Abstract
Background: Lymphomas are ranked as the sixth most common malignancy worldwide. Endorsing a significant impact on the health sector among the developing countries like Pakistan. The aim of the current study was to estimate the burden and clinicopathological features of lymphomas in one of the major referral centers in Southern Punjab Pakistan.
 Methodology: A descriptive cross-sectional study was conducted at the Pathology department of Nishtar Medical University, Multan January 2016 to August 2019. A total of 74 patients both male and females of all age groups with diagnosed lymphoma were enrolled in the study. Diagnosis was made on morphology and immunohistochemistry of lymph node and cases with complete immunohistochemical workup were included and those without immunohistochemical panel were excluded from the study. Baseline tests were performed and bone marrow specimens were extracted from all cases. The data was analyzed using SPSS Version 23.0.
 Results: Out of the total, 22.6% patients had Hodgkin lymphoma (HL) and 77.4% had Non-Hodgkin lymphoma (NHL). Classical Hodgkin lymphoma (CHL) was the most frequent histology (94%) among HL patients while Diffuse large B cell lymphoma (DLBCL) was the commonest B cell NHL (29.3%) and T cell lymphoblastic lymphoma (T-LBL) was found to be the most common T cell variant (5.3%). B symptoms, splenomegaly and hepatomegaly were documented in 96%, 42.7% and 25.3% patients respectively. Moreover, the disease was nodal in 65% cases and extranodal presentation was observed in 35% of the cases. Cervical node (lymph node) was involved in 25.3% of the cases while bone marrow was common among 53.3% cases. The patterns of bone marrow infiltration were para trabecular (24.3%), diffuse (22.5%), interstitial (1.8%) and mixed pattern (3.75%).
 Conclusion: Lymphomas are relatively more common among younger population in Pakistan. NHLs constitute more than 2/3rd of all lymphomas with DLBCL as the commonest histology. Stage IV disease as evidenced by bone marrow infiltration is seen in more than half of our patients.
Highlights
Lymphomas are a heterogenous group of clonal malignancies of lymphoid system[1]
Lymphomas can be broadly classified as Hodgkin lymphoma (HL) and NHL4 and high prevalence of the disease has been reported in the regions including Southwest Asia, Middle East and North Africa[5], comprises Pakistan as well and collectively called as Lymphoma belt
The study results indicate that HL was prevalent among 22.6% of the study population while Non-Hodgkin lymphoma (NHL) were found in 77.4% patients presented to the study setting
Summary
Lymphomas are a heterogenous group of clonal malignancies of lymphoid system[1]. The clinical spectrum is varied and signs and symptoms of chronic diseases such as tuberculosis (TB) and systemic lupus erythematosus (SLE) overlap. Diagnosis is established on the basis of histopathological findings of affected lymph node. Viral infections such as human immunodeficiency viruses (HIV), Epstein– Barr virus (EBV), hepatitis C virus (HCV) and human T-lymphotropic virus (HTLV) are believed to be risk factors for the development of lymphoma[2,3]. Classical Hodgkin lymphoma (CHL) was the most frequent histology (94%) among HL patients while Diffuse large B cell lymphoma (DLBCL) was the commonest B cell NHL (29.3%) and T cell lymphoblastic lymphoma (T-LBL) was found to be the most common T cell variant (5.3%). Stage IV disease as evidenced by bone marrow infiltration is seen in more than half of our patients
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