Nathwani B N, Griffith R C, Kelly D R, Shuster J J, Hvizdala E, Sullivan M P, Murphy S B, Berard C W
Cancer. 1987 Mar 15;59(6):1138-42. doi: 10.1002/1097-0142(19870315)59:6<1138::aid-cncr2820590617>3.0.co;2-8.
Of 227 cases of pediatric non-Hodgkin's lymphoma with adequate histopathologic material for review, 72 (32%) were classified as diffuse "histiocytic" lymphoma (DHL). These cases were further divided into different morphologic subtypes according to the Lukes-Collins classification, and the National Cancer Institute Working Formulation, to ascertain whether there were any significant prognostic differences among the different subtypes. The results of our study showed that 40 patients were classified as immunoblastic lymphomas, and 32 were called large follicular center cell (FCC) tumors. Of the 40 patients with immunoblastic histology, 19 had morphologic features of the clear cell type and were interpreted as consistent with T-immunoblastic lymphomas; an additional two had polymorphous features also consistent with T-cell type: 17 had plasmacytoid features, and were morphologically classified as B-immunoblastic lymphomas; two could not be subtyped. Of the 32 patients with morphologic features of FCC lymphomas, 29 were classified as large noncleaved type, and three as large cleaved type. A clinicopathologic analysis showed that 90% of the patients obtained complete remission, and there were no significant differences in complete remission rate among the different morphologic subtypes of DHL. The estimated five year disease-free survival for all patients was over 70%, with no failure after the second year; and there were no significant differences in the disease-free survival among the different subtypes. The only clinical differences that we found, were that patients with lymphomas of FCC (large noncleaved) type were younger (P = 0.01); had less nodal involvement (P = 0.03); and had more organ involvement (P less than 0.01). We conclude that the morphologic subclassification of DHL in children currently has limited clinical prognostic significance.
在227例有充分组织病理学资料可供复查的儿童非霍奇金淋巴瘤病例中，72例（32%）被分类为弥漫性“组织细胞性”淋巴瘤（DHL）。根据卢克斯-柯林斯分类法和美国国立癌症研究所工作分类法，将这些病例进一步分为不同的形态学亚型，以确定不同亚型之间是否存在显著的预后差异。我们的研究结果显示，40例患者被分类为免疫母细胞性淋巴瘤，32例被称为大滤泡中心细胞（FCC）肿瘤。在40例具有免疫母细胞组织学特征的患者中，19例具有透明细胞型的形态学特征，被解释为与T免疫母细胞性淋巴瘤一致；另外2例具有多形性特征，也与T细胞型一致；17例具有浆细胞样特征，形态学上分类为B免疫母细胞性淋巴瘤；2例无法分型。在32例具有FCC淋巴瘤形态学特征的患者中，29例被分类为大无裂细胞型，3例为大裂细胞型。临床病理分析显示，90%的患者获得完全缓解，DHL不同形态学亚型之间的完全缓解率无显著差异。所有患者的估计五年无病生存率超过70%，第二年之后无复发；不同亚型之间的无病生存率无显著差异。我们发现的唯一临床差异是，FCC（大无裂细胞）型淋巴瘤患者更年轻（P = 0.01）；淋巴结受累较少（P = 0.03）；器官受累较多（P<0.01）。我们得出结论，目前儿童DHL的形态学亚分类临床预后意义有限。
