The Changing Pattern of Lymphocytic Malignancies 183 



matous disorders and shall limit them to the brief resume of a few illustra- 

 tive cases. 



Follicular Lymphoma to Chronic Lymphocytic Leukemia 



Case 1. The patient was 68 years of age when first admitted because of 

 generalized and rapidly progressive lymphadenopathy, the spleen and liver 

 being normal in size. Biopsy of an axillary node established the diagnosis 



FOLLICULAR LYMPHOMA 



LYMPHOCYTIC 

 LEUKEMIA 



HODGKINS 



(RETICULUM CELL) 



SARCOMA 



MONOCYTIC 

 LEUKEMIA 



PRIMARY CUTANEOUS LYMPHOMAS 



Follicular ( Spiea | er .f- end) SQrco ,d) 



Lymphocytic 



Granulomatous (Mycosis fungoides) 



Reticulum cell 



GRANULOCYTIC LEUKEMIA 4 

 (Myelogenous Leukemia) *\ 



THROMBOCYTE LEUKEMIA 

 ( Megakaryocyte Leukemia) 



SOLITARY MYELOMA' 



"ERYTHROMYELOSIS' 

 (diGuglielmo) 



^ERYTHREMIA 



PLASMOCYTOMA, 

 (Multiple Myeloma) 



k EXTRAMEDULLAR Yr 

 PLASMOCYTOMA 



PLASMOCYTIC LEUKEMIA* 



Fig. 15-3. Composite diagram of transitions observed in the overall lymphoma-leukemia 

 complex (malignant disease of the reticuloendothelial system). 



of follicular lymphoma (Fig. 15-4/f). Because of pleomorphism within the 

 nodular centers, a transition to the reticulum cell type was predicted. How- 

 ever, about one year later a progressive increase in circulating lymphocytes 

 of adult type was noted (Fig. 15-45), followed later my hepatosplenomegaly. 

 The process proved unusually aggressive despite maximal therapy within the 

 realm of safety, the leukocyte count at one point reaching 250.000 per cubic 

 millimeter (all mature lymphocytes). The patient died within three years. 

 The autopsy findings were typically those of chronic lymphocytic leukemia. 



