[Classification of malignant lymphomas and the relationship between histopathological aspects and clinical course].
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Biomedical subjects
Publications and source records attributed to R Somers.
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An analysis is given of the clinico-pathological correlations of non-Hodgkin's lymphomata in 332 patients referred to the Netherlands Cancer Institute in Amsterdam and the Rotterdam Radiotherapy Institute. Clinical staging proved to be an important prognostic index. In Stage I the 5 year survival was 55%, in Stage II 25% and in Stages III and IV less than 10%. The presence of follicular structures in non-Hodgkin's lymphomata has similarly an important prognostic significance especially in Stage I and II. In lymphocytic lymphomata a larger cell size is correlated with less favourable prognosis. The presence of macrophages in non-Hodgkin's lymphomata is found in patients with short survival. The histiocytic lymphomata have a different survival pattern from the lymphocytic lymphomata in Stages I and II.
The spread of non-Hodgkin's lymphomata was investigated in a group of 323 cases. Differences were sought between 4 histological groups: lymphocytic vs histiocytic lymphomata and diffuse vs follicular types. Histiocytic and follicular types were rare in childhood. Histiocytic lymphomata, compared with lymphocytic ones, were more often confined to sites above the diaphragm. They exhibited a higher rate of loco-regional recurrences within the first 3 months and also of late recurrence after 4 years. Lymphocytic lymphomata of the follicular type more commonly presented with nodal involvement below the diaphragm as primary or secondary site than the diffuse form. Follicular types of lymphoma compared with diffuse types, occurred more frequently in women. They were more seldom seen as primary or secondary sites in extranodal localizations. They had a smaller chance of late disease recurrence and were associated with a longer survival time after first recurrence. The mediastinum often remained clinically uninvolved. With regard to this mediastinal "skip" no differences were found between the histological groups.
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Light and electron microscopical, immunohistochemical and clinical characteristics in 42 cases of malignant neoplasms, arising from true histiocytes, are described. These were separated in a lymphoma-like subtype, called true histiocytic lymphoma (29 patients) and a disseminated variant, called malignant histiocytosis (9 patients). In addition 4 related histiocytic tumors are discussed, including 2 tumors arising from interdigitating cells. Sinus pattern and cytologic features, especially 'window' nuclei, are emphasized as diagnostic criteria. Erythrophagocytosis was not a constant finding. Electron microscopic features, presence of acid phosphatase, acid alpha-naphthylacetate esterase, lysozyme, alpha 1-antitrypsin, alpha 1-antichymotrypsin, Ia-antigen and absence of B- and T-cell markers, were important in establishing the histiocytic nature or excluding a non-histiocytic tumor. A distinct male predominance existed (male:female = 2.5:1) with a higher relapse free period in females (p = 0.032). A high number of mitotic figures appeared to be a favourable sign, p = 0.020 and 0.019, for remission rate and relapse free period respectively. The degree of cell differentiation and the immunohistochemical pattern did not show a correlation with remission and relapse free period. Extranodal involvement and the presence of short profiles of endoplasmic reticulum were prognostically unfavourable signs. True histiocytic lymphomas showed a higher remission rate (p = 0.041) and relapse-free period (p = 0.017) than malignant histiocytosis.
The concept "quality of life" is becoming increasingly popular in both the medical and general press. However, from a literature survey of approximately 100 scientific publications in which this concept was used, it appeared that rarely is a definition of this term given. Therefore, it seems useful to formulate several guiding principles: (1) "Quality of life" apparently is too vague a concept. It seems more sensible to isolate a number of relevant factors and to choose the best operational definition possible. The following factors may be considered: daily activity, pattern of complaints, subjective feeling of well-being, and sexual behavior. Based upon these factors one composite score of psychological and social consequences should be developed, analogous to an IQ test. (2) The patient is the sole authority concerning questions on "quality of life." (3) The concept "quality of life" should indicate more than a person's momentary well being, since this is dependent on mood, physiologic state, accidental events, etc. It is not the situation at one specific point which should be considered but the situation over a certain period. (4) Questions concerning "quality of life" should be put relatively. For example, does a person have more or less complaints during one period as compared to another? A second possibility is to compare a person's answers to those of a carefully chosen control group. It is essential to keep in mind that these psychologic measures are descriptive; they indicate how patients feel during a certain period concerning the above-mentioned areas and are definitely not normative in the sense of stating what is or is not desirable.