Pathological staging of 100 consecutive untreated patients with non-Hodgkin's lymphomas: extramedullary sites of disease.

One hundred consecutive untreated cases of non-Hodgkin's lymphomas were reviewed according to Rappaport's classification. There were 49 males and 51 females, almost evenly distributed between nodular (49) and diffuse (51) patterns. Only diffuse lymphomas were seen in patients under age 20 and they were twice as common as nodular lymphomas in patients over 60. Nodular lymphomas were predominantly lymphocytic (61%) or mixed (35%) while diffuse lymphomas were commonly histiocytic (43%). Standardized pathological staging was based upon the serial performance of bone marrow needle biopsy, percutaneous hepatic biopsy, peritoneoscopic hepatic biopsies and exploratory laparotomy. For all patients this sequence terminated with the first positive biopsy. Hepatic involvement was documented in 40 patients by either percutaneous biopsies,18 peritoneoscopic biopsies,9 or wedge biopsy at laparotomy.13 Thirty-seven of 49 patients who underwent laparotomy had biopsy-proven abdominal involvement. Overall incidence of biopsy-proven abdominal disease was 64%. Positive spleens varied widely in weight but all negative spleens weighed less than 270 g. Constancy of histologic type in multiple sites was observed in 90% of cases.