Lymphoblastoma

THIS study is based on eight cases of lymphoblastoma of the stomach observed at the Massachusetts General Hospital, and a review of the literature. In all but one of the cases reviewed or examined, the roentgen findings were either negative or inaccurately interpreted. Had the clinical and roentgen findings been correlated and interpreted in the light of the known pathology of this disease, a correct diagnosis could have been made in a greater percentage of the cases. Clinically, it is extremely difficult to differentiate the various forms of lymphoblastoma which are described in the textbooks on pathology. The histologic classification of this group is far from settled. The cases showing involvement of the stomach which have been collected from die literature may be classified under three headings: (1) lymphogranulomatosis (Hodgkin's disease), (2) pseudoleukemia, and (3) lymphosarcoma. Recently fhere has been a tendency among pathologists of wide experience to consider these various conditions as different manifestations of the same pathologic process. The term “malignant lymphoma” as a synonym for lymphoblastoma has been used in the Department of Pathology of the Massachusetts General Hospital. Thus, reports are made of “malignant lymphoma” without special subdivision as to type. But in reviewing the literature, as different authors have used different subdivisions, the reported cases are recorded herein under the term applied by the authors. Lymphogranulomatosis (Hodgkin's disease).—Cases given this name have been described by Sternberg (13). He believes, from microscopic examination of the lesions, that the condition is a well characterized affection of the lymphatic system belonging to the infectious granulomas. Although the literature contains reports of many cases given the name of lymphogranulomatosis, there are only 22 recorded cases (1–19) in which involvement of the gastro-intestinal tract was reported. Of the 22 cases collected, the stomach was involved in 12. The gross pathologic picture varies from small thickenings of the mucosa to large, infiltrative, ulcerative lesions, which invade the muscularis, and which may continue to perforation. Only by a microscopic examination can the ulcerative lesions be distinguished from gastric carcinoma. The condition is usually a part of a general lymphatic involvement, and only infrequently is the disease localized in the gastro-intestinal tract and mesenteric lymph nodes. The disease is generally found in the cancer age, although one case was observed in a child of five and a half years (7). The clinical course of most cases in which ulceration predominates is marked by rapid loss of strength, emaciation, fever, and the advent of abdominal symptoms, vomiting, and diarrhea with blood in the stools. Characteristically, these symptoms continue up to the time of exitus, which is generally only a few weeks later.