250 The Lymphocyte and Lymphocytic Tissue 



the blood smear. If platelets and neutrophils were not present in sufficient 

 numbers, the marrow biopsy will determine if this depression is due to 

 atrophy, invariably serous and not simple, or due to a hypersplenic 

 syndrome. 



Changing Morphology 



Most studies on the lymphocytic malignancies have laid emphasis upon 

 the progressive nature of these diseases, 31, 35, 3e with inevitable metamor- 

 phoses toward a more malignant, less treatment-sensitive condition. Accord- 

 ingly, one would expect that the histopathology of the lesions in a given 

 patient would also change; as a result serial biopsies would be needed to 

 keep pace with these changes. 



The diseases under consideration were notoriously accompanied by vari- 

 ous complications. Hypersplenic syndromes, acid fast, fungal, and pyogenic 

 infections, abnormal proteins, and poor antibody formation were examples. 

 In addition the patient may have had coincidental disease, such as occurred 

 in Case 6 of this report and in Walter's case, 56 the manifestations of which 

 were erroneously ascribed to the lymphoma. Serial biopsy was needed to 

 determine whether failure to respond to therapy in a previously responsive 

 patient was due to a change in the lymphoma to a more malignant type, 

 or whether the lymphoma had responded but the persistent symptoms 

 were due to a complicating factor. If a patient who has had a paragranuloma 

 failed to respond to therapy at a time when a repeat node biopsy had 

 shown a change to Hodgkin's sarcoma, the therapist may reasonably ascribe 

 the failure to a change in the biologic nature of the disease. However, if the 

 node biopsy in this patient still was characteristic of a paragranuloma or 

 granuloma, then the physician should logically search for some complicating 

 disease. An excellent example recently encountered was that of a man with 

 benign Hodgkin's disease which was treated repeatedly with nitrogen 

 mustard, soft skin x-ray, and prednisone for pruritus. Thereafter, the patient 

 developed severe chills and fever, mistakenly ascribed to the Hodgkin's 

 disease. At autopsy these symptoms were found to be due to systemic no- 

 cardiois. 



Ancillary Factors 



Sites of Involvement 



The sites of demonstrable involvement of disease have had an undoubted 

 bearing upon prognosis and response to therapy. Unfortunately, this aspect 

 of the problem has been beclouded by limitations in our ability to recog- 

 nize areas of involvement other than those obvious by the ordinary tech- 



