Histopathology in Prognosis & Therapy of Lymphocytic Lymphomas 2H 



Classification of Response and Prognosis in Terms of Severity of 

 Disease 



We are now in a position to recognize an early, asymptomatic stage in 

 chronic lymphatic leukemia 29 - 44 ' 5T primarily as a result of the fact that blood 

 counts are now obtained on all hospitalized patients and biopsy of the 

 bone marrow is usually performed whenever an absolute lymphocytosis is 

 noted. The diagnosis of chronic lymphatic leukemia under such circum- 

 stances was usually fortuitous. Pisciotta and Hirschboek, 44 for example, 

 noted that 38 per cent of all the patients with chronic lymphatic leukemia 

 in his series were diagnosed while under investigation for another problem. 



Patients with early benign chronic lymphatic leukemia have minimal 

 lymphadenopathy or hepatosplenomegaly. There is no anemia, only slight 

 thrombopenia, and moderate leukocytosis. They form a group in which any 

 type of cytocidal treatment will give an excellent response as evidenced by 

 a fall in white blood cell count and shrinkage of masses; in retrospect one 

 may ask whether treatment was indicated or was of any real benefit. 20 



The histopathologic hallmark of the benign type of chronic lymphatic 

 leukemia was a marrow which contained occasional islands of lymphatic 

 tissue, composed of normal, small, heavily stained lymphocytes with a poorly 

 demonstrable reticular cell background. Mitoses were not seen, there was no 

 follicular pattern manifested by the lymphatic tissue, and a sharp border 

 between the lymphatic and myeloid tissue was recognizable. The latter was 

 normal in amount and distribution of cells and lineages and had a normal 

 amount of tissue iron. 



This benign type of chronic lymphatic leukemia is illustrated by Case 5. 

 The patient was a 70-year-old nurse who was known to have had normal 

 white blood cell counts in 1949 and 1951; in each instance the count was 

 obtained following an injury. In 1953, at a routine examination, a white 

 blood cell count of 14,000 with 80 per cent small lymphocytes and a normal 

 hemoglobin was discovered. Marrow biopsy revealed a normal amount of 

 myeloid tissue (Fig. 17-5A) with an occasional small island of dense lym- 

 phatic tissue, each of which was composed of a sheet of small lymphocvtes 

 ■ — hardly more than is seen normally in many elderly patients. 14 



By March, 1959, her white blood cell count without treatment had risen 

 to between 25,000 and 35,000 with 80 per cent small lymphocytes. She re- 

 mained asymptomatic with normal hemoglobin and platelets. The only ab- 

 normality on physical examination was a 1 cm. node in her left axilla. 

 Figure 17-55, taken from a section of bone marrow obtained in March, 

 1959, demonstrates a large island of lymphatic tissue and normal myeloid 

 tissue. The lymphatic - tissue was composed predominantly of dense sheets 



