한국인 악성임파종의 조직학적 및 면역조직학적 연구 = Histopathologic and Immunohistologic Studies of Non-Hodgkin's Lymphomas in Korean Patients

다국어 초록 (Multilingual Abstract)

Abstract
Various designations uses in malignant lymphomas lacked precise definition and many investigators had uses different terms for the came tumor. As a result of this imprecise terminology, no meaningful clinicopathologic correlations could be eatablished.
Rappaport classification was based purely on the cellular morphology and growth pattern of the lymphomas. It was widely accepted, not only because it was relatively easy to apply, but also because it was clinically useful in the design of treatment protocols and in predicting response to therapy and survival of patients. However, based on the new knowledge regarding the nature and origin of the lymphoid cells in malignant lymptomas, many investigators attempted to correct the scientific inaccuracies of the Rappaport classification by proposing new classifications. Lukes and Collins, as well as Lennert et al., placed great emphasis on the fact that the non-Hodgkin's lymphomas were tutors of B- or T-lymphocytes, and they asserted that immunologic identification of lymphoid ceils is an integral part of the diagnosis and classification of the lymphomas.
The existence of many classifications not only has resulted in confusion and controversy, but also has made it impossible to compare effectively the results of clinical studios utilizing different systems. To resolve this, the National Cancer Institute of U.S.A. has suggested a new Working Formulation(WF) for Clinical Usage. Relatively recently immunologic methods suck as immunofluorescent and immunoperoxidase staining were popularly used in the diagnosis and stuffy of lymptoproliferative diseases. We performed this stuffy to reclassify the malignant lymphomas according to WF baaed on the histologic features and immunologic phenotypes and to compare the usability and advantages of various immunohistologic staining methods.
The material consisted of 53 crises of malignant lymphomas examined at the Department of Pathology, Yonsei University College of Medicine from May, 1983 through December, 1984.
All crises were subjected to histopathological analysis, review of clinical records and immunologic studies. The paraffin blocks were sectioned at 5 micron thickness and sections were stained with hematoxylin-eosin and if needed be, methyl-green pyronin. Immunologic studies were also performed on the sections of paraffin-embedded tissue and on 9 cases of frozen sections; immunoperoxidase staining for demonstration of cytoplasmic immunoglobulins and lysozyme and immunofluorescent staining with fluorescein-conjugated monoclonal antibody for demonstration of HLA-DR and Leu-1 antigens in the tumor cells. Prepared elides were examined by light microscope or immunofluorescent miscroscope as occasion demands.
The results were as follows:
1) Of the 53 crises of malignant lymphomas, 28 cases(52.9%) and 15 cases(28.2%) were belong to intermediate and high grades respectively. Most of these were "diffuse, small cleaved", "diffuse, mixed", "diffuse, large cell", and "large cell, immunoblastic" types, which ranged from 15.1% to 18.9% respectively. True histiocytic lymphoma was absent.
2) According to Rappaport classification, histiocytic lymphomaa were the most frequent type (30.2%) and the next, lymphocytic, poorly differentiated type (18.9%).
3) Among the 44 crises of morphologically putative B-cell lymphomas, immunoper-oxidase staining for immunoglobulin was positive in 68.2% of crises and immunofluorescent staining for anti-HLA-DR, positive in 65.9%.
4) Monoclonality of light chain was observes in 66.7% of the cases that stained positive for immunoglobulin by immunoperoxidase method.
5) Histiocytes were present and mixed with tumor cells ranging from mild to severe degree in 41.5% of the 44 crises of morphologically putative B-cell lymphomas. In mycosis fungoides histiocytes were mixed with tumor cello in 80%, but in lymphoblastic lymphomas, all cases lacked histiocytes.

목차 (Table of Contents)

• Ⅰ. 서론
• Ⅱ. 연구재료 및 방법
• 1. 연구재료
• 2. 연구방법
• Ⅲ. 연구결과
• 1. WF에 의한 악성임파종의 분포 및 Rappaport분류법(Nathwani등, 1978)에 의한 결과와의 비교
• 2. WP에 의해 분류한 악성임파종의 한국과 미국과의 비교
• 3. 연령 및 성별분포
• 4. 위장관에 발생한 악성임파종의 유형별 분포
• 5. 악성임파종의 면역학적 소견과 분포
• Ⅳ. 고찰
• Ⅴ. 결론