Generalized lymphangiectosis associated with chylothorax; a possible dysplasia of the lymphatic system.
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Most malignant tumours are classified according to their cellular origins. With regard to the classification of the malignant lymphomas, however, the application of this concept was not possible for a long period. Attitudes towards this changed rapidly with the discovery and description of the various cellular components of lymphoid tissue, and with the development of methods, which reliably distinguish the cells of the lymphoid system from each other. It has become apparent that the cellular origin of most lymphomatous diseases determines their respective morphological and clinical characteristics and, therefore, represents a sound basis for the classification of most lymphomas. This principle of classifying malignant lymphomas was initially applied by the Kiel Classification. Since itsí publication, further scientific discoveries have enabled us to close the gaps in our knowledge regarding the development of lymphoid tissue and cells. These advances were incorporated in the REAL Classification, and, subsequently, in the new WHO Classification. It is obvious, therefore, that an understanding of the malignant lymphomas and their classification requires a basic understanding of the differentiation of the cells of the lymphoid system. Consequently, a description of the components, the development and of the various developmental stages of the lymphoid cells will be briefly reviewed here, serving as a basis for the following chapters, which will summarise the characteristics of the different lymphomas. As the majority of the malignant lymphomas arise from B- and T-cells, these cell types will be concentrated upon in this review.
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Inocula of cultured sheep cells that had been transformed with FeSV were injected into the legs of sheep so that the changes in the cellular and humoral composition of the efferent lymph from the regional node could be studied throughout the immune responses. The times at which immunoblasts and specific antibodies appeared in the lymph were similar to those recorded during responses to conventional antigens. The antiboides were mainly 7S, G1 immunoglobulins directed against virion antigens on the membranes of the transformed cells.
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In 75 patients with lymphoma (46 Hodgkin's disease, 29 non-Hodgkin lymphomas) computed tomography was performed in order to detect neoplastic invasion of the abdominal organs (55 new cases) or to control the results of treatment (20 cases). In 30 cases enlarged retroperitoneal or mesenteric lymphnodes and/or liver or spleen enlargement were found. Neoplastic involvement of lymphnodes without enlargement was missed in two cases. CT failed also to demonstrate microscopic malignant invasion of liver and spleen. The false-negative rate in our series was 10.9%. Computed tomography is a non-invasive method which is very well suited for staging malignant lymphoma.
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An acute pain stimulus resulted in elevated lymph flow and output of cells from the popliteal lymph node of the sheep in the first 15 min after the stress. Efferent lymph flow increased by an average of 93% above the mean resting flow and cell output rose by an average of 170% during this period, but by 30 min after the stress, values for both lymph flow and cell output had returned to normal. The cell content of the efferent lymph was significantly higher in the first 15 min after the acute stress and it is suggested that there is a sizeable pool of lymphocytes within the resting popliteal node which can be mobilized into the lymph by an acute stress. A single intravenous injection of 1 mg adrenaline the efferent lymph flow in all the sheep examined but gave rise to an increased cell output in only 50% of the sheep. This indicated that there may be other factors, possibly hormonal, involved in the movement of the pool of lymphocytes out of the regional lymph node following acute stress. Both acute pain stress and adrenaline resulted in an increased afferent popliteal lymph flow and output of cells from the regional tissues in the first 15 min after administration. The results are suggestive of a small pool of lymphocytes in the regional tissues which may be readily mobilized by either acute stress or adrenaline. Part of the increases in efferent and afferent lymph flow observed following acute stress and adrenaline appeared to be due to an increased lymph formation, presumably as a result of an increased capillary pressure. Nevertheless, it is considered that the greater part of the increased flow of lymph from both regions resulted from an accelerated movement of performed lymph.
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