The Spread of Malignant Lymphomas in Children

1968 ◽  
Vol 54 (4) ◽  
pp. 311-319 ◽  
Author(s):  
Gianni Bonadonna ◽  
Franca Fossati-Bellani
Keyword(s):  
Bone Marrow ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Blood Stream ◽  
Pathological Examination ◽  
Malignant Lymphomas ◽  
Waldeyer’S Ring ◽  
Work Up

The preferential sites of involvement and the mode of spread of malignant lymphomas have been evaluated in 71 consecutive untreated children up to and including the age of 15 years (33 with Hodgkin's disease, 19 with lymphosarcoma and 19 with reticulum cell sarcoma). In all cases the diagnosis was defined by pathological examination. Lower-extremity lymphography (3–5 ml of Lipiodol Fluid per foot) was carried out only in 17 patients (10 with Hodgkin's disease and 7 with lymphoreticular sarcomas) without untoward reactions or pulmonary complications. Patients were staged according to the international four stage clinical classification proposed at Rye in 1965. Hodgkin's disease was confined to lymph nodes and spleen in practically all patients (97.5%), while in comparison lymphoreticular sarcomas revealed an appreciable involvement of Waldeyer's ring (6.5%) and a considerable extension to extranodal sites (18%) with frequent invasion of adbomen and bone marrow. Mediastinal nodes were definitely more involved in Hodgkin's disease (18.5%) than in lymphoreticular sarcomas (5.5%), while the opposite occurred for extensions below the diaphragm (inguinal, retroperitoneal and mesenteric nodes). The mode of spread has been studied by counting the number of untreated patients (only with primary involvement of lymph nodes and Waldeyer's ring) with contiguous and non contiguous adenopathies, as well as the next sites of involvement after localized radiation therapy. The majority of children with Hodgkin's disease showed adenopathies distributed throughout contiguous areas (15/18 cases). This occurred also in those with lymphoreticular sarcomas (5/8 cases) although in 4/5 patients the disease had its primary onset in Waldeyer's ring where, as in adults, cervical adenopathies are often present. A total of 14 children with Hodgkin's disease developed a recurrence after different lengths of time. This occurred in 10 patients in lymph node-bearing areas clinically uninvolved at the time of initial work up, but adjacent to those treated with local radiation therapy. The lymphoreticular sarcomas, on the contrary, showed a tendency to spread earlier to viscera and bones. The analysis of our pediatric lymphomas shows that the spread of Hodgkin's disease in children is similar to that observed in adults, i.e. with an initially slow and orderly lymphatic progression in the large majority of patients. Lymphoreticular sarcomas on the contrary, with the possible exception of those arising in Waldeyer's ring, were very often a generalized process (Stage IV) at the time of presentation with frequent invasion of bone marrow and abdominal cavity. These observations could be probably explained in part by the fact that lymphoreticular sarcomas arise in the gastrointestinal tract or in lymph nodes below the diaphragm (retroperitoneal, mesenteric) in a much higher percentage than usually seen on routine work up. Therefore through the thoracic duct, and without involvement of mediastinum, malignant cells reach the blood stream earlier. The orderly lymphatic spread in most patients with Hodgkin's disease and the predominant dissemination through the blood stream in lymphoreticular sarcomas could explain the difference in prognosis. On the basis of the mode of spread prophylactic irradiation to adjacent clinically uninvolved lymphoid regions is therefore indicated in patients with Hodgkin's disease and only in lymphoreticular sarcomas with primary involvement of Waldeyer's ring.

scholarly journals Atypical hodgkin and reed-sternberg cells in peripheral blood of a patient with advanced stage of Hodgkin's disease - a case report

2003 ◽  
Vol 131 (9-10) ◽  
pp. 400-402 ◽  
Author(s):  
Rajko Milosevic ◽  
Milica Colovic ◽  
Vesna Cemerikic-Martinovic ◽  
Natasa Colovic ◽  
Marina Bogunovic
Keyword(s):  
Bone Marrow ◽  
Lymph Nodes ◽  
Peripheral Blood ◽  
Hodgkin's Disease ◽  
Mononuclear Cells ◽  
Hodgkin’S Disease ◽  
Lymphoid Cells ◽  
High Dose ◽  
Advanced Stage ◽  
Neck Lymph Nodes

The occurrence of abnormal Hodgkin's and Reed-Sternberg cells in the peripheral blood in a patient suffering from Hodgkin's disease has been noticed exceptionally rare in a previous period, and especially rare in last ten years primarily due to successfull treatment of this disease. The presence of atypical mononuclear cells in peripheral blood which cytomorphologically resembled Reed-Sternberg cells was registered in 8 patients till 1966. During the last decade, the presence of atypical mononuclear cells in the peripheral blood was used for their isolation cultivation, and detailed immunophenotypic and genetic analysis. The analysis of mononuclear cells in rare patients with Hodgkin's disease was established that they belong to the B-lymphoid cells with expression of CD30 and CD15 antigens. The examination of presence of Hodgkin's cells in the peripheral blood of patients with Hodgkin's disease is important for patients with advanced stage of the disease in which autologous stem cell transplantation and high dose chmeotherapy is planned. The authors present a 33-year-old patient, who noticed enlarged neck lymph nodes in September 2000, high temperature and loss in weight. On physical examination enlarged neck lymph nodes 5x8 cm and hepatosplenomegaly were found. There was anemia and thrombo-cytopenia, and normal WBC count with 24% of lymphoid elements in differential formula. On histologic examination of lymph nodes Hodgkin?s disease, type nodular sclerosis with mixed cellularity was found. Histology of bone marrow showed nodal lymphomatous infiltration. Immunohistochemistry with monoclonal antibodies of concentrate of peripheral blood cells showed expression of CD30+ and CD15+, immunophenotypically and morphologically matching Reed-Sternberg cells. Cytogentic analysis of mononuclear cells of the bone marrow showed normal karyotype. The patient was in clinical stage IV/V of the disease and chemotherapy with 9 cycles of ABVD+Mp protocol was applied. He is still in remission.

The Pathology of Malignant Lymphoma in Cattle: A Study of 1113 Cases

1965 ◽  
Vol 2 (1) ◽  
pp. 68-94 ◽  
Author(s):  
Hilton A. Smith
Keyword(s):  
Lymph Nodes ◽  
Malignant Lymphoma ◽  
Hodgkin's Disease ◽  
Plasma Cells ◽  
Hodgkin’S Disease ◽  
Neoplastic Disease ◽  
Malignant Lymphomas ◽  
Defensive Reaction ◽  
Considerable Evidence ◽  
Histological Types

About 1100 cases of malignant lymphoma were studied. Malignant lymphomas in cattle occur mostly at the older ages but they are by no means absent in the very young. Sex, breed and season of the year have little significance. Nearly all organs and tissues are susceptible to invasion, but some much more so than others, lymph nodes and heart being outstanding. Several histological types are described, as well as a relation to Hodgkin's disease. Reactions by eosinophils, plasma cells and other cells are described and an attempt made to evaluate them etiologically. Considerable evidence suggests that this neoplastic disease originates as an unsuccessful, generalized defensive reaction.

Cis-Dichlorodiammineplatinum (II), VP 16-213, and Prednisone (Dvp Regimen) in the Treatment of Pretreated Advanced Malignant Lymphomas

1982 ◽  
Vol 68 (6) ◽  
pp. 515-518
Author(s):  
Vinicio P. Fosser ◽  
Luigi Salvagno ◽  
Romana Segati ◽  
Giovanni L. Pappagallo ◽  
Eros Ferrazzi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Partial Remission ◽  
Hodgkin’S Disease ◽  
Bone Marrow Involvement ◽  
Malignant Lymphomas ◽  
Schedule Interval ◽  
Heavily Pretreated ◽  
Pretreated Patients

Eighteen evaluable patients with advanced malignant lymphoma were treated with a combination of cis-dichlorodiammineplatinum (II) (50 mg/m2 i.v. on day 1), VP 16-213 (100 mg/m2 i.v. on days 1, 3, 5), and prednisone (50 mg/m2 per os on days 1–5), recycling every 2 weeks. All patients were previously pretreated. There were 3 complete remissions (patients with Hodgkin's disease), and 4 partial remission (2 patients with Hodgkin's and 2 with non-Hodgkin's lymphoma), for a median duration of 8 weeks. In addition, 2 minor responses (patients with Hodgkin's disease) were observed. Vomiting and myelosuppression were the most prominent toxic effects. In most heavily pretreated patients, myelosuppression was moderate to severe: in these patients and in patients with bone marrow involvement, a schedule interval of 3 weeks should be more appropriate. Nephrotoxicity was minimal. This combination chemotherapy showed some activity in the management of advanced malignant lymphomas; further studies in this area are justified.

scholarly journals Therapeutic Results in Treatment of Hodgkin’s Disease with CB 1348 and R-48

Blood ◽  
1957 ◽  
Vol 12 (8) ◽  
pp. 755-765 ◽  
Author(s):  
ANTONIO ROTTINO
Keyword(s):  
Radiation Therapy ◽  
Lymph Nodes ◽  
Therapeutic Effect ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Subjective Symptoms ◽  
Therapeutic Results

Abstract Forty patients with Hodgkin’s disease were treated with CB 1348 or R-48 or both. These drugs are useful and easy to administer. They have a therapeutic effect upon subjective symptoms and enlarged lymph nodes. The average remission lasts two months, shorter in some cases and longer in other cases. Toxicity is minimal. Hematologic depression occurs late as a rule and is reversible upon discontinuance of the drugs. Both drugs appeared to produce the same effect at about the same rate, and the effect lasted for about the same length of time. R-48 proved effective in some instances where CB 1348 had not been so, and CB 1348 sometimes induced a remission when T. E. M. had failed. In some cases radiation therapy caused recession of nodes when both drugs had been ineffective.

Diagnostic Cell Pathology in Lymph Nodes Diseases

1972 ◽  
Vol 58 (5) ◽  
pp. 289-310 ◽  
Author(s):  
Silvana Pilotti ◽  
Franco Rilke
Keyword(s):  
Lymph Nodes ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Cell Types ◽  
Malignant Lymphomas ◽  
Histological Sections ◽  
Histiocytic Lymphoma ◽  
Poorly Differentiated ◽  
Nuclear Structures ◽  
Metastatic Malignant Tumor

The investigation is based on the cytological findings in imprints, stained by the modified Papanicolaou E.A. 50 method, of 190 lymph nodes, of which 10 were normal 60 with benign diseases, 58 with malignant lymphomas and 62 with metastases. The cytological data were controlled by and correlated with histological sections. Touch preparations of lymph nodes do not present technical difficulties, are rapidly prepared and are always satisfactory. Cytological details are much better preserved and more recognizable than in histological sections but little information on lymph node organization is yielded. Imprints do not replace tissue diagnoses or even frozen sections, but under certain circumstances they may supply sufficient data for immediate diagnostic purposes, such as findings of metastatic malignant tumor cells or of Reed-Sternberg cells and their variants in lymph nodes during laparatomy for the staging of Hodgkin's disease. In addition to their supplementary diagnostic as well as teaching value, touch preparations allow minute caryological observations in malignant lymphomas. Peculiar basic nuclear structures in both well and poorly differentiated lymphocytic lymphomas and two different nuclear types in histiocytic lymphoma are described. The variations and frequency of several cell types (reticulum cells, lymphocytes, histiocytes, Reed-Sternberg and lacunar cells) in Hodgkin's disease are described and correlated with the histologic type.

Organ Culture of Human Lymph Nodes, Normal or with Malignant Lymphomas

1971 ◽  
Vol 57 (5) ◽  
pp. 343-348
Author(s):  
Roberto Navone
Keyword(s):  
Characteristic Feature ◽  
Organ Culture ◽  
Lymph Nodes ◽  
Hodgkin's Disease ◽  
Lymphocytic Leukaemia ◽  
Hodgkin’S Disease ◽  
Original Structure ◽  
Reticulum Cell ◽  
Malignant Lymphomas ◽  
Severe Fibrosis

Human lymph nodes, normal or with malignant lymphomas, in organ culture present after four days various types of changes (loss of lymphocytes, necrosis, and fibrotic hyaline changes). In many cases these changes do not destroy the original structure. The latter is more recognizable in reactive hyperplasias, in lymphosarcomas, in reticulum cell sarcomas and in chronic lymphocytic leukaemia than in Hodgkin's disease. Severe fibrosis constitutes a fairly characteristic feature differentiating Hodgkin's disease from other lymphomas.

Preferential Sites and Mode of Spread of Hodgkin's Disease and Lymphoreticular Sarcomas on the Basis of Clinical Evaluation of 500 Cases.

1967 ◽  
Vol 53 (6) ◽  
pp. 551-564 ◽  
Author(s):  
Gianni Bonadonna ◽  
Alberto Banfi ◽  
Giuseppe Carnevali ◽  
Franco Milani ◽  
Enea Salvini
Keyword(s):  
Lymph Nodes ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Lymph Node Involvement ◽  
Reticulum Cell ◽  
Important Conclusion ◽  
Therapeutic Implications ◽  
Waldeyer’S Ring ◽  
Node Involvement ◽  
Prophylactic Irradiation

The preferential sites and mode of spread in 500 consecutive untreated patients with malignant lymphomas (200 Hodgkin's diseases, 150 lymphosarcomas and 150 reticulum cell sarcomas) have been studied. After a detailed diagnosis all patients with primary involvement of lymph nodes and spleen were staged according to the international four-stage clinical classification proposed at Rye in 1965. The lymphoreticular sarcomas with primary onset in Waldeyer's ring were staged according to the T.N.M. classification as modified in Milano by the National Cancer Institute in 1965. Patients with involvement of viscera or tissues without apparent disease in the lymph nodes, spleen or pharynx were listed separately. Primary involvement in Hodgkin's disease was confined in 99.5 % to lymph nodes and spleen. In lymphosarcoma and in reticulum cell sarcoma there was a high primary involvement of Waldeyer's ring (20 % and 53 % respectively) and in other extranodal sites (11–12%). Besides the cervical regions the distribution of lymph node involvement in Hodgkin's disease was predominantly in the mediastinum (20%) and in the paraaortic area (20%), while in lymphoreticular sarcomas mainly in the axillary (16%), iliac (23%) and inguinal (17%) regions. In the lymphoreticular sarcomas with primary onset in Waldeyer's ring the disease on first admission was limited to the pharynx and to the neek nodes in 73 % of cases. Study of the mode of spread showed that in untreated Hodgkin's disease the number of cases with contiguous involvement was 66 % while in lymphoreticular sarcomas it was only 35 %. Further, after localized radiation therapy Hodgkin's disease has a higher (72%) tendency to recur in adjacent lymphoid regions than lymphoreticular sarcomas with primary involvement in nodes and spleen (45%). The therapeutic implications of this study are discussed. The most important conclusion is that prophylactic irradiation should be given to localized Hodgkin's disease and not to lymphoreticular sarcomas with the exception of those arising in Waldeyer's ring.

scholarly journals An Evaluation of Paraffin Sections of Aspirated Bone Marrow in Malignant Lymphomas

Blood ◽  
1955 ◽  
Vol 10 (8) ◽  
pp. 820-830 ◽  
Author(s):  
JACQUELINE D. PETTET ◽  
GERTRUDE L. PEASE ◽  
TALBERT COOPER
Keyword(s):  
Bone Marrow ◽  
Malignant Lymphoma ◽  
Peripheral Blood ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Reticulum Cell ◽  
Reticulum Cell Sarcoma ◽  
Paraffin Sections ◽  
Malignant Lymphomas ◽  
Cell Sarcoma

Abstract Examination of serial paraffin sections of bone-marrow aspirations has increased the known incidence of marrow involvement in malignant lymphomas. The results of this study can be seen in the table. In the 72 cases reviewed here, lesions compatible with malignant lymphoma were seen in paraffin sections in 22 cases. In 12 cases this was the only material available for diagnosis at the time. In an additional seven cases paraffin sections were considered suggestive of malignant lymphoma and in five of these a diagnosis could be made on the basis of examination of both smear and paraffin section. This procedure is particularly helpful in Hodgkin’s disease and reticulum cell sarcoma, where marrow smears are only rarely diagnostic. In general, the patients in whom lesions were found in the bone marrow tended to have more advanced disease than those in whom lesions were not found, and abnormalities in the peripheral blood were more common. This was especially true of patients with Hodgkin’s disease, less so in those with reticulum cell sarcoma. Patients with lymphosarcoma, lymphocytic type, did not show this difference, either in the extent of the disease or in findings on examination of peripheral blood. Diagnosis was most difficult in patients who had lymphocytic lymphosarcoma, since it was occasionally difficult to distinguish between the benign aggregations of lymphocytes which are not infrequently found in a large number of unrelated conditions and those aggregations which represented malignancy. Differentiation was made on the basis of number of aggregations, degree of circumscription, presence or absence of reaction centers and the cytologic appearance of the cells. Examination of the smears of the marrow is most helpful in these cases. Seven patients in this series (9.7 per cent) had granulomatous lesions in the marrow. In five of these the final diagnosis was Hodgkin’s disease, in one reticulum cell sarcoma and in one follicular lymphoma. Although these lesions were not specific, the incidence is high enough to make the finding of a granuloma of some significance in any patient suspected of having malignant lymphoma. The importance of thorough examination of any material obtained in an apparent dry tap and the value of repeated marrow-examinations is emphasized by three cases in this series. Since in many cases diagnostic lesions are found in only one portion of the material, examination of only one section of the paraffin sections of aspirated bone marrow is not sufficient for proper evaluation. This fact is emphasized by the greater incidence of positive findings in this report than in that of Cooper and Watkins. Studies of bone marrow should be particularly helpful in instances in which the diagnosis of malignant lymphoma is suggested by clinical features but cannot be proved by biopsy of peripheral nodes or other readily accessible tissue.

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