The value of staging laparotomy in non-Hodgkin's lymphomas.(With emphasis on the histiocytic type)

Abstract

Laparotomy with splenectomy and multiple tissue biopsies was performed in 106 adult patients with non‐Hodgkin's lymphoma (histiocytic—76, lymphocytic—25, and mixed type—5). The histologic pattern at initial biopsy showed nodular lymphoma in 33% and diffuse lymphoma in 67%. Diffuse histiocytic was the most frequently observed histologic type in this series (54%). Before laparotomy, 92% of patients had primary lymphatic and 8% primary extralymphatic involvement. Waldeyer's ring involvement accounted for 27% of all patients. Systemic symptoms were present in 7%. Clinical stage (Ann Arbor Classification as proposed for Hodgkin's disease) was as follows: I—29%, II—32%, IIs— 2%, III—24%, IIIs—8%, and IV—5%. After staging laparotomy these figures were 25%, 29%, 1%, 20,% 8%, and 17%, respectively (down stage 23%, up stage 4%). Spleen was involved in 23%, liver in 12%, gastrointestinal tract in 5%, and bone marrow in 12%. In 27%, lesions were occult to conventional diagnostic methods. Although not sampled in all patients, splenic hilar, celiac, and mesenteric nodes were the most frequent occult sites of intra‐abdominal lymphoma. With clinical methods, false negative findings for spleen involvement were 12% and for liver 11%. Spleen involvement occurred more often in nodular (29%) than in diffuse lymphoma (19%). There was no appreciable difference in the splenic infiltration among histiocytic (22%), lymphocytic (24%), and mixed (20%) types. With the exception of one case, there were no patients with hepatic involvement without concomitant splenic involvement. Lymphography yielded a 96% accuracy proving once more to be a sufficiently reliable diagnostic method. Two patients died after laparotomy because of acute peritonitis and acute pancreatic necrosis, respectively. Otherwise, the incidence and type of complications were found acceptable. Collectively, our findings indicate that staging laparotomy is a useful procedure in non‐Hodgkin's lymphomas to identify occult lesions before planning treatment and to gain more information on the natural history of these diseases.

The Spleen in Non-Hodgkin Lymphoma

“…Literature data indicate that the presence of lymphoma in the liver practically always means that the spleen is involved as well (9,17). We confirmed this finding: all patients with proven hepatic involvement, from whom splenic tissue was available, also demonstrated splenic involvement (Table 3).…”

“…5 5~ splenic index (16). Thus an index of 480 as upper limit for normal size (13) corresponds to a weight of 265 g. Several other studies revealed that a splenic weight of more than 500 g consistently implied splenic involvement (8,10,17). It was calculated that weight determination using a weight of 500 g as threshold value would result, for the present series, in an accuracy of 77 per cent, a specificity of 100 per cent and a sensitivity of 72 per cent.…”

Surgical approach of primary splenic lymphoma: report of a case and review of the literature

“…Histologic subtypes according to the Japanese literature are summarized in the categories of diffuse large cell, lymphoblastic, diffuse small cell and diffuse mixed and lymphoblastic PSL. Concomitant immunohistochemical subdivision of malignant PSL seems to determine associated prognosis and therapeutic outcome [22]. Ahmann classifi ed the gross pathological appearance of primary lymphomatous involvement of the spleen into 4 categories including homogenous enlargement without masses, miliary masses, 2-10 cm neoplasms and a large solitary tumor.…”

The Spleen in Non-Hodgkin Lymphoma

“…In patients with malignant lymphoma (HD and NHL), subjected to staging laparotomy, the spleen is found to be histologically involved in 23 to 50 per cent of cases (3,5,6,9,10,12,14,17). Although the incidence of splenic involvement increases with increasing weight of the specimen, there is no absolute correlation between weight as measured after splenectomy and histologic state.…”