Clinico‐Pathological Correlations in the Kiel Classification of Non‐Hodgkin's Lymphomata in Children

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Abstract
The rapid development of chemotherapy and radiotherapy during the last decade makes an increasing demand for a reliable classification of malignant non-Hodgkin''s lymphomas. This is especially important in children since in this age group lymphomas show a worse prognosis than in adults. An attempt at a modern classification is offered by the so-called Kiel classification. Thirty-eight children with non-Hodgkin''s lymphomas previously classified according to Rappaport were reevaluated according to the Kiel system. Reclassification was technically feasible in 26 patients. There was good agreement on typing between the 2 independently working cytopathologists. Three patients were cases of histiocytic medullary reticulosis. Among the remaining patients, a larger variety of histological subgroups was seen than in the 1 published pediatric series of Lennert. Seventeen patients had high-grade malignant lymphomas with lymphoblastic lymphomas predominating. Some clinical correlations not detectable with the Rappaport classification were found using the Kiel system. Six patients were judged as having low-grade malignant lymphomas but in this group survival was poorer than expected and 1 patient showed leukemic transformation. The Kiel classification makes high demands for adequate surgical techniques and preparatory routines. It seems to represent a step forward in the classification of non-Hodgkin''s lymphomas but more experience is needed, especially in children, to evaluate its role as a guide to differentiated therapy.