Histopathology in Prognosis & Therapy of Lymphocytic Lymphomas 2-17 



either as Hodgkin's sarcoma or reticulum cell sarcoma. 



Systemic symptoms, especially malaise, fever, weight loss, and anorexia, 

 predominated in patients with reticulum cell sarcoma. The overwhelming 

 majority of patients have died within two years of onset. 51 :! - :;T :,s - (il As in 

 Hodgkin's sarcoma, there was very little evidence that a significant remission 

 has ever been induced in any patient. 3032 



DISCUSSION 



Histopathologic analysis should not only serve as a means of diagnosis 

 but should be a guide to prognosis and therapy. This Utopian objective will 

 probably never be attainable solely on the basis of morphology, even if the 

 present-day custom of relying on a single biopsy is changed to one of analysis 

 of multiple biopsies. Consequently, the microscopist must not adopt too 

 narrow an attitude but must take into account other aspects of the patient's 

 illness such as the presenting symptoms, location of tumors, the presence of 

 abnormal proteins, and the type and amount of treatment. 41 ' 47 In other 

 words, in the present state of our knowledge, histopathologic analysis must 

 be supplemented by a thorough acquaintance with all aspects of the patient's 

 disease. 



Histopathologic Analysis 



In order to obtain a maximum amount of information from morphology, 

 one must consider the dominant cell type, architectural pattern, cellularity 

 of the marrow, and the (hanging morphologic pattern. 



Dominant Cell Type 



The dominant cell type was probably the most important single factor. 

 When the microscopic field was usurped almost exclusively by small lympho- 

 cytes, the prognosis was the most favorable within any specific architectural 

 pattern. For example, Hodgkin's paragranuloma, Type I giant follicular 

 lymphoma of Gall and Mallory, and lymphocytic lymphosarcoma repre 

 sented the most benign varieties of Hodgkin's disease, giant follicular 

 lymphoma, and lymphosarcoma, respectively. Patients with these forms were 

 the ones who responded best to therapy. They also were the patients who 

 least needed treatment, if one accepts the indication for treatment outlined 

 in this chapter. As the dominant cell type approached the reticulum cell 

 morphologically, the prognosis and response to therapy became poorer. 



Between the two extremes of cytologic differentiation, there were an in- 

 finite number of gradations which we have subdivided for each architectural 

 pattern as a matter of clinical convenience. These gradations are beautifully 

 illustrated in the semidiagrammatic figure in the paper by Warren and 



