Search

The present study reports of the geographic distribution of 2,878 cases of uniformly classified malignant lymphomas and of 2,349 similar cases from the literature. Data on histological entities are compared with the geographic and socio-economic characteristics of the regions where they preferentially occur. The results provide three patterns in lymphoma distribution: small cell lymphocytic lymphomas are frequent among populations of European extraction and in farming rather than industrial regions. Lymphomas derived from cells of the germinal center are seen preferentially in so-called "underdeveloped countries", and large cell (immunoblastic) lymphomas appear rather characteristic of industrial areas. Besides genetic influences (rare chronic lymphocytic leukemia (CLL) in Asia as compared to Europe), the results suggest environmental cofactors in the pathogenesis of malignant lymphomas. CLL is more frequent in areas with rather low-dose chronic toxic influences such as from the use of fertilizers and pesticides in farming. Germinal center cell lymphomas tend to occur more frequently in countries with nutritional and hygienic deficiencies with frequent infectious diseases. Large cell high malignancy lymphomas apparently prefer highly industrialized regions with pollution of water supplies by more toxic and immunosuppressive substances.

Two hundred thirty cases of malignant non-Hodgkin's lymphomas were reclassified in a retrospective study according to the New Working Formulation for Clinical Usage of the NCI as compared to the Rappaport and Kiel classifications. The reproducibility for the individual schemes this study was 81% (Rappaport), 79% (Kiel), and 85% (New Working Formulation). In keeping with the results of the NCI international study, all lymphomas were subdivided into 3 prognostic groups: (1) low-grade malignancy (6.0 years median survival); (2) intermediate-grade malignancy (3.5 years median survival); and (3) high-grade malignancy (1.4 years median survival). The NCI-proposed New Working Formulation for Clinical Usage is thus recommended as practical and unprejudicing classification scheme for general application; however, its usefulness as tool for translating one classification scheme into another appears limited.