The Changing Pulton of Lymphocytic Malignancies 193 



Nonetheless, she remained active and comfortable for another year, toward 

 the end of which the blood studies during her periodic check-ups showed a 

 steady increase in circulating myeloblasts. In September, 1953, she developed 

 herpes zoster, requiring readmission to the hospital, and close observation 

 of the blood picture disclosed progressive anemia and thrombocytopenia 

 with increasing myeloblasts. Sections of aspirated bone marrow units re- 

 vealed virtually complete displacement of normal hematopoietic tissue by 

 a homogeneous sheet of myeloblasts (Fig. 15-1 1 C). A remission lasting two 

 months was obtained by combined antimetabolite and corticosteroid 

 therapy, but the patient died in November, 1953. The autopsy findings 

 were purely those of acute granulocytic leukemia, no vestige of the original 

 lymphoma being present. 



SUMMARY 



Through the study of many such cases, it becomes apparent that the 

 distinctive cytologic patterns in the lymphoma-leukemia complex do not 

 denote separate neoplastic entities. They appear to be varied expressions of 

 a single malignant process stemming from cellular derivatives of the embry- 

 onal mesenchyme. Thus, the neoplastic proliferation may remain pure as 

 to cell type from the outset, may become composite, or may alter completely 

 during; the course of the disease. 



REFERENCES 



1. Cister, R. P. Borderlands dim in malignant disease of the blood-forming 

 organs. Radiology 61:764-770, 1953. 



2. Custer, R. P., and Bernhard, W. G. The interrelationship of Hodgkin's dis- 

 ease and other lymphatic tumors. Am. J. Med. Sc. 2/6:()25, 1948. 



3. Gael, E. A. Cytological identity and interrelation of mesenchymal cells ol 

 lymphoid tissue. A>\)}. New York Acad. Sc. 73:120-130, 1958. 



4. Lawrence, J. H.. and Rosenthal, R. L. Multiple myeloma associated with 

 polycythemia. Report of four cases. Am. J. Med. Sc. 218:\ 19-154, 1949. 



The illustrations in this chapter were reproduced from the original color photomicrographs; 

 much of the cytologic detail was lost in the process. 



