Immunohistological types of head and neck lymphomas and their correlation to HIV status among patients at Muhimbili National hospital

Abstract

ABSTRACT Background: Lymphoma is a heterogeneous and uncontrolled proliferation of lymphoid cells (i.e., B cells and T cells or natural killer cells). Recently, according to the literature, there has been a gradual but remarkable 3-4% annual increase in the occurrence of lymphocytic malignancy in the whole population. Although it has been revealed to be among the most common acquired immunodeficiency syndrome-defining malignancies, its trend in the head and neck was not reported in Tanzania. Broad objective: This study was meant to determine the Immunohistological types of head and neck lymphomas and their correlation to Human immunodeficiency virus (HIV) status among patients diagnosed at Muhimbili National Hospital during the study period. Methodology: This was a retrospective cross-sectional study (with data coverage between January 2021 to December 2023), and study duration was 6 months. The study involved 280 patient’s medical records with diagnosis of head and neck lymphoma at Muhimbili National Hospital. Data including patient’s age, sex, HIV status, histology and immunohistochemistry results were collected from the Hospital medical records (both from soft and hard files). Statistical Package for the Social Sciences (SPSS-25) and Microsoft Excel were used for analysis. Categorical variables were summarized through tables using frequencies and percentages, while the Pearson correlation coefficient was applied to determine the correlation relationship between HIV status and head and neck Lymphomas variables, Chi-square test was used to determine the association between variable findings, and their significance level was set at p < 0.05 with a confidence interval of 95%. Results; The study involved 280 head and neck Lymphomas. Their ages ranged between 1 to 83 years, the common age group was 21- 40 years (29.3%) with mean age and standard deviation of 37.76 and 20.47 years respectively. There was slightly male predominance 155 (55.4%) with male to female ratio of 1.3:1. vi Non-Hodgkin lymphomas (NHL) was the common type 210(75.0%) mostly involving age group 41- 60 years (32.4%) and males 122(58.1%) with male to female ratio of 1.4 :1. Hodgkin lymphomas (HL) was common in females 37(52.9%) and age group of 21-40 years (38.6%). These findings were statistically significant (P – value = 0.028) For HL subtypes, the Classical variant was the most common (74.3%), more in males 27 (51.9%). It presented with bimodal peaks in age groups 1-20 and 21-40 years both rating 36.5%. In cases of NHL subtypes, diffuse large B cell lymphoma was the most common variant 108(51.4%) counting more in males 64(59.3%) and involved all age groups. These findings were not statistically significant (p – values > 0.005) Of all 280 patent’s medical records, HIV status documentations were only obtained in about 176(62.9%). Whereby regarding HL, 14(34.1) tested HIV positive. Among 135 patients with NHL, 41(30.4) were HIV positive. Pearson correlation coefficient for HL to HIV status was - 0.070 and 0.116 for the NHL. All of these findings were not statistically significant with P- values of 0.667 and 0.181 respectively. Conclusion: In this study, 75% of all participants had non-Hodgkin lymphomas. diffuse large B cell lymphoma comprised > 50% of all NHL subtypes and affected all age groups. Peripheral T-cell lymphomas became second instead of follicular cell lymphomas as reported by most studies from different parts of the world. The proportion of Nodular lymphocytes predominant HL was found to be relatively higher (25.7%), and in our setting classical HL had bimodal peaks in age groups 1-20 and 21-40 years. A weak positive correlation was found between types of NHL to HIV status. Recommended are more emphasize on increasing diagnostic and treatment requirement supply for diffuse large B cell lymphoma, improvement in documentation of patient’s medical records by clinicians, HIV screening in patients with non-Hodgkin Lymphomas.