Histopathology in Prognosis if Therapy of Lymphocytic Lymphomas 27 > 



at autopsy. 50 He found marrow affected in 78 per cent of cases but implied 

 that if enough areas of active marrow are studied, the specific lesion should 

 be demonstrable in all patients. Depending upon the method of study. 

 Hodgkin's tissue was recognizable in from per cent to 15 per cent of cases 

 studied prior to autopsy. Pettet and colleagues demonstrated the lesion in 

 9 of 34 cases. 43 Five other cases had nonspecific lesions which were abnormal 

 but not pathognomonic of Hodgkin's disease. 



My own experience 9 ' 14 with at least a hundred cases, many of which had 

 multiple biopsies, was at variance with both Steiner and Pettet. A lesion 

 pathognomonic of Hodgkin's has been demonstrated in about 10 per cent 

 of cases (Fig. 17-18). Case 18 was typical of those in which a specific lesion 

 was demonstrable in the marrow. The patient presented with fever of un- 

 known origin and with a pancytopenic blood picture. The lesion in such 

 instances has usually been a sarcoma or intermediate between a sarcoma and 

 granuloma and has almost invariably been correlated with a poor prognosis 

 and no response to therapy (Fig. 17-18.6). Pettet, Rappaport, and their col- 

 leagues also noted that involvement of the marrow was seen in patients 

 with far-advanced disease (and presumably a poor prognosis) or patients with 

 pancytopenia. 43 - 43 The poor prognosis in these cases was correlated with 

 the histopathologic characteristics of the specific Hodgkin's lesion rather 

 than with the extent of marrow replacement (Fig. 17-18). Even at autopsy, 

 physical replacement of the marrow was a very rare occurrence. 50 



The second facet, the amount and character of the residual myeloid tissue, 

 was more frequently a guide to therapy than was the comparatively rarely 

 demonstrable specific Hodgkin's lesion. The more benign the prognosis 

 and/or the earlier in the stage of the disease that the patient is encountered, 

 the more granulocytic and megakaryocytic hyperplasia there was. Figure 17- 

 13C is from a marrow biopsy obtained from Case 13 in 1953, immediately 

 prior to a three-year remission induced by nitrogen mustard. A patient with 

 so hyperplastic a marrow will not develop severe pancytopenia following 

 either nitrogen mustard or x-ray therapy and will usually obtain a remission. 



Over the course of years, as patients lost weight, the marrow underwent 

 a serous rather than a simple fat atrophy. This change is illustrated by 

 Figure 17-1 3D obtained from Case 13 in 1958 when the patient had begun 

 to lose weight. At that time he developed mild pancytopenia, and subsequent 

 courses of therapy have produced remissions measured in months and not 

 years. The marrow had undergone a moderate serous fat atrophy, but there 

 still was enough myeloid tissue to withstand the effects of a course of nitro- 

 gen mustard. 



Figure 17-16C was obtained from Case 16 a few weeks prior to death when 

 the patient was severely pancytopenic. febrile, and emaciated. She had al 



