Histopathology in Prognosis & Therapy of Lymphocytic Lymphomas 231 



Hypersplenic Syndrome. The best prognosis was Eound when the mye- 

 loid tissue in the marrow was most nearly normal, neither replaced by 

 lymphoma or fat, nor hyperplastic because of a hypersplenic syndrome. 

 When hyperplasia of myeloid tissue was accompanied In other evidence of 

 autoimmune hemolytic disease (Fig. 17-11 7-> vs. 17-1 IE), the response of the 

 hemolytic component at least to prednisone or splenectomy was gratifying. 

 Radiation (either isotopic or x-ray) and chemotherapy were less effective in 

 this variation of lymphosarcoma. 



Case 11, characterized by a fairly benign course from 1 950 to 1957, there- 

 upon developed severe hemolytic anemia with a reticulocytosis, and an 

 elevated indirect serum bilirubin. His marrow showed an increase in lym- 

 phatic tissue and, in addition, a severe erythroblastic hyperplasia. The 

 hemolytic syndrome responded very well to treatment with prednisone until 

 July, 1957, when the patient again developed a reticulocytosis, indirect 

 bilirubinemia, and anemia. The marrow showed marked lymphatic meta- 

 plasia with hyperplasia of residual myeloid tissue (Fig. 17T1£). Splenectoim 

 was performed on October 4. 1957. with alleviation of the hypersplenic: 

 syndrome as manifested by a marked decline in the number of transfusions 

 needed until the patient's death in January, 1958. 



Change in Cytology. The hemolytic syndrome of Case 1 1 had responded 

 first to prednisone and thereafter to splenectomy. However, following 

 splenectomy, the biologic characteristics of his disease changed as manifested 

 h\ the onset of fever, anorexia, increasing hepatomegaly and lymphade- 

 nopathy, and lack of response to therapy. The nodes obtained at autopsy in 

 January, 1958, were characterized by the predominance of large and 

 medium-sized lymphocytes in marked contrast to the dense sheets of small 

 lymphocytes that had been the dominant cell type when he had responded 

 to irradiation earlier in the natural history of his disease (Fig. 17-115 vs. 

 17-1 1C). 



Intercurrent Disease. Case 1 1 had rather severe coronary arteriosclerosis. 

 He experienced incapacitating angina at a level of 9 or 10 gm. of hemo- 

 globin, a degree of anemia to which most chronically ill patients are not 

 sensitive. Consequently therapy, first prednisone and later splenectomy, was 

 necessary in contrast to other patients with a similar disease and severity of 

 anemia. 



Monocytic Leukemia 



This very vexing problem is an example of our subjective approach to 

 cytologic- diagnosis. The incidence of this disease approximates 30 per cent 

 of all acute leukemias according to those who use the supravital staining 

 technique primarily; in contrast, other workers, such as Willis, are not con- 

 vinced the disease exists or, at best, believe it to be a variant of acute lym- 



