228 The Lymphocyte and Lymphocytic Tissue 



normal. Figure 17-11 is from a biopsy of a lymph node taken in January, 

 1954. It illustrates the typical diffuse lymphatic tissue in which all architec- 

 tural pattern was obscured by small lymphocytes. 



Because of subjective complaints of weakness and symptoms related to 

 pressure of nodes, he was treated with P 32 intermittently through 1954 and 

 1955 but received no specific therapy thereafter until November, 1956; 

 during this period he worked as a uranium prospector. He did not miss any 

 more time from work than the average man of similar age. The patient's 

 clinical course was therefore typical of lymphocytic lymphosarcoma in that 

 most of these patients live from four to six years. 48 



Occasionally a patient with lymphosarcoma characterized by small lym- 

 phocytes will exhibit an unusually benign course. I am now following a 50- 

 year-old woman whose diagnosis was made by femoral node biopsy in 1953 

 and verified by another lymph node biopsy in 1955. This patient has never 

 been treated and as of August, 1959, was carrying on an active life and work- 

 ing as a waitress. In March, 1959, she survived a radical mastectomy with 

 postoperative pneumonia and atelectasis requiring emergency tracheostomy. 

 In another woman of similar age, diagnosis was first made in 1947 by node 

 biopsy at which time she received one course of x-ray therapy. She had a 

 splenectomy in 1953 for hemolytic anemia and also had a nephrectomy for 

 a hypernephroma, discovered by chance at the same time. Without any 

 further therapy she lived a normal life until April, 1959, when the hemolytic 

 anemia recurred. In neither of these patients did the findings in the lymph 

 node biopsies explain why their disease has been so much more benign than 

 the average case of lymphocytic lymphosarcoma. 



Much more rarely the dominant cell type in a patient with lymphosarcoma 

 was a medium-sized or large lymphocyte. Some of the latter cases have been 

 difficult to distinguish from reticulum cell sarcomas. The response to therapy 

 and prognosis has been increasingly poor with increasing size and delicacy 

 of staining of the lymphocytes in biopsy specimens. For example, a remission 

 was rarely obtained and the patient usually died within a year when the 

 lymphocytes were similar to those in Figures 17-3# and 17-4C. 



Other Factors 



Although usually the type of lymphocyte that constitutes the dominant 

 cell was the most important factor in determining response to therapy and 

 prognosis, other factors occasionally became more important. Some of these 

 were the following: (1) specific sites of involvement by the lymphosarcoma, 

 (2) hypersplenic syndromes, (3) the changing natural history which was 

 usually a result of a change in cytology, and (4) various intercurrent affec- 

 tions such as coronary artery disease. 



