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Thirty patients under 20 years of age with non‐Hodgkin's lymphoma, with nodal and extranodal involvement, were reviewed retrospectively according to Rappaport's classification. All cases had a diffuse histologic pattern. There were 10 patients with lymphoblastic lymphoma (nine with convoluted nuclei and one with non‐convoluted nuclei), 10 with Burkitt's lymphoma, six with undifferentiated lymphoma, and four with histiocytic lymphoma. Histochemistry was done in 28 cases, and electron microscopy in three. Twenty‐four patients were male and six were female; ages at presentation ranged from 3 to 19 years. Nine patients with lymphoblastic lymphoma (with convoluted nuclei) and two with Burkitt's lymphoma had a mediastinal mass at diagnosis. Three patients with Burkitt's lymphoma and one with undifferentiated lymphoma had bone marrow involvement initially. Leukemic transformation occurred in four patients with lymphoblastic lymphoma within a year of diagnosis. Initial treatment included radiotherapy alone in three patients, chemotherapy alone in three patients, and combined radiotherapy and chemotherapy in 24 patients. Thirteen patients have died at 2 to 52 months from diagnosis: five of 10 with lymphoblastic lymphoma, three of 10 with Burkitt's lymphoma, four of six with undifferentiated lymphoma, and one of four with histiocytic lymphoma. Our findings suggest that in this patient population, non‐Hodgkin's lymphoma can be classified using Rappaport's criteria and that malignant lymphomas of the lymphoblastic type and undifferentiated lymphoma seem to have the worst prognosis.
Thirty patients under 20 years of age with non‐Hodgkin's lymphoma, with nodal and extranodal involvement, were reviewed retrospectively according to Rappaport's classification. All cases had a diffuse histologic pattern. There were 10 patients with lymphoblastic lymphoma (nine with convoluted nuclei and one with non‐convoluted nuclei), 10 with Burkitt's lymphoma, six with undifferentiated lymphoma, and four with histiocytic lymphoma. Histochemistry was done in 28 cases, and electron microscopy in three. Twenty‐four patients were male and six were female; ages at presentation ranged from 3 to 19 years. Nine patients with lymphoblastic lymphoma (with convoluted nuclei) and two with Burkitt's lymphoma had a mediastinal mass at diagnosis. Three patients with Burkitt's lymphoma and one with undifferentiated lymphoma had bone marrow involvement initially. Leukemic transformation occurred in four patients with lymphoblastic lymphoma within a year of diagnosis. Initial treatment included radiotherapy alone in three patients, chemotherapy alone in three patients, and combined radiotherapy and chemotherapy in 24 patients. Thirteen patients have died at 2 to 52 months from diagnosis: five of 10 with lymphoblastic lymphoma, three of 10 with Burkitt's lymphoma, four of six with undifferentiated lymphoma, and one of four with histiocytic lymphoma. Our findings suggest that in this patient population, non‐Hodgkin's lymphoma can be classified using Rappaport's criteria and that malignant lymphomas of the lymphoblastic type and undifferentiated lymphoma seem to have the worst prognosis.
Histiocytic lymphoma with sclerosis was found together with a small nodular lymphoma in a cervical lymph node biopsy from a 48-year-old man. Since the cellular origin of this entity is unclear and its ultrastructure has not been described before, we processed formalin-fixed samples for electron microscopy, which revealed three cell types: small lymphocytes with cleaved nuclei, large lymphocytes with vesticular noncleaved nuclei, and mesenchymal stromal cells occasionally bearing desmosomes or hemidesmosomes. In addition, there was an increase of the intercellular connective tissue, which consisted of a mixture of normal and fibrous long spacing collagen fibers. The results indicate that histiocytic lymphoma with sclerosis can evoke from a nodular lymphoma, and that diagnostic information can be obtained by electron microscopy of tissue samples previously fixed in formalin.
Two patients who presented with acute leukemia of Burkitt's cell type are discussed. Although one patient died within four months of diagnosis, the other has maintained a one year clinical complete remission. The clinical and morphologic picture of Burkitt's leukemia is nonspecific and therefore requires complementary studies including cytochemistry, transmission electron microscopy, cell surface markers and cytogenetics studies to establish diagnosis. Serial bone marrow aspirations with marker analyses may detect relapse at an earlier stage than conventional cytology, allowing therapy to be modified prior to overt clinical relapse.
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