Clinical Conferences*

A patient with an abdominal mass for 4 years developed hypereosinophilia and weight loss. Bone marrow aspirations and biopsy specimens showed hypercellularity of eosinophils. No cause for hypereosinophilia was found. Biopsy specimens of several organs, including the abdominal mass, showed eosinophilic infiltration with reactive fibrosis in some. Cytogenetic studies of the bone marrow before treatment with cytoxic drugs showed chromosomal abnormalities. Several of these have been reported in association with acute or eosinophilic leukemias. Based upon these findings, the authors believe that the patient had eosinophilic leukemia and that the abdominal mass probably was an eosinophilic chloroma.

Is hypereosinophilic syndrome a malignant disease?

Goh

Tso

et al. 1985

Non-Hodgkin's lymphoma in the elderly. A retrospective clinicopathologic study of 50 patients

Carbone¹,

Tirelli²,

Volpe³

et al. 1986

The pathologic and clinical findings of 50 patients aged 65 or older (median, 71.5 years) with non-Hodgkin's lymphomas (NHL) are reported. These patients formed 27% of all cases of NHL seen in a single institution over a 7-year period. Forty patients presented with nodal and 10 with extranodal NHL. According to the Ann Arbor system, 20 were clinical and/or pathologic Stages I and II, and 30 were Stages III and IV; of the 10 patients presenting with extranodal NHL, 8 were Stages I and II. Histologically, 84% of the cases were of the intermediate and high-grade groups according to the Working Formulation; diffuse histiocytic was the most frequent histotype (34%) according to the Rappaport classification. The pattern was diffuse in 94% of the cases. Five patients received no treatment; treatments were conservative (monochemotherapy and/or local radiotherapy) in 19 patients and aggressive (polychemotherapy and/or extended-field radiotherapy) in 26. Four patients of the latter group died of toxicity; 22 patients died of lymphoma and 13 of other causes; the other 11 (22%) patients are still alive. The overall median survival was 2.2 years. A significantly better survival was observed in patients with Stages I and II (P less than 0.025) and in those with intermediate grade (P less than 0.05) when compared with patients having Stages III and IV and high-grade histology, respectively. Apparently, no significant difference both in response and survival was found between the groups of patients which arbitrarily underwent conservative or aggressive treatments on the basis of their general conditions. Randomized clinical trials should be designed in order to draw more significant conclusions on the correct management of elderly patients with NHL.

Non-Hodgkin's lymphoma in the elderly I. Pathologic features at presentation

Carbone

Volpe

Gloghini

et al. 1990

The pathologic findings of 118 patients aged 70 years or older with non-Hodgkin's lymphoma (NHL) are reported. These patients formed 27.2% of 433 consecutive cases of NHL seen in a single institution over a 5-year period. Thirty-one of 433 NHL cases were histologically not classified, whereas the remaining 402 could be classified according to the International Working Formulation (WF) of NHL for clinical usage. Immunophenotypic analyses were carried out in 112 NHL cases; of this group 28 were NHL in elderly patients. Of the 95 elderly NHL that could be classified in the histologic categories of the WF 28 cases were in the low-grade, 41 in the intermediate-grade, and 26 in the high-grade categories. Eighty-one cases had diffuse histologic types and 14 had follicular/nodular histologic types. Thirty-five cases were of the G (diffuse large cell) + H (large cell, immunoblastic) categories. No significant differences in the prevalence of the different subtypes were observed among patients younger or older than 70 years. Immunohistologically, most NHL cases in the elderly expressed B-cell phenotype. Sixty-two NHL in the elderly were extranodal at presentation. The results of this study indicate that elderly patients form a relevant proportion of patients developing NHL and thereby present a very difficult management problem. The pathologic features of NHL in the elderly does not differ significantly from those of their younger counterparts, although an increase in diffuse versus follicular histologic patterns, and in extranodal versus nodal disease was observed with advancing age. Cancer 66:1991-1994,1990. ORE THAN 50% of cancers occur in persons older M than 65 years, and about one third in those aged 70 years or Although elderly patients constitute a significant proportion (1 8%-38%) of the patients with non-Hodgkin's lymphoma (NHL),3-6 pathologic data fo-cused on NHL in the elderly are still inconspicuous7-10 and somewhat scattered in the major series published in the l i t e r a t ~ r e. ~-~. ". ' ~