Extra-lymph-node reticulum-cell sarcoma.

Abstract

Within recent years, there has been great interest in the problem of Hodg-kin's disease, and much has been written about its somewhat predictable clinical course, its radiosensitivity, and its radio-curability. Considerably less attention has been devoted to the other diseases which comprise the malignant lympho-mata. It is our aim to investigate the problem of reticulum-cell sarcoma from the points of view of the pathologist and the clinician. The present communication will deal with the overall problem. Specialized aspects will be considered in greater detail in subsequent reports. The present series comprises a group of 103 patients seen between 1950 and 1966 in the Radiotherapy Departments of University Hospital, The Hospital for Joint Diseases, and St. Vincent's Hospital, New York, N. Y. The reticulum cell is derived from embryonal mesenchyme and is identical with the histiocyte. It occurs not only in lymphoid tissue but to a varying degree in all tissues. It is this diversity which accounts for the various clinical pictures of reticulum-cell sarcoma. Unlike the other malignant lymphomata, the disease is found more frequently in nonlymphatic tissue than in the lymph nodes. Material The present series is based on 110 patients originally referred with a diagnosis of reticulum-cell sarcoma (TABLE I). The histology was reviewed first by one of us (F. de N.) without knowledge of the clinical picture, and then by the group as a whole. Review of most of the histological material was possible. Seven cases were diagnosed as not being reticulum-cell sarcoma and were discarded from the series. Of the remaining 103, the diagnosis was accepted in 95, and these constitute the group on which this analysis is based. In 8 others, histologic diagnosis was equivocal in that there were resemblances to undiffer-entiated carcinoma or to some other form of malignant lymphoma. These were analyzed separately. Their clinical behavior resembled that of the 95 cases in which the diagnosis was confirmed histologically, and their management should be that of genuine reticulum-cell sarcoma. The breakdown as to the presenting site (TABLE II) shows that of the 95 cases, 69 ( 74 per cent) presented at a site other than a lymph node. The purpose of this paper is to analyze these 69 extra-lymph-node reticulum-cell sarcomata in relation to those of lymph-node origin. Histology Many attempts have been made at a histologic description or classification of reticulum-cell sarcoma, with little agreement among the histologists. Histological interpretation is very difficult.