NON-HODGKIN MALIGNANT-LYMPHOMAS AND PERIPHERAL NEUROPATHIES-13 CASES

Non-Hodgkin's malignant lymphomas (NHML) are malignant lymphoid prolif erations which may be of B or T cell type. Thirteen observations of an association between peripheral neuropathy and B type NHML ale reporte d. None of the cases had evidence of meningeal propagation or neurotox icity from chemotherapy. The NHML were classified according to the Wor king Formulation and Kiel classifications. The various mechanisms of p eripheral neuropathy in these cases were split into four broad groups. Group I consisted of four cases in which the peripheral nerve lesions were directly linked to a propagation of malignant cells into the per ipheral nervous system; this was revealed by autopsy and/or nerve biop sy. Malignant B cell proliferation was demonstrated in three out of fo ur of these cases by immunolabelling of the infiltrates. Group II incl uded three patients whose serum contained a monoclonal immunoglobulin (IgM) with antimyelin activity, and two who had pathological IgM depos its in endoneurial connective tissue. Group III comprised two cases. T he immune dysfunction of the NHML was responsible for a Guillain-Barre syndrome in one, and for a chronic inflammatory demyelinating polyneu ropathy in the other Group IV included two patients in whom the mechan ism of the peripheral neuropathy, although almost certainly directly r elated to the NHML, could not be determined beyond doubt. The peripher al neuropathy might have been a result of a paraneoplasic process or p ossibly, an undetected lymphomatous invasion of nervous tissue. All th ese cases of clinically diverse peripheral neuropathy, which either oc curred before the discovery of the haemopathy or arose as complication s of it, are discussed along with similar observations reported in the literature. Immunolabelling of lymphomatous proliferations and nerves is now of considerable value for classifying and indicating the exact aetiology of the peripheral neuropathy. It can also detect pathogenic consequences of any associated monoclonal dysglobulinemia. In any eve nt, a direct link between the peripheral neuropathy and NHML represent s an indication for intensification of specific chemotherapy, which in some of our patients led to significant regression of the peripheral neuropathy. Nonetheless, in some cases, the link between peripheral ne uropathy and NHML could not be established with certainty. Long-term f ollow-up is essential in such cases. The present results show the impo rtance of a case by case study of patients with NHML and peripheral ne uropathy.