242 The Lymphocyte and Lymphocytic Tissue 



to prognosis and therapy because of the lack of a sufficient range of material, 

 i.e., benign as well as malignant types of Hodgkin's disease early in its 

 course. However, it is common experience in Hodgkin's disease that, when 

 there has been marked hepatic involvement, the prognosis and response to 

 treatment is poor. 37 



Spleen. Spleen biopsies have been even more dangerous to do than 

 liver biopsies, but more studies are available than in the case of the liver 

 because of the more obvious involvement of the spleen early in the 

 natural history of Hodgkin's disease. 9, ln ' 13, 14 Although, in general, the dis- 

 ease in the spleen paralleled that in the lymph nodes, it was not uncommon 

 for splenic tissue to be uninvolved by Hodgkin's disease in a patient in whom 

 node biopsy has been positive. Biopsy of the spleen offered little additional 

 information over that obtainable from study of a lymph node removed con- 

 comitantly. Response to therapy and prognosis were governed by the concen- 

 tration of lymphocytes. The more lymphocytes or, in other words, the closer 

 the resemblance to Hodgkin's paragranuloma, the better has been the re- 

 sponse to therapy and the better the prognosis. In addition one may assume 

 that following therapy an intensely fibrotic spleen will not shrink as much 

 as one with less fibrosis. 



Marrow. Of all the tissues involved in Hodgkin's disease, the marrow 

 has been studied the least. The reasons are as follows. First, most pathologists 

 consider Hodgkin's disease to be a disease of lymphatic tissue and con- 

 sequently believe there is little merit in the study of myeloid tissue de- 

 spite Steiner's report which emphasized the frequency of marrow involve- 

 ment. 50 Second, analysis of smears of aspirated marrow has been the usual 

 method employed by the hematologist for studying marrow. Although this 

 technique may suffice when there is a qualitative change in the marrow, it 

 is not adequate for evaluation of the much more subtle changes in Hodgkin's 

 disease. 8 For example. Cooper and Watkins 18 in 1949 concluded on the basis 

 of smears of aspirated marrow that this tissue was of little use in evaluation 

 of patients with Hodgkin's disease. In 1950, Cooper and colleagues began 

 the study of sections of marrow and came to the opposite conclusion. 43 



There are two areas for evaluation in the study of the marrow in 

 Hodgkin's disease: Hodgkin's tissue itself and the residual nonmalignant 

 myeloid tissue. The former was of lesser importance in the majority of cases. 

 Not enough attention has been paid to the latter for reasons already 

 mentioned. 



Demonstration of Hodgkin's tissue in the marrow is dependent upon the 

 number of lesions which in turn determines the likelihood with which the 

 lesion may be demonstrated by biopsy. The incidence and extent of involve- 

 ment have been reviewed by Steiner, based primarily upon marrow studied 



