HODGKINS-DISEASE IN COSTA-RICA - A REPORT OF 40 CASES ANALYZED FOR EPSTEIN-BARR-VIRUS

We studied 40 cases of Hodgkin's disease (HD) from Costa Rica for evid ence of Epstein-Barr virus (EBV) in the Reed-Sternberg and Hodgkin (RS -H) cells. We also compared the epidemiologic features of these patien ts with previous reports of HD in industralized and developing nations . Because Costa Ricans enjoy a relatively higher standard of living th an the residents of other developing Central American nations yet live in the same general geographic region and are genetically similar, we believed that this comparison might shed additional light on the hypo thesis that the prevalence of EBV in HD and the epidemiologic factors of HD are influenced by socioeconomic factors. In 16 (40%) of 40 cases , immunohistochemical studies demonstrated that the RS-H cells were po sitive for EBV latent membrane protein (LMP), including 1 case of lymp hocytic depletion analyzed, 12 (86%) of 11 cases of mixed cellularity, and 3 (15%) of 20 cases of nodular sclerosis. All five cases of lymph ocytic predominance were negative. In the 16 EBV LMP-positive cases, p olymerase chain reaction studies revealed that the virus was type A in 12 cases and type B in 4 cases. Nodular sclerosis was the most common type of HD, accounting for 20 cases (50%), followed by mixed cellular ity, with 14 cases (35%). The relatively low prevalence of EBV in the RS-H cells of HD and the high incidence of nodular sclerosis in Costa Rica are similar to industrialized nations and are unlike HD in neighb oring Central American countries. These findings further support the h ypothesis that the prevalence of EBV in HD and the epidemiologic featu res of HD are most closely linked with socioeconomic conditions, and g eographic location or ethnic heritage are of relatively less importanc e.