246 The Lymphocyte and Lymphocytic Tissue 



admittedly fragmentary observation of spleen biopsies, which are neverthe- 

 less probably more valid than those made on nodes, that the amount of 

 fibrosis tended to be inversely correlated with the clinical response. 



HlSTOPATHOLOGY AS A GUIDE TO THERAPY IN HODGKIN's DISEASE 



There were two aspeets to be considered: when to treat a patient and 

 which therapeutic agents should be utilized. For years the former problem 

 was simple — the indication for treatment was a diagnosis of Hodgkin's dis- 

 ease based on biopsy. This attitude is no longer valid if one subscribes to 

 the concept that treatment should be reserved for the patient with active 

 disease as defined in this chapter. Histopathology would then be of lesser 

 importance than a weight scale and a thermometer in deciding when to 

 initiate treatment. As already mentioned, study of the marrow was an ex- 

 cellent method for determining when not to treat a patient. 



Our choice of treatment is limited to two types, systemic and local. Sys- 

 temic therapy is synonomous with nitrogen mustard or any of the closely 

 related compounds such as urethane, chlorambucil, and TEjVI. Despite the 

 enthusiasm engendered by each investigator who introduced a variant of the 

 original nitrogen mustard, all these compounds are similar in mechanism of 

 action and therapeutic index. 34 ' 51, ■'- Consequently, analysis of biopsy tissue 

 can hardly play a role in a selection of one type of chemotherapy in prefer- 

 ence to another. However, local x-ray therapy, since it has little if any effect 

 on marrow not directly exposed to the x-ray beam, has caused a lesser degree 

 of pancytopenia than nitrogen mustard. Consequently, x-ray therapy has 

 been safely used when nitrogen mustard is contraindicated because of mar- 

 row depletion (Figs. 17-1 3D, 17T6C). However, x-ray therapy under these 

 circumstances may not induce a remission. 



There was no histologic pattern correlated with a response to nitrogen 

 mustard as opposed to x-ray therapy or vice versa. The decision to use one 

 or the other is based more upon whether a patient has systemic or local 

 manifestations of activity. 



Reticulum Cell Sarcoma 



The separation of reticulum cell sarcoma from Hodgkin's sarcoma has 

 been difficult; some authorities held that they are basically similar. 3 -' 61 In 

 general, if a patient has been known not to have had Hodgkin's disease and 

 if Sternberg-Reed cells were not demonstrable, the diagnosis of reticulum 

 cell sarcoma rather than of Hodgkin's sarcoma has been made. However, 

 the distinction between an anaplastic reticulum cell with a hypertrophicd 

 lobate nucleus and a developing Sternberg-Reed cell may be difficult and 

 perhaps invalid. Figure 17-17 illustrates a biopsy that could be classified 



