Histopathology in Prognosis & Therapy o) Lymphocytic Lymphomas 245 



ready proved resistant to therapy. The severe serous Eat atrophy was not 

 pathognomonic of Hodgkin's disease but has been seen in a wide variety of 

 diseases which have had as their common denominator long-standing pro- 

 oressive weight loss. Serous fat atrophy has been produced by protein de- 

 ficient diets in animals,- by malnutrition in man, 14 by total body 

 irradiation, 1 "' by Aminopterin, and by nitrogen mustard. 11 After treatment 

 of a patient with such a lesion by nitrogen mustard, and to a lesser extent by 

 local x-ray therapy, severe, even fatal pancytopenia often ensued. Further- 

 more, patients with this type of marrow lesion were prone to develop active 

 tuberculosis or disseminated mycosis, especially after systemic cytocidal 

 therapy. Therefore, the major importance of bone marrow histopathology 

 (provided adequate sections are studied) was that it provided assessment of 

 the patient's ability to withstand the cytocidal effect of systemic chemothera- 

 peutic agents such as nitrogen mustard. 



Peripheral Blood. Since the peripheral blood reflects the marrow, one 

 may obtain invaluable information from the determination of the absolute 

 number of neutrophils and platelets. When an exacerbation of Hodgkin's 

 was accompanied by a polynucleosis and thrombocythemia, the marrow was 

 usually hyperplastic. There were two exceptions: first, the occasional patient 

 with a benign or treatment-responsive disease in whom an exacerbation was 

 accompanied by neutropenia even though the marrow showed myeloid 

 hyperplasia and, second, the splenectomized patient who may have a 

 polynucleosis and adequate platelets in spite of an atrophic marrow. Treat- 

 ment of such a patient with systemic agents has been disastrous, producing 

 fatal pancytopenia. 



Significance of Fibrosis 



It was very difficult to evaluate the significance of fibrosis in a node biopsy 

 in terms of prognosis and response to therapy. Once a biopy had been taken 

 of a node so that the degree of fibrosis could be estimated, further observa- 

 tions upon that node were manifestly impossible. Nevertheless, Smetana 

 and Lumb have concluded that sclerosis carried a favorable prognosis. 17 '■' 

 The evidence for this statement was not uneqivocal. To complicate the prob- 

 lem, both Hodgkin's paragranuloma and Hodgkin's sarcoma, representing 

 respectively the forms with the best and poorest response to therapy, were 

 characterized by a minimum of fibrosis. 



Splenic tissues offer more information; by repeated sampling with an 

 adequate technique, the spleen may serve as its own control. 9 - 10 - 13 - 14 A 

 markedly fibrotic spleen did not shrink under therapy as much as did a less 

 fibrotic spleen. In general, but not invariably, diminution in size under 

 therapy was correlated with a good clinical response. It is my view based on 



