CLASSIFICATION OF NON-HODGKIN'S LYMPHOMAS
1
586 problem of unsolicited data, generated by multichannel analysers, which may be irrelevant to the patient’s condition. Of perhaps equal importance, but less obvious, is the repetition of observations at unnecessarily short intervals. Much laboratory effort could be saved if sampling intervals were matched more closely to the rate of change in the concentration of the substance measured. Department of Clinical Chemistry, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ. M. G. RINSLER. CLASSIFICATION OF NON-HODGKIN’S LYMPHOMAS SIR,-The announcement in The Lancet (Aug. 17, pp. 405-408) of two more classifications of non-Hodgkin’s lymphomas encourages me to put forward my classification of these classifications: ’ Well-defined, high-grade, oligosyllabic diffuse Poorly differentiated, polysyllabic circumlocutory with dyslexogenesis Unicentric derivative nlcentnc 1.. Multicentric, cycnophilic (Gk. 1(U1(Vo!> = swan) Cleaved and convoluted types Rappaport (non-Lukes) Cleaved and convoluted types Lukes (non-Rappaport) This system makes no claim to be comprehensive or even comprehensible, so there may well be scope for other classifications of classifications and ultimately, one hopes, a classification of classifications of classifications. At that point we shall need a conference in the Caribbean. Royal Marsden Hospital, Fulham Road, London SW3 6JJ. H. E. M. KAY. ORIGIN OF MALIGNANT LYMPHOMAS Sm,—In the past few years the B or T cell origin of the various malignant lymphomas has been the subject of many studies, especially those employing immunological methods. However, the histological data on the initial involvement of the lymphatic tissue should also be taken into considera- tion. As has been well established for the lymph-node, one can clearly distinguish a B-cell and a T-cell region. The B-cell region comprises the outer part of the cortex, especially the primary and secondary nodules. The T-cell region is called the paracortical area, although we prefer the old term tertiary nodule. The first site of infiltration of a particular lymphoma might give an indication of the origin of the tumour when either the B or T cell region is primarily affected. We therefore studied the early infiltration of lymph-nodes in 8 cases of hairy-cell leukaemia (leuksemic reticuloendo- theliosis) and 8 cases of Sezary syndrome. In hairy-cell leukaemia we found that the infiltration was chiefly con- fined to the outer cortex, whereas the tertiary nodules were at least partially intact in most cases. In contrast, in Sézary syndrome the first infiltration took place in the tertiary nodules (" paracortical area "); apart from the influx of Sezary cells through the afferent lymphatics, the primary and secondary nodules were not affected at first. These findings speak in favour of the B-cell origin of hairy-cell leukaemia and the T-cell origin of Sezary syn- drome. They are consistent with many experimental data lately reported. Institute of Pathology, University of Kiel, Postfach 43 24, D-2300 Kiel, Germany. K. LENNERT. GREY-SCALE ULTRASONOGRAPHY IN THE INVESTIGATION OF OBSTRUCTIVE JAUNDICE SIR,-A common clinical problem is the differentiation of obstructive jaundice due to multiple intrahepatic space-occupying lesions from extrahepatic causes which usually require surgical relief. In the presence of even moderate jaundice, the only radiological procedure of possible value is transcutaneous cholangiography-a hazardous investigation which may precipitate surgery. Operation may be highly undesirable in the presence of severe and inoperable liver disease with defects of hxmo- stasis. Radioisotope examination is especially unreliable in the presence of obstructive jaundice, since multiple small metastases are not adequately resolved and appear as non-specific diffuse enlargement, while dilated portions of the biliary tree caused by extrahepatic obstruction produce cold areas which simulate malignant involvement. Grey-scale ultrasonography is done with a technically sophisticated ultrasound scanner and produces a resolution of a few millimetres in the liver substance.1 It has been successfully applied to cancer diagnosis and solves the problems of differentiating between intrahepatic and extrahepatic causes of jaundice. The resolution which may be obtained and its use in this particular application are shown in the accompanying figures. Fig. 1-Schema to show the plane of section and the displayed anatomy. ’.:b 0.a r £ my A _ © z : » z‘ s xc : -r .. - , ,.., .z._ _ Fig. 2-Ultrasonogram showing a parasagittal section 4 cm. to the right of the midline. The liver is bounded by the anterior abdominal wall (AAW), the diaphragm above (D), and the right kidney posteriorly (K). Multiple small black tumours can be seen replacing the normal liver substance. 1. Taylor, K. J. W., Carpenter, D. A., MaCready, V. R. J. zur. Ultrasound, 1973, 1, 284.
Transcript of CLASSIFICATION OF NON-HODGKIN'S LYMPHOMAS
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problem of unsolicited data, generated by multichannelanalysers, which may be irrelevant to the patient’s condition.Of perhaps equal importance, but less obvious, is the
repetition of observations at unnecessarily short intervals.Much laboratory effort could be saved if sampling intervalswere matched more closely to the rate of change in theconcentration of the substance measured.
Department of Clinical Chemistry,Northwick Park Hospital,
Harrow, Middlesex HA1 3UJ. M. G. RINSLER.
CLASSIFICATION OF NON-HODGKIN’SLYMPHOMAS
SIR,-The announcement in The Lancet (Aug. 17,pp. 405-408) of two more classifications of non-Hodgkin’slymphomas encourages me to put forward my classificationof these classifications: ’
Well-defined, high-grade, oligosyllabicdiffuse
Poorly differentiated, polysyllabic circumlocutorywith dyslexogenesisUnicentric
derivativenlcentnc 1..Multicentric, cycnophilic (Gk. 1(U1(Vo!> = swan)
Cleaved and convoluted types Rappaport (non-Lukes)Cleaved and convoluted types Lukes (non-Rappaport)This system makes no claim to be comprehensive or even
comprehensible, so there may well be scope for otherclassifications of classifications and ultimately, one hopes, aclassification of classifications of classifications. At that
point we shall need a conference in the Caribbean.Royal Marsden Hospital,
Fulham Road,London SW3 6JJ. H. E. M. KAY.
ORIGIN OF MALIGNANT LYMPHOMAS
Sm,—In the past few years the B or T cell origin of thevarious malignant lymphomas has been the subject of manystudies, especially those employing immunological methods.However, the histological data on the initial involvementof the lymphatic tissue should also be taken into considera-tion. As has been well established for the lymph-node, onecan clearly distinguish a B-cell and a T-cell region.The B-cell region comprises the outer part of the cortex,especially the primary and secondary nodules. The T-cellregion is called the paracortical area, although we preferthe old term tertiary nodule.The first site of infiltration of a particular lymphoma
might give an indication of the origin of the tumour wheneither the B or T cell region is primarily affected. Wetherefore studied the early infiltration of lymph-nodes in8 cases of hairy-cell leukaemia (leuksemic reticuloendo-theliosis) and 8 cases of Sezary syndrome. In hairy-cellleukaemia we found that the infiltration was chiefly con-fined to the outer cortex, whereas the tertiary nodules wereat least partially intact in most cases. In contrast, in Sézarysyndrome the first infiltration took place in the tertiarynodules (" paracortical area "); apart from the influx of
Sezary cells through the afferent lymphatics, the primaryand secondary nodules were not affected at first.These findings speak in favour of the B-cell origin of
hairy-cell leukaemia and the T-cell origin of Sezary syn-drome. They are consistent with many experimental datalately reported.
Institute of Pathology,University of Kiel,Postfach 43 24,
D-2300 Kiel, Germany. K. LENNERT.
GREY-SCALE ULTRASONOGRAPHY INTHE INVESTIGATION OF OBSTRUCTIVE
JAUNDICESIR,-A common clinical problem is the differentiation
of obstructive jaundice due to multiple intrahepaticspace-occupying lesions from extrahepatic causes whichusually require surgical relief. In the presence of evenmoderate jaundice, the only radiological procedure of
possible value is transcutaneous cholangiography-ahazardous investigation which may precipitate surgery.Operation may be highly undesirable in the presence ofsevere and inoperable liver disease with defects of hxmo-stasis. Radioisotope examination is especially unreliable inthe presence of obstructive jaundice, since multiple smallmetastases are not adequately resolved and appear as
non-specific diffuse enlargement, while dilated portions ofthe biliary tree caused by extrahepatic obstruction producecold areas which simulate malignant involvement.
Grey-scale ultrasonography is done with a technicallysophisticated ultrasound scanner and produces a resolutionof a few millimetres in the liver substance.1 It has been
successfully applied to cancer diagnosis and solves theproblems of differentiating between intrahepatic and
extrahepatic causes of jaundice. The resolution whichmay be obtained and its use in this particular applicationare shown in the accompanying figures.
Fig. 1-Schema to show the plane of section and the displayedanatomy.
’.:b 0.a
r £
my A _
©
z :
»
z‘ s xc :
-r _
.. - ,
,..,
-
.z._
_
Fig. 2-Ultrasonogram showing a parasagittal section 4 cm. tothe right of the midline.
The liver is bounded by the anterior abdominal wall (AAW),the diaphragm above (D), and the right kidney posteriorly (K).Multiple small black tumours can be seen replacing the normalliver substance.
1. Taylor, K. J. W., Carpenter, D. A., MaCready, V. R. J. zur.Ultrasound, 1973, 1, 284.
