236 The Lymphocyte and Lymphocytic Tissue 



been the presence of many small lymphocytes, one of the most radiation- 

 sensitive cells in the hematopoietic tissues. 15 



The consensus is that a Hodgkin's paragranuloma indicates a survival of 

 8 to 20 years in the great majority of cases. During most of this time, the 

 patients are essentially asymptomatic and are able to live a normal and even 

 active physical life. Most of the patients reported have been treated solely 

 on the basis of the diagnosis per se or of the presence of a palpable node; 

 activity as herein defined has not been the indication for therapy. Occasion- 

 ally, for various reasons some patients have remained untreated. Wright 

 described two such cases. 00 In one patient who was asymptomatic, recurrence 

 of a node occurred 8 years after biopsy. The second patient was treated 

 initially 7 years after the diagnosis was made, purely because of palpable 

 nodes; at the time he was asymptomatic. Harrison's two untreated cases were 

 still asymptomatic at 8 and 12 years after biopsy.- These four cases represent 

 as good results as are reported in treated patients. The possible deleterious 

 effect of cytocidal therapy has recently been emphasized in the German 

 literature in which the transformation of a benign Hodgkin's granuloma to 

 a treatment-resistant Hodgkin's sarcoma has been ascribed to therapy. 32 - G1 



Granuloma. Hodgkin's granuloma, representing about 80 per cent of 

 all patients with Hodgkin's disease, occupies an intermediate position be- 

 tween sarcoma and paragranuloma. As Jellife has pointed out, the mor- 

 phologic pleomorphism parallels the marked variability in prognosis. 33 Some 

 patients with a granuloma have had the benign course characteristic of a 

 paragranuloma. 30 Patients with this lesion have survived from less than 2 

 to more than 15 years, overlapping the paragranulomatous and sarcomatous 

 varieties of Hodgkin's disease. The great majority of patients have lived from 

 4 to 7 years after the diagnosis has been made. 



Figure 17-14 is taken from a previously untreated patient (Case 14) and 

 shows a case intermediate between that of a granuloma and paragranuloma, 

 corresponding to Loew's group IIC. 35 There were an unusually large number 

 of lymphocytes, but the eosinophilia, scarring, plasmacytosis, and numerous 

 Sternberg-Reed cells were characteristic of the granuloma. In Case 14 re- 

 missions of 18 months followed each of two courses of nitrogen mustard. 

 The patient's course has been described in greater deail in another 

 publication. 13 



Figure 17-15 from Case 15 is an example of a typical granuloma. There 

 was marked pleomorphism and scarring (Fig. 17- 15/1), but the node had 

 many areas in which lymphocytes were numerous (Fig. 17-155). This biopsy 

 was taken approximately two years after diagnosis and initiation of x-ray 

 therapy. The patient responded well to further treatment with both x-ray 

 and nitrogen mustard for another three years. 



