• Mozaffer Rahim Hingorjo
  • Sadiqa Syed


Background: Due to lack of awareness among health professionals, lymphoma is often misdiagnosed.This study was done to evaluate the clinical features and histopathologic subtypes of lymphoma.Methods: Sixty diagnosed cases of lymphoma were selected (aged 12–65 years) from medical units ofCivil Hospital Karachi, during 1993 to 1998. Clinical history, physical examination and basiclaboratory investigations including imaging procedures were done in all the patients. The diagnosis oflymphoma was based on histology, following the International Working Formulation classificationsystem. This included lymph node biopsy and in some cases, biopsy of the bone marrow. The AnnArbor Staging Classification was used to classify the extent of disease. Results: Out of 60 cases oflymphoma, 81.6% (49 cases) were diagnosed as non-Hodgkin’s lymphoma and 18.3% (11 cases) asHodgkin’s disease, with an overall male predominance. Both categories exhibited a bimodal agedistribution. Lymphadenopathy was the commonest presenting features in both the types oflymphomas; however, patients with Hodgkin’s disease had a prominence of ‘B’ symptoms, whereasabdominal signs and symptoms were more common in non-Hodgkin’s lymphoma. On histopathology,majority of non-Hodgkin’s lymphomas (91.8%) showed a diffuse pattern, while mixed cellularity wasthe commonest type seen in Hodgkin’s disease (81.8%). Conclusion: Non-Hodgkin’s lymphoma was 4times more common than Hodgkin’s disease. The vast clinical spectrum of lymphoma sometimesdelays its diagnosis, leading to its eventual presentation in late stages. A general awareness is hencerequired among the health professionals regarding its varied clinical presentations.Keywords: Non-Hodgkin’s lymphoma, Hodgkin’s disease, Lymphadenopathy, Hepatomegaly,Splenomegaly


Jose BO, Koerner P, Spanos WJ Jr, Paris KJ, Silverman CL,

Yashar C, et al. Hodgkin’s lymphoma in adults – clinical

features. J Ky Med Assoc 2005;103:15–7.

Al-Mobeireek AF, Arafah M, Siddiqui N. An African male

with cough, hemoptysis, weight loss and hypercalcemia: TB or

not TB? Eru Respir J 2002;20:1060–3.

Phelan E, Lang E, Gormley P, Lang J. Kikuchi-Fujimoto

disease: a report of 3 cases. Ear Nose Throat J 2007;86:412–3.

Young, Iland. Clinical perspectives in lymphoma. Internal

Medicine Journal 2007;37:478–84.

The Non-Hodgkin’s Lymphoma Pathologic Classification

Project. National Cancer Institute sponsored study of

classifications of non-Hodgkin’s lymphomas: summary and

description of a working formulation for clinical usage. Cancer


Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML

et al. A revised European–American classification of lymphoid

neoplasms: a proposal from the International Lymphoma Study

Group. Blood 1994;84:1361–92.

Jaffe ES, Harris NL, Stein H, Vardiman JW (eds). Pathology and

Genetics of Tumours of Haematopoietic and Lymphoid Tissues.

World Health Organization Classification of Tumours. Lyon,

France: IARC Press, 2001.

Pongpruttipan T, Sitthinamsuwan P, Rungkaew P, Ruangchiraurai R, Vongjirad A, Sukpanichnant S. Pitfalls in classifying

lymphomas. J Med Assoc Thai 2007;90:1129–36.

Armitage JO. Staging non-Hodgkin lymphoma. CA Cancer J

Clin 2005;55:368–76.

Franco V, Tripodo C, Rizzo A, Stella M, Florena AM. Bone

marrow biopsy in Hodgkin’s lymphoma. Eur J Haematol


Peh SC, Kim LH, Thanaletchimy N, Chai SP, Poppema S.

Spectrum of malignant lymphomas in Klang Hospital, a public

hospital in Malaysia. Malays J Pathol 2000;22:13–20.

Haddadin WJ. Malignant lymphoma in Jordan: a retrospective

analysis of 347 cases according to the World Health Organization

classification. Ann Saudi Med 2005;25:398–403.

Shome DK, George SM, Al-Hilli F, Satir AA. Spectrum of

malignant lymphomas in Bahrain. Leitmotif of a regional pattern.

Saudi Med J 2004;25:164–7.

Groves FD, Linet MS, Travis LB, Devesa SS. Cancer

surveillance series: Non-Hodgkin’s lymphoma incidence by

histologic subtype in the United States from 1978 through 1995. J

Natl Cancer Inst 2000;92:1240–51.

Landgren O, Caporaso NE. New aspects in descriptive, etiologic,

and molecular epidemiology of Hodgkin’s lymphoma. Hematol

Oncol Clin North Am 2007;21:825–40.

Dinand V, Dawar R, Arya LS, Unni R, Mohanty B, Singh R.

Hodgkin’s lymphoma in Indian children: prevalence and

significance of Epstein-Barr virus detection in Hodgkin’s and

Reed-Sternberg cells. Eur J Cancer 2007;43:161–8.

Flavell KJ, Murray PG. Hodgkin’s disease and the Epstein-Barr

virus. Mol Pathol 2000;53:262–9.

Gutensohn NM. Social class and age at diagnosis of Hodgkin's

disease; new epidemiologic evidence on the “two-disease”

hypothesis. Cancer Treat Rep 1982;66:689–95.

Mayall F, Darlington A, Harrison B. Fine needle aspiration

cytology in the diagnosis of uncommon types of lymphoma. J

Clin Pathol 2003;56:821–5.

Olu-Eddo AN, Ohanaka CE. Peripheral lymphadenopathy in

Nigerian adults. J Pak Med Assoc 2006;56:405–8.

Song JY, Cheong HJ, Kee SY, Lee J, Sohn JW, Kim MJ, et al.

Disease spectrum of cervical lymphadenitis: analysis based on

ultrasound-guided core-needle gun biopsy. J Infect


Biagi JJ, Seymour JF. Insights into the molecular pathogenesis of

follicular lymphoma arising from analysis of geographic

variation. Blood 2002;99:4265–75.

Sahni CS, Desai SB. Distribution and clinicopathologic

characteristics of non-Hodgkin’s lymphoma in India: a study of

cases using WHO classification of lymphoid neoplasms

(2000). Leuk Lymphoma 2007;48:122–33.

Aziz Z, Rehman A, Akram M, Saeed A. Non-Hodgkin’s

lymphoma in Pakistan: a clinicopathological profile of 175

patients. J Pak Med Assoc 1999;49:11–5.

Siddiqui N, Ayub B, Badar F, Zaidi A. Hodgkin’s lymphoma in

Pakistan: a clinico-epidemiological study of 658 cases at a cancer

center in Lahore. Asian Pac J Cancer Prev 2006;7:651–5.