CHILDHOOD HODGKINS-DISEASE IN THE UNITED-STATES - AN ANALYSIS OF HISTOLOGIC SUBTYPES AND ASSOCIATION WITH EPSTEIN-BARR-VIRUS

Hodgkin's disease (HD) typically has a bimodal age distribution and is less common than non-Hodgkin's lymphoma in the pediatric age group, e specially in very young children. Recent reports described a high prev alence of Epstein-Barr virus (EBV) in HD from developing countries in both adult and pediatric populations, In this series, we studied with immunohistochemical analysis 44 cases of pediatric HD from the United States to investigate the association with EBV in developed countries and to determine which subtypes occur in this group, The 44 cases (40 boys, 4 girls; male-to-female ratio, 10:1) were categorized as nodular lymphocyte predominance in 16 (36.4%) of 44; nodular sclerosis in 13 (29.5%); and mixed cellularity in 4 (9.1%), Eleven of the cases were d ifficult to subclassify by the usual morphologic and immunophenotypic criteria Of these, eight (18.1%) were designated interfollicular HD, a nd three were classified as HD ''not otherwise specified.'' EBV LMP wa s positive in 38.6% of cases: 5 (38.5%) of the 13 with nodular scleros is; 3 (75%) of the 4 with mixed cellularity; 1 (6.0%) of the 16 with n odular lymphocyte predominance; 7 (87.5%) of the 8 with interfollicula r HD; and 1 (33.3%) of the 3 with HD ''not otherwise specified.'' Ther e was a strong association between the age of the patient and EBV expr ession, In children 4 years or younger, all of the 3 cases were LMP po sitive; in the 5- to 9-year-old age group, 8 (61.5%) of 13 were LMP po sitive; and in the 10- to 15-year-old group, only 21.4% were positive. Our results confirm the male predominance in pediatric HD and show an association with EBV, especially in the youngest patients and with th e mixed cellularity and interfollicular subtypes, Most, but not all, c ases of pediatric HD can be subclassified by traditional criteria.