Clinical, histopathological and histochemical studies on maligant lymphomas among Koreans
The malignant lymphoma is a malignant proliferation of the rerticuloendothelial and lymphoid elememts that are in lymphnodes and other lymphoid tissues of spleen, tonsil, small intestine, etc.
The clinical picture of this malignant disorder is sometimes so variable, and causes of lymphnode enlargement are so many that the lymphoma has been taken a much importance both clinically and pathologically. Many authors have reported and discussed about the so-called pseudolymphomatous lymphadenitis (Saltstein, 1958 ;
Canale and Smith, 1967 ; Hartsick, 1968 ; Rosai and Dorfman, 1969), viral lymphnodes (Evans, 1944 ; Motulsky et al., 1952 ; Stansfeld, 1961) which resemble the malignant lymphomas, early Hodgkin's disease, mild inflammatory reactions and reticular hyperplasias may be defficult or impossible to distinguish from one another (Wills, 1967) in spite of diligent research of pathologists in that field.
The classification of the lymphomas has undergone a series of changes over the yearsm and now the one porposed by Rappaport et al. (1956) is widely used as the classification of Lukes et al. (1966) for Hodgkin's disease.
There are several reports on lymphomas among Koreans based on clinical aspects but there is very little reports on lymphomas based on pathological aspects, especially the ones which are classified by the Rappaport et al. ?? and Lukes et al.
The present study is an attempt to investigate mainly histopathological characteristicsm such as classification of malignant lymphoams, relationship berween histological type of lymphoma, sex, age and location, and to research differential criteria to distinguish the benign lesions from lymphoma of lymphnodes by way of special stainings.
Materials and Methods
The meterials used in this study consist of 286 cases of malignant lymphoma for 12 years and 8 months from January, 1960 to August, 1972, and 37 cases of benign lesions of the lymphnode.
All specimens were fixed in 10% neutral formalin, paraffin embedded blocks were out in 5 micron thickness, and sections were stained by hematoxylin-eosin method, and according to the classification of Rappaport et al. (1956) and Lukes et al.
(1966), histopathological studied were done on all cases of lymphoma. In addition, methl-green phronin and Gomori's silver impregnation and 81 cases of lymphoma of lymphnodes to observe the number of plasms cells and the amount end distributed pattern of reticulin fibers in them.
For all cases of malignant lymphoma whose clinical records were available, sex, age, chief complaints, durations of disease and hematologic data were reviewed.
Results and Summary
Clinical and histopathological studies were made on 286 cases of lymphoma, and histochemical studies were performed on 113 cases of excided lymphnodes (benign lesions ; 37, malignant lymphomas ; 81), that were submitted to the Department of Pathology, Yonsei University College of Medicine,during the period of 12 years and 8 months from january, 1960 to August, 1972.
1. The histological types in order of frequency were as follows : reticulum cell sarcoma (53.9%), lymphocytic lymphoma(20.3%), lymphoma, mixed cell type (13.6%), Hodgkin's desease (10.1%) and undertermined (2.1%).
2. The histological types of Hodgkin's disease in order of frequency were as follows : reticular (48.3%), mixed cellularity (27.6%), lymphocytic and / or histiocytic (13.8%) diffuse fibroses (6.9%) and nodular sclerosis (3.4%(.
3. Among 286 cases, 195 cases (68.2%) were male and 91 cases (31.8%) were female.The average age was 37.1 year-old (male : 33.9 years, female 44.9 years).
4. Clicical symptoms in order of frequency were as follows : enlargment of thelymphnode or palpable mass (75.2%), local pain (34.3%), gastrointestinal symptoms(21.2%) and ENT symptoms (14.6%). The duration of chief complaints was mostly within 6 months (78.2%).
5. The locations of malignant lymphomas were as follows : nodal, 143 cases (50.5%) and extranodal, 124 cases (43.4%). Among the nodal group, cervical area was the most common (81.1%), and the nextm axillary (21.7%) and inguinal (10.3%). Among the extra-nodal group, nasopharynx was the most common (27.4%), and the next, tonsil (25.8%) and small intestine(16.9%).
6. Hodgkin's disease showed somewhat bimodal curve in age distributon, was more common in male than other types of lymphoma, and involed gastrointestinal tract most commonly when extranodal in its origin.
7. Except cases of Hodhin's disease, the more the number of Plasma cells in lymphnodes, the more likely the lesion was benign but this was not absolute criterion in deciding the nature of lesions.
8. The amount and distribution pattern of reticulin fibers in lymphnodes gave a considerable aid in some cases to distinguish between benign and malignant but there did not have a great significance in deciding the nature of lesions.
In conclusion based on these findings, it can be stated that reticulum cell sarcomas are more common and Hodgkin's disease are less common than western countries.
The existing number of plasma cells and the amount and distribution of reticulin fibers could be considerable aid in deciding the nature of lesions of lymphnodes, but could not be the decisive factor.