Non-Hodgkin's lymphoma in the first two decades of life.A pathological study of 30 cases

Abstract

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.