The immunologic and morphological approach of our recently proposed functional classification of malignant lymphomas based on the T and B cell systems and lymphocyte transformation has been reviewed. Preliminary results of our retrospective morphological studies indicate: 1) Over 70% of non‐Hodgkin's lymphomas involve cleaved or noncleaved follicular center cell (FCC) or B cell types. 2) Nodularity is observed only with FCC types and suggest origin in follicular centers as a block or a “switch on” (derepression) in B cell lymphocyte transformation. 3) Lymphomas of “true” histiocytes appear rare and need to be redefined with functional studies since those previously regarded as histiocytic are indistinguishable morphologically from transformed lymphocytes. 4) Lymphomas of large transformed lymphocytes, “immunoblastic sarcoma” of B and T cell types, have been observed to develop in abnormal immune states and senescence and represent a distinctive entity. Ideal characterization of lymphomas using integrated morphological, cytochemical, and immunologic membrane marker studies has been outlined, and preliminary results of this approach provide support for our new proposal.
Immunoblastic lymphadenopathy, although it resembles Hodgkin's disease, is a distinct, hyperimmune disorder apparently of the B-cell system. In 32 cases, it was characterized by a morphologic triad: proliferation of arborizing small vessels; prominent immunoblastic proliferations; and amorphous acidophilic interstitial material. Clinically, it is manifested by fever, sweats, weight loss, occasionally a rash, generalized lymphadenopathy and often hepatosplenomegaly. There is a consistent polyclonal hyperglobulinemia and often hemolytic anemia. The course of the disease is usually progressive, with a median survival of 15 months in 18 fatal cases. The cellular proliferation appears benign morphologically in the pretherapy biopsies and in 10 of 12 available autopsy cases. In three cases the process evolved into a lymphoma of immunoblasts, immunoblastic sarcoma. The basic process appears to be a non-neoplastic hyperimmune proliferation of the B-cell system involving an exaggeration of lymphocyte transformation to immunoblasts and plasma cells that may be triggered by a hypersensitivity reaction to therapeutic agents.
This paper evaluates the significance of the clinical stages and histologic features of Hodgkin's disease in 377 U. S. Army cases from World War II with a 15‐ to 18‐year follow‐up. From this study 6 histologic types have emerged: (1) lymphocytic and/or histiocytic (L & H), nodular; (2) lymphocytic and/or histiocytic (L & H), diffuse; (3) nodular sclerosis; (4) mixed; (5) diffuse fibrosis and (6) reticular. There is a definite relationship between histologic types, clinical stages and survival. The L & H types are expressions of lymphocytic proliferation and diffuse fibrosis and reticular types represent lymphocytic depletion while the mixed is intermediate between these extremes. Nodular sclerosis appears to be a regional expression of Hodgkin's disease in the mediastinum and is of major prognostic significance in stage I. The histologic types are regarded as expressions of an attempted host response and possibly evidence of the dramatic interplay between the host and the factors responsible for the development of Reed‐Sternberg cells. The authors suggest that the Hodgkin's disease process represents the attempted induction of malignant neoplasia and that the evolution of the histologic process is a manifestation of the natural history of the disease.
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