Diffuse Small Cell Type Research Articles

子宮頚部細胞診による推定可能であった悪性リンパ腫の１例

A case of malignant lymphoma, who could be diagnosed by cervical smear, is presented. A 43-year-old patient complained of genital bleeding and presented herself to Tottori University Hospital. Biochemical examination and blood analysis results were within normal limits. No lymph-node swellings were observed. Bone marrow biopsy revealed no abnormal cells. Cervical smear showed abnormal lymphocytes including immature lymphocytes. Immunochemical staining for cervical smear revealed positive LCA and L 26, and negative UCHL-1. Tissue diagnosis was malignant lymphoma, diffuse small cell type (B cell). She underwent radical hysterectomy followed by 6 courses of chemotherapy. She has been followed up without any evidence of recurrence.

Malignant Lymphomas of the Bone in Korea

Eleven cases of primary non-Hodgkin's lymphoma of the bone collected from several institutes in Seoul, Korea were histologically and immunologically reclassified accord ing to U.S. National Cancer Institute working formulation, and the results were com pared with those in Western countries and in one Asian country (Japan). No significant differences were found in sex or in the distribution of primary lymphomas of bone between Korea, Japan, or the Western countries. Six cases previously diagnosed as "histiocytic lymphoma" were reclassified as diffuse large cell type lymphoma according to the working formulation. Two cases were diffuse small cell type and three cases were diffuse mixed small and large cell type. B cell immunophenotype was shown in 10 of 11 cases and T cell type was exhibited in 1 case. Patients with stage IE tumors had a better prognosis than those with stage IV. Histologic grade according to the U.S. National Cancer Institute working formulation correlated with clinical stage. A tendency towards better prognosis with lower grade tumors was possible but not statistically significant. Int J Surg Pathol 2(3):187-192, 1995

低悪性度リンパ腫の治療 化学療法について

We analyzed 113 cases of low-grade lymphoma including follicular medium-sized cell type, follicular mixed type and diffuse small cell type of B-cell origin in the LSG classification. Diffuse medium-sized cell type of B-cell origin corresponding to diffuse small cleaved cell in working formulation and intermediate lymphocytic lymphoma, both of which are classified in indolent lymphoma by national cancer institute, was excluded because our study showed poor prognosis of this type. Chemotherapy was done as the primary therapy in 89 patients and anthracycline was used in 63 patients. Analysis of survival rate revealed better prognosis of the chemotherapy with anthracycline from 5 -to 10-year survival, although CR ratio was less than that of the chemotherapy without anthracycline. Significant differences in prognosis were found in clinical stage (I vs II), primary sites (nodal vs exnodal), serum LDH (normal vs high) and therapeutic response (CR vs PR). Follicular medium-sized cell type showed almost the same survival as that of diffuse small cell type within 5 years after onset. Ten patients with follicular medium-sized cell type, however, died more than 5 years after onset and all of 4 patints of 10-year survival were under recurrent disease. In contrast, none of patients with diffuse small cell type died after 4-year survival and all of 4 patients of 10-year survival were disease-free. Improvement of long-term survival of follicular lymphoma is a major problem in chemotherapy of low-grade lymphoma, and a more intensive chemotherapy and/or combination with radiotherapy will be necessary in the near future.

脊髄神経症状を呈した悪性リンパ腫の経験

We reported on two cases of Malignant Lymphoma in the spinal epidur al space. Case 1 was a 49-year-old man and case 2 was an 82-year-old wo man. Both cases had a neurological deficit without any evidence of systemic lymphoma. Laminectmy was performed in both cases and the tumors were removed and proved to be Malignant Lymphoma, the diffuse small cell type, pathologically. Postoperatively, radiotherapy and chemotherapy were administered and led to the improvement of the neurological symptoms.

TWO CASES OF PRIMARY SPLENIC MALIGNANT LYMPHOMA

Two patients with primary malignant lymphoma of the spleen were surgically treated. The first case, a 86-year-old female, admitted with complaints of general fatigue and high fever. With a preoperative diagnosis of abscess of the spleen, a splenectomy was performed and the spleen was adherent to the diaphragm, stomach and great omentum. The spleen measured 15 by 13 by 6 centimeters, weighted 580 grams and was almost replaced yellowish white tumor with a centrally necrotic tissues. Histological diagnosis was malignant lymphoma, diffuse large cell type, and the patient died 3 months later. The second case, a 66-year-old female, had no complaints but a splenic tumor was detected at the ultrasonographical mass examination. A clinical diagnosis of malignant lymphoma of spleen was made, then a splenectomy was undergone. The spleen weighted 168 grams and the tumor measured 6 centimeters in diameter. The microscopic examination established the diagnosis of malignant lymphoma, diffuse small cell type. This case has the lightest primary splenic malignant lymphoma among those ever reported in the medical literature of Japan. The patient is alive and well for 1 year and 2 months with no signs of malignant disease after splenectomy and chemotherapy.

Primary Intracranial Malignant Lymphoma

Nine cases of primary intracranial malignant lymphoma, which accounts for 3.3% of all intracranial tumors seen in the authors' institution, were studied in terms of diagnostic computed tomographic (CT) features, the tumors' histologic appearance, treatment, post-treatment blood immunologic and cerebrospinal fluid (CSF) characteristics, and outcome. The patients were seven males and two females aged 42 to 67 years. Their chief signs and symptoms on admission were intracranial hypertension, focal signs, and disturbance of consciousness. CT, which proved the most useful preoperative diagnostic technique, demonstrated multiple lesions in seven cases and, in all cases, regions of isodensity or slight high density that were enhanced by contrast medium. According to the patterns of enhancement, the tumors were classed as diffuse (three cases) or nodular (six cases). The former is considered typical of malignant lymphoma, whereas the latter type was sometimes indistinguishable from metastatic tumor and meningioma. At surgery, one patient underwent radical tumor excision, two partial removal, and six biopsy only. Histologic examination revealed one tumor to be of the diffuse small cell type, three of the medium cell type, and five of the large cell type (Lymphoma Study Group classification). Of seven tumors in which lymphocytes were examined by peroxidase-antiperoxidase staining, four were of the B cell type. Postoperatively, whole brain irradiation with 29 to 46 Gy was followed by local irradiation with 15 to 50 Gy. If the tumor persisted, one of three chemotherapies was administered. In one case, methotrexate was given intrathecally. Seven patients were divided into two groups: long remission (three) and recurrence (four). These two groups were compared in terms of serum immunoglobulin levels, T and B cell ratios, CSF characteristics, CT features, tumor cell type, and treatment. No clear differences were found.

Undifferentiated thyroid tumors of diffuse small cell type. Histological and immunohistochemical evidence for their lymphomatous nature.

A histological review of 72 undifferentiated thyroid tumors was performed in order to discover small cell anaplastic carcinomas and Non-Hodgkin lymphomas. Cases suspected to be lymphoma were examined for the presence of Ig and keratin and lectins with a PAP-procedure. Among the 72 cases, 68 (94,5%) were anaplastic carcinomas of various types. Four cases (5,5%) were diffuse small cell tumors, which had previously been regarded as anaplastic carcinomas. All four could be identified as Non-Hodgkin lymphomas by histology, immunohistochemistry, repeat biopsy or autopsy. The findings suggest that the majority of small cell anaplastic thyroid tumors are lymphomas and that true anaplastic small cell carcinoma of the thyroid must be extremely rare. Its diagnosis requires electronmicroscopy and/or immunohistochemistry to demonstrate the epithelial nature of tumor cells.