PROLIFERATIVE DISEASES 



5. Hodgkin's disease 



Hodgkin's disease is the most important of the reticuloses. 

 According to Marshall (1956) about 15 to 20% of cases of 

 Hodgkin's disease from which early biopsies are available 

 show, when first seen, a 'lymphoid' type of hyperplasia. 

 Here the lymph-node structure is replaced by a prolifera- 

 tion of small lymphocytes with scattered, large, sometimes 

 multinuclear, reticular cells. Sometimes a frank lympho- 

 sarcoma develops, but much more frequently the histological 

 picture changes to that of typical Hodgkin's disease. This 

 shows proliferating reticulum cells with pale cytoplasm, 

 often multinuclear, and in addition lymphocytes, plasma 

 cells and eosinophils. Marshall, in general, accepts the view 

 that Hodgkin's disease is a benign multifocal neoplasm 

 involving the primitive reticular cells with subsequent differ- 

 entiation along some of the possible lines of their develop- 

 ment. The additional possibility is, however, seriously con- 

 sidered that the primary benign neoplastic process evokes 

 an inflammatory hyperplastic response. A proportion of 

 Hodgkin's cases end as a 'Hodgkin's sarcoma', and in some 

 this is the picture from the beginning. The interpretation of 

 the histology of Hodgkin's disease, however, seems too obscure 

 to use it in the discussion of possible clonal selection effects. 



6. Multiple myeloma 



If we are correct in applying concepts of clonal selection both 

 to the phenomena of antibody production and malignancy, 

 it should be of particular interest to examine the conditions 

 in which gamma-globulin-producing cells develop malig- 

 nancy. The classical example is multiple myelomatosis with 

 Bence-Jones proteinuria. This topic has recently been 

 reviewed by Putnam (1957) and this discussion is based 

 essentially on his review. 



The essential features of the disease arise from the localized 

 and diffuse proliferation of plasma cells in the bone marrow, 



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