DIAGNOSIS

Excellent cytologic and histologic preparations are essential for precise diagnosis; accurate classification of lymphomas and special precautions must be taken in handling the lymph node. Most diagnostic problems result from improperly and poorly prepared material and crushing artifacts. Selection of the appropriate node and histologic material is important. Histologic material that is obviously necrotic and that has been subject to vascular compromise creates major diagnostic problems.

STAGING

Staging of NHL requires an expeditious investigation to determine the clinical extent of the disease, the degree of organ impairment, and the biochemical disturbance present.

Table 4 Staging System for Childhood Non-Hodgkin's Lymphoma: Murphy Classification

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Stage I

• A single tumor (extranodal) or single anatomic area (nodal) with the exclusion of mediastinum or abdomen

Stage II

• A single tumor (extranodal) with regional lymph node involvement
• Two or more nodal areas on the same side of the diaphragm
• Two single (extranodal) tumors with or without regional lymph node involvement on the same side of the diaphragm
• A resectable primary gastrointestinal tract tumor, usually in the ileocecal area, with or without involvement of associated mesenteric nodes only

Stage III

• Two single tumors (extranodal) above and below the diaphragm
• Two or more nodal areas above and below the diaphragm
• All primary intrathoracic (mediastinal, pleural, thymic) tumors
• All extensive primary intra-abdominal disease
• All paraspinal or epidural tumors, regardless of other tumor site (or sites)

Stage IV

• Any of the above with initial involvement of central nervous system or bone marrow or both.

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Staging laparotomy to determine precise pathologic staging of the disease is not indicated. Radiation therapy alone, with fields determined by an anatomic stating system, is not employed. Chemotherapy is the mainstay because of the multicentric origin of NHL.