Histopathology in Prognosis & Therapy of Lymphocytic Lymphomas 203 



Romanovsky mixtures, should be content to study the same cells in tissue 

 sections after Formalin fixation and hematoxylin and eosin staining. 



The following steps should be carried out so that sections adequate for 

 cytologic analysis can be obtained. 8 Tissue should be sliced into pieces 2 or 

 3 mm. in thickness and immediately immersed into fixative for no longer 

 than 2 or 3 hours. Refrigeration of the tissues overnight or even for a few 

 hours 37 is not a substitute for immediate fixation. Embedding must be done 

 carefully to avoid shrinkage. If nitrocellulose rather than paraffin is used. 

 less distortion occurs. Contrary to Lumb, 37 there is no need to cut sections 

 thinner than 6 ^. Eosin-azure or any other convenient Romanovsky stain 

 should he employed after a light preliminary stain with hematoxylin. The 

 addition of silver impregnation for reticular fibers may be an aid in demon- 

 strating tissue architecture. 37 



Autopsy material, unless obtained within minutes after the patient's 

 death, will not yield good cytologic detail even though architectural features 

 are preserved. Concepts based upon the interpretation of fine morphologic 

 detail in tissues obtained at autopsy should be viewed with caution. 



Many other techniques have been advocated to demonstrate adequately 

 cytologic detail. Some, such as peroxidase and oxidase stains, have fallen 

 into disrepute. More recently smears made from aspirated tissues or from 

 the cut surface of biopsy specimens have been utilized. This approach has 

 been predicated on the belief that cytologic detail has been better delineated 

 in smears than in sections. 4 ' "'■ 38 ' 54 This contention is not valid provided 

 that the sections are prepared by an adequate technique. On the other hand 

 the smear method has had the following obvious disadvantages: 8, 43 (1) it 

 fails to demonstrate architecture, (2) the numerical interrelationships of the 

 cells are disturbed in the process of making the smears, and (3) there is no 

 means of determining whether the area of a pleomorphic tissue which has 

 been smeared is representative. In regard to the last objection, the smear 

 technique has been particularly unreliable in evaluating the relative 

 amounts of fat, myeloid, and lymphatic tissue in the marrow. s ,:; Based on 

 my own somewhat limited experience, as well as on a review of the literature, 

 I believe there has been no new information of value resulting from the 

 smear technique. 



Some techniques are still too new to evaluate. The study of enzyme 

 systems"'' and phase and electron microscopy merit further consideration. 



Criteria of Response to Therapy 



The major purpose of this investigation is to correlate histopathology with 

 prognosis and response to therapy. Accordingly, it is appropriate to define 

 precisely what is meant by a good and poor response to therapy. At the out- 



