different geographic locations is shown in [Figure 4].
Figure 4: Frequencies of peripheral T/NK cell lymphomas in our study as compared to Far East, Western, and previous Indian studies

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Among the PTCLs, PTCL, NOS was the most common subtype accounting for 26% and was slightly higher than ALCL which constituted 23% in our study. This is similar to reports from the Western [1],[3],[12] and other Far East countries. [6],[7],[14],[15] Other studies from India [9] and China [4] have shown a slightly higher frequency of ALCL as compared to PTCL, NOS. The comparison of frequencies of subtypes of PTCLs in our study with the reports from other countries is shown in [Figure 5].
Figure 5: Comparison of peripheral T-cell lymphoma subtypes in our study and other studies

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AITL constituted approximately 9% of all PTCLs, similar to a previous Indian study (11%). [8] In contrast, a much higher frequency of 21% and 18% has been reported in Japan [3] and Western literature, [14] respectively. This was statistically significant (P < 0.002).

Our frequency of extranodal NK/T-cell lymphoma, nasal type (7%) is similar to that reported in the previous Indian studies [8],[9] and slightly higher than that reported from Western countries like Europe (4.3%) and North America (5.1%). [3] This is in contrast to other Asian countries where it has a very high frequency, with 17.4% in Japan (P < 0.003), [14] 26% in Taiwan (P < 0.000), [15] and 38% in China (P < 0.000). [4]

HSTL constituted 5.5% of all our PTCLs. This is higher than the reported frequency from a previous Indian study (0.4%) [8] and from other parts of the world (1-3%). [3],[4],[12],[14],[15]

MF constituted 11.6% (21 of 180 cases) of all our PTCLs, almost similar to the reported frequency of 9% in the previous Indian study [8] and higher than in Western and Far East literature (1.5-7.8%). [1],[4],[12],[14],[15],[16]

SPTCL accounted for 8% (15 of 180 cases). This subtype is rare in most of the Western countries and other Asian countries where it constitutes less than 2%. [3],[4],[6],[14] Even the previous Indian study showed a frequency of only 1.2%. [8] This is probably related to detection of cases with wider immunohistochemical panels now available in India. There may be a viral/chemical etiological agent which needs to be identified.

There were five cases each of primary cutaneous ALCL and lymphomatoid papulosis, together constituting 5.5%. The reported frequency in other studies is similar and varies from 1 to 6%. [3],[8],[9],[14],[15]

There were only two cases of enteropathy-associated T-cell lymphoma (EATL), accounting for 1.1% of all the cases, similar to that reported in Far East [4],[14] and lower than in the Western literature, [3] probably related to the lower incidence of celiac disease in our country.

We had no cases of adult T-cell leukemia/lymphoma which is a very common subtype (up to 25%) reported in Far East countries. [3] This is probably related to the higher frequency of HTLV1 infections in these countries.

Lymph nodes were the predominant site of involvement seen in 45% (78 of 173 cases), as seen in literature. [4]

This study documents the frequency and distribution of PTCLs from South India. The frequency of PTCLs in our 2-year study was higher than that reported in Western literature and earlier Indian studies and almost similar to some reports from Far East. MF, SPTCL, and HSTL were higher compared to earlier reports in Indian and World literature. The frequencies of extranodal NK/T-cell lymphoma and AITL were much lower than those reported from the Far East and Western literature. EATL was similar to that reported in Far East and lower than in the Western literature. There was no case of adult T-cell leukemia/lymphoma, which constituted a large proportion of cases in Far East literature.

 
   References Top

1.Anderson JR, Armitage JO, Weisenburger DD. Epidemiology of the non-Hodgkin's lymphomas: Distributions of the major subtypes differ by geographic locations. Non-Hodgkin's Lymphoma Classification Project. Ann Oncol 1998;9:717-20.  Back to cited text no. 1
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2.Rudiger T, Weisenburger DD, Anderson JR, Armitage JO, Diebold J, MacLennan KA, et al. Peripheral T-cell lymphoma (excluding anaplastic large-cell lymphoma): Results from the Non-Hodgkin's Lymphoma Classification Project. Ann Oncol 2002;13:140-9.  Back to cited text no. 2
    
3.Vose J, Armitage J, Weisenburger D; International T-Cell Lymphoma Project. International peripheral T-cell and natural killer/T-cell lymphoma study: Pathology findings and clinical outcomes. J Clin Oncol 2008;26:4124-30.  Back to cited text no. 3
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4.Au WY, Ma SY, Chim CS, Choy C, Loong F, Lie AK, et al. Clinicopathologic features and treatment outcome of mature T-cell and natural killer-cell lymphomas diagnosed according to the World Health Organization classification scheme: A single center experience of 10 years. Ann Oncol 2005;16:206-14.  Back to cited text no. 4
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5.Sukpanichnant S. Analysis of 1983 cases of malignant lymphoma in Thailand according to the World Health Organization classification. Hum Pathol 2004;35:224-30.  Back to cited text no. 5
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6.Lee SS, Cho KJ, Kim CW, Kang YK. Clinicopathological analysis of 501 non-Hodgkin's lymphomas in Korea according to the revised European-American classification of lymphoid neoplasms. Histopathology 1999;35:345-54.  Back to cited text no. 6
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7.The world health organization classification of malignant lymphomas in japan: Incidence of recently recognized entities. Lymphoma Study Group of Japanese Pathologists. Pathol Int 2000;50:696-702.  Back to cited text no. 7
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9.Sahni CS, Desai SB. Distribution and clinicopathologic characteristics of non-Hodgkin's lymphoma in India: A study of 935 cases using WHO classification of lymphoid neoplasms (2000). Leuk Lymphoma 2007;48:122-33.  Back to cited text no. 9
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12.Economopoulos T, Papageorgiou S, Dimopoulos MA, Pavlidis N, Tsatalas C, Symeonidis A, et al. Non-Hodgkin's lymphomas in Greece according to the WHO classification of lymphoid neoplasms. A retrospective analysis of 810 cases. Acta Haematol 2005;113:97-103.  Back to cited text no. 12
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13.Chai SP, Peh SC, Kim LH, Lim MY, Gudum HR. The pattern of lymphoma in east Malaysian patients as experienced in the University Hospital, Kuala Lumpur. Malays J Pathol 1999;21:45-50.  Back to cited text no. 13
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14.Niitsu N, Okamoto M, Nakamine H, Aoki S, Motomura S, Hirano M. Clinico-pathologic features and outcome of Japanese patients with peripheral T-cell lymphomas. Hematol Oncol 2008;26:152-8.  Back to cited text no. 14
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15.Lee MY, Tsou MH, Tan TD, Lu MC. Clinicopathological analysis of T-cell lymphoma in Taiwan according to WHO classification: High incidence of enteropathy-type intestinal T-cell lymphoma. Eur J Haematol 2005;75:221-6.  Back to cited text no. 15
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16.Ko YH, Kim CW, Park CS, Jang HK, Lee SS, Kim SH, et al. REAL classification of malignant lymphomas in the Republic of Korea: Incidence of recently recognized entities and changes in clinicopathologic features. Hematolymphoreticular Study Group of the Korean Society of Pathologists. Revised European-American lymphoma. Cancer 1998;83:806-12.  Back to cited text no. 16
    

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Correspondence Address:
Deepak K Burad
Department of General Pathology, 4th floor, ASHA block, Christian Medical College Hospital, Ida Scudder Road, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.107770

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
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