Pseudo-Leukæmic Lymphosarcoma

IT iS over a century ago since Thomanas Hodgkini described a conidition characterised by "morbid appearances of the absorbent glands and(I spleen." Subsequently, it-was found that Hodgkin hadl really groupc(l together a niumber of diilerenit diseases with similar gross appearances. From this group Kundrat separated off aind(define(d the conditioni knowNvn as lymphosarconma in 1893. Lymphosarcoma is ac malignant tumour of the lymnphoid tissues. It occurs clhiefly in the middle age groups and appears more frequently in males than in females. It usually arises in onie or otlher group of superficial lymph nodes and although it is claimed that the commoniest site of origin is in the cervical lymph nodes, it is possible that enllargement of these nodes may be preceeded by an undetectedl enlargement of the thoracic or abdominal nodes (Willis, 1948). Thelc tumour may occasionally arise from the abdominal or thoracic lymph nodes or sometimes from the lymphoid tissue of the tonsil, intestine, or from the spleeni. Usually at autopsy most of the lymph nodes are enlarged atnl inidications pointinig to the site of the primary growth are only obtainable from the clinical history (Ehrlich and Gerber, 1935). The tumour spreads to the uninvolved g roups of lymph nodes and produces enlargemenit of these. It is possible that the tumour is of multicentric origin, that is, it arises simultaneously in several different groups of lymph nodes. The tumour also spread by the blood to the liver, spleen, heart, kidney, bone-marrow, etc. These metastases may only be detected on microscopic examination, but larger nodules of tumour tissue, visible to the naked eye, may be present. Microscopically, the tumour shows a very uniform cytological picture. It is composed of cells of the lymphoid series, both mature and immature forms of lymphocyte being present in varying proportions. These cells are small and have a narrow rim of cytoplasm surrounding a hyperchromatic nucleus. The more immature form show a vesicular arrangement of the nuclear chromatin, while the more mature forms present a darkly staining solid nucleus. Multinucleated cells and mitotic figures aire very scarce in lvmphosarcoma. l'hese lvmphoid cells do not produce any reticulum, an{d the silver impregnationl techinique shows only the normal retictululml of the tissue invaded by the tumour. In the lymph nodes the proliferation of these tumour cells leads to a gradual loss of the normal nodal architecture. The tumour cells invade the capsule of the node and infiltrate the …