Abstract

Since Thomas Hodgkin described tumors of the lymph nodes in 1832, morphologic classification of malignant lymphoma has been studied by various approached, and among them, the classification of Rappaport has been most widely accepted. But his approach entirely depended on morphology which failed to properly reflect the functional aspect of the component cells. With the recent development in the immunologic knwoledge of the lymphoreticular system and more acurate definition of various cells by histochemical methods, Lukes and Collins initiated a new approach to the classification of the malignant lymphomas taking the functional and histochemical aspects into consideration in 1974. For its proven usefulness in the clinical prognostication of the malignant lymphomas, this new concept has been widely disseminated. However, in Korea the old classification of Rappaport is still being used for largely technical reasons. In view of the recent trends of development in this important field, the author has made attempts at reclassification of the malignant lymphomas in Korea. The material consists of 142 cases of malignant lymphomas examined at the Department of Pathology, Yonsei University College of Medicine from January, 1975 through August, 1980. All cases were subjected to histopathological analysis and review of the clinical records. The paraffin blocks were sectioned serially at 5 micron thickness and sections were stained with hematoxylin and eosin and methyl green pyronin(MGP), and were examined by light microscopy up to the magnification of 1000 times. 1) Among 142 cases of malignant lymphomas, 111 cases (78%) were follicular enter cell type, and of the latter, 40 cases (28.2%) were "large noncleaved" type and 33 cases (23.2%) were "large cleaved" type. 2) Of the seventy-seven cases formerly diagnosed as "histiocytic" type according to Rappaport classification, 23 cases turned out to be "large cleaved" type and 22 cases, "large noncleaved" type. Thus 58.4% of the 77 cases proved to be of "large cell" line by the new approach. 3) There were no cases belonging to S?zary syndrome related to mycosis fungoides and small lymphocytic lymphomas in this study. 4) Of 130 cases of the malignant lymphomas in which the pattern of cell arrangement was clearly discernible, 97 cases (74.6%) demonstrated diffuse pattern of lymphomatous proliferation, and it was noted that all of the cases of plasmacytoid lymphocytic lymphomas and "small noncleaved" type, and also most of the cases of convoluted lymphocytic lymphoma, "large noncleaved" type and immunoblastic sarcoma showed this diffuse pattern. 5) Convoluted lymphocytic lymphoma predominantly occurred in adolescent and young adult male characteristically showing mediastinal mass, and the prognosis was poor because of generalized manifestation at the time of clinical diagnosis and the tendency of conversion to acute lymphoblastic leukemia. 6) While three quarters of the cases of "small cleaved", "large cleaved" and "large noncleaved" type showed partial or complete remission, most of the cases belonging to convoluted lymphocytic lymphoma and immunoblastic sarcoma resulted in poor prognosis clinically.