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PATHOLOGISTS have recognized for many years that two important factors in the prognosis of malignant lymphoma are the size of the neoplastic cells and the presence or absence of a follicular pattern. Tumours composed of small cells or possessing a follicular structure occupy the benign end of a spectrum of malignancy. Despite the looseness of definition and the profound effects of fixation on cell size, there is a general awareness that the old terms "reticulum cell sarcoma" and "histiocytic tumour" refer to large-cell neoplasms. Today there is a tendency to have within this category a number of subgroups which have arisen from defined cells found in the germinal centres of lymphoid tissue. These are: (1) Large centrocytes: these cells have an irregular nuclear outline, an inconspicuous nucleolus and abundant cytoplasm. They are common in reactive follicle centres hut less so in neoplasms. (2) Centroblasts: the nuclei are about the same size as those of macrophages and are round and vesicular. They have up to 4 nucleoli, often close to the nuclear membrane, and a thin rim of pyroninophilic cytoplasm. (3) Immunoblasts: these are found in the germinal centres and also in the interfollicular areas of lymphoid tissue. The nucleolus is usually single and central and the cytoplasm is strongly pyroninophilic. They may show plasmacytoid differentiation (plasmablastic). These cell types give rise to 3 recognizable morphological subgroups of neoplasm; i.e. (1) large centrocytic, (2) centroblastic, (3) immunoblastic and plasmablastic. Immuno-peroxidase methods which detect cytoplasmic immunoglobulin enable us to distinguish between blast cells containing Ig and those without. A fourth group, still controversial and awaiting further research with marker studies, is thought to be composed of large neoplastic histiocytes. At present these are rarely recognized. In addition, tumours composed of pleo-morphic large and multinucleated giant cells which defy precise categorization are encountered. Some of these may prove to be epithelial or mesenchymal in origin. Thus, we have 5 subgroups of large-cell tumour which can be recognized by the hospital pathologist using a light microscope and routine staining procedures. When marker studies are added, some of these groups can often be shown to be derived from B or T lymphocytes. These large-cell tumours, with the exception of the large centrocytic type, are highly aggressive and pose a challenge to all concerned with their management. An important contribution to this management may rest with clear recognition of the tumour sub-tvpes.

Workshop on large-cell lymphomas. 6 June 1981, Newcastle, England. Extended abstracts