CHAPTER 19 



STRUCTURE OF THE LYMPHOCYTIC 



SERIES OF CELLS IN RELATION 



TO DISEASE 



JOHN W. REBUCK 



The histologic appearance of the malignant lymphomas and related lym- 

 phocytic lenkemias as seen in sections is now familiar to American patholo- 

 gists through the detailed reports of Warren and Picena, 60 Gall and Mal- 

 lory, 25 Custer, 9 Richter, 50 and Berman. 2 - 3 The reader is urged to familiarize 

 himself with these works. Readily available is the text by Gall and Rappa- 

 port 2(i on diseases of the lymph nodes and spleen which summarizes in full 

 the necessary characteristics for assay of histologic sections of diseased lym- 

 phocytic tissues and at the same time brings home a growing conformity of 

 American pathologists' attitudes toward classification of diseases of these 

 same tissues. 



Table 19-1 outlines the origins of the lymphocytic series of cells and the 

 diseases pertaining to each cell type. Cell types are designated in accordance 

 with Standard Nomenclature 7 whenever possible. Such a straightforward 

 classification must be modified to include two further reports which merit 

 our studied consideration. A vast experience with lesions of this type during 

 the second World War led Custer and Bernhard 10 to stress a not uncommon 

 interrelationship among cell types of the malignant lymphoma group lead- 

 ing to the recognition of additional mixed types of malignant lymphomas. 

 The mixed types, then, are a spectrum of any of the cell types in Table 

 19-1, reading up or down the lineages. Of equal importance was the 

 re-evaluation of the follicular lymphomas by Rappaport, Winter, and 

 Hicks, 14 demonstrating that the cell patterns of the nodular growths could 

 be almost pure collections of any one of the five elements designated by 



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