Page 75 - The lraternational Journal of the Royal Society of Thailand.indd

The International Journal of the Royal Society of Thailand
Volume XV-2023

Introduction
This article of “reflections on how to diagnose and classify lymphoma” comes

from the author’s personal experience as a hematopathologist for 30 years since
finishing training in 1993 at Department of Pathology, Vanderbilt University Medical
Center with Professor Dr. Robert D Collins, one of the well-known hematopathologists
in the early 1970s for the Lukes-Collins classification for lymphoma (Lukes & Collins,

1974). The author has been serving as a hematopathologist at Department of Pathology,
Faculty of Medicine Siriraj Hospital, Mahidol University since June 1993. This
government-based hospital is the largest hospital in Thailand. Every year, we diagnose
approximately 250 new cases of lymphoma at this hospital and nearly 100 consultation

cases from other hospitals and private laboratories. The authors has been involving
in a good number of publications on lymphoma throughout the ongoing career
(Swerdlow et al, 1993; Sukpanichnant et al, 1998; Sukpanichnant, 2004; Sukpanichnant
et al, 2004; Pongpruttipan et al, 2012; Intragumtornchai et al, 2018; Sitthinamsuwan

et al, 2018; Ngamdamrongkiat et al, 2022; Vangveeravong et al, 2022).

Reflections on how to diagnose and classify lymphoma

Since the first description and illustration of Reed-Sternberg cells in Hodgkin
disease by Dorothy Reed in 1902 (Reed DM, 1902: 133-98), the diagnosis and classification

(D&C) of lymphoma have been improved in the past 120+ years. Struggles, however,
were encountered by morphology alone without understanding the nature of the
lymphoma cells. At one time, lymphoma was defined as a malignancy of lymphatic
tissue encompassing varieties of cells, not only lymphoid cells but also mononuclear

phagocyte system cells and other supporting cells. Using comparison to the lymphocytes
and reticulum cells given to any large mononuclear cells with close relationship to
reticulin fibers as highlighted by histochemical stains, e.g., reticulum stain, NHL was
once classified into 2 groups – lymphocyte (for the small cells) and reticulum cell (for

the large cells) (Sundberg, 1947). Then, misunderstanding continued for nearly a decade
when the large lymphoma cells were interpreted as histiocytes (Rappaport, 1966).
It took a lot of research works and publications to demonstrate that the reticulum cell
sarcoma or histiocytic lymphoma are in fact large lymphoma cells, either of B-cell or

T-cell phenotype, in most cases of lymphoma with large cell morphology (Taylor &
Hartsock, 2011; Jaffe, 2019).

Immunology provides us knowledge and better understanding in normal
lymphoid cells and neoplastic ones. Nevertheless, it took time to accept immunologic
approach to the D&C of lymphoma. Lukes-Collins classification (1974) and Kiel

Sanya Sukpanichnant 67