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The Korean Journal of Pathology 1973;7(1): 13-28.
한국인의 악성 임파종에 관한 임상적 병리조직학적 및 조직화학적 연구
Clinical, Histopathological and Studies on Malignant Lymphomas among Koreans
The malignant lymphoma is a malignant proliferation of the reticuloendothelial and lymphoid elements that are found 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 (Saltzstein, 1958 ; Canale and Smith, 1967 ; Hartsock, 1968 ; Rosai and Dorfman, 1969), viral lymphadenitis (Salvador et at., 1971) and marked follicular hyperplasia of lymphnodes (Evans, 1944 ; Motulsky et al., 1952 : Stansfeld, 1961) which resemble the malignant lymphoma histopathologically, and in fact, early lymphocytic lymphomas, early Hodgkin’s disease, mild inflammatory reactions and reticular hyperplasias may be difficult or impossible to distinguish from one another (Willis, 1967) in spite of diligent research of pathologists in that field. The classification of the lymphomas has undergone a series of changes over the years, and now the one proposed 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 lymphoma among Koreans based on clinical aspects but there are very little reports on lymphomas based on pathological aspects, especially the ones which are classified by the Rappaport et al.’s and Lukes et al.’s. The present study is an attempt to investigate mainly histopathological characteristics, such as classification of malignant lymphoma, relationship between histological types of lymphoma, sex, age and location, and to research differential criteria to distinguish the benign lesions from lymphoma of lymphnodes by way of special staining. Materials and Methods ; The materials 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 cut in 5 micron thickness, and sections were stained by hematoxylin-eosin methods, and according to the classification of Rappaport et al, (1956) and Lukes et al. (1966), histopathological studies were done on all cases of lymphoma. In addition, methyl-green pyronin and Gomori’s silver impregnation methods were performed on the 37 cases of benign lesion and 81 cases of lymphoma of lymphnodes to observe the number of plasms cells and the amount and distributed pattern of reticulin fibers in them. For all cases of malignant lymphoma whose clinical records were available, sex, age, chief complaints, duration 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 118 cases of excised 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 disease (10.1%) and undetermined (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 fibrosis (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. Clinical symptoms in order of frequency were as follows : enlargement of the lymphnode 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 next, 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 distribution, was more common in male than other types of lymphoma, and involved gastrointestinal tract most commonly when extranodal in its origin. 7 Except cases of Hodgkin’s disease, the more the number of plasma cells in lymphnodes, the more likely the lesion was benign but this was not an 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 these 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 in this country than in 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.