186 The Lymphocyte and Lymphocytic Tissue 



I5-5J5), the growth now forming a diffuse sheet of small lymphocytes (Fig. 

 15-5C). Three and one-half years after his first admission there was major 

 recurrence, and the tumor proved resistant to various therapeutic measures. 

 He developed panhematocytopenia and died of sepsis incident thereto. The 

 tumor found at autopsy was composed entirely of large, pleomorphic 

 reticulum cells (Fig. 15-5LT). 



Follicular Lymphoma to Multi faceted Hodgkin's Type 



Case 3. A white woman 49 years old was admitted to the Cardio-Thoracic 

 Surgical Service for resection of a large mediastinal tumor which proved to 

 be Hodgkin's lymphoma, some parts being typically granulomatous (Fig. 

 15-6B), others purely sarcomatous (Fig. 15-6C), while still others showed a 

 fibrosarcomatous pattern (Fig. 15-6D). On being questioned later about an 

 axillary scar, she recalled having had a node removed nine years previously; 

 a course of x-ray therapy followed. We were able to obtain a section of the 

 biopsy which showed the follicular type of lymphoma (Fig. 15-6.4). 



Follicular Lymphoma to Desmoplastic Hodgkin's Type 



Case 4. Th's was the fascinating case of a woman Avho, at the age of 51, 

 developed bi'ateral supraclavicular tumors which remained relatively static 

 for four years and then began to enlarge rapidly. A biopsy showed the tumor 

 to be a follicular lymphoma (Fig. 15-7/4) which was controlled by chemo- 

 therapy for the next three years. A large mass then appeared in the left 

 lower quadrant of the abdomen and regressed after treatment with x-rays 

 and alkylating agents. Five months later she was readmitted with the com- 

 plete syndrome of malignant hypertension, striking cardiac enlargement hav- 

 ing occurred in the interim. A Goldblatt kidney situation was suspected, 

 treatment directed toward the abdominal tumor was resumed, and a brief 

 respite was obtained. The patient then became virtually moribund, and, 

 mostly as a gesture, an additional 15 mg. of methylene melamine were 

 administered. To the amazement of everyone, symptoms were gradually 

 relieved over the next three weeks, and she became ambulatory and com- 

 fortable during the subsequent two years. Recurrence of malignant hyper- 

 tension, this time unaffected by chemotherapy, led to her final admission, 

 and she died as the result of renal failure complicated by staphylococcic 

 pneumonia. 



The autopsy disclosed the left kidney encased by dense white tissue, its 

 major blood vessels rendered stenotic thereby. The right renal artery was 

 likewise constricted, and both kidneys were the seat of pyelonephritis. Sec- 

 tions of the tumor mass showed it to be composed chiefly of acellular 

 collagenous tissue punctuated by virtually empty spaces (Fig. 15-7B), one of 



