As it has been experienced that the differential diagnosis of malignant lymphoma and
lymphoid leukemia is a quite frequent problem to the hematologists and surgical
pathologists, we made an attempt to clarify it from the hematological, cytological and
histopathological aspects with the accumulated materials at the Section of Hematology
and Surgical Pathology, Clinical Laboratories, College of Medicine, Seoul National
University.
The materials consisted of 153 cases of malignant lymphoid and 3 cases of lymphoid
leukemia diagnosed by lymph node biopsy, and 101 cases of lymphoid leukemia and 36
cases of malignant lymphoma diagnosed by peripheral blood and bone marrow
examinations during the period of January 1969 to September 1973.
Original diagnosis were re-evaluated and the results were summerized as follows :
1. Among 153 cases of malignant lymphoma were 73 cases of lymphocytic type, 44
histiocytic type, 8 mixed type, 14 Hodgkin's disease 14 undifferentiated and unclassified
type. While in lymphoid leukemia, 99 were acute type and only 2 cases were chronic
type.
2. Leukemic manifestations in the peripheral blood were observed in 25% out of 153
cases of malignant lymphoma.
3. Male to female sex ratio was 2.0 : 1 in malignant lymphoma, while it was 1.8 : 1
in acute lymphoid leukemia.
4. The peak age incidence was 30 to 45 years of age in malignant lymphoma but in
acute lymphoid leukemia it ranged from 1 to 15 years of age.
5. The hemoglobin and Hct. in initial stage of diagnosis revealed normal or slightly
decreased values in majority cases of malignant lymphoma while it revealed moderate to
marked decrease in acute lymphoid leukemia.
6. WBC counts at the initial stage of malignant lymphoma were normal or moderately
decreased in majority of cases, but majority of acute lymphoid leukemia case revealed
either marked leukocytosis or marked leukopenia.
7. In differential counts, the malignant lymphoma cases without leukemic manifesta-
tions revealed marked lymphopenia while those cases of lymphoma with leukemic
manifestations revealed considerable increase in number of lymphoid cells but far less
than that of acute lymphoid leukemia. Presence of immature granulocytes and eosinophils
in peripheral blood was a frequent association of the malignant lymphoma.
8, Lymphosarcoma cells in peripheral blood was a prominent feature of the malignant
Iymphoma, however differential diagnosis between each type of lymphoma was
extremely difficult by cytological characteristics.
9. Of bone marrow differential count, the mean value of lymphoid cells was 27.4% in
total cases of malignant lymphoma and there appeared relatively more lymphoid cells in
those cases with leukemic manifestations in peripheral blood while it was 76.6% in acute
lymphoid leukemia.
Normoblasts, megakaryocytes and granulocytes were relatively high in number in the
malignant lymphoma while they were markedly depressed in acute lymphoid leukemia.
10. Histo-pathological findings of lymph node biopsy of the acute lymphoid leukemias
comparing to those of lymphoma illustrated monotonous and uniform cellular pattern,
less mitosis, more fibrosis, diffuse invasion of capsules and evidences of extramedulary
hemopoiesis in subcapsular spaces.
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