An Illustrated Guide to Skin Lymphoma

Publisher: Wiley; 22 edition
Language: English
ISBN: 1405113766
Paperback: 186 pages
Data: June 22, 2004
Format: PDF
Description: The classification of lymphomas has been a challenge to our intellect and to our science. Over the past 40 years, we have moved through numerous classification schemes, which have varied in usefulness. Some schemes were purely morphologic classifications with some clinical implications, such as those based on whether the tumor cells were small, medium, or large lymphocytes (e.g., the Rappaport classification). Others have been more clinically oriented and have encompassed a number of different morphologic types; for example, in the Working Formulation, lymphomas were grouped into low, intermediate, and high grades according to their clinical behavior. High-grade lymphomas included both small-noncleaved-cell lymphomas and large-cell, anaplastic lymphomas. Later, attempts were made to incorporate immunohistochemical and molecular genetic data into the classifications, such that T-cell and B-cell lymphomas were separated (e.g., the Lukes-Collins and Kiel classifications).

While the gurus of lymph-node pathology struggled with these classifications, many ignored lymphomas arising in the skin and relegated them to the "other" category. Now there is renewed interest in cutaneous lymphomas, primarily because of the recognition that they are not rare oddities but, rather, are common and potentially lethal disorders. Early studies that failed to separate T-cell and B-cell lymphomas pooled disparate entities on the basis of their clinical behavior: for instance, mycosis fungoides (a T-cell lymphoma presenting initially in the skin) was categorized with B-cell lymphomas, which can be primary or secondary in the skin. Such B-cell lymphomas are often discrete, purplish nodules in the skin and were misclassified as "mycosis fungoides d’emblee," or mycosis fungoides arising as new tumors of the skin. With the introduction of modern immunohistochemistry and genetic techniques, these lymphomas have been distinguished, and a clearer classification has been based on specific disease "entities" in lymphoma. For instance, a single disease can start as a small-cell lymphoma and progress to a large-cell lymphoma. Examples of this approach to classification are the Revised European-American Lymphoma (REAL) and the European Organization for Research and Treatment of Cancer (EORTC) classifications, and now the World Health Organization (WHO) classification.


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