Pediatric Hodgkin Lymphoma in a South Indian Regional Cancer Center: Its Immunomorphology, Tumor-Associated Macrophages, and Association with Epstein-Barr Virus.

[hodgkin lymphoma, classical]

Pediatric Hodgkin lymphoma (HL ) comprises approximately a fifth of all patients with HL in India . Seventy -four cases of pediatric classical Hodgkin Lymphoma (cHL ) from a regional cancer center in southern India were analyzed on a tissue microarray (TMA ) for the stage of B-cell differentiation of the Hodgkin /Reed Sternberg (HRS ) cell by immunohistochemistry (IHC ) using CD 10 , bcl 6 , MUM 1 /IRF 4 , and CD 138 . Fifty -two of seventy-four (70 .3 %) cases were of late germinal center /early post-germinal center phenotype (CD 10 -/bcl 6 -/MUM 1 +/CD 138 -). Epstein-Barr virus (EBV ) association using Epstein-Barr virus encoded RNA (EBER ) RISH and EBV-LMP 1 immunohistochemistry (IHC ) revealed an EBV association of 93 %. Tumor -associated macrophages (TAM ) in the microenvironment were also assessed on the TMA by CD 68 IHC , and most cases (59 .7 %) showed >25 % TAMs , with no case showing ≤5 %. These findings indicate that pediatric cHL in India is a tumor , predominantly , of late germinal center /early post-germinal center B cells , is almost invariably EBV associated , and with a high number of TAMs in the microenvironment . This latter finding suggests that criteria other than TAM scores need to be developed for risk stratification of pediatric EBV-associated HL especially in developing countries .