Histopathology in Prognosis & Therapy of Lymphocytic Lymphomas 205 



able clinical course and with a poorer response to therapy. These concepts 

 have been in general verified by Lumb, 37 Bilger, 7 Wright, 59 and 



Baggenstoss. : 



Rappaport and colleagues 45 in a more recent paper, advocated a slightly 

 different interpretation. He recognized the four general types described by 

 Gall and added a filth, or Hodgkin's type. In addition, Rappaport believed 

 that the lymph nodes lost their follicular pattern and retained the character- 

 istic dominant cell type. For example, a Type I node, composed of small 

 lymphocytes, will lose its follicular pattern and evolve into lymphocytic 

 lymphosarcoma. Similarly, a Type IV node composed of reticular cells, if 

 it loses its follicular pattern, takes on the characteristics of a reticulum cell 

 sarcoma. The latter has a poor response to therapy and thus a poor 

 prognosis. 



Cytologic Varieties 



My own experience with giant follicular lymphoma has indicated that all 

 these varieties have occurred and that, further, the prognosis and response 

 to therapy have been related to the histopathology at the time of biopsy. 

 Figure \1-\A and B, from a node biopsy in 1943, was an example of the most 

 benign type (Type I of Gall and Rappaport) in which the follicles were com- 

 posed predominantly of dense sheets of small lymphocytes. The interfollic- 

 ular tissue also consisted of small lymphocytes in slightly reduced 

 concentration. The patient had been treated with nitrogen mustard (HN 2 ) 

 in 1943 and 1944 in spite of a lack of activity of his disease. In 1948 he re- 

 ceived x-ray therapy because of a swollen right leg. 



The follicular pattern was more clearly demonstrable in a node obtained 

 by biopsy in 1950 than it was in the specimen studied in 1943 (Fig. 17TC 

 vs. 17-1.-/). However, the lymphocytes were larger and more delicately stained 

 than those in the node removed earlier (Fig. 17-12? vs. 17- ID). Examination 

 of splenic tissue obtained by needle biopsy within a day of last node biopsy 

 revealed numerous large follicles similar to those in the node. In both, the 

 predominant cell more clearly resembled a medium than a small lymphocyte. 



This patient pursued a gainful occupation until 1950. From that time on. 

 he required increasingly frequent treatment until 1955. Thereafter he was 

 unable to work until his death in December, 1956, with generalized lymph- 

 adenopathy and hepatosplenomegaly. In retrospect one wonders whether 

 his favorable course from 1943 to 1950 resulted from the nitrogen mustard 

 he received in 1943. According to Cocchi. 17 the longest remissions have 

 followed surgical extirpation of nodes. Nevertheless, in his paper he referred 

 to patients who survived equally long and had never been treated. Accord 



