LYMPH-NODE CLASSIFICATION SYSTEMS IN CUTANEOUS T-CELL - LYMPHOMA EVIDENCE FOR THE UTILITY OF THE WORKING FORMULATION OF NON-HODGKINS-LYMPHOMAS FOR CLINICAL USAGE

Background. This study was undertaken to compare three classification schemes used to evaluate lymph nodes (LN) obtained from patients with cutaneous T-cell lymphoma (CTCL): a modified Rappaport classification, the National Cancer Institute-Veterans Administration (NCI-VA) classi fication based on the relative numbers of cerebriform cells in the par acortical areas, and the Dutch classification based on the presence of cerebriform cells with large nuclei in mycosis fungoides (MF) and dif fuse infiltration by cerebriform cells in Sezary syndrome. Methods. A study set of 195 LN obtained from patients with CTCL (MF, Sezary syndr ome, and nonepidermotropic T-cell lymphomas) and 14 LN from patients w ith benign dermatoses was reviewed independently by three groups of pa thologists familiar with each classification system. Results. Each cla ssification system provided useful prognostic information. However, co ntrary to prior reports, no significant difference in survival was app arent in patients with uneffaced LN when classified according to the N CI-VA (LN0-2 versus LN3) or Dutch (Gr0-1 versus Gr2) ratings. In addit ion, all classification systems demonstrated a poor survival time asso ciated with effaced LN. By combining results from the modified Rappapo rt and Dutch classifications, three prognostic groups could be identif ied based on cell morphology: a low-grade category with a small cell h istologic subtype (median survival time, 40 months); a high-grade immu noblastic subtype (median survival time, 9 months) composed of cells w ith an oval nucleus containing a large, usually solitary central nucle olus; and an intermediate-grade category composed of all cases without the distinctive small cell and immunoblastic morphologies (median sur vival time, 26 months). Conclusions. The authors propose that clearly involved LN in CTCL can be categorized on the basis of cell morphology into prognostic groups analogous to what has been proposed for the Wo rking Formulation for Non-Hodgkin's Lymphomas for Clinical Usage.