Berard C W, Hutchison R E
St. Jude Children's Research Hospital, Memphis, TN, USA.
Ann Oncol. 1997;8 Suppl 2:3-9.
In the late 1960s and early 1970s, the most widely recognized 'new' classifications of the non-Hodgkin's lymphomas were those proposed by Rappaport (the 'Rappaport' classification) and by Lennert (the 'Kiel' classification). With the advent of immunologic and histochemical markers in the early 1970s, however, new concepts arose to supplement the traditional purely morphologic approach to diagnosis and classification of these tumors. Lymphomas were increasingly recognized to be neoplasms of the immune system, composed of malignant proliferations which retained many of the morphologic and functional characteristics of their normal counterparts. These advances led to a flurry of new classifications proposed in 1974-1976, leading to confusion for both clinicians and pathologists, perhaps most evident at the International Cancer Congress in Florence in 1974. To address this problem, the National Cancer Institute (USA) sponsored an international workshop of expert pathologists and clinicians on 4-5 September 1975. It became apparent at that meeting that only a well-planned retrospective study would provide data for meaningful progress and resolution of differences. From 1976 to 1980, such a massive collaborative project was accomplished and served as the basis for the Working Formulation for Clinical Usage, proposed as a vehicle for translation among the six tested schema. Since the Working Formulation was published in 1982 there have been momentous strides in scientific and clinical understanding of these cancers, fueled by contributions from immunology, cytogenetics, and molecular biology. To recognize and disseminate understanding of these newer observations, the International Lymphoma Study Group promulgated in 1994 a new proposal entitled 'A Revised European-American Classification of Lymphoid Neoplasms'. As a sequel to another international assembly of pathologists and clinicians, held at the National Cancer Institute (USA) on 21-23 March 1994, a second large-scale retrospective study has been accomplished, the results of which were presented at the Sixth International Conference on Malignant Lymphoma, 5-8 June 1996, along with data from other institutions and cooperative groups. Concurrent with these events, the World Health Organization has enlisted a committee of expert pathologists to prepare a new edition of 'Neoplastic Diseases of Hematopoietic and Lymphoid Tissues'. Composed of 10 pathology subcommittees and a clinical advisory committee, with broad international representation, this body should generate in the near future a consensus proposal with broad scientific and geographic support. These historical and ongoing efforts in lymphoma pathology are a paradigm for progress in clinicopathologic understanding of all cancers.
在20世纪60年代末和70年代初，非霍奇金淋巴瘤最广为人知的“新”分类是拉帕波特提出的（“拉帕波特”分类）和伦内特提出的（“基尔”分类）。然而，随着20世纪70年代初免疫和组织化学标志物的出现，新的概念应运而生，以补充传统的单纯形态学方法来诊断和分类这些肿瘤。淋巴瘤越来越被认为是免疫系统的肿瘤，由恶性增殖组成，这些增殖保留了其正常对应物的许多形态和功能特征。这些进展导致在1974年至1976年期间提出了一系列新的分类，给临床医生和病理学家都带来了困惑，这在1974年佛罗伦萨的国际癌症大会上可能最为明显。为了解决这个问题，美国国立癌症研究所于1975年9月4日至5日主办了一次由专家病理学家和临床医生参加的国际研讨会。在那次会议上很明显，只有精心策划的回顾性研究才能为取得有意义的进展和解决分歧提供数据。从1976年到1980年，完成了这样一个大规模的合作项目，并作为临床使用工作方案的基础，该方案被提议作为六种经过测试的模式之间转换的工具。自1982年工作方案发表以来，在免疫学、细胞遗传学和分子生物学的推动下，对这些癌症的科学和临床认识取得了重大进展。为了认识和传播对这些新观察结果的理解，国际淋巴瘤研究组于1994年颁布了一项新提案，题为“欧美淋巴瘤修订分类”。作为1994年3月21日至23日在美国国立癌症研究所举行的另一次病理学家和临床医生国际会议的后续行动，完成了第二项大规模回顾性研究，其结果在1996年6月5日至8日的第六届恶性淋巴瘤国际会议上与其他机构和合作组的数据一起公布。与此同时，世界卫生组织已召集一个专家病理学家委员会编写新版《造血和淋巴组织肿瘤性疾病》。这个机构由10个病理学小组委员会和一个临床咨询委员会组成，具有广泛的国际代表性，应该在不久的将来产生一个得到广泛科学和地域支持的共识提案。淋巴瘤病理学方面这些历史性的和持续不断的努力是对所有癌症临床病理理解取得进展的一个范例。
