Histopathology in Prognosis & Therapy o) Lymphocytic Lymphomas 209 



Changes in Histopathology 



Case 4, similar to Case 1, illustrated another point, namely, the need Eoi 

 repeated biopsies if the physician is to keep pace with changes in the biology 

 of the patient's disease. The patient was asymptomatic when seen originally 

 in May, 1957, for a routine check-up; at that time the spleen extended to 

 the umbilicus. There was no lymphadenopathy and peripheral blood counts 

 were normal. Figure 17-4/1, from a marrow biopsy, shows a large nodule 







Fig. 17-3. c'c/.\r 5, giant follicular lymphoma. (A) Liver, follicles separated by 

 hepatic: tissue (HT). (x 80) (B) Follicle of A composed primarily of medium-sized 

 lymphocytes. (X 650) 



resembling that seen in the node of Case 2 (Fig. 17-2). The rest of the speci- 

 men consisted of hyperplastic myeloid tissue. As in Case 2, there was a 

 peripheral ring of small lymphocytes and a pleomorphic central core like a 

 normal follicle in the cortex of a lymph node (Fig. \~-4B). The center of 

 the follicle also contained nuclear debris, a rather unusual finding in giant 

 follicular lymphoma but one which Wright does not consider a contraindica- 

 tion to this diagnosis. 



The patient was not treated. In February. l<). r >9. he developed fever, 



