Malignant lymphoma, well differentiated lymphocytic.Its relationship with chronic lymphocytic leukemia and macroglobulinemia of Waldenström

Abstract

A clinicopathologic analysis of 108 patients originally diagnosed as malignant lymphoma, well differentiated lymphocytic type on the basis of lymph node (l.n.) biopsy sections showed that in 41 patients neither absolute lymphocytosis nor monoclonal gammopathy was evident (Group I). A monoclonal serum immunoglobulin was present in 20 patients, 18 of whom had no absolute lympocytosis (Group II). The remaining 47 patients had absolute lymphocytosis (above 4,000/mm3) and no monoclonal gammopathy (Group III). Of the 41 Group I patients, 11 had no bone marrow involvement at the time of 1.n. biopsy and 35 never developed lymphocytosis over follow-up periods ranging from 24 to 150 months. Our observations indicate that malignant lymphoma of the well differentiated lymphocytic type (WDL) may be a tissue manifestation of chronic lymphocytic leukemia (CLL) but may also exist as a distinct form of non-Hodgkin's lymphoma. Of the 20 patients with monoclonal gammopathy (Group II) 90% had plasmacytoid lymphocytes and/or plasma cells in tissue sections. However, these cells were also present in 9.7% of patients with WDL (Group I) and in 7% of patients with CLL (Group III) without demonstrable monoclonal gammopathy. Our findings suggest that although WDL, CLL and well differentiated lymphoproliferative diseases with monoclonal gammopathy are histologically similar, their clinical and hematological presentations differ sufficiently to justify their separation into three distinct entities. At the same time they could well represent different hematopathologic expressions of the same basic process, namely a proliferation of small lymphocytes usually of the B-cell type.