Malignant lymphoma of gastric mucosa-associated lymphoid tissue in Jamaica

The recently appreciated concept of Mucosa-Associated Lymphoid Tissue (MALT) and the characteristics of the lymphomas arising therein are discussed with reference to the clinical, histological and immunohistochemical features of the first four cases of gastric MALT lymphomas diagnosed at the University Hospital of the West Indies. These tumours are low-grade B-cell lymphoas, which may undergo high-grade transformation. They are aetiologically associated with Helicobacter pylori (H pylori) infection in the stomach and may be cured in the early stages with antibiotics. Our cases were diagnosed from gastrectomy specimens removed for suspected carcinoma. All were high-grade, and associated with H pylori; 3 cases presented as advanced disease. Documentation of the features of these lymphomas will increase awareness and earlier recognition (AU)

Effect of human T-lymphotropic virus type I infection on non-Hodgkin's lymphoma incidence

We previously reported from a case-control analysis that T-cell non-Hodgkin's lymphoma (NHL) was strongly associated with human T-lymphomphotropic virus type I (HTLV-I) infection in Jamaica and Trinidad and that the relative risk for HTLV-I infection was very high in younger patients. Purpose: the objective of this study was to estimate the age-specific incidence rates of NHL among HTLV-I-infected and HTLV-I-uninfected adults in Jamaica and Trinidad. Methods: Population rates of HTLV-I infection were calculated from available census reports and serosurvey data. Incidence rates for NHL were calculated from all incident cases in Jamaica during 1984-1987 (n = 135) and from all incident cases in Trinidad during 1986-1990 (n = 117). Using biopsy material, we determined whether the immunophenotype or the tumor cells was T cell, B cell, or other. NHL incidence rates were computed according to HTLV-I status, age, sex, and tumor phenotype for each country separately and for both countries combined by weighting to the relative population size of each country. Results: The age-standardized NHL incidence rate (mean ñ SE) in Jamaica was 1.9 ñ 0.2 per 100,000 person-years (PY). In Trinidad, the rate was 2.9 ñ 0.4 per 100,000 PY. Overall, the incidence of NHL increased with age and was higher in males than in females. In the HTLV-I-infected population, the incidence of NHL was inversely related to age, and age-specific rates were higher in males than in females. The NHL incidence in those estimated to have acquired HTLV-I infection in childhood, however, showed no sex difference, and one in 1300 such carriers (95 percent confidence interval: one in 1100 to one in 1600) per annum were estimated to be at such risk. For T-cell NHL, as proxy for adult T-cell lymphoma/leukemia, incidence was highest in those patients infected with HTLV-I early in life (perinatally or via breast milk), with high, sustained risk from early adulthood in both sexes. Conclusions: While overall NHL incidence rates reveal that HTLV-I endemicity does not impose an exaggerated lymphoma burden on these populations, the risk for lymphoma among carriers who acquire infection early in life is dramatic and is consistent with the hypothesis that virus exposure early in life is most important for lymphomagenesis. Implications: Studies of HTLV-I carriers known to be infected in childhood may provide insight into markers intermediate in the lymphomagnetic process. Strategies to disrupt early-life transmission of HTLV-I, notably mother-infant transmission, may be critical in reducing the burden of lymphoreticular disease in these populations (AU)

Role of HTLV-I in development of non-Hodgkin lymphoma in Jamaica and Trinidad and Tobago. The HTLV lymphoma study group

Human T-cell lymphotropic virus type I (HTLV-I) has been implicated in the aetiology of adult T-cell leukaemia/lymphoma in Japan and elsewhere, particularly the Caribbean. We have carried out parallel case-control studies in Jamaica and in Trinidad and Tobago to quantify the role of HTLV-I in the development of non-Hodgkin lymphoma (NHL). 135 cases of NHL were enroled in Jamaica and 104 in Trinidad and Tobago. Controls were selected from patients treated in the same wards or clinics at the same time as the cases. Overall, patients with NHL were 10 times more likely than were controls to be seropositive for HTLV-I (Jamaica odds ratio 10.3 [95 percent CI 6.0-18.0], Trinidad and Tobago 14.4 [7.6-27.2]). In both countries the association between NHL and HTLV-I was greatest for T-cell lymphomas (18.3 [9.5-35.6] and 63.3 [25-267]). Among T-cell lymphomas especially, there was no significant difference between men and women in the association between NHL and HTLV-I, but there was a significant inverse relation between age and likelihood of HTLV-I seropositivity. B-cell lymphomas were predominant in the older age groups and were not associated with HTLV-I seropositivity. These findings are consistent with the hypothesis that early life exposure to HTLV-I is important for risk of subsequent ATL. Prevention of vertical transmission of HTLV-I could reduce by 70-80 percent cases of NHL in people under 60 years in this region (AU)

Sibling adult T-cell leukemia/lymphoma and clustering of human T-Cell lymphotropic virus type I infection in a Jamaican family

BACKGROUND:- Human T-cell lymphotropic virus type I (HTLV-I) infection is endemic in Jamaica, with an estimated crude seroprevalence of 5percent. Adult T-cell lymphoma/Leukemia (ATL), a disease caused by HTLV-I, has an incidence of 1-2/100,000 in the Jamiacan population. Familial ATL has not previously been reported from Jamaica. METHODS:- Hospital records and histologic specimens of the two cases were reviewed. HTLV-I infection was confirmed by antibody testing and by polymerase chain reaction on paraffin-embedded tissue,where serum was unavailable. Family members identified by the patient's parents. After giving informed consent, family members were asked to complete an interviewer-administered questionnaire and to agree to phlebotomy. RESULTS:- ATL developed 10 years apart in two siblings from a Jamaican family at age 16 and 24 years. A study of 19 members of their extended family, including both parents, 2 grandparents, and 3 siblings, revealed an overall HTLV-I seroprevalence of 17 percent. This compared with 75 percent among parents and sibling living in the same household as the patients (AU)

Review of non-Hodgkin's lymphoma at the Queen Elizabeth Hospital (QEH) - abstract

To determine the immunophenotypes and review the clinical features of non-Hodgkin's lymphomas (NHL) seen at the QEH, Barbados, 1988-89. Twenty-seven cases were diagnosed; clinical charts were reviewed in 24 (19 Barbadian residents, 5 other Caribbean territories). Immunophenotyping was performed on paraffin blocks (UWI, Mona) in 22 cases. Human T-cell lymphoma virus type I (HTLV-1) antibody status was determined by ELISA in 20 cases at CAREC. Most patients had lymph node involvement with or without hepatosplenomegaly. There was one case each where the brain, the stomach and the ovary were the primary sites. Eight tumours were B-cell and 12 T-cell phenotype; results were inconclusive in 2 cases. Of the 12 patients with T-cell lymphomas (age range 3 to 75, median 59, 4 M, 4 F), 4 were seropositive (all females) for HTLV-1, representing cases of adult T-cell lymphoma/leukaemia (ATLL), of whom one patient had tropical spastic paraparesis, 7 were sero-negative and serostatus was unknown in 1. All patients with B-cell lymphomas age range 21-89, median 44, 6M, 2F) were HTV-1 sero-negative, while one patient with inconclusive immunotyping was sero-positive. In this small study, a trend towards T-cell immunophenotype predominace was observed. There is, however, a need for further studies (AU)

The immunophenotyping of non-hodgkin's lymphoma in formalin-fixed paraffin-embedded tissue - abstract

In this study, we have retrospectively determined the immunophenotype of forty-five cases of non-Hodgkin's lymphoma (HNL) diagnosed in the Department of Pathology at the University Hospital of the West Indies (UHWI) between 1984 and 1986. We used an immunoalkaline phosphatase technique with a panel of monoclonal antibodies reactive against T-cells (UCHL 1; MT 1), B cells (L 26; 4KB5; LN 2) and macrophages (Ber.H2). We found that this panel could accurately identify T-cell lymphomas and B cell lymphomas in formalin-fixed paraffin-embedded tissues. Of forty-five cases, twenty-six were of T-cell lineage and twelve were of B-cell lineage. Sixteen of the T-cell lymphomas were human T-cell leukemia-lymphoma virus type 1 (HTLV-1) positive and showed the additional clinical and pathological features of adult T-cell leukemia/lymphoma (ATL). The HTLV-1 negative cases were neither morphologically nor immunologically different from the HTLV-1 positive patients. None of the B cell lymphomas were HTLV-1 positive. The results lend further support to the finding that NHL in Jamaican patients is predominantly of T cell origin and associated with human T cell lymphotropic virus, type 1 (AU)

Molecular epidemiology of HTLV-I-associated non-Hodgkin's lymphomas in Jamaica

As part of epidemiologic studies of human T-lymphotropic virus (HTLV)-I-associated malignancies in Jamaica, the authors evaluated 26 patients with non-Hodgkin's lymphoma for the presence of integrated HTLV-I provirus in their malignant cells. Fifteen of 26 patients had integrated provirus. All 15 also were HTLV-I antibody positive. Eleven patients did not have integrated provirus, and all 11 were antibody negative. All of the antibody-positive cases had onset of their disease in adulthood (age range, 21-57 years) as opposed to the broad age range of negative cases (4-66 years). Clinical features which were more common in provirus positive than negative patients included leukemic phase, skin involvement, and hypercalcemia, which are all features frequently seen in HTLV-I-associated adult T-cell leukemia/lymphoma (ATLL). The presence of skin involvement, circulating malignant cells, abnormal liver function tests, or the presence of two or more of these four features were statistically significantly different between virus-positive and virus-negative cases. Although the survival of positive cases (6 months) was shorter than that of negative cases (9 months), this was not statistically significant. The only significant determinant of survival was hypercalcemia, with those who developed hypercalcemia at some point in their disease course, independent of their HTLV-I status, surviving a mean of 5 months as compared to a mean of 17.5 months in those who never became hypercalcemic. The six HTLV-I-positive lymphomas that underwent cell typing were all primarily OKT4 positive, whereas two HTLV-I antibody-negative cases that were typed were B-cell lymphomas. (AU)

Non-hodgkin lymphoma in Jamaica and its relation to adult T-cell leukemia-lymphoma [published erratum appears in Ann Intern Med 1987 Jun;106(6):917]

Of 95 patients consecutively diagnosed with non-hodgkin lymphoma, 52(55 percent) had antibodies to human T-cell leukemia-lymphoma virus, type I. Antibody positively was strongly associated with skin involvement, leukemia, and hypercalcemia (p<0.02). Two patients had systemic opportunistic infections. Neither meningeal nor lung infiltration was detected, and lymph node infiltration was diffuse in all patients. Of 36 patients who received immunophenotypic classifications, 30 had diseases that affected the T-cell system, and the cells of all tested patients with these diseases showed the helper/inducer (T4) phenotype. Twenty-seven of these thirty-six patients were found to have adult T-cell leukemia-lymphoma, and of the 27, 24 had antibodies to HTLV-I. The median duration of survival in patients with adult T-cell leukemia-lymphoma was 17 weeks, but a subgroup of 81 weeks, which suggests that the disease has differing expression with courses that range from smoldering and indolent to acute and rapidly fatal. Hypercalcemia was the most important prognostic determinnant of adult T-cell leukemia-lymphoma.(AU)

Immunology of non-hodgkin's lymphoma in Jamaica - abstract

This study was undertaken to determine the immunological profile of non-Hodgkin's lymphoma (NHL) patients in Jamaica. Immunoperoxidase (IP) and immunofluorescence (IF) techniques were used, employing a panel of monoclonal antibodies, to detect T and B lymphocytes and their subjects in lymph nodes and cell suspensions obtained from 22 patients diagnosed consecutively from January, 1985. Results of immunological typing were compared with results of HTLV-1 (Human T-cell lymphotropic virus type I) antibody testing, and with the histological pattern. Sixteen of the patients (73 percent) had T-cell disease and 4 had B-cell disease. Results were equivocal or unsatisfactory in 2 patients. Fourteen who had T-cell disease were further subtyped. Thirteen had the helper-inducer phenotype and 1 had the cytotoxic-suppressor phenotype. There was close agreement between the results of IP typing of lymph nodes and cell suspensions, and of IF typing of cell suspensions, 15 (12 T-cell and 3 B-cell) of the 20 patients tested showing identical results. Three patients who were typed as T-cell disease by the IP technique were typed as normal or immunosuppressed by the IF technique. However, the IP typing was done before, and the IF was done after, treatment. Discrepancies in the results for 2 patients are unexplained. Eight of the 14 patients with T-cell disease for whom results of HTLV-I antibody testing are available are HTLV-I antibody-positive. Both of the patients with B-cell disease for whom these results are available are antibody-negative. There was no correlation between lymphocyte phenotype and histological pattern (AU)

Non-Hodgkin's lymphoma in Jamaica: a ten year experience - abstract

In the period January 1969 - July 1979, 235 cases of Non-Hodgkin's Lymphoma (NHL) were seen at the University Hospital of the West Indies. Of these cases 95 were sufficiently documented to be available for study. There were 53 Males and 42 females among these patients. The median age at presentation was 47 years. Of the 95 patients, 6 (6 percent) were stage I or II at presentation while 89 (94 percent) presetned in stages III or IV. 76 of these cases (80 percent), were stage IV. A haemoglobin (Hb) concentration of less than 12 g/dl was noted in 44 patients (46 percent) when they were first admitted, with 15 (16 percent) having a haemoglobin value of less than 9 g/dl. The bone marrow was infiltrated in 38 of 72 patients (53 percent) who had this investigation done. The skin was involved with lymphoma in 20 patients (21 percent) and a leukaemic spill was seen in 18 patients (19 percent). Hypercalcaemia was present in 17 of 70 cases (24 percent) in whom this investigation was performed at first contact and a further 2 patients developed this complication during the course of their disease. Scabies was a presenting feature or developed during the illness in 8 (8.4 percent) patients. CNS infiltration was seen in only 2 patients (2.1 percent). Infections developed in 35 patients (37 percent) of which 29 were bacterial, 4 fungal and 2 unknown. Of 79 patients in whom it was documented, a complete remission was noted in 15 (19 percent), partial remission in 25 (32 percent) and no response to therapy was seen in 39 (49 percent) patients. Twenty-nine patients were lost to follow-up. Of the remaining 66 patients. 57 had died during the period of study with a range of survival of 1 - 238 weeks from diagnosis. The median duration of survival was less than 20 weeks (AU)

Clonal evolution in two patients with autoimmune disease and lymphoreticular neoplasia

Two cases are described, one with proven lymphosarcoma and doubtful autoimmune disease, and the second with the reverse situation, in which circulating abnormal mononuclear cells showed PHA responsiveness and an abnormal chromosomal constitution (clonal evolution). These findings are discussed in the light of previous cytogenic studies of lymphoreticular neoplasia and autoimmune disease and the relationship between these two conditions (Summary)

Clinico-pathological study of malignant lymphoma in Jamaica

A clinico-pathological study of malignant lymphoma in Jamaica was undertaken to examine the disease pattern in a predominantly Negro population of West African origin. During a 9-year period (1958-66) 260 histologically verified cases of malignant lymphoma were encountered. The distribution of the different histological types was as follows: Hodgkin's disease 50.9 percent, lymphoma 1.9 percent. No cases of Burkitt's tumour were encountered. This study indicates that malignant lymphoma is not uncommon in Jamaica, and that its distribution pattern is similar to that observed in Europe and North America, except for the apucity of giant follicular lymphoma, and is different from the pattern observed in parts of Africa populated by Negroes, where Burkitt's tumour is the most common type, and where Hodgkin's disease is relatively uncommon. The age and sex incidence was in general similar to other reported series, but the duration of symptoms was short. The majority of patients presented with generalised periperal lymphadenopathy. Hepatosplenomegaly and anaemia were common on admission. The prognosis was generally poor in comparison with European and North American series due to advanced stage of disease on presentation.(Summary)