From Big Medical Encyclopedia

LYMPHOMA GIGANTOFOLLIKULYARNY (Latin lympha pure water, moisture + - oma; grech, gigas, gigantos huge, powerful + lat. follicularis meshotchaty; synonym: Brill's disease — Simmersa, a macrofollicular lymphoma, a nodulyarny lymphosarcoma) — the malignant tumor which is developing from an adenoid tissue and characterized by the follicular growth of tumor cells. Brillom is for the first time described in 1925 (N. E. Brill) with soavt, and in more detail — in 1927 Mr. D. Symmers. The tumoral nature patol, changes in adenoid tissue (see) it was established to L a little later and since then. under the name «Brill's disease — Simmersa» it was allocated as an independent disease. In 1948 Simmers published data on a possible follicular structure of tumoral fabric at a lymphogranulomatosis, lymphatic leukemia and a lymphosarcoma. In 1956 H. Rappaport and soavt, also found various morfol, types in group of tumors of a follicular structure and offered classification, in a cut of L. lost value independent nozol. units also began to be considered among other malignant lymphoma as their options according to preferential cellular composition of tumoral fabric. In the WHO classification (1976) L. it is called a nodulyarny lymphosarcoma.

L., according to various authors, meets more than in 10% of cases of tumoral diseases of an adenoid tissue. More often women, average age of patients — are ill 40 — 50 years. Etiology and pathogeny of L. are not known.

Microscopic picture of a gigantofollikulyarny lymphoma: the follikulopodobny formations of various form and the sizes (1) surrounded with layers of the sclerosed stroma (2); X48.

Preferential are surprised limf, nodes and a spleen, went less often. - kish. path and other bodies. Microscopically tumoral fabric is presented by a set of sharply increased follikulopodobny educations (fig.) having more often the correct rounded or oval shape and constructed of lymphoid cells of different degree of a maturity. The centers of follikulopodobny educations have strong likeness with the light centers normal limf. follicles, are expanded, formed by the least mature cells with a large number of figures of mitoses. In various terms from the beginning of a disease (from several months to several years) the tumor can lose a follicular structure and gain diffusion character. The cellular structure at the same time can change towards strengthening of an anaplaziya with increase in number of mitotic figures that is found originally in the centers of follikulopodobny educations.

On a wedge, to manifestations of L. is the most high-quality option lymphosarcomas (see). At the beginning of a disease increase in one group limf, nodes or the isolated damage of a spleen, stomach is noted; other localizations of primary tumor meet seldom. Idiosyncrasies of L. — long-term asymptomatic increase limf, nodes and defeat of such groups limf, nodes, to-rye are usually seldom involved at other tumors of an adenoid tissue (parotid, occipital, elbow, etc.) - During nek-ry, sometimes quite long, a span of L. has limited distribution, and then there occurs generalization of a tumor with distribution on limf, nodes both nearby, and remote, with involvement of skin, hypodermic cellulose, almonds, internals, marrow. At generalization of L. proceeds as violently metastasizing sarcoma or blast leukemia. In blood about 15% of patients the absolute lymphocytosis with the picture reminding hron, a lymphoid leukosis is observed. At the same time in drugs lymphoid cells with the kernels which are jagged, as if split can be found in different quantity that, according to nek-ry authors, is typical for L.

The diagnosis is established at morfol. research of biopsy material. The greatest difficulties are presented by differential diagnosis with a reactive follicular hyperplasia and hron, nonspecific lymphadenites (see).

At limited defeat apply radiation therapy; at generalized process — chemotherapy; the isolated tumors went. - kish. a path are subject to operational treatment.

The forecast for life adverse, however many patients during a long span keep working capacity.

Bibliography: The guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky and I. B. Smolyannikova, page 356, M., 1976; Brill N. E., In and e hr G. Rosenthal N. Generalized giant lymph follicle hyperplasia of l^mph nodes and spleen, J. Amer. med. Ass., v. 84, p. 668, 1925; Len-nert K., Stein H. Kaiser-1 i n g E. Cytological and functional criteria for the classification of malignant lymphomata, Brit. J. Cancer, v. 31, suppl. 2, p. 29, 1975; Lukes R. J. a. Col lins R. D. New approaches to the classification of the lymphomata, ibid., p. 1; L u m b G. Tumours of lymphoid tissue, p. 34, Edinburgh — L., 1954; Rappaport H., Winter W. J. a. Hicks E. B. Follicular lymphoma, Cancer, v. 9, p. 792, 1956; Spiro S. o. Follicular lymphoma, Brit. J. Cancer, v. 31, suppl. 2, p. 60, 1975; Symmers D. Follicular lymphadenopathy with splenomegaly, Arch. Path., v. 3, p. 816, 1927; it she, Lymphoid diseases, ibid., v. 45, p. 73, 1948.

G. V. Kruglova.