Assessment Of Epsteın Barr Vırus Molecular Polymorphısm And Tumor Bıomarkers Assocıated Wıth Non- Hodgkın’s Lymphoma In Iraqı Patıents

Abstract

The current study was conducted to evaluate the Epstein-Barr virus molecular polymorphism and tumor biomarkers associated with non-Hodgkin's lymphoma in Iraqi patients. Our study concerned 50 cases pooled together in the hematology service of the Department of Pathology at Hawler Medical University, Erbil (Hawler) in the Kurdistan Region of Iraq from January 2020 through March 2021. Male patients were 56.1 years and female patients were 56.4 years old without any difference statistically. In our study, we identified 4 age groups where the average age of our patients is 56.5 years. Maximum 18 years old up to 79 years old. Almost half of our patients belong to the age group above 60 years, or 42% of cases, on the other hand, the group of patients under 20 years of age makes up only 8% of cases. The distribution of patients by sex showed an increase statistical of men, i.e. 60% and only 40% of women, most patients came from different parts of Iraq, which capital region (Baghdad) with a frequency of 30%, followed by the region of Erbil with a frequency of 20% and the rest distributed among the different regions of the Diyala: 15%, Wasit: 15%, Thi Qar: 10%, and Al-Najaf: 10%. The frequency of anti-EBNA-l antibody in the infected group was higher than in the control group, however, the frequency of anti-EBNA- l IgG Ab in the case group was higher than anti-EBNA- l IgM Ab may be due to latent re-infection, so the high-frequency distribution of anti-EBNA- l IgG Ab were data 19 cases (47.5%) in age group (60-74)years, followed by 8cases (20.2%), in the age group 45-59 and 5 cases (12.5%) recorded in age group ˃75 years and 30-44 years respectively while the lowest level 3(7.5%) show in the age group 15-29 years. The level of anti-EBNA- l IgG Ab showed 23 cases (57.5%) in males was higher than anti-EBNA- l IgM Ab in 16 cases (76.1) while in females IgG was 17 cases (42.5%) and for IgM 5 cases (23.8). Evaluation according to the antecedents, the majority of patients (64%) present with ATCD or we notice that heart disease presents the large percentage either 30% followed by type 2 diabetes or 24% while hypertension and tuberculosis have only been presented. By 8% and 2% for each and only 36% of patients did not present with DCDA. Assessment according to general signs Almost all of our patients (74%) presented general signs of fever, night sweats, and weight loss. And only 26% of patients presented no symptoms. The presence of general signs or signs commonly called B symptoms such as fever, weight loss, and sweating were present in the majority of our patients with 74%. Evaluation according to the clinical stage we have observed that a large number of our patients have stage 4 NHL (i.e. 50%). Evaluation according to the phenotype: In our series, the majority of patients are type B NHL with a percentage of 86% and only 14% phenotype T. Evaluation according to the secondary location the major localization is in the bone marrow (40%) followed by the liver (36%) while the spleen represents the least affected organ (6%). 6% of our patients do not present an extranodal extension. Assessment according to the subtypes of NHL almost half of these patients present a large cell NHL (40%) followed by small B cell NHL (29%) while the other subtypes are present with small percentages (20.1%). Assessment according to the tumor syndrome (ADNP) the existence of ANDP in 82 % of cases. Cervical involvement is the most common, estimated at (50%), while axillary involvement is only present in 32% of cases, while only 18% of cases do not present with DNAP. In the histological study, the histological appearance of the ganglion affected by diffuse large B-cell non-Hodgkin lymphoma, where it shows that the structure of the ganglion parenchyma is disorganized and erased by tumor cells as well as lymphoma cells (CL) are large in size. Gastric histology shows that the chorionic is largely ascended; at high magnification, we note the presence of a polymorphic lymphoid population with a decrease in glandular mass and the presence of foci of a cryptic abscess as well as sectors of intestinal metaplasia sometimes in dysplasia. And shows a medullary space, the whole of which is infiltrated by a diffuse and dense lymphomatous proliferation made up of a rounded lymphomatous cell population of varying sizes. In Molecular study recorded the Level of L1PA2 Gene Expression significant increase in lymphoma patients' level of L1PA2 gene expression in the blood tissue. And MicroRNA- 532-5p gene recorded a significant decrease in the level of lymphoma patients of patients with non-Hodgkin's lymphoma compared with the control group.