Histopathology in Prognosis & Therapy of Lymphocytic Lymphomas 239 



Smetana and Cohen 41 ' and [ackson and Parker 51 described the presence of 

 sarcoidlike lesions. These occurred in about 10 per cent of cases in my ex- 

 perience and have had no discernible effect on prognosis or response to 

 therapy. The major problem in this variety of Hodgkin's granuloma has 

 been the difficulty in differentiating between it and sarcoid and other non- 

 caseating granulomas. 



Case 16 originally had a Hodgkin's granuloma. She responded favorably 

 to courses of nitrogen mustard and x-ray therapy for five years. The lymph 

 node illustrated in Figure 17-16, obtained a few months prior to her death 

 at the onset of a treatment-resistant stage of the disease, had undergone 

 metamorphosis to a Hodgkin's sarcoma. The tissue was somewhat acellular 

 and fibrous (Fig. 17-16.-J). The predominant cell was a reticulum cell with 

 an anaplastic appearance due to a prominent nucleolus and lobing of the 

 nucleus (Fig. 17-16#). Lymphocytes were sparse. 



The following interpretations of the histopathology of Hodgkin's granu- 

 loma seem warranted and are in agreement with J el life's concepts/ 58 The 

 more closely the histopathology of Hodgkin's granuloma resembled that of 

 the paragranuloma, the better was the prognosis and response to therapy. 

 The most critical feature in this resemblance was the presence of large 

 numbers of small lymphocytes. The prognosis and response to therapy be- 

 come poorer as the ratio of reticulum cells and Sternberg-Reed cells to 

 small lymphocytes increased, that is, as the histopathology more closely re- 

 sembled the sarcoma. - r ' ::1 :; -- 3r> " 38 There were undoubtedly other important 

 factors, but they were not discernible by microscopic examination. 



Hodgkin's Sarcoma. Patients with this entity usually presented with 

 systemic manifestations such as chills, fever, weight loss, and anorexia. The 

 overwhelming majority have died within two years; 38 in some series all pa- 

 tients have died within a year. 25 - 49 A few patients have had a short remission 

 following treatment, but most patients were treatment-resistant. 30 - 33, 3T The 

 histopathology was the same regardless of whether the patient's disease 

 began as a paragranuloma or granuloma or had the characteristics of a sar- 

 coma from the onset (Fig. 17-16,4, B). 



Figure 17-17 is from a patient who had a brief and poor response to 

 nitrogen mustard, dying within a few weeks of treatment. There was com- 

 plete loss of normal architectural pattern. The dominant cell was a hyper- 

 trophied reticulum cell (Fig. 17-17). Occasional lymphocytes and neutrophils 

 were scattered between the reticulum cells. Mitoses and degenerating cells 

 were frequent. There was no fibrosis or eosinophil ia. 



