232 The Lymphocyte and Lymphocytic Tissue 



phatic Leukemia. 58 One of two events has transpired in every instance in 

 which I have made the diagnosis of acute monocytic leukemia on the basis 

 of smears of the peripheral blood or bone marrow. Either examination of 

 the sections prepared by the Maximow technique demonstrated specific 

 neutrophilic granules in the cells, or in the course of time, specific neutro- 

 philic granules appeared in the cells even in dry smears. My own personal 

 bias in this still bitterly debated subject is that there is no such entity as 

 monocytic leukemia. 



Hodgkin's Disease 



Evaluation of Prognosis and Response to Therapy Based on Lymph 

 Node Biopsy 



Since the classic monograph by Jackson and Parker 31 published in 1937, 

 there has been almost universal acceptance of the fact that the lymph nodes 

 are the site of three types of Hodgkin's disease, the paragranuloma, granu- 

 loma, and sarcoma. 19 ' 25 - 2G - 32 - 33 > 35 - 38 - 45 - 49 ' G0 - G1 Investigators agreed that the 

 paragranuloma had the best prognosis, the sarcoma had the poorest, and the 

 granuloma, which is commonest, occupied an intermediate position. In my 

 experience prognosis and prediction of response to therapy based upon the 

 division into these three types on the first node biopsy will be accurate in 

 about 80 per cent of cases. 



Paragranuloma. The paragranuloma is characterized by a dense, small 

 lymphocytic infiltrate, by a variable degree of architectural effacement, and 

 by the presence of Sternberg-Reed cells. Rappaport and colleagues described 

 in addition the presence of a follicular pattern early in the disease. 45 Ac- 

 cording to Harrison, the lymph node may be divided into lobules by fibrous 

 tissue, although most other authors believe that sclerosis is not a feature of 

 the paragranuloma.- Pleomorphism, irregular fibrosis, eosinophilia, neutro- 

 philia, and foci of necrosis, all common in Hodgkin's granuloma, are not 

 found. 33 



Fig. 17-13, from Case 13, is an untreated cervical node which appeared a 

 few weeks prior to biopsy in a patient who had had Hodgkin's disease for 20 

 years, the original biopsy showing a paragranuloma. Many of the features 

 characteristic of the paragranuloma were still demonstrable despite the long 

 duration of the disease. There was preservation of normal architecture even 

 to persistence of fairly normal-appearing follicles and recognizable medul- 

 lary cords and sinuses (Fig. 17-13,4, B). There were still areas very rich in 

 lymphocytes (Fig. 17-13£), and Sternberg-Reed cells were demonstrable 

 (Fig. 17-13F). Unlike the paragranuloma, areas of prominent reticulum cells 

 were found, similar to what Loew and Lennert 30 described, as the patient's 



