Abstract
Malignant lymphomas are tumors of lymphoid tissue that make up almost 30% of cancers in childhood. The term “lymphoma” covers a variety of histologic types of tumor that have been placed in many different classifications. Based on biological behavior and current management, it is convenient to divide lymphomas in children into 2 broad categories: (a) Hodgkin’s disease, and (b) non-Hodgkin’s lymphoma. Hodgkin’s disease in children resembles the disease in adults. It is a slowly progressive chronic disease, often lacking in systemic symptoms in early stages. Evaluation of Hodgkin’s disease involves careful determination of extent of disease by radiologic, scanning, biochemical, and surgical staging techniques. Non-Hodgkin’s lymphoma, in contrast, is one of the most rapidly growing cancers in children. The disease differs greatly from adult non-Hodgkin’s lymphoma both in behavior and management. The rapid clinical course and early spread to bone marrow and central nervous system resembles acute leukemia more than adult non-Hodgkin’s lymphoma. The children are often extremely sick at the time of diagnosis and evaluation. More than a 24-hour delay in treatment may increase the problems of subsequent management and jeopardize cure. The planned staging laparotomy carried out electively in Hodgkin’s disease has no place in the management of non-Hodgkin’s lymphoma in children. Surgery in this tumor consists of biopsy of peripheral node for diagnosis and determination of peripheral nodal presentation, and exploratory laparotomy for resection of gross tumor in abdominal presentation. Whereas the pretreatment evaluation may take 1 week in Hodgkin’s disease, non-Hodgkin’s lymphoma requires urgent induction of chemotherapy within 48 hours of diagnosis. This discussion of lymphoma in children involves separate considerations of Hodgkin’s disease and non-Hodgkin’s lymphoma. The reader should think of these groups as 2 distinct diseases requiring quite different types of management.
Résumé
Les lymphomes malins sont des tumeurs du tissu lymphoïde qui représentent presque 30% des cancers de l’enfant. Le terme lymphome englobe divers types histologiques, dont la classification a varié au cours du temps. Si l’on se base sur leur comportement biologique et sur les thérapeutiques usuelles, il faut, pour des raisons de facilité, diviser les lymphomes en deux grands groupes: (a) la maladie de Hodgkin, (b) les lymphomes non-hodgkiniens. La maladie de Hodgkin de l’enfant ressemble à celle de l’adulte: elle est chronique, lentement progressive et souvent sans symptomes généraux aux premiers stades. Pour une évaluation correcte de la maladie de Hodgkin, il faut préciser l’étendue des lésions par radiographie, scintigraphie, examens biochimiques, et exploration chirurgicale. A l’opposé, les lymphomes non-hodgkiniens sont des cancers à croissance très rapide chez l’enfant, dont l’évolution et le traitement sont très différents de ce que l’on observe chez l’adulte. L’évolution clinique rapide et l’atteinte précoce de la moëlle osseuse et du système nerveux central suggèrent plus la leucémie aiguë que le lymphome non-hodgkinien de l’adulte. Les enfants sont souvent très malades au moment du diagnostic et de la mise au point. Un retard de plus de 24 heures dans le début du traitement peut aggraver les problèmes thérapeutiques ultérieurs et mettre en danger les chances de guérison. La laparotomie pour définir le stade de la maladie, qui est utilisée dans la maladie de Hodgkin, est inutile dans les lymphomes non-hodgkiniens de l’enfant. Le traitement chirurgical de ce type de tumeur doit consister en: (a) biopsie d’un ganglion pour diagnostic dans les formes ganglionnaires périphériques, (b) laparotomie pour résection des volumineuses masses tumorales dans la forme abdominale. Dans la maladie de Hodgkin, la mise au point peut s’étendre sur une semaine; dans le lymphome non-hodgkinien, la chimiothérapie doit être commencée dans les 48 heures qui suivent le diagnostic. Toute discussion des lymphomes de l’enfant doit clairement distinguer la maladie de Hodgkin des lymphomes non-hodgkiniens: il faut les considérer comme deux maladies nettement distinctes et dont le traitement est différent.
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Exelby, P.R. Malignant lymphomas in children. World J. Surg. 4, 49–60 (1980). https://doi.org/10.1007/BF02393095
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DOI: https://doi.org/10.1007/BF02393095