6 - “Real compared to what?”: Diagnosing leukemias and lymphomas

Summary

Reviewing the classification of lymphomas in the late 1970s, Henry et al. concluded rather gloomily:

Ten years ago Willis (1967) wrote: “Nowhere in pathology has a chaos of names so clouded clear concepts as in the subject of lymphoid tumors.”

We now have a reasonably satisfactory working classification and approach to the diagnosis of Hodgkins disease, but as far as non-Hodgkins lymphomas are concerned there is currently no universally accepted classification.

(Henry et al. 1978: 275)

Sixteen years later, having found the original reference for the Willis quote (Willis 1948), Rosenberg figured it was a case of plus ça change: “It was Willis who in his 1948 textbook stated, ‘Nowhere in pathology has a chaos of names so clouded clear concepts as in the subject of lymphoid tumours.’ The situation has not changed today” (Rosenberg 1994: 1359).

Taken separately, each quotation laments the lack of consensus in the classification of lymphomas. Taken together, they seem further to imply that the field itself is advancing at a snail's pace. This, despite the availability of radically new diagnostic tools, borrowed from immunology, cytogenetics and molecular biology. And yet, Rosenberg's somewhat jaded remarks appeared in an editorial criticizing a 1994 proposal for a new classification of lymphomas that incorporated (in addition to traditional morphological and clinical criteria) the latest antibody and cytogenetic techniques and that claimed, as a result, to have finally pinpointed well-defined, real disease entities (Harris et al. 1994: 1361).