MALIGNANT LYMPHOMAS: FURTHER STUDIES ON THEIR PREFERENTIAL SITES OF INVOLVEMENT AND POSSIBLE MODE OF SPREAD

Abstract

In the past 10 years the therapeutic design for rational treatment of malignant lymphomas has been based primarily on the delivery of curative doses of radiation to all involved tissues if after accurate evaluation of its anatomical extent the disease appeared to be localized or moderately diffuse (11, 12). It is well known that routine lymphographic studies play a role of primary importance in the meticulous program of diagnostic evaluation (7). Lymphography in fact has been exhaustively proved to be mandatory for detecting clinically silent retroperitoneal extensions. This more precise definition of the actual lymph node involvement recently prompted a new fourstage clinical classification which was established for Hodgkin's disease on an international agreement (18).

On the basis of long-term therapeutic results the majority of clinicians believe that both Hodgkin's disease and lymphoreticular sarcomas (lymphosarcoma and reticulum cell sarcoma) are unicentric in origin but may have different patterns of spread. Previous studies performed by Scheer (21), Rosenberg and Kaplan (19), Han and Stutzman (10) and ourselves (2, 3, 4, 5) provided evidence that Hodgkin's disease spreads predominantly through adjacent and therefore predictable lymphatic areas while an irregular pattern of dissemination seems to occur in lymphoreticular sarcomas. Knowledge of the preferential sites of involvement as well as the patterns of initial spread in malignant lymphomas is obviously of primary importance to establish optimal treatment. In particular further evidence should be provided in favour or against prophylactic treatment to adjacent regions in apparently localized disease.

The present investigation has been undertaken in order to further contribute to the knowledge of these problems.