204 The Lymphocyte and Lymphocytic Tissue 



set, it must be emphasized that as long as cells sensitive to radiation, 

 chemotherapeutic agents, or steroids are present in malignant tissues, treat- 

 ment with any of these agents will result in a shrinkage of palpable masses 

 and a fall in the patient's white blood cell count without necessarily pro- 

 ducing a favorable clinical response. 913 Consequently these indexes are not 

 valid criteria of a favorable response to therapy. 



A more logical and meaningful concept is that amelioration or regression 

 of signs and symptoms which interfere with the patient's normal way of life 

 may be considered as evidence for a favorable clinical remission. These signs 

 and symptoms may be divided into systemic, hematopoietic, and local evi- 

 dences of activity of the disease and may be utilized as an indication for 

 treatment. Systemic symptoms are exemplified by chills, fever, malaise, 

 anorexia, and weight loss. Hematopoietic abnormalities include lack of pro- 

 duction of cells and platelets at a normal rate or a decrease in survival of 

 these structures in the peripheral blood. Local manifestations result when 

 a mass exerts pressure upon or interferes with the function of a tissue or 

 organ in which it is located, or exerts a similar effect upon adjacent 

 structures. 



It is evident that if the foregoing criteria are accepted, many patients have 

 been subjected to treatment when they were in an asymptomatic state. What 

 has been considered a remission, therefore, has often merely consisted of the 

 shrinkage of a node or group of nodes or of a fall in white blood cell count 

 occurring as a result of the particular treatment, without improvement in 

 the patient's prognosis or condition. 



ANALYSIS OF PROGNOSIS AND RESPONSE TO THERAPY 



Giant Follicular Lymphoma 



Newer Concepts of Classification 



Our concepts concerning this disease have altered considerably. At first, 

 giant follicular lymphoma was considered to be a benign hyperplasia; later, 

 it was thought to be a somewhat benign lymphoma. Gall was the first to 

 recognize that not all cases fulfilling the morphologic criteria for giant fol- 

 licular lymphoma had the same prognosis or response to therapy.- 4 He recog- 

 nized four types based upon the relative number of small lymphocytes, 

 medium lymphocytes, and reticulum cells in the follicles and upon the 

 degree of preservation of the follicular architecture. His Type I, character- 

 ized by nodules composed of small lymphocytes, tended to develop toward 

 Type IV; the loll ides became less distinct and anastomosed with each other. 

 Both changes coincided with a progressive tendency toward a more unfavor- 



