Structure of Lymphocytic Series of Cells in Relation to Disease 267 



monocytic leukemia. The bizarre nuclear outlines apparent in some of the 

 malignant reticulum cells of Figure 19-4 should not alone be misconstrued 

 as diagnostic of monocytic differentiation. II one is to make the diagnosis 

 of monocytic leukemia of the Schilling type, evidence for differentiation 

 to true adult human monocytic forms (extreme right of Fig. 19-10) should 

 be established. Far more often the leukemic manifestation of reticulum cell 

 malignancy, although similarly classified in much of the literature as 







f .7* 



Fig. 19-5. A lymph node imprint in Hodgkin's disease showing 

 (bottom) a malignant reticulum cell, (center) a Reed-Sternberg cell, 

 and (top) a spindle-shaped endothelial cell. Leishman stain, (x 1100) 



"monocytic" leukemic, is merely a leukemic outpouring of the malignant 

 reticulum cells depicted in Figure 19-4 in considerable numbers into 

 the patient's blood stream (Fig. 19-9). Cases of this type in which the leu- 

 kemic process is centered primarily in the malignant reticulum cells have 

 been reported and correctly designated by Ewald, 20 Downey, 16 and others 

 as leukemic reticuloendotheliosis. With this background it is far more 

 reasonable to appreciate the rare "monocytic" leukemia complicating 

 Letterer-Siwe's disease or Hodgkin's disease as a similar accession of the 

 malignant reticulum cells basic to these conditions to the blood stream. 



Characteristic of the imprinted lesions of the second reticular malignancy, 

 Hodgkin's disease, are the giant, pleomorphic Reed-Sternberg cells, one of 

 which is depicted in the center of Figure 19-5. All transitions are found 

 between this giant cell peculiar to Hodgkin's disease and the atypical, large, 



