Histopathology in Prognosis & Therapy of Lymphocytic Lymphomas 225 



formly refractory to treatment, the patient dying of pancytopenia and not 

 leukemia. 



Acute Lymphatic Leukemia 



By the time a patient with this disease is first seen, the marrow has alread\ 

 been replaced by anaplastic lymphatic tissue (Fig. 17-10), and there was 

 usually a minor degree of palpable enlargement of lymph nodes, liver, and 

 spleen. In some instances the dominant cell is so immature as to make impos- 

 sible differentiation from acute stem cell or myelogenous leukemia. At this 

 point diagnosis rests upon the somewhat illogical approach of "the company 

 they keep." 



Case 10 was an 18-year-old man who presented with fever, malaise, weak- 

 ness, and a hemorrhagic diathesis. He failed to respond to steroid therapy, 

 Aminopterin, or 6-mercaptopurine and lived about (> months following 

 diagnosis. The normal myeloid tissue was almost completely replaced by a 

 monomorphous sheet of medium-sized lymphocytes (Fig. 17-10). These cells 

 were so numerous as to obscure all other cell types. 



Although it was impossible to determine on the basis of the histopathology 

 whether the patient was an adult or a child, the remission rate after steroids 

 is much higher in children than in adults; nor may one predict from the 

 histopathologic findings which patient will obtain a remission from folic 

 acid antagonists, steroids, or 6-mercaptopurine. 



Lymphosarcoma 



Definition 



Under this heading (Figs. 17-11, 17-12) were included all lymphomas in 

 which the predominant cell type was a lymphocyte and in which the number 

 of lymphocytes was sufficient to obscure the architecture of the involved 

 organ. When there was invasion through the capsule or metaplasia of sur- 

 rounding extracapsular tissue, the extracapsular malignant tissue had the 

 same cytology and architecture as that within the lymph node. Marrow in- 

 volvement was absent or minimal, and there was no invasion of the periph- 

 eral blood in early stages of the disease. 



Cytologic Pattern 



Case 1 1 was a 52-year-old electrician who first noted generalized lymph- 

 adenopathy in 1951. In August, 1953, while asymptomatic, he was given 

 nitrogen mustard at another institution. When first seen by me in January, 

 1954, he had generalized lymphadenopathv, and the spleen and liver were 

 both enlarged 3 cm. below the costal margin. The peripheral blood was 



