A 32-year-old male from Delhi presents with painless cervical lymphadenopathy and constitutional symptoms (fever, night sweats, weight loss). Lymph node biopsy shows classical Hodgkin lymphoma. All of the following are accurate regarding the epidemiology and etiology of Hodgkin lymphoma in India EXCEPT:
A. EBV infection is associated with approximately 40% of cases worldwide, with higher rates in developing countries
B. There is a bimodal age distribution with peaks in the 20s–30s and 55+ years
C. The nodular sclerosis subtype is the most common histological variant in India
D. Hodgkin lymphoma incidence is significantly higher in immunocompromised patients, particularly those with HIV/AIDS
Explanation
Epidemiology and Etiology of Hodgkin Lymphoma
Age Distribution and Global Patterns
Key Point
Hodgkin lymphoma shows a bimodal age distribution in developed countries with peaks in the 20s–30s (young adults) and 55+ years (older adults). In developing countries, including India, the distribution may be skewed toward younger ages.
Histological Subtypes in India
Table
Subtype
Frequency (Developed)
Frequency (India/Developing)
Key Features
Nodular Sclerosis
60–70%
40–50%
Fibrosis bands, lacunar cells
Mixed Cellularity
15–25%
30–40%
Numerous RS cells, diffuse infiltrate
Lymphocyte-Rich
5%
<5%
Abundant small lymphocytes
Lymphocyte-Depleted
<5%
<5%
Numerous RS cells, few lymphocytes
High-YieldNEET PG
In India and other developing countries, mixed cellularity is often more common than nodular sclerosis, contrary to the pattern in Western countries. This is an important epidemiological distinction.
EBV Association
Key Point
EBV is associated with approximately 40% of Hodgkin lymphoma cases globally. The association is stronger in:
Developing countries (up to 80–90% in some regions)
Mixed cellularity and lymphocyte-depleted subtypes
Older patients
Immunocompromised individuals
Immunocompromise and Risk
Clinical Pearl
Hodgkin lymphoma incidence is markedly elevated in HIV-positive individuals (100–300 times higher than general population), particularly when CD4+ count is <50 cells/μL. This is a well-established risk factor.
Why Mixed Cellularity is More Common in India
The statement that "nodular sclerosis is the most common variant in India" is incorrect. While nodular sclerosis remains the most common subtype globally, in India and other developing countries with higher EBV prevalence, mixed cellularity is often equally common or more prevalent than nodular sclerosis. This reflects the higher burden of EBV-associated disease in these populations.
Robbins 10e Ch 13
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